The Feasibility and Acceptability of Two Methods of Snack Portion Control in United Kingdom (UK) Preschool Children: Reduction and Replacement

Abstract: Large portions of high energy dense (HED) snacks are offered to children from a young age

and are pervasive in our food environment. This study aimed to explore the feasibility, acceptability,

and preliminary efficacy of two strategies of snack portion control: reduction and replacement.

Forty-six mother-child dyads aged 22–56 months (36.6 9.5 m, 48% female) completed a three-week

intervention. In week 1 (baseline) no changes were made to the child’s diet; week 2 (acclimation)

children received a standardised selection of HED snacks, and in week 3 (intervention) participants

were randomly assigned to snack replacement (n = 24) or snack reduction (n = 22). Snack replacement

involved swapping HED snacks for fruits and vegetables, whilst snack reduction involved reducing

the size of HED snacks by 50%. Food and energy intake were measured using a weighed food diary

for four consecutive days. Snack replacement resulted in more positive changes to children’s diets;

vegetable intake increased (p < 0.01), and total daily energy intake decreased when compared to snack

reduction (p < 0.05). Mothers expressed a more favourable attitude to snack replacement, although

snack reduction was also well received by mothers. Despite increased preliminary efficacy of snack

replacement on dietary intake, both strategies were feasible and acceptable. The current pilot study

provides the necessary information to inform the design of future interventions.