NUTRIENT INTAKE

Appetite, 1997, 29, 11–24
Meal Pattern and Nutrient Intake Among Adult Finns
EVA ROOS and RITVA PRÄTTÄLÄ
National Public Health Institute, Finland
The purpose of this study was to investigate the relationship between meal pattern
and diet. Nutrient contents of meals, snacks and other eating occasions were
compared and differences in dietary intake analysed between respondents following
a conventional meal pattern and others. A random sample of 1861 adults aged
25–64 from four regions of Finland completed a mailed questionnaire and 3-day
food record in the spring of 1992. A conventional meal pattern was defined on
the basis of national dietary guidelines as including breakfast, warm lunch and
warm dinner, and subjects were identified with the help of the questionnaire.
Meals and snacks were defined according to the respondents subjective criteria.
Forty-four percent of all respondents followed the conventional meal pattern.
Meal pattern has no effect on nutrient intake in men and small effects in women.
Women following the conventional meal pattern had higher energy and cholesterol
intake and lower alcohol and vitamin C intake than other women. Meals
contributed to energy, protein and fat intake, and snacks to sugar and alcohol.
Meal pattern had only a small effect on diet and conventional meal pattern
cannot be considered healthier than other meal patterns.
© 1997 Academic Press Limited
INTRODUCTION
During this century the number of daily cooked meals has declined in Finland
and other western countries. The main social factors promoting the meal pattern
change have been urbanisation, industrialisation and the convenience provided by
food processing (Rotenberg, 1981; Mintz, 1985; Prättälä & Helminen, 1990; Mennel,
Murcott & van Otterloo, 1992; Prättälä, Pelto, Pelto, Ahola & Räsänen, 1993).
There have been concerns expressed by the scientific community as well as the
mass media about the rising consumption of snacks at the expense of “proper meals”.
In public health studies skipping breakfast and eating snacks between meals have
been classified as ‘‘bad’’ health habits (e.g. Belloc & Breslow, 1972; Segovia, Bartlett
and Edwards, 1989; Sobal, Revicki & DeForge, 1992). Concern about the declining
role of meals can even be seen in dietary recommendations. For example, the Swedish
recommendations include a meal pattern (Standing Nordic Committee on Food,
We are grateful to Dr Pirjo Pietinen, Head of the 1992 Dietary survey of Finnish Adults, M.Sc. Päivi
Kleemola for checking the food records and analysing the dietary data and M.Sc. Jukka Lauronen for
technical help.
This work was supported by research grants from the Academy of Finland and the University of
Helsinki.
Correspondence should be addressed to: Eva Roos, National Public Health Institute, Department
of Nutrition, Mannerheimintie 166, FIN-00300 Helsinki, Finland.
0195–6663/97/040011+14 $25.00/0/ap960095 © 1997 Academic Press Limited

12 EVA ROOS AND RITVA PRÄTTÄLÄ
1989): breakfast should provide you 1/4 of the daily energy intake, lunch and
dinner both about 1/3, and the remainder should come from 1–2 snacks. Such
recommendations are not based on scientific evidence, but on practical experience
and the assumption that a regular pattern of warm meals guarantees a varied diet
(Bruce, 1987; 1991; Standing Nordic Committee on Food, 1989). Although nutritional
scientists have been worried about snacking patterns, especially among children and
teenagers (Thomas & Call, 1973; Gillespie, 1983; McCoy et al., 1986; Dugdale,
Townsend & Rigsby, 1988; Anderson, Macintyre and West, 1993; Cross, Babicz &
Cushman, 1994) and obese (Birckbeck, 1981; Basdevant, Craplet and Guy-Grand,
1993), meal patterns have received little attention in studies.
A complication in meal pattern studies is that definitions of meals and snacks
are not universal. In medical research, meals have been defined as any eating occasion
(e.g. Franceschi, La Vecchia, Bidoli, Negri & Talamini, 1992; Fabry & Tepperman,
1970) while in sociological studies a meal is regarded as a social event (see Mäkelä,
1991, for review). In nutritional studies meals are usually defined by time, e.g.
breakfast, lunch and dinner, and snacks as eating occasions between these meals
(Pao & Mickle, 1981; Kennedy, Harrell & Frazao, 1982; Haraldsdottir, Holm, Jensen
& Møller, 1987; Morgan, Johnson & Stampley, 1988; Virtanen, 1988; Ryan, Craig
& Finns, 1992; Anderson et al., 1993; Prätälä et al., 1993; Roos, Quandt & DeWalt,
1993; Summerbell, Moody, Shanks, Stock & Geissler, 1995). Time-based meal
definitions can also be found in dietary recommendations (Standing Nordic Committee
on Food, 1989). In some nutritional studies, however, meal definitions are
based on the food and nutrient composition of eating occasions (Johansson, Callmer
& Gustafsson, 1992; Lennernäs, Åkerstedt, Hagman, Bruce & Hambraeus, 1993;
Rothenberg, Bosaeus, Steen, 1994).
Because food is eaten as meals and snacks, not as single food items or nutrients,
investigations of meal patterns have relevance for nutritional educators and food
policy planners, as well as for multidisciplinary food research (Prättälä, 1991;
Johansson et al., 1992; Holm, 1993). Since meals have social as well as nutritional
significance, research on meals, by focusing on overlapping issues in the two fields,
could narrow the gap between the social and nutritional sciences. In addition, dietary
assessment methods could be improved by incorporating evaluations of meal patterns
(Kohlmeier, 1994).
The main question in the present study was: is a conventional meal pattern of
breakfast, lunch and dinner healthier than other meal patterns including fewer meals?
Nutrient contents of meals, snacks and other eating occasions of the study participants
were compared, and the differences in dietary intake between those following a
conventional three-meal daily pattern and those eating fewer meals were analysed.
SUBJECTS AND METHODS
Subjects
The subjects and their recruitment have been described earlier (Kleemola, Virtanen
& Pietinen, 1994; Roos, Ovaskainen & Pietinen, 1995a). Briefly, 1861 adults (991
women and 870 men) who participated in a dietary survey in spring 1992 and had
completed a 3-day food record were included in this study. The subjects were aged
25–64 years and from four different regions of Finland; North Karelia (rural),

MEAL PATTERN AND NUTRIENT INTAKE AMONG ADULT FINNS
13
Kuopio (urban+rural), Turku-Loimaa (urban+rural) and Helsinki-Vantaa (urban).
The original random sample was stratified by 10-year age groups, regions and sex.
The response rate was 66% of the 2822 people contacted. Younger people, men and
those who from the metropolitan area of Helsinki-Vantaa had lower response rates
than others.
Because our definition of a conventional meal pattern was time-based, we excluded
160 shift workers (men 60, women 100) from the meal pattern analyses. We also
excluded 12 subjects for missing values in the meal pattern question. Altogether,
1689 subjects (801 men and 888 women) were used in the analyses of meal patterns.
Questionnaire and 3-day Food Record
All participants completed a mailed questionnaire before their study visit to a
local health centre, where all answers were checked. In addition to several questions
on socioeconomic status, health, smoking, alcohol intake and food habits (not
reported here), the questionnaire included one question on meal pattern.
During their examination on a weekday at the health centre, the participants
were also asked to keep records of all the foods and beverages they consumed over
the following three days. They were personally instructed on how to keep a food
record starting the following morning. All days of the week were included in the
results, with weekend days slightly over-represented. Amounts of food were estimated
using a 63-page picture booklet or household measures. The record was open-ended
and the subjects were asked to note the time, place (pre-coded) and company (precoded)
of every eating occasion, and also to define each one as either a meal or a
snack.
Meal Patterns, Meals and Snacks
The conventional meal pattern was defined by criteria outside this study. The
definition was based on national dietary guidelines and recommendations for special
population groups such as children, the elderly, sportsmen, and for hospital catering
(National Board of Health, 1989; 1990; Ministry of Social Affairs and Health, 1992;
1994). All these guidelines assume a meal pattern of 3 meals and 2–3 snacks during
the day. A warm lunch and dinner are not recommended in every case, but a warm
meal is considered more nutritious than a cold one. In our study the conventional
meal pattern meant 3 meals during the day: breakfast, warm lunch, and warm dinner.
The other meal pattern types were ‘‘2 meals per day’’ or ‘‘one meal or less per day’’.
Subjects who had a conventional meal pattern were identified with the help of
the mailed questionnaire. The question on meal pattern included in the questionnaire
was structured into six time-based options: breakfast, snack in the morning, lunch,
snack in the afternoon, dinner, and snack in the evening. For every eating occasion
the subjects could choose between three pre-coded alternatives: 1. Do not eat, 2.
Eat warm prepared food (including porridge) or 3. Eat something else—what? This
question identified those who usually ate breakfast, warm lunch and warm dinner.
Lunch and dinner was considered as a meal if the food eaten was warm. They
were not defined by the type of food eaten at the eating occasion. This definition
was used because of the structure of the meal pattern question. Breakfast was
considered as a meal if 1. it was warm (e.g. porridge) or 2. the subject had something
to eat (not just liquids) before 10 o’clock in the morning according to his/her food

14 EVA ROOS AND RITVA PRÄTTÄLÄ
1200
1000
800
Kjoule/hour
600
400
200
0
0 2 4 6 8 10 12 14 16 18 20 22 24
Time
FIGURE 1.
Distribution of energy intake during the day. Ε, men; Φ, women.
record. Ten o’clock was chosen as the cut off point because it lay between the two
energy peaks in the morning (Fig. 1). If the subject did not record breakfast against
the meal pattern question, breakfast was not considered as a meal even if his/her
food record indicated something eaten before 10 o’clock.
Contrary to the definition of the conventional meal pattern, meals and snacks
were defined according to the respondents subjective criteria. When keeping the food
record the subjects were instructed to classify every eating occasion as either a meal
or a snack. The respondents, however, were not able to classify all eating occasions,
and the uncoded ones were called ‘‘other eating occasions’’ for the analyses.
Dietary Analyses
Daily intakes of nutrients and foods were computed from the 3 day food records
using software developed at the National Public Health Institute and its food and
nutrient data base (Ovaskainen, Lauronen & Haapakoski, 1994). The daily intakes
of nutrients and food items were computed separately for meals, snacks and other
eating occasions. Energy intake from different nutrients on an hourly basis through
the day were also derived from the food records.
Macronutrients, cholesterol, fibre, vitamin C, and carotenoids were analyzed as
separate dietary items in order to form a general view of the quality of the diet.
Cholesterol indicates the extent of animal sources, while fibre, vitamin C and
carotenoids are good indicators of the consumption of vegetables, fruits and foods
with high densities of other micronutrients. The macronutrient density of each type
of eating occasion and the overall diet was measured as percentage of energy (E%);
micronutrient and food item densities were measured as intake per 10 MJ.
The food item classification used in this study was developed at the National
Public Health Institute (Ovaskainen, 1992). The recorded items and dishes were

MEAL PATTERN AND NUTRIENT INTAKE AMONG ADULT FINNS
15
TABLE 1
Percentage of men and women following different types of meal pattern according to
age and region
Three meals Two meals One meal per Total (N)
per day per day day or less
Men
Age
25–34 47 41 12 100 (167)
35–44 49 44 7 100 (175)
45–54 44 48 8 100 (208)
55–64 46 50 4 100 (251)
Region
Helsinki-Vantaa (urban) 37 55 8 100 (186)
Turku-Loimaa (urban+rural) 39 50 11 100 (213)
Kuopio (urban+rural) 57 40 3 100 (212)
North Karelia (rural) 52 42 6 100 (190)
Men all 47 (371) 46 (372) 7 (58) 100 (801)
Women
Age
25–34 41 51 8 100 (204)
35–44 44 48 8 100 (213)
45–54 39 56 5 100 (215)
55–64 46 49 5 100 (256)
Region
Helsinki-Vantaa (urban) 29 59 12 100 (199)
Turku-Loimaa (urban+rural) 35 55 10 100 (214)
Kuopio (urban+rural) 51 47 2 100 (243)
North Karelia (rural) 52 45 3 100 (232)
Women all 42 (377) 51 (452) 7 (59) 100 (888)
Total 44 (748) 49 (824) 7 (117) 100 (1689)
grouped by their food use, processing and nutrient content into the food item groups
presented in Table 5.
Statistical Analyses
The SAS statistical package (Release 6.08) was used for all analyses, which were
carried out separately for men and women. All differences between eating occasions
or meal pattern groups were tested by analysis of variance. The analyses of eating
patterns were carried out in two different ways: firstly, intake and density of nutrients
and food items were compared between meals and snacks; secondly, the daily intakes
of nutrients and food items were compared between the groups following the
conventional meal pattern or the other meal pattern. Because meal patterns were
not equally distributed across the regions (Table 1) and because of the study design
(sample stratified for age and region), all analyses where statistical significance was
tested were adjusted for age and region.

16 EVA ROOS AND RITVA PRÄTTÄLÄ
600
Energy derived from fat kjoule/hour
500
400
300
200
100
0
0 2 4 6 8 10 12 14 16 18 20 22 24
Time
FIGURE 2. Distribution of energy intake derived from fat during the day. Ε, men; Φ,
women.
RESULTS
The distribution of energy intake during the day corresponded to the conventional
3-meal pattern of one energy peak at breakfast time, one at lunch time and one at
dinner time, for both men and women (Fig. 1). For the energy derived from fat,
two peaks could be observed, one at lunch and one at dinner time, but a peak at
breakfast time could only be observed for women (Fig. 2). The energy intake derived
from sugar was evenly distributed from 6 a.m. to 9 p.m. (Fig. 3).
About half the daily energy was obtained from meals (Table 2) and over 10% of
the total daily energy intake came from eating occasions other than meals or snacks.
Fat and protein intakes were associated with meals, whereas sugar and alcohol were
mostly consumed in snacks and other eating occasions. Comparing nutrient densities
of different eating occasions showed that meals contained more fat, proteins, fibre,
carotenoids and cholesterol per energy unit, but less sugar, vitamin C and alcohol
than other eating occasions (Table 3).
The analysis of food items in different eating occasions showed that meals had
a higher density of cereals and vegetables, and a lower density of fruit and berries,
juices, coffee and tea, and desserts and cakes. As expected, meals had the highest
density of cooked dishes, potatoes, pasta and rice, and snacks the lowest. Other
eating occasions were intermediate in these respects and they included the highest
proportions of juice, soft drinks, coffee and tea, candies and crisps.
The distribution of meal patterns in different age groups and regions is shown
in Table 1. The last two groups in Table 1 were combined in a further analysis of
meal pattern into a single group ‘‘Other meal pattern’’ (2M), because of the few
cases in the one meal group. Ninety two percent of the 2M-group ate breakfast,
51% ate warm lunch and 46% ate warm dinner.

MEAL PATTERN AND NUTRIENT INTAKE AMONG ADULT FINNS
17
600
Energy derived from sugar kjoule/hour
500
400
300
200
100
0
0 2 4 6 8 10 12 14 16 18 20 22 24
Time
FIGURE 3. Distribution of energy intake derived from sugar during the day. Ε, men; Φ,
women.
TABLE 2
Energy and nutrient intake from different eating occasions among 991 women and 870
men
Nutrients Meal Snack Other eating occasions Total
Absolute (% of Absolute (% of Absolute (% of intake
intake daily intake daily intake daily
intake) intake) intake)
Men
Energy, kjoule 5 638 (55) 3 409 (32) 1 333 (13) 10 380
Fat, g 56·1 (59) 29·2 (30) 10·1 (11) 95·3
Saturated fat, g 25·0 (58) 13·9 (31) 4·1 (11) 43·7
Carbohydrate, g 150 (51) 107 (36) 37 (13) 293
Sugar, g 19·2 (34) 30·3 (50) 8·7 (16) 58·2
Protein, g 62·7 (64) 24·9 (25) 10·2 (11) 98·2
Alcohol, g 2·4 (20) 5·4 (40) 6·2 (40) 14·0
Women
Energy, kjoule 4 314 (55) 2 706 (34) 789 (11) 7 807
Fat, g 41·8 (59) 22·3 (31) 6·6 (10) 71·1
Saturated fat, g 18·5 (57) 11·0 (33) 3·1 (10) 32·6
Carbohydrate, g 118 (50) 92 (39) 24 (11) 234
Sugar, g 17·4 (35) 27·2 (53) 5·9 (12) 50·5
Protein, g 48·0 (65) 18·8 (26) 6·8 (9) 73·9
Alcohol, g 1·0 (24) 2·0 (48) 1·3 (28) 4·3

18 EVA ROOS AND RITVA PRÄTTÄLÄ
TABLE 3
Nutrient density of different eating occasions in 991 women and 870 men
Density
Nutrients In meals In snacks In other eating occasions
Men
Fat, E% 37·4∗ 30·9 22·8∗
Saturated fat, E% 16·6∗ 14·8 10·6∗
Carbohydrate, E% 45·2∗ 55·4 57·7
Sugar, E% 5·6∗ 16·0 16·9
Protein, E% 19·1∗ 12·1 10·6∗
Alcohol, E% 1·3∗ 4·1 16·3∗
Fibre, g/10 MJ 26·2∗ 21·9 18·6∗
Vitamin C, mg/10 MJ 132∗ 172 183
Carotenoids, mg/10 MJ 6·6∗ 2·8 3·6
Cholesterol, mg/10 MJ 462∗ 316 239∗
Women
Fat, E% 36·5∗ 29·7 25·2∗
Saturated fat, E% 16·1∗ 14·6 11·9∗
Carbohydrate, E% 46·7∗ 59·3 57·0∗
Sugar, E% 6·6∗ 16·9 18·2∗
Protein, E% 19·2∗ 11·8 12·0
Alcohol, E% 0·6∗ 2·0 6·7∗
Fibre, g/10 MJ 27·8∗ 25·3 24·0
Vitamin C, mg/10 MJ 181∗ 244 246
Carotenoids, mg/10 MJ 9·3∗ 4·0 7·4∗
Cholesterol, mg/10 MJ 449∗ 303 285
∗ Starred density values are significantly different to snack density values (p

MEAL PATTERN AND NUTRIENT INTAKE AMONG ADULT FINNS
19
TABLE 4
Daily intake of energy and nutrients by meal pattern of 888 women and 801 men
Nutrients Conventional Other meal Δ 3M–2M, p-value,
meal pattern pattern adjusted for adjusted for
(3M), (2M), age and age and
unadjusted unadjusted region region
Men (N=371) (N=430)
Kjoule 10656 10142 316 0·14
Kcal 2548 2425 76 0·14
Fat, E% 34·3 34·8 −0·2 0·60
Saturated fat, E% 15·6 15·8 −0·2 0·48
Carbohydrate, E% 48·9 47·6 0·8 0·15
Sugar, E% 9·1 9·6 −0·6 0·09
Protein, E% 16·5 16·1 0·4 0·10
Alcohol, E% 3·4 4·4 −0·8 0·07
Fibre g/10 MJ 24·8 23·2 0·9 0·08
Vitamin C mg/10 MJ 134 136 0·4 0·94
Carotenoids mg/10 MJ 4·8 4·7 0·2 0·35
Cholesterol mg/10 MJ 399 394 10 0·32
Women (N=377) (N=511)
Kjoule 8107 7554 529 0·0003
Kcal 1938 1807 126 0·0003
Fat, E% 33·8 34·4 −0·2 0·60
Saturated fat, E% 15·6 15·8 −0·03 0·90
Carbohydrate, E% 51·7 50·5 0·6 0·27
Sugar, E% 10·4 10·5 −0·2 0·49
Protein, E% 16·5 16·3 0·2 0·40
Alcohol, E% 1·2 1·9 −0·5 0·03
Fibre g/10 MJ 26·8 25·7 0·5 0·36
Vitamin C mg/10 MJ 184 201 −17 0·03
Carotenoids mg/10 MJ 6·6 7·2 −0·3 0·33
Cholesterol mg/10 MJ 399 385 17 0·05
DISCUSSION
Fewer than half the subjects followed the conventional meal pattern model used
in dietary guidelines. About half those who did not follow this pattern skipped lunch
and about half dinner, while breakfast was normally not skipped. The distribution
of meal patterns we found corresponds well with data from a study of women in
Helsinki, in which 47% ate breakfast, lunch and dinner, 27% skipped lunch and 25%
skipped dinner (Prättälä et al., 1993).
More than 10% of the energy intake in the present study came from the uncoded
‘‘other eating occasions’’. These seemed to be partly missing entries and partly
occasions when subjects were simply unable to code as either meals or snacks. In
the earlier meal pattern study in Helsinki, snacks never included prepared or cooked
food (Prättälä et al., 1993). The density of cooked food in ‘‘other eating occasions’’
lay between those of meals and snacks; which suggests that some of the responses
classified as ‘‘other eating occasions’’ were actually missing entries. The densities of
beverages and typical snack foods like candies and crisps were highest for other
eating occasions; maybe eating occasions that generally were not regarded as meals

20 EVA ROOS AND RITVA PRÄTTÄLÄ
TABLE 5
Daily intake of foods by meal pattern of 888 women and 801 men
Food items g/10 MJ Conventional Other meal Δ 3M–2M, p-value
meal pattern pattern adjusted for adjusted for
(3M), (2M), age and age and
unadjusted unadjusted region region
Men (N=371) (N=430)
Milk 359 345 1 0·96
Cereals 95 68 26 0·001
Bread 167 151 10 0·05
Cheese 28 31 −2 0·42
Cooked dishes 387 366 24 0·05
Potatoes, pasta and rice 154 142 17 0·02
Cooked vegetables 22 23 0 0·90
Fresh vegetables 71 65 9 0·10
Desserts and cakes 160 145 9 0·28
Fruit & berries 155 174 −13 0·25
Juices 135 125 5 0·71
Coffee and tea 543 627 −83 0·0005
Sweet and salty snacks 37 43 −6 0·13
Women (N=377) (N=511)
Milk 373 303 57 0·002
Cereals 123 81 33 0·0002
Bread 144 138 3 0·50
Cheese 37 47 −7 0·005
Cooked dishes 383 364 14 0·22
Potatoes, pasta and rice 135 117 21 0·002
Cooked vegetables 34 34 1 0·83
Fresh vegetables 104 114 −2 0·75
Desserts and cakes 207 189 8 0·40
Fruit & berries 241 288 −45 0·0006
Juices 147 147 −5 0·69
Coffee and tea 639 733 −86 0·002
Sweet and salty snacks 43 54 −11 0·005
or snacks were not coded at all. It may have been difficult for subjects to code eating
occasions as only meals or snacks; perhaps more pre-coded alternatives in the good
record, e.g. drinks, would have decreased the frequency of uncoded eating occasions.
Meals contributed to more than half of the daily energy and therefore retained
their importance over snacks or other eating occasions during the day. However,
the proportion of energy intake derived from meals (55%) was lower than that found
in British and North American studies (Kennedy et al., 1982; Summerbell et al., 1995)
and what was recommended in the Swedish nutrition and food recommendations
(Standing Nordic Committee on Food, 1989). Uncoded eating occasions were quite
commonly reported in our study, and probably some of the energy involved was
actually derived from uncoded meals. Another possible reason why meals in Finland
provided less of the daily energy intake than in the U.K. and U.S.A. is cultural
differences in meal pattern or in defining eating occasions. The meaning of the words
meal and snack might be different in Finland compared to their everyday use in the
English language. For example, what is in this study meant by ‘‘meal’’ might be

MEAL PATTERN AND NUTRIENT INTAKE AMONG ADULT FINNS
21
better translated into English as a ‘‘proper meal’’ (Prättälä et al., 1993) and what is
in this study meant by ‘‘snack’’ might be better translated into ‘‘sandwich meal’’.
Also lay people and nutritional educators seemed to define eating occasions, especially
breakfast, differently. Moreover, the studies themselves applied different methodologies
and meal definitions.
Meals contribute to protein and fat intake and snacks to sugar and alcohol
intake. The macronutrient density (alcohol excluded) in the present study compares
favourably with data from Virtanen (1988), who looked at the nutrient density in
meals and snacks of Finnish adolescents. The only exception was the higher content
of sugar among the young people’s snacks. Previous researchers have also found
snacks to be higher in carbohydrate and sugar densities, and lower in protein and
fat compared with meals (Pao & Mickle, 1981; Kennedy et al., 1982; McCoy et al.,
1986; Summerbell et al., 1995). Differences in nutrient densities of meals and snacks
can be explained in terms of food densities. In Finland cooked dishes are a primary
source of fat (Roos, Kleemola & Pietinen, 1995b), so the high density of cooked
dishes explains partly the high fat contribution of meals. The high consumption of
vegetables during meals explains the high intake of carotenoids, and the high
consumption of fruits, berries, desserts and cakes during snacks the high intake of
sugars and vitamin C. Fruits, berries and fruit juices consumed as snacks seem to
be more common in Finland than in the U.S.A. because we found a higher vitamin
C density in snacks than meals, in contrast to the U.S.A. (Thomas & Call, 1973;
Kennedy et al., 1982; McCoy et al., 1986).
Findings of earlier studies in young people that snacks contribute far more than
just ‘‘empty calories’’ (Thomas & Call, 1973; McCoy et al., 1986) are confirmed
among adults by our findings. In fact, the fat density of snacks in our study was
closer to the national recommendations (National Nutrition Council, 1989) than
that of the meals. On the other hand, the sugar and fibre densities of meals were
closer to the recommendations than those of snacks. Nutrient densities of snacks
and meals are different and we find favourable and less favourable ‘‘components’’
in both meals and snacks.
The results of this study suggest, that meal pattern had only a small effect on
diet and that meal pattern did not influence the healthfulness of the diet. Meal
pattern had no effect on nutrient intake in men, but some effect in women; alcohol
and vitamin C intakes were lower and cholesterol intake higher among women
following the conventional meal pattern. Even though the differences between the
meal pattern groups in women were significant, they were not large, and it is
impossible to state that one meal pattern group had a more healthy diet than the
others. The response rate in this study was 66% and those who answered the
questionnaire had probably a healthier lifestyle than those who did not. It is possible
that an association between meal pattern and the quality of diet existed in the entire
population, but was not observed in this study due to selection bias. It is also
possible that only a very irregular meal pattern (no warm meals daily) lowers the
nutrient quality of diet. Finns eating very irregularly, i.e., less than two meals per
day were too few for statistical analysis. A larger number of respondents would
probably have permitted significant differences to emerge between this group and
the others.
Although meal pattern had no effect, or only a minor one, on nutrient intake, it
had more influence on food intake. The intakes of cereals (porridge), potatoes, rice
and pasta, and cooked dishes were higher and those of cheese, fruits and berries,

22 EVA ROOS AND RITVA PRÄTTÄLÄ
sweet and salty snacks, and coffee and tea lower among those who followed the
conventional meal pattern. Generally, the diet of the conventional meal pattern
eaters seemed to be more traditional than that of the others, but did not differ in
nutrient content from the more modern food pattern. The lower coffee and tea
consumption among followers of the conventional meal pattern was expected; earlier
studies have shown that warm and prepared meals have been replaced by coffee and
tea (Mintz, 1985; Prättälä & Helminen, 1990).
Today, the traditional assumption of a three meal pattern is true for less than
half the population. We need new meal models in dietary guidelines which correspond
better to daily meal patterns. The conventional three-meal pattern promoted in
dietary recommendations seems not to be sufficiently relevant for encouraging a
more nutritious diet. A healthy diet is possible both for those who follow the
conventional meal pattern and for those who eat fewer meals per day. Both dietary
guidelines and educators should place more emphasis on eating occasions. For
example, it is more relevant to focus on meals when trying to decrease fat intake,
and on snacks when sugar is the target.
This study was not able to examine those with a very irregular meal pattern. The
irregular meal pattern group was too small for further analysis in the present study.
An irregular meal pattern could probably affect the daily nutrient intake. Other
‘‘bad’’ lifestyle habits such as smoking and low physical activity may also be more
common among those who eat irregularly. Unfortunately, this group of people is
difficult to reach by mailed questionnaires and more likely to be found among study
non-attenders. Other approaches and methods should be used to identify the irregular
meal pattern group and to analyse associations between life style, irregular eating
and nutrient intakes.
REFERENCES
Anderson, A. S., Macintyre, S. & West, P. (1993). Adolescent meal patters: grazing habits in
the west of Scotland. Health Bulletin, 51, 158–165.
Basdevant, A., Craplet, C. & Guy-Grand, B. (1993). Snacking patterns in obese French
women. Appetite, 21, 17–23.
Belloc, N. B. & Breslow, L. (1972). Relationship of physical health status and health practices.
Preventive Medicine, 1, 409–421.
Birkbeck, J. A. (1981). Obesity, socioeconomic variables and eating habits in New Zealand.
Journal of Biosocial Science, 13, 299–307.
Bruce, Å. (1987). Måltidsordning (Meal pattern). Vårföda, 6, 244–246.
Bruce, Å. (1991). Inledning (Introduction). In Måltiden och måltidsordningen (Meal and meal
pattern). p. 5–7. Forskningsrådsnämnden. Report 91:3.
Cross, A. T., Babicz, D. & Cushman, L. F. (1994). Snacking patterns among 1,800 adults and
children. Journal of American Dietetic Association, 94, 1398–1403.
Dugdale, A. E., Townsend, B. & Rigsby, B. (1988). The eating and snacking patterns of young
people in Brisbane, Australia. Journal of Human Nutrition and Dietetics, 1, 95–104.
Fabry, P. & Tepperman, J. (1970). Meal frequency—a possible factor in human pathology.
American Journal of Clinical Nutrition, 23, 1059–1068.
Franceschi, S., La Vecchia, C., Bidoli, E., Negri, E. & Talamini R. (1992). Meal frequency
and risk of colorectal cancer. Cancer Research, 52, 3589–3592.
Gillespie, A. (1983). Assessing snacking behavior of children. Ecology of Food and Nutrition,
13, 167–172.
Haraldsdottir, J., Holm, L., Jensen, J. H. & Møller, A. (1989). Danskernes kostvaner 2. Hvem
spiser hvad? (Danish food habits 2, who is eating what?) Denmark: LST, 154.

MEAL PATTERN AND NUTRIENT INTAKE AMONG ADULT FINNS
23
Holm, L. (1993). Cultural and social acceptability of a healthy diet. European Journal of
Clinical Nutrition, 47, 592–599.
Johansson, G., Callmer, E. & Gustafsson, J.-Å. (1992). Changing from a mixed diet to a
Scandinavian vegetarian diet: effects on nutrient intake, food choice, meal pattern and
cooking methods. European Journal of Clinical Nutrition, 46, 707–716.
Kennedy, E. T., Harrell, M. W. & Frazao, B. (1982). Distribution of nutrient intake across
meals in the United States Population. Ecology of Food and Nutrition, 11, 225–233.
Kleemola, P., Virtanen, M. I. & Pietinen, P. (1994). The 1992 Dietary Survey of Finnish Adults.
Publications of the National Public Health Institute B2/1994. Helsinki.
Kohlmeier, L. (1994). Gaps in dietary assessment methodology: meal- vs. list-based methods.
American Journal of Clinical Nutrition, 59 (suppl), 175–9.
Lennernäs, M. A.-C., Åkerstedt, T., Hagman, U., Bruce, Å. & Hambraeus, L. (1993). A new
approach for evaluation of meal quality and meal patterns. Journal of Human Nutrition
and Dietetics, 6, 261–273.
McCoy, H., Moak, S., Kenney, M. A., Kirby, A., Chopin, L., Billon, W., Clark, A., Disney,
G., Ercanli, F. G., Glover, E., Korslund, M., Lewi, H., Ritchey, J., Schilling, P., Shoffner,
S. & Wakefield, T. Jr. (1986). Snacking patterns and nutrient density of snacks consumed
by southern girls. Journal of Nutrition Education, 18, 61–66.
Mennel, S., Murcott, A. & van Otterloo, A. H. (1992). The Sociology of Food: Eating, Diet
and Culture. SAGE Publications, London.
Ministry of Social Affairs and Health. (1992). Dietary guidelines for elderly (in Finnish).
Publications of Ministry of Social Affairs and Health 12/92. Helsinki.
Ministry of Social Affairs and Health. (1994). Dietary guidelines for hospital catering (in
Finnish). Publications of Ministry of Social Affairs and Health 1994:2. Helsinki.
Mintz, S. (1985). Sweetness and power. The place of Sugar in Modern History. New York:
Viking.
Morgan, K. J., Johnson, S. R. & Stampley, G. L. (1988). Relationship between snack and
meal consumption. Nutrition Research, 8, 703–716.
Mäkelä, J. (1991). Defining a meal. In: Fürst, E. L., Prättälä, R., Ekström, M., Holm, L. &
Kjærnes, U. (Eds), Palatable worlds: sociocultural food studies. Pp. 87–108. Oslo: Solum
Forlag A/S.
National Board of Health. (1989). Child, family and diet (in Finnish). Publications of the
National Board of Health, Finland. Series statistics and reviews 7/1989. Helsinki.
National Board of Health. (1990). Dietary guidelines for sportsmen (in Finnish). Publications
of the National Board of Health, Finland. Series statistics and reviews 5/1990. Helsinki.
National Nutrition Council. (1989). Dietary Guidelines and their scientific principles. Résumé
of the committee report 1987:3. Helsinki: Government Printing Centre. 55 pp.
Ovaskainen, M.-L. (1992). The diet of male smokers, its structure and associations with health
status (in Finnish). English summary. Publications of the National Public Health Institute
A9/1992. Helsinki.
Ovaskainen, M.-L., Lauronen, J. & Haapakoski, J. (1994). Epidemiological food and nutrient
database at the National Public Health Institute. Scandinavian Journal of Nutrition,
Supplement No 29 (Advances in Nutrition Research 10-Year Anniversary Symposium of
the Department of Clinical Nutrition), 38, 10.
Pao, E. M. & Mickle, S. J. (1981). Nutrients from meals and snacks consumed by individuals.
Family Economics Review, Summer 1981, 9–15.
Prättälä, R. & Helminen, P. (1990). Finnish meal patterns. In: Somogyi, J. C. & Koskinen,
E. H., (Eds), Nutritional adaptation to new life-styles. Bibl Nutr Dieta, 45, Pp. 80–91.
Basel, Karger.
Prättälä, R. (1991). Outlining multidisciplinary food research. In: Fürst, E. L., Prättälä, R.,
Ekström, M., Holm, L. & Kjærnes, U. (Eds), Palatable worlds: sociocultural food studies.
Pp. 17–31. Oslo: Solum Forlag A/S.
Prättälä, R., Pelto, G., Pelto, P., Ahola, M. & Räsänen, L. (1993). Continuity and chance in
meal patterns: the case of urban Finland. Ecology of Food and Nutrition, 31, 87–100.
Roos, E., Ovaskainen, M.-L. & Pietinen, P. (1995a). Validity and comparison of three saturated
fat indices. Scandinavian Journal of Nutrition, 39, 55–59.
Roos, E., Kleemola, P. & Pietinen, P. (1995b). Tyydyttyneen rasvan lähteet eri väestöryhmien
ravinnossa (Diet and sources of saturated fat in different socioeconomic classes). Suomen
Lääkärilehti, 50, 1735–1739.

24 EVA ROOS AND RITVA PRÄTTÄLÄ
Roos, G. M., Quandt, S. A. & DeWalt, K. M. (1993). Meal patterns of the elderly in rural
Kentucky. Appetite, 21, 295–298.
Rotenberg, R. (1981). The impact of industrialization on meal patterns in Vienna, Austria.
Ecology of Food and Nutrition, 11, 25–35.
Rothenberg, E., Bosaeus, I. & Steen, B. (1994). Food habits, food beliefs and socio-economic
factors in an elderly population. Scandinavian Journal of Nutrition, 38, 159–165.
Ryan, A. S., Craig, L. D. & Finns, S. C. (1992). Nutrient intakes and dietary patterns of
older Americans: A national study. Journal of Gerontology, 47, M145–M150.
Segovia, J., Bartlett, R., F. & Edwards, A. C. (1989). The association between self-assessed
health status and individual health practices. Canadian Journal of Public Health, 80,
32–37.
Sobal, J., Revicki, D. & DeForge, B. R. (1992). Patterns of interrelationships among healthpromotion
behaviors. American Journal of Preventive Medicine, 8, 351–359.
Standing Nordic Committee on Food. (1989). Nordic Nutrition Recommendations. 2nd ed.
Copenhagen: Nordic Council of Minister.
Summerbell, C. D., Moody, R. C., Shanks, J., Stock, M. J. & Geissler, C. (1995). Sources of
energy from meals versus snacks in 220 people in four age groups. European Journal of
Clinical Nutrition, 49, 33–41.
Thomas, J. A. & Call, D. L. (1973). Eating between meals—a nutrition problem among
teenagers. Nutrition Reviews, 31, 137–139.
Virtanen, S. (1988). Meal pattern and composition of the diet of Finnish adolescent diabetics
and non-diabetic controls. Näringsforskning, 32, 9–13.
Received 26 February 1996, revision 25 April 1996