The role of energy density

Passive overconsumption? Limited evidence of compensation in meal size when consuming foods high in energy density: Two randomised crossover experiments

Research has drawn contradictory conclusions as to whether humans adjust meal size based on meal energy density (ED) or exhibit 'passive overconsumption'. Recent observational research has suggested that meal EDs greater than 1.7-2 kcal/g are compensated for through consumption of smaller meal sizes. We tested the relationship between ED and meal size by examining energy intake of meals at three levels of ED: low (∼1.0 kcal/g), medium (1.7-2.0 kcal/g) and high (>3.0 kcal/g). Two randomised, crossover experiments were conducted with adult participants. In experiment 1 (n = 34, 62% female, mean age 37.4 years), participants were served a lunch including a familiar low, medium or high ED dessert to eat ad libitum. In experiment 2 (n = 32, 66% female, mean age 36.4 years), participants were served a lunch meal manipulated to be low, medium or high ED to eat ad libitum. For experiment 2, later energy intake (post-meal energy intake) was also measured. In experiment 1, participants consumed a similar amount of energy from the low vs. medium ED food. The high ED food was associated with an increased intake of approximately 240 kcals compared to medium (p < 0.001, Cohen's d = 2.31) and low (p < 0.001, Cohen's d = 4.42) ED foods. In experiment 2, there were no significant differences in meal size (grams) between ED meals, resulting in a largely linear relationship between meal ED and energy intake across the three ED conditions ('passive overconsumption'). There were no differences in later energy intake between ED conditions. Contrary to recent suggestions, foods higher in ED were not associated with adjustments to meal size and were associated with increased energy intake across two experiments. Reformulation of foods high in ED may be an effective population level approach to reducing energy intake and obesity. Clinical trial registry number: NCT05744050; https://clinicaltrials.gov/ct2/show/NCT05744050.

The visual analogue scale as a child-friendly measure of the unhealthy = tasty intuition

Worldwide, obesity is a growing concern. The implicit belief that healthiness and tastiness in food are inversely related (the Unhealthy = Tasty Intuition or UTI) decreases healthy food consumption and increases the risk of obesity. Since also childhood obesity has increased at an alarming rate and a large component of adult obesity is established during childhood, questions about children's own food beliefs and preferences are important. However, methods currently used to assess the UTI are either unvalidated Likert scales or implicit measures that are time intensive and too complex to be used for children. Two studies presented here offer an alternative measurement - the simple visual analogue scale. The findings show that this measure is more effective in predicting dietary quality in adults and the frequency of healthy food consumption in children compared to more traditional measures. This simple and effective tool could be used by academics and health practitioners alike to better understand children's food beliefs at an early age, which is a critical step when addressing the increasing obesity problem.

High-fat-sugar diet is associated with impaired hippocampus-dependent memory in humans

Overconsumption of high-fat and high-sugar (HFS) diet may affect the hippocampus, and consequently, memory functions. Yet, converging evidence is needed to demonstrate that the type of memory affected by HFS diet consumption is indeed hippocampus dependent. Moreover, the extent to which HFS diet can also affect executive functioning, and indirectly affect memory requires further examination. In this online study, we asked 349 young adults to report their HFS diet consumption and complete a word memory task, the Everyday Memory Questionnaire, and importantly two memory tasks that have been shown to robustly engage the hippocampus, i.e., the Pattern Separation and Associative Memory Tasks. Participants also completed two executive functioning tasks, the Trail Making Task (TMT) and the Stroop Task. These measures assess attention/cognitive flexibility and the ability to inhibit cognitive interference, respectively. After controlling for confounding variables, we found that participants who reported higher level consumption of a HFS diet performed worse on the Pattern Separation Task and that higher HFS intake was significantly associated with poorer TMT task performance and longer Stroop average reaction time (RT). TMT and Stroop RT scores indicative of reduced executive function also partially mediated the relationship between HFS diet and memory performance on the pattern separation task. Taken together, our results provide converging evidence that HFS diet may impair hippocampus-dependent memory. HFS diet may also affect executive functioning and indirectly impair memory function. The findings are consistent with human subject and animal studies and call for further investigations on the psychological and neural mechanisms underlying the dietary effects on cognitive processes.

Challenging inhibitory control with high- and low-calorie food: A behavioural and TMS study

Most people are often tempted by their impulses to "indulge" in high-calorie food, even if this behaviour is not consistent with their goal to control weight in the long term and might not be healthy. The outcome of this conflict is strongly dependent on inhibitory control. It has already been reported that individuals with weaker inhibitory control consume more high-calorie food, are more often unsuccessful dieters, overweight or obese compared to people with more effective inhibitory control. In the present study, we aimed at investigating inhibitory control in the context of human eating behaviour. A sample of 20 healthy normal-weight adults performed a 50% probability visual affective Go/NoGo task involving food (high- and low-calorie) and non-food images as stimuli. Single-pulse transcranial magnetic stimulation (TMS) was administered over the right primary motor cortex (M1) either 300 ms after image presentation to measure corticospinal excitability during the different stimulus categories or 300 ms after the appearance of a fixation point, as a control stimulation condition. The experimental session consisted of a food target and a non-food target block. Behavioural outcomes showed a natural implicit inclination towards high-calorie food in that participants were faster and more accurate compared to the other categories. This advantage was selectively deleted by TMS, which slowed down reaction times. MEPs did not differ according to the stimulus category, but, as expected, were bigger for Go compared to NoGo trials. Participants judged high-calorie food also as more appetising than low-calorie food images. Overall, our results point to a differential modulation when targeting inhibitory control, in favour of the more palatable food category (high-calorie). Present data suggest that the activity of the motor system is modulated by food nutritional value, being more engaged by appetising food. Future work should explore to what extent these processes are affected in patients with eating disorders and should aim to better characterise the related dynamics of cortical connectivity within the motor network.

Associations between Resilience and Food Intake Are Mediated by Emotional Eating in the NutriNet-Santé Study

BACKGROUND

Resilience, the ability to bounce back or recover from stress, has been associated with several health-related behaviors. However, data on food intake and emotional eating are lacking.

OBJECTIVES

The objective of this cross-sectional study was to analyze the associations between resilience and diet quality and ultraprocessed food (UPF) and food group consumption, and to assess whether emotional eating was a mediator of these associations.

METHODS

In 2017, 17,840 participants (73.5% female, mean age = 55.4 ± 14.0 y) of the NutriNet-Santé study completed the Brief Resilience Scale, the revised 21-item Three-Factor Eating Questionnaire, and ≥3 self-administered 24-h dietary records. Diet quality was assessed with the modified French National Nutrition and Health Program Guideline Score. Foods and beverages consumed were categorized according to their degree of processing by the NOVA classification. We assessed the association between resilience and emotional eating using linear regression models. We also assessed the mediating role of emotional eating in the associations between resilience and diet quality, energy intake, and UPF and food group consumption, controlling for sociodemographic characteristics.

RESULTS

In our study, resilience was negatively associated with emotional eating (P < 0.0001). More resilient participants had greater overall diet quality, greater intakes of seafood, whole-grain foods, fats, unsalted oleaginous fruits, and alcoholic beverages, and lower intakes of UPFs, starchy foods, dairy desserts, sugary fatty products, and sugar and confectionery (all P < 0.05). Emotional eating was a mediator of the inverse associations between resilience and intake of energy, UPFs, dairy desserts, sugary fatty products, and of the positive associations between resilience and alcoholic beverages (all P < 0.05), with a 20-70% mediation.

CONCLUSIONS

Our findings showed that resilience was associated with an overall better diet quality in the NutriNet-Santé population-based study. These associations were partially explained by emotional eating. These findings suggest that resilience should be considered in the promotion of healthy dietary habits.The study is registered at clinicaltrials.gov as #NCT03335644.

Dietary patterns and food insecurity of students participating in a food aid programme: the Mediterranean perspective

BACKGROUND

To explore the effect of household food insecurity on dietary patterns of children and adolescents participating in a school food-aid programme in regions of Greece with low socioeconomic status.

METHODS

A cross-sectional study was conducted during the school year 2013-14, among 406 schools in low socioeconomic status regions of Greece. Dietary habits and sociodemographic characteristics of students and their families were recorded. Factor analysis was used in order to derive children's and adolescents' dietary patterns and analysis of covariance was performed to examine the effect of households' food insecurity level on those patterns. A total of 31 399 students participated in the study; 16 652 children (5-11 years) and 14 747 adolescents (12-18 years).

RESULTS

Factor analysis identified five dietary patterns in both age groups, explaining the 49.1% (children) and 53.0% (adolescents) of the total variation in intake. After adjusting for various factors, the household's food insecurity was significantly associated with the majority of the derived patterns in both age groups, with most pronounced differences being observed for the consumption of red meat, poultry and fish, fruits, as well as red processed meat, cereals and dairy products, which was lower among children and adolescents with food insecurity. Children with food insecurity consumed significantly more unhealthy food, such as chips, fast food, sugared drinks, sweets, French fries and mayonnaise sauce.

CONCLUSIONS

Promotion of healthy eating to households facing food insecurity is of crucial importance, giving emphasis in the design of low cost, yet highly nutritious programmes.

Low-calorie sweeteners in the human diet: scientific evidence, recommendations, challenges and future needs. A symposium report from the FENS 2019 conference

Overconsumption of free sugars, particularly from sugar-sweetened beverages (SSB), has potential negative health impacts. Implementation of a range of public health strategies is needed to reduce intakes of free sugars, including reducing portion sizes, promoting healthier dietary choices and reformulating foods and beverages. Although low-calorie sweeteners (LCS) are a useful tool for reducing energy intake and control glucose response when consuming sweet foods and drinks, several opinions persist about the adverse health effects of LCS, many of which are based on poor, little or no scientific evidence. This symposium report summarises key messages of the presentations and related discussions delivered at a scientific symposium at the 13th European Nutrition Conference (FENS 2019). These presentations considered the scientific evidence and current recommendations about the use and potential benefits of LCS for human health, with a particular focus on current evidence in relation to body weight and glycaemic control. Many of the studies to date on LCS have focused on low-calorie sweetened beverages (LCSB); however, the psychological and behavioural factors influencing consumer beliefs and consumption of LCSB need to be further explored. Current recommendations for LCS use are described, including the conclusions from a recent expert consensus report identifying the challenges that remain with LCS research. Finally, existing knowledge gaps and future actions are described, as well as two large ongoing research projects: SWITCH and SWEET.

Do low-calorie sweetened beverages help to control food cravings? Two experimental studies

Low-calorie sweetened (LCS) beverages may help consumers to satisfy hedonic food cravings without violating dieting goals, however this remains unexplored. The present research investigated the effect of priming hedonic eating motivations on ad libitum energy intake in frequent and non-consumers of LCS beverages. It was hypothesised that energy intake would be greater after the hedonic eating prime relative to a control prime in non-consumers, but that frequent LCS beverage consumers would be protected from this effect. In Study 1 (N = 120), frequent and non-consumers were exposed to either chocolate or neutral cues (craving vs. control condition) and then completed a beverage-related visual probe task with concurrent eye-tracking. Ad libitum energy intake from sweet and savoury snacks and beverages (including LCS) was then assessed. Study 2 followed a similar protocol, but included only frequent consumers (N = 172) and manipulated the availability of LCS beverages in the ad libitum eating context (available vs. unavailable). Measures of guilt and perceived behavioural control were also included. In Study 1, as hypothesised, non-consumers showed greater energy intake in the craving condition relative to the control condition, but frequent consumers had similar energy intake in both conditions. Frequent consumers (but not non-consumers) also demonstrated an attentional bias for LCS beverage stimuli compared to both sugar and water stimuli. In contrast, in Study 2 frequent consumers showed greater energy intake in the craving condition relative to the control condition; however, overall energy intake was significantly greater when LCS beverages were unavailable compared to when they were available. Ratings of guilt were higher and perceived control was lower in the LCS-unavailable condition relative to the LCS-available condition. Conclusions: LCS beverages did not consistently protect consumers from craving-induced increases in energy intake. However, frequent consumers consumed fewer calories overall when LCS beverages were available (relative to unavailable), as well as perceiving more control over their food intake and feeling less guilty.

Desigualdades sociais no perfil de consumo de alimentos da população brasileira: Pesquisa Nacional de Saúde, 2013

RESUMO: Introdução: É amplamente reconhecido que elevada concentração de renda prevalece no Brasil e que a posição socioeconômica dos segmentos sociais exerce influência nas condições de vida e saúde, incluindo a qualidade da alimentação. Objetivo: Medir a magnitude das desigualdades sociais no perfil da qualidade alimentar da população brasileira. Método: Analisaram-se dados da amostra de 60.202 adultos da Pesquisa Nacional de Saúde de 2013. Foram estimadas as prevalências de indicadores de qualidade alimentar segundo sexo, raça/cor, renda, escolaridade e posse de plano de saúde. Razões de prevalência foram estimadas por meio de regressão múltipla de Poisson. Resultados: Maior prevalência de consumo de alimentos saudáveis foi verificada no sexo feminino, entre os brancos e no grupo de melhor nível socioeconômico. Entretanto,para alguns alimentos considerados não saudáveis, como doces, sanduíches, salgados e pizzas, também foi observada maior prevalência nos segmentos sociais mais favorecidos, nas mulheres e nos brancos, expressando a concomitância de escolhas alimentares saudáveis e não saudáveis. Desigualdade de maior magnitude foi observada quanto à comparação do consumo de leite desnatado e semidesnatado segundo renda (razão de prevalência - RP=4,48). Conclusão: Além de expressiva desigualdade social no perfil alimentar dos brasileiros, foram detectados perfis mistos, incluindo alimentos saudáveis e não saudáveis, sinalizando a necessidade de monitoramento e de intervenções de promoção de alimentação saudável que levem em conta as desigualdades sociais e as contradições no consumo alimentar.

How Western Diet And Lifestyle Drive The Pandemic Of Obesity And Civilization Diseases

Westernized populations are plagued by a plethora of chronic non-infectious degenerative diseases, termed as "civilization diseases", like obesity, diabetes, cardiovascular diseases, cancer, autoimmune diseases, Alzheimer's disease and many more, diseases which are rare or virtually absent in hunter-gatherers and other non-westernized populations. There is a growing awareness that the cause of this amazing discrepancy lies in the profound changes in diet and lifestyle during recent human history. This paper shows that the transition from Paleolithic nutrition to Western diets, along with lack of corresponding genetic adaptations, cause significant distortions of the fine-tuned metabolism that has evolved over millions of years of human evolution in adaptation to Paleolithic diets. With the increasing spread of Western diet and lifestyle worldwide, overweight and civilization diseases are also rapidly increasing in developing countries. It is suggested that the diet-related key changes in the developmental process include an increased production of reactive oxygen species and oxidative stress, development of hyperinsulinemia and insulin resistance, low-grade inflammation and an abnormal activation of the sympathetic nervous system and the renin-angiotensin system, all of which play pivotal roles in the development of diseases of civilization. In addition, diet-related epigenetic changes and fetal programming play an important role. The suggested pathomechanism is also able to explain the well-known but not completely understood close relationship between obesity and the wide range of comorbidities, like type 2 diabetes mellitus, cardiovascular disease, etc., as diseases of the same etiopathology. Changing our lifestyle in accordance with our genetic makeup, including diet and physical activity, may help prevent or limit the development of these diseases.

Rural-Urban Disparities in Obesity Prevalence Among Working Age Adults in the United States: Exploring the Mechanisms

PURPOSE

Higher prevalence rates of overweight and obesity in rural America have been consistently reported, but sources of these disparities are not well known. This study presented patterns and mechanisms of these disparities among working age Americans.

DESIGN

Cross-sectional study.

SETTING

United States of America.

PARTICIPANTS

The study included 10 302 participants of the 2003-2008 National Health and Nutrition Examination Survey (NHANES) who were 20 to 64 years old, not pregnant, and with a body mass index ranging from 18.5 to 60.

MEASURES

Individual-level data were from NHANES including age, gender, race/ethnicity, immigrant status, education, and family income. The outcomes were prevalence of obesity and prevalence of overweight and obesity combined. Neighborhood data were constructed from the 2000 US Census providing tract-level information on family median income and built environmental features and from the 2006 ESRI ArcGIS 9.3 Data DVD providing tract-level park location information.

ANALYSIS

Geographic information system (GIS) methods were used to create a measure of spatial distance to local parks capturing park accessibility. Random intercept logistic and ordinal logit regression analyses were performed.

FINDINGS

Multivariate regression results showed that the odds of obesity was higher in rural areas compared to urban areas (odds ratio = 1.358, P < .001) net of demographic controls and that this gap was largely attributable to individual educational attainment and neighborhood median household income and neighborhood built environmental features. After controlling for these hypothesized mediators, the elevated odds associated with rural residence was reduced by nearly 94% and rendered statistically insignificant.

CONCLUSIONS

In this nationally representative cross-sectional sample, rural-urban obesity disparities were large and explained by rural-urban educational differences at the individual level and economic and built environmental differences at the neighborhood level.

Synchronic inverse seasonal rhythmus of energy density of food intake and sleep quality: a contribution to chrono-nutrition from a Polish adult population

BACKGROUND/OBJECTIVES

There is evidence which suggests that sleep behavior and dietary intake are interlinked. Thus, we investigated whether a seasonal rhythm in food-energy density exists, and how this relates to quality of sleep.

SUBJECTS/METHODS

Two hundred and thirty adult volunteers were investigated across the four seasons. Anthropometrical measurements were obtained and The Pittsburgh Sleep Quality Index was used for an assessment of sleep quality and disturbances. The dietary intake was evaluated using a 24 h dietary recall. Generalized estimating equations were used to estimate seasonal changes in energy density and sleep quality, as well as the association of energy density with sleep quality. All analyses were adjusted for age, sex, education, occupation and shift-work.

RESULTS

Mean food energy density was significantly higher in winter as compared with other seasons (P<0.05), although no seasonal variations were observed in macronutrient intake (fat and protein). Overall, the sleep quality was low (score value >5) in all seasons, with the lowest quality occurring in winter and the highest in spring (P<0.05). The components of sleep quality score showed that winter had statistically (P<0.05) poorer subjective sleep quality, sleep latency and sleep disturbances, but lower daytime dysfunction compared with spring and summer. After adjusting for seasonal effects (correlated outcome data) and shift-work, energy density was found to be inversely associated (P<0.0001) with sleep quality.

CONCLUSIONS

An inverse association between seasonal fluctuation of food energy density and sleep quality was found with winter time, associated with the intake of higher energy dense food products and the lowest sleep quality.

Association between energy density and diet cost in children

Highlights

The average of the energy-adjusted diet cost in 6-12 years-old children was 2.17€/1000Kcal (SD + 0.49).Energy-density diets (EDs - Kcal/g) were calculated by three distinct methods: (1) with food and all beverages (ED1), (2) with food and caloric beverages (ED2), and (3) only with food (ED3).The distributions of the three EDs were statistically different, being higher the ED3 - calculated excluding all beverages (1.15Kcal (SD + 0.28) vs. ED2: 1.10Kcal/g; SD + 0.24 vs. ED1: 0.99Kcal/g; SD + 0.22).Lower energy-density diets (EDs) were associated with higher diet cost in a sample of school children from a Mediterranean country, regardless the differences between the EDs calculated by three distinct methods.

Background

Lower energy density diets tend to cost more, but data using different ways to calculate the dietary energy density, is scarce.

Objectives

To estimate the dietary energy density, and to assess how it is associated with the diet cost in children.

Methods

Data were obtained from a community-based survey from public elementary schools in Portugal. Dietary intake of 464 children (6-12 years) was assessed by a 24 h recall in 2007/2008. Dietary energy density (kcal/g) was calculated as following: (1) with food and all beverages (ED1), (2) with food and caloric beverages (ED2), and (3) only with food (ED3). Energy-adjusted diet cost (€/1000 kcal) was calculated based on the collection of food prices from a national leader supermarket. Anthropometric measures were taken and socio-demographic data were obtained from parents. Logistic regression was used to estimate the association between diet cost and energy density.

Results

For boys, the energy-adjusted diet cost of the highest third of energy density was lower, between 81% in the ED3 (p for trend <0.001) and 87% in the ED1 (p for trend <0.001), compared to the lowest third. Girls showed similar, but weaker associations.

Conclusions

Higher dietary energy density was associated with lower dietary cost among children.

A comparison of food pattern, macro- and some micronutrients density of the diet across different socio-economic zones of Tehran

BACKGROUND

The consumption of low quality foods is common in low socioeconomic areas; and according to epidemiological studies, the density of nutrients often proves the quality of diet. This study aimed to compare the density of macronutrients and micronutrients in various parts of Tehran.

METHODS

This was a cross-sectional study performed from September to December 2007 in all the 22 districts of the municipality of Tehran including 1,807 households. Experienced interviewers completed a 24-hour recall questionnaire. To estimate the nutrient densities, nutrient intake (grams or milligrams) was calculated per 1,000 kcal energy intake. To calculate the density of energy intake, energy intake (kcal) was divided by 100 g of foodstuff. The 22 districts of Tehran were divided into five zones of north, center, east, west and south. ANOVA and Tukey tests were used.

RESULTS

The highest density of protein and fat intake was observed in the north of Tehran, while carbohydrate density was highest in the west, east and south zones, and energy density was highest in the south zone (p<0.05). Calcium and vitamin C had the highest density in the north of Tehran, and vitamin A and riboflavin had the highest density in the north and center of Tehran, and the lowest level in the south of Tehran (p<0.05).

CONCLUSION

Despite the high density of energy in the south of Tehran, a deficiency of micronutrient intake was obvious, reflecting the importance of the impact of socioeconomic factors.

Effects of Recording Food Intake Using Cell Phone Camera Pictures on Energy Intake and Food Choice

BACKGROUND

The well-documented increases in obesity and unhealthy dietary practices substantiate the need for evidence-based tools that can help people improve their dietary habits. The current spread of mobile phone-embedded cameras offers new opportunities for recording food intake. Moreover, the act of taking pictures of food consumed may enhance visual consciousness of food choice and quantity. The present study aimed to assess the effect of using cell phone pictures to record food intake on energy intake and food choice in college students. The effectiveness and acceptability of cell phone picture-based diet recording also was assessed.

METHODS

A repeated measures crossover design was used. One group of participants entered their food intake online during 3 days based on their memory, although a second group recorded their food intake using cell phone pictures as their reference. Participants then crossed over to complete 3 more days of diet recording using the alternate method. Focus groups were conducted to obtain feedback on the effectiveness and acceptability of cell phone picture-based diet recording.

RESULTS

Intake of meat and vegetable servings were significantly higher in the memory period compared with the cell phone period, regardless of the order. Results from the focus group indicated a positive attitude toward the use of cell phone pictures in recording food intake and an increased awareness of food choice and portion size.

LINKING EVIDENCE TO ACTION

Cell phone pictures may be an easy, relevant, and accessible method of diet self-monitoring when aiming at dietary changes. Future trials should combine this technique with healthy eating education.

Energy and macronutrient intakes in Brazil: results of the first nationwide individual dietary survey

OBJECTIVE

To characterize energy and macronutrient intakes in Brazil and to describe the top food items contributing to energy and macronutrient intakes.

DESIGN

Two non-consecutive 24 h dietary records were collected and energy and macronutrient data were adjusted for usual intake distribution. Descriptive statistics and ANOVA with the Bonferroni post hoc test were analysed using SAS version 9·1. Means and standard deviations were estimated for sex, age and income strata.

SETTING

Nationwide cross-sectional survey, 2008-2009.

SUBJECTS

Nationally representative sample of individuals ≥10 years old (n32 749), excluding pregnant and lactating women (n 1254).

RESULTS

The average energy intake was 7958 kJ/d (1902 kcal/d) and mean energy density was 6·82 kJ/g (1·63 kcal/g). Added sugar represented 13 % of total energy intake and animal protein represented 10 %. The mean contribution of total fat to energy intake was 27 %, while the mean saturated fat contribution was 9 %. Compared with the lowest quartile of income, individuals in the highest income quartile had greater mean intakes of energy, added sugar, alcohol, animal protein, total fat, saturated fat, monounsaturated fat and trans fat. Rice, beans, beef, bread and coffee were among the top five foods contributing most to the intakes of energy, carbohydrates, protein, fat and fibre.

CONCLUSIONS

In general, Brazilians' dietary intake is compatible with a high risk of obesity and non-communicable chronic diseases, being characterized by high intakes of added sugar and saturated fat. Income may be a major determinant of diet nutritional characteristics.

The associations between emotional eating and consumption of energy-dense snack foods are modified by sex and depressive symptomatology

In recent years, emotional eating (EmE) has incited substantial research interest as an important psychologic determinant of food intake and overweight. However, little is known about factors that might modulate its relations with dietary habits. The objective of this study was to examine the association between EmE and consumption of energy-dense snack food and assess the 2-way interaction of EmE with sex and depressive symptoms. A total of 7378 men and 22,862 women from the NutriNet-Santé cohort (France, 2009-2013) who completed ≥6 self-reported 24-h food records were included in this cross-sectional analysis. EmE was evaluated via the revised 21-item Three-Factor Eating Questionnaire. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale. The associations between EmE and energy-dense food consumption were assessed by multivariable logistic and linear regression models adjusted for sociodemographic and lifestyle factors. Higher EmE was associated with higher consumption of energy-dense snacks and, in particular, with consumption of sweet-and-fatty foods across most categories studied. However, these associations were stronger in women with depressive symptoms (e.g., high consumption of chocolate, OR: 1.77, 95% CI: 1.43, 2.20; cakes/biscuits/pastries, OR: 1.81, 95% CI: 1.45, 2.26) compared with those without depressive symptoms (e.g., high consumption of chocolate, OR: 1.52, 95% CI: 1.36, 1.69; cakes/biscuits/pastries, OR: 1.44, 95% CI: 1.29, 1.61). In contrast, the significant positive associations observed in men without depressive symptoms (e.g., high consumption of chocolate, OR: 1.33, 95% CI: 1.16, 1.52; cakes/biscuits/pastries, OR: 1.28, 95% CI: 1.11, 1.48) were not found in men with depressive symptoms. In conclusion, in women, EmE was positively associated with consumption of energy-dense snack food, particularly in those with depressive symptoms. For men, the relation between EmE and energy-dense snack foods was found only in those without depressive symptoms. These findings call for consideration of the psychologic state when targeting unhealthy dietary habits, especially in women. This trial was registered at eudract.ema.europa.eu as 2013-000929-31.

Cost and cost-effectiveness of the Mediterranean diet: results of a systematic review

The growing impact of chronic degenerative pathologies (such as cardiovascular disease, type 2 diabetes and Alzheimer’s disease) requires and pushes towards the development of new preventive strategies to reduce the incidence and prevalence of these diseases. Lifestyle changes, especially related to the Mediterranean diet, have the potential to modify disease outcomes and ultimately costs related to their management. The objective of the study was to perform a systematic review of the scientific literature, to gauge the economic performance and the cost-effectiveness of the adherence to the Mediterranean diet as a prevention strategy against degenerative pathologies. We investigated the monetary costs of adopting Mediterranean dietary patterns by determining cost differences between low and high adherence. Research was conducted using the PubMed and Scopus databases. Eight articles met the pre-determined inclusion criteria and were reviewed. Quality assessment and data extraction was performed. The adherence to the Mediterranean diet has been extensively reported to be associated with a favorable health outcome and a better quality of life. The implementation of a Mediterranean dietary pattern may lead to the prevention of degenerative pathologies and to an improvement in life expectancy, a net gain in health and a reduction in total lifetime costs.

Effects of fruit and vegetable, consumed in solid vs beverage forms, on acute and chronic appetitive responses in lean and obese adults

BACKGROUND

The effects of fruits and vegetables in solid vs beverage forms on human appetite and food intake, acutely and chronically, are unclear.

METHODS

This 21-week, randomized, crossover study assessed appetitive ratings following the inclusion of fruits and vegetables, in solid and beverage form, into the habitual diet of healthy lean (n=15) and overweight/obese (n=19) adults with low customary consumption. The primary acute outcomes were satiation (amount of challenge meal consumed), satiety (latency of subsequent eating event) and dietary compensation after a 400 kcal fruit preload. Ratings of appetite were also obtained before and after 8 weeks of required increased fruit and vegetable consumption (20% estimated energy requirement).

RESULTS

Acutely, overweight/obese participants reported smaller reductions of hunger after consuming the fruit preload in beverage compared with solid form (preload × form × body mass index effects, P=0.03). Participants also consumed significantly less of a challenge meal (in both gram and energy) after the ingestion of the solid fruit preload (P<0.005). However, the subsequent meal latency was not significantly different between the solid and the beverage fruit preloads. Total daily energy intake was significantly higher when the obese participants consumed the beverage fruit preload compared with the solid (P<0.001). Daily energy intake was markedly, but not significantly, higher among the lean with the beverage vs solid food form. Hunger and fullness ratings remained stable when participants consumed fruits and vegetables in solid or beverage form for 8 weeks each.

CONCLUSION

Acute post-ingestive appetitive responses were weaker following consumption of fruits in beverage vs solid food forms. Consumption of beverage or solid fruit and vegetable food loads for 8 weeks did not chronically alter appetitive responses.

Age-related variations of appetite sensations of fullness and satisfaction with different dietary energy densities in a large, free-living sample of Japanese adults

BACKGROUND

The effective energy density (ED) diet model for customized meal plans has not been adequately explored, and the specific differences in appetite sensation among age groups remain unclear.

DESIGN

A randomized, crossover study was conducted in 2010 to examine the effects of lunches with different dietary EDs on sensory properties across age groups.

PARTICIPANTS/SETTING

In this experiment, 276 healthy Japanese subjects aged 22 to 59 years consumed packed lunches over six sessions. Using the control meal (150 g cooked rice, sautéed beef menu containing 40 g raw beef, and 240 g vegetable) as a reference, a high-meat/low-rice meal, a low-vegetable meal, a medium-fat/low-vegetable meal, a high-fat meal, and a high-fat/low-vegetable meal were served as modified test meals with varying macronutrient distribution and ED.

MAIN OUTCOME MEASURES

Subjective levels of fullness and satisfaction were assessed over time by visual analogue scale ratings.

STATISTICAL ANALYSES PERFORMED

Data were analyzed using analysis of variance with body mass index as a covariate followed by Bonferroni post hoc tests.

RESULTS

Meals with high vegetable content resulted in greater fullness and satisfaction than meals with low vegetable content, regardless of the diner's age. Particularly among the 500-kcal low-ED meals, a high-meat meal resulted in greater fullness and satisfaction than a medium-fat/low-vegetable meal among participants aged 30 to 40 years. Postprandial fullness was significantly higher with control meal than with high-meat meal among participants aged 40 to 50 years.

CONCLUSIONS

This study indicated that high vegetable content in the low-ED diet model provided sufficient fullness and satisfaction despite the low energy content and increased rice content is more effective for satiety than increased meat content for Japanese adults aged around 40 years.

Dietary strategies to increase satiety

Obesity has a multifactorial etiology. Although obesity is widespread and associated with serious health hazards, its effective prevention and treatment have been challenging. Among the currently available treatment approaches, lifestyle modification to induce a negative energy balance holds a particularly larger appeal due to its wider reach and relative safety. However, long-term compliance with dietary modifications to reduce energy intake is not effective for the majority. The role of many individual nutrients, foods, and food groups in inducing satiety has been extensively studied. Based on this evidence, we have developed sample weight-loss meal plans that include multiple satiating foods, which may collectively augment the satiating properties of a meal. Compared to a typical American diet, these meal plans are considerably lower in energy density and probably more satiating. A diet that exploits the satiating properties of multiple foods may help increase long-term dietary compliance and consequentially enhance weight loss.

Dietary energy density: a mediator of depressive symptoms and abdominal obesity or independent predictor of abdominal obesity?

BACKGROUND

In the U.S., Europe, and throughout the world, abdominal obesity prevalence is increasing. Depressive symptoms may contribute to abdominal obesity through the consumption of diets high in energy density.

PURPOSE

To test dietary energy density ([DED]; kilocalories/gram of food and beverages consumed) for an independent relationship with abdominal obesity or as a mediator between depressive symptoms and abdominal obesity.

METHODS

This cross-sectional study included 87 mid-life, overweight adults; 73.6% women; 50.6% African-American. Variables and measures: Beck depression inventory-II (BDI-II) to measure depressive symptoms; 3-day weighed food records to calculate DED; and waist circumference, an indicator of abdominal obesity. Hierarchical regression tested if DED explained waist circumference variance while controlling for depressive symptoms and consumed food and beverage weight. Three approaches tested DED as a mediator.

RESULTS

Nearly three-quarters of participants had abdominal obesity, and the mean waist circumference was 103.2 (SD 14.3) cm. Mean values: BDI-II was 8.67 (SD 8.34) which indicates that most participants experienced minimal depressive symptoms, and 21.8% reported mild to severe depressive symptoms (BDI-II ≥ 14); DED was 0.75 (SD 0.22) kilocalories/gram. Hierarchical regression showed an independent association between DED and waist circumference with DED explaining 7.0% of variance above that accounted for by BDI-II and food and beverage weight. DED did not mediate between depressive symptoms and abdominal obesity.

CONCLUSIONS

Depressive symptoms and DED were associated with elevated waist circumference, thus a comprehensive intervention aimed at improving depressive symptoms and decreasing DED to reduce waist circumference is warranted.

Hábitos alimentares e comportamento de consumo infantil: influência da renda familiar e do hábito de assistir à televisão

OBJETIVO: Comparar hábitos alimentares e comportamento de consumo de crianças de diferentes níveis de renda familiar de Florianópolis (SC), Brasil, relacionando-os com o hábito de assistir à televisão. MÉTODOS: Estudo qualitativo com análise de conteúdo de manuscritos originados de 23 grupos focais, realizados em uma escola pública e uma escola particular de Florianópolis (SC), compostos por 111 estudantes de 7 a 10 anos. Para verificar a renda familiar dos estudantes, dados sobre a ocupação dos pais foram classificados pela Classificação Brasileira de Ocupações. Os estudantes da escola particular pertenciam a famílias de maior renda em relação aos da escola pública. RESULTADOS: Nas duas escolas, a maioria das crianças entrevistadas referiu assistir à televisão sempre que possível, sem sentir controle dos pais sobre esse hábito. Além disso, afirmaram ter dinheiro para gastos independentes e vontade de comprar os produtos anunciados nas propagandas de televisão. Estudantes da escola pública relataram ingerir e adquirir guloseimas mais frequentemente e ter maior liberdade para fazer compras do que os estudantes da escola particular, que revelaram sentir-se controlados pelos pais em relação aos seus hábitos alimentares e compras realizadas. CONCLUSÃO: O fato de os estudantes da escola particular sentirem-se mais controlados por seus pais pode ter reduzido uma provável influência da televisão sobre seus hábitos alimentares e de compras. Evidencia-se a importância da formulação de estratégias para auxiliar os pais a reduzirem os efeitos da televisão sobre os hábitos de seus filhos e de políticas públicas que incentivem o consumo saudável, além da regulamentação do marketing de alimentos pouco nutritivos para o público infantil.

Successful development of satiety enhancing food products: towards a multidisciplinary agenda of research challenges

In the context of increasing prevalence of overweight and obesity in societies worldwide, enhancing the satiating capacity of foods may help people control their energy intake and weight. This requires an integrated approach between various food-related disciplines. By structuring this approach around the new product development process, this paper aims to present the contours of such an integrative approach by going through the current state of the art around satiety enhancing foods. It portrays actual food choice as the end result of a complex interaction between internal satiety signals, other food benefits, and environmental cues. Three interrelated routes to satiating enhancement are to change the food composition to develop stronger physiological satiation and satiety signals, anticipate and build on smart external stimuli at the moment of purchase and consumption, and improve palatability and acceptance of satiety enhanced foods. Key research challenges in achieving these routes in the field of nutrition, food technology, consumer, marketing, and communication are outlined.

Densidade energética de refeições oferecidas em empresas inscritas no programa de alimentação do Trabalhador no município de São Paulo

OBJETIVO: Estimar a densidade energética de refeições ofertadas em amostra de empresas inscritas no Programa de Alimentação do Trabalhador e os fatores a ela associados e avaliar a relação entre densidade energética e oferta de nutrientes. MÉTODOS: Estudo transversal envolvendo 21 empresas na cidade de São Paulo. A densidade energética das refeições foi calculada por dois métodos: inclusão dos alimentos sólidos e bebidas (densidade energética 1); e inclusão dos alimentos sólidos e exclusão das bebidas (densidade energética 2). Os valores médios para energia (kcal) e para o peso dos alimentos e bebidas (g) foram obtidos pela avaliação do cardápio do almoço em três dias consecutivos. As análises estatísticas foram realizadas por meio de testes não paramétricos. RESULTADOS: A mediana para densidade energética 1 foi 1,10kcal/g e para densidade energética 2 foi 1,43kcal/g. Das empresas estudadas, 76,2% eram do setor industrial; em 57,9%, a maioria dos funcionários recebia até cinco salários-mínimos; 85,7% das unidades de alimentação e nutrição das empresas eram terceirizadas; 71,4% contavam com nutricionista e 61,9% realizam planejamento de cardápio, sendo essa a única diferença signi-ficante observada entre a densidade energética 2 e os setores de atividade econômica (p=0,039). Em relação ao aporte de nutrientes das refeições, observou-se correlação positiva entre densidade energéticas 1 e oferta de proteína, gordura total e fibra, e entre densidade energetica 2 e oferta de gordura total e gordura satu-rada. CONCLUSÃO: É necessário que as empresas cadastradas no Programa de Alimentação do Trabalhador melhorem a qualidade das refeições oferecidas aos trabalhadores, atentando para a redução da oferta de gordura total, nutriente bastante correlacionado à alta densidade energética.

Exercising women with menstrual disturbances consume low energy dense foods and beverages

Women with exercise-associated menstrual cycle disturbances (EAMD) restrict energy intake. Reducing energy density (ED; kcals·g–1of food or beverage) may be a strategy employed by EAMD women to maintain lower energy intake. The purpose of this study was 3-fold: to determine whether EAMD women consume low ED diets; to identify food groups associated with low ED; and to determine concentrations of total peptide YY (PYY), a satiety factor. Twenty-five active females were divided into 2 groups, according to menstrual status: EAMD (n = 12) and ovulatory controls (OV) (n = 13). Two 3-day diet records were analyzed for ED and other parameters. Body composition, fitness, resting metabolic rate, and PYY were measured. Groups did not differ in age, age of menarche, body mass index, maximal aerobic capacity, body fat (%), or amount of exercise per week. For fat mass (12.4 ± 1.7 vs. 14.9 ± 3.5 kg; p = 0.046), energy availability (28.8 ± 11.5 vs. 42.1 ± 9.2 kcal·kg–1FFM; p = 0.006), and energy intake (29.8 ± 9.2 vs. 36.3 ± 10.6 kcals·kg–1BW; p = 0.023), EAMD was lower than OV. ED was lower in EAMD than in OV (0.77 ± 0.06 vs. 1.06 ± 0.09 kcal·g–1; p = 0.018) when all beverages were included, but not when noncaloric beverages were excluded. Vegetable (p = 0.047) and condiment (p = 0.014) consumption and fasting PYY (pg·mL–1) (p = 0.006) were higher in EAMD. EAMD ate a lower ED diet through increased vegetable, condiment, and noncaloric beverage consumption, and exhibited higher PYY concentrations. These behaviors may represent a successful strategy to restrict calories and maximize satiety.

Effects of grapefruit, grapefruit juice and water preloads on energy balance, weight loss, body composition, and cardiometabolic risk in free-living obese adults

BACKGROUND

Reducing dietary energy density has proven to be an effective strategy to reduce energy intakes and promote weight control. This effect appears most robust when a low energy dense preload is consumed before meals. Yet, much discussion continues regarding the optimal form of a preload. The purpose of the present study was to compare effects of a solid (grapefruit), liquid (grapefruit juice) and water preload consumed prior to breakfast, lunch and dinner in the context of caloric restriction.

METHODS

Eighty-five obese adults (BMI 30-39.9) were randomly assigned to (127 g) grapefruit (GF), grapefruit juice (GFJ) or water preload for 12 weeks after completing a 2-week caloric restriction phase. Preloads were matched for weight, calories, water content, and energy density. Weekly measures included blood pressure, weight, anthropometry and 24-hour dietary intakes. Resting energy expenditure, body composition, physical performance and cardiometabolic risk biomarkers were assessed.

RESULTS

The total amount (grams) of food consumed did not change over time. Yet, after preloads were combined with caloric restriction, average dietary energy density and total energy intakes decreased by 20-29% from baseline values. Subjects experienced 7.1% weight loss overall, with significant decreases in percentage body, trunk, android and gynoid fat, as well as waist circumferences (-4.5 cm). However, differences were not statistically significant among groups. Nevertheless, the amount and direction of change in serum HDL-cholesterol levels in GF (+6.2%) and GFJ (+8.2%) preload groups was significantly greater than water preload group (-3.7%).

CONCLUSIONS

These data indicate that incorporating consumption of a low energy dense dietary preload in a caloric restricted diet is a highly effective weight loss strategy. But, the form of the preload did not have differential effects on energy balance, weight loss or body composition. It is notable that subjects in GF and GFJ preload groups experienced significantly greater benefits in lipid profiles.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00581074.

Psychological factors are important correlates of dietary pattern in overweight adults

INTRODUCTION AND PURPOSE

Abdominal obesity, the central distribution of adipose tissue, is a well-established cardiometabolic disease risk factor. The prevalence has steadily increased since 1988, and now more than 50% of adults have abdominal obesity. Psychological distress coupled with increased dietary energy density (ED) may contribute to abdominal obesity. Guided by the stress and coping model, this study examined the relationship between psychological factors (perceived stress and depressive symptoms) and dietary ED in overweight, working adults. The first hypothesis tested if psychological factors explained a significant amount of food and beverage ED variance above that accounted for by demographic factors. The second hypothesis tested if psychological factors explained a significant amount of food and nonalcoholic beverage ED variance above that accounted for by demographic factors. Post hoc analyses compared macronutrient composition and food group pattern between overweight, working adults with and without depressive symptoms.

METHODS

This descriptive, cross-sectional, correlation study was composed of 87 overweight, working adults (mean age, 41.3 [SD, 10.2] years; mean body mass index, 32.1 [SD, 6.1] kg/m²; 73.6% women; 50.6% African American). Participants completed the Beck Depression Inventory II and Perceived Stress Scale and weighed-3-day-food record analyzed for caloric intake (kilocalories) and weight (in grams) of consumed foods and beverages that were used to calculate ED (in kilocalories/gram). Height and weight were measured to calculate body mass index. Descriptive statistics, Mann-Whitney U test, and sequential regression modeling were used for data analysis.

RESULTS

Depressive symptoms were reported by 21.9% of participants and explained variance in food and beverage ED above that accounted for by African American race and reporting adequate caloric intake. Depressive symptoms explained variance in food and nonalcoholic beverage ED above that accounted for male sex, African American race, and reporting adequate caloric intake. Perceived stress and depressive symptoms were positively correlated; however, perceived stress was not a significant predictor of food and beverage ED.

CONCLUSIONS

Depressive symptoms, potentially modifiable, were 4 times that found in the general population and independently predicted increased food and beverage ED. Further research is needed to determine if improvements in depressive symptoms alter dietary ED, potentially reducing cardiometabolic disease risk.

High-fat diet-induced obesity in animal models

Epidemiological studies have shown a positive relationship between dietary fat intake and obesity. Since rats and mice show a similar relationship, they are considered an appropriate model for studying dietary obesity. The present paper describes the history of using high-fat diets to induce obesity in animals, aims to clarify the consequences of changing the amount and type of dietary fats on weight gain, body composition and adipose tissue cellularity, and explores the contribution of genetics and sex, as well as the biochemical basis and the roles of hormones such as leptin, insulin and ghrelin in animal models of dietary obesity. The major factors that contribute to dietary obesity - hyperphagia, energy density and post-ingestive effects of the dietary fat - are discussed. Other factors that affect dietary obesity including feeding rhythmicity, social factors and stress are highlighted. Finally, we comment on the reversibility of high-fat diet-induced obesity.

The effect of fibre amount, energy level and viscosity of beverages containing oat fibre supplement on perceived satiety

Background

Soluble fibre has been proposed to suppress appetite-related perceptions and it could thus contribute favourably to the regulation of energy intake and the increasing obesity problem.

Objective

To investigate the effect of an oat ingredient rich in β-glucan on perceived satiety at different dietary fibre (DF) concentrations, energy levels and viscosity levels.

Design

A total of 29 healthy volunteers, age 19–39, mean BMI 23.2 kg/m² participated in this study. Measurement of subjective perceptions (satiety, fullness, hunger, desire to eat something/the sample food and thirst) was performed during a 180-min period after ingestion of the sample. There were altogether six samples: two beverages without fibre at energy levels 700 and 1,400 kJ; two beverages containing 5 or 10 g oat DF (2.5 and 5 g oat β-glucan, respectively) at energy level 700 kJ, one beverage containing 10 g oat DF/1,400 kJ and one beverage containing 10 g enzymatically treated oat DF with low viscosity at energy level 700 kJ. Each beverage portion weighted 300 g. The order of the samples was randomised for each subject and evaluated during six separate days. The results are reported in three sets of samples: ‘fibre’, ‘energy’ and ‘viscosity’.

Results

In the fibre set, the beverages containing 5 or 10 g of fibre had a larger area under curve (AUC) for perceived satiety and smaller AUC for hunger compared to the beverage without fibre, but no significant dose–response relationship was detected. Increasing the energy content from 700 to 1,400 kJ in the energy set did not affect the satiety-related perceptions. In the viscosity set, the beverage with low-viscosity β-glucan increased satiety-related perceptions from no fibre containing beverage, but less compared to the beverage with the same amount of fibre and higher viscosity.

Conclusions

Addition of an oat ingredient rich in β-glucan and high viscosity of beverages enhance post-meal satiety induced by beverages. The effect was, however, not related to the amount of ingested fibre or energy.

Snacking increased among U.S. adults between 1977 and 2006

This study built on limited knowledge about patterns and trends of adult snacking in the US. We selected adults aged 19 y and older (n = 44,754) between 1977-1978 and 2003-2006 with results weighted and adjusted for sample design effects. Differences testing, by a Student's t test, used STATA 10 (P < or = 0.01). We defined a snacking event as intake of foods over a 15-min period and excluded food defined as snacks but eaten at a meal. Dietary data were obtained from the first 2 d for the 1977-1978 Nationwide Food Consumption Survey (NFCS 77) and the 1989-1991 Continuing Survey of Food Intake by Individuals (CSFII 89); and 2-d dietary data from the 1994-1996 CSFII (CSFII 96) and the NHANES from 2 consecutive surveys: NHANES 2003-2004 and NHANES 2005-2006 (NHANES 03-06). Results showed that snacking prevalence increased significantly from 71 to 97% in 2003-2006 with increases in both the 1989-1994 and the 1994-2006 periods. In all adults, snacking occasions increased 0.97 events over this time period (P < 0.01) and the contribution of snacks to total energy intake increased from 18 to 24% (P < 0.01). The energy density of snacks (food plus beverages) also increased progressively over the time period studied. Important changes in snacking food sources were found among desserts, salty snacks, candies, and sweetened beverages. More research is needed to gain a better understanding of the implications for overall energy intake and energy imbalance.

Dietary energy density as a marker of dietary quality in Swedish children and adolescents: the European Youth Heart Study

OBJECTIVE

To investigate if dietary energy density is associated with measures of dietary quality (food group, micronutrient and macronutrient intakes) in children and adolescents.

SUBJECTS/METHODS

In all, 551 children (mean age 9.6 years, 52% girls) and 569 adolescents (15.5 years, 55% girls), sampled from schools in Sweden, completed a single 24-h dietary recall. Dietary energy density (kJ/g) was calculated as the energy from all food consumed divided by the weight of all food consumed. Beverages were excluded from the calculation. Food and micronutrient intakes were adjusted for energy intake. A one-way analysis of variance (ANOVA) was used to test for differences in food group and nutrient intakes across age- and gender-specific tertiles of energy density. Discriminant analysis was used to confirm the groupings formed by tertiles.

RESULTS

Subjects with low-energy-density diets were significantly more likely to consume fruits, vegetables, pasta, rice, potatoes and cereals and less likely to consume sweetened drinks, sweets and chocolate. After energy adjustment, their intakes of many foods recommended in the Swedish food-based dietary guidelines were higher and intakes of nutrient-poor foods were lower. The macronutrient energy profile (% energy) of low-energy-density diets was closest to the recommended level. Low-energy-density diets contained greater amounts of most micronutrients. Discriminant analysis confirmed the existence of heterogeneous dietary patterns and the likelihood of correct classification by energy density in 65% of cases.

CONCLUSIONS

Lower dietary energy density is associated with better dietary quality in children and adolescents. Energy density has advantages over other whole diet analysis methods and may be suitable as a simple proxy of diet quality.

The modernization of cooking techniques in two rural Mayan communities of Yucatán: the case of lard frying

The objective of this article is to provide information on cooking techniques used by two rural communities of Yucatán. We used a 24-hour recall method with 275 participants consuming 763 dishes. Dishes were classified according to cooking technique: 205 were lard-fried (27%), 169 oil-fried (22%), and 389 boiled/grilled (51%). The smaller more secluded community (San Rafael) consumed more fried dishes than the larger community (Uci) (54% versus 45%) and used more lard-frying than Uci (65% versus 46%). The more extensive use of lard in the smaller community appears to be due to fewer modernizing influences such as the availability and use of industrialized vegetable oils.

Lower-energy-density diets are associated with higher monetary costs per kilocalorie and are consumed by women of higher socioeconomic status

OBJECTIVE

Diets of lower energy density are associated with higher diet quality, lower body weights, and better health outcomes. This study examined associations among dietary energy density, energy-adjusted diet costs, and socioeconomic indicators of study participants.

DESIGN

In this cross-sectional study, energy and nutrient intakes for 164 men and women aged 25 to 65 years were obtained using a food frequency instrument between June 2005 and September 2006. Dietary energy density (kcal/g) was calculated with and without beverages. Energy-adjusted diet costs ($/2,000 kcal) were calculated using food prices in Seattle, WA. Tertile splits of energy density and energy cost were analyzed using tests for linear trend. Linear regression models tested the association between education, income, and dietary variables, adjusting for age and sex.

RESULTS

Diets of lower energy density were associated with higher absolute nutrient intakes. Diets of lower energy density were also associated with higher energy-adjusted diet costs. Conversely, highest energy density diets were associated with lower intakes of micronutrients and fiber and lower costs. Education and household income showed a negative association with dietary energy density in regression models. Education and household incomes showed a positive association with the energy-adjusted cost of the diet. Education was a stronger predictor of both energy density and energy cost than was household income.

CONCLUSIONS

Higher-quality diets were not only more costly per kilocalorie but were also consumed by persons of higher educational level. The influence of diet quality on health, observed in some epidemiologic studies, might be modulated by unobserved indexes of socioeconomic status.

Dietary energy density predicts women's weight change over 6 y

BACKGROUND

Dietary energy density (ED) is positively associated with energy intake, but little is known about long-term effects on weight change.

OBJECTIVE

We assessed whether dietary ED predicts weight change over 6 y among a sample of non-Hispanic, white women.

DESIGN

Participants were part of a 6-y longitudinal study (n = 186), assessed at baseline and biennially. ED (in kcal/g) was calculated from the energy content of all foods (excluding beverages) with the use of three 24-h recalls. Height and weight were measured in triplicate to calculate body mass index (BMI; in kg/m(2)). Repeated measures (PROC MIXED) were used to examine the influence of ED on weight change, before and after adjusting for initial weight status. Food choices were examined among subjects consuming low-, medium-, and high-ED diets at study entry.

RESULTS

ED did not change across time for a subject. ED was positively associated with weight gain and higher BMI over time; this association did not vary by BMI classification. Food group data showed that, compared with women consuming higher-ED diets, women consuming lower-ED diets reported significantly lower total energy intakes and consumed fewer servings of baked desserts, refined grains, and fried vegetables and more servings of vegetables, fruit, and cereal. Women consuming lower-ED diets ate more meals at the table and fewer meals in front of the television.

CONCLUSIONS

Findings indicate that consumption of a lower-ED diet moderates weight gain, which may promote weight maintenance. Consuming lower ED diets can be achieved by consuming more servings of fruit and vegetables and limiting intake of high-fat foods.

Minimal effect on energy intake by additional evening meal for frail elderly service flat residents--a pilot study

BACKGROUND

Nutritional problems are common in frail elderly individuals receiving municipal care.

OBJECTIVE

To evaluate if an additional evening meal could improve total daily food intake, nutritional status, and health-related quality of life (HRQOL) in frail elderly service flat (SF) residents.

DESIGN

Out of 122 residents in two SF complexes, 60 subjects agreed to participate, of which 49 subjects (median 84 (79-90) years, (25th-75th percentile)) completed the study. For six months 23 residents in one SF complex were served 530 kcal in addition to their regular meals, i.e. intervention group (I-group). Twenty-six residents in the other SF building were controls (C-group). Nutritional status, energy and nutrient intake, length of night time fast, cognitive function and HRQOL was assessed before and after the intervention.

RESULTS

At the start, the Mini Nutritional Assessment classified 27% as malnourished and 63% as at risk for malnutrition, with no difference between the groups. After six months the median body weight was unchanged in the I-group, +0.6 (-1.7-+1.6) kg (p=0.72) and the C-group -0.6 (-2.0-+0.5) kg (p=0.15). Weight change ranged from -13% to +15%. The evening meal improved the protein and carbohydrate intake (p<0.01) but the energy intake increased by only 180 kcal/day (p=0.15). The night time fast decreased in the I-group from 15.0 (13.0-16.0) to 13.0 (12.0-14.0) hours (p<0.05). There was no significant difference in cognitive function or HRQOL between the groups.

CONCLUSION

Nine out of ten frail elderly SF residents had nutritional problems. Serving an additional evening meal increased the protein and carbohydrate intake, but the meal had no significant effect on energy intake, body weight or HRQOL. The variation in outcome within each study group was large.

Does social class predict diet quality?

A large body of epidemiologic data show that diet quality follows a socioeconomic gradient. Whereas higher-quality diets are associated with greater affluence, energy-dense diets that are nutrient-poor are preferentially consumed by persons of lower socioeconomic status (SES) and of more limited economic means. As this review demonstrates, whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher SES. In contrast, the consumption of refined grains and added fats has been associated with lower SES. Although micronutrient intake and, hence, diet quality are affected by SES, little evidence indicates that SES affects either total energy intakes or the macronutrient composition of the diet. The observed associations between SES variables and diet-quality measures can be explained by a variety of potentially causal mechanisms. The disparity in energy costs ($/MJ) between energy-dense and nutrient-dense foods is one such mechanism; easy physical access to low-cost energy-dense foods is another. If higher SES is a causal determinant of diet quality, then the reported associations between diet quality and better health, found in so many epidemiologic studies, may have been confounded by unobserved indexes of social class. Conversely, if limited economic resources are causally linked to low-quality diets, some current strategies for health promotion, based on recommending high-cost foods to low-income people, may prove to be wholly ineffective. Exploring the possible causal relations between SES and diet quality is the purpose of this review.

The rising cost of low-energy-density foods

BACKGROUND

Consuming lower-energy-density foods is one recommended strategy for management of body weight. This cross-sectional study used retail food prices to test the hypothesis that low-energy-density foods are not only more costly per kilocalorie, but have increased disproportionately in price as compared to high-energy-density foods.

DESIGN

For a list of 372 foods and beverages belonging to a food frequency questionnaire database, retail prices were obtained from major supermarket chains in the Seattle, WA, metropolitan area in 2004 and 2006. Energy density of all items was calculated and prices were expressed as $/100 g edible portion and as $/1,000 kcal. Foods were stratified by quintiles of energy density and the differences in energy cost and in percent price change were tested using analyses of variance.

RESULTS

High-energy-density foods provided the most dietary energy at least cost. Energy cost of foods in the bottom quintile of energy density, beverages excluded, was $18.16/1,000 kcal as compared to only $1.76/1,000 kcal for foods in the top quintile. The 2-year price change for the least energy-dense foods was +19.5%, whereas the price change for the most energy-dense foods was -1.8%.

CONCLUSION

The finding that energy-dense foods are not only the least expensive, but also most resistant to inflation, may help explain why the highest rates of obesity continue to be observed among groups of limited economic means. The sharp price increase for the low-energy-density foods suggests that economic factors may pose a barrier to the adoption of more healthful diets and so limit the impact of dietary guidance.

Deconstructing the vanilla milkshake: the dominant effect of sucrose on self-administration of nutrient-flavor mixtures

Rats and humans avidly consume flavored foods that contain sucrose and fat, presumably due to their rewarding qualities. In this study, we hypothesized that the complex mixture of corn oil, sucrose, and flavor is more reinforcing than any of these components alone. We observed a concentration-dependent increase in reinforcers of sucrose solutions received (0%, 3%, 6.25%, and 12.5%) in both fixed ratio and progressive ratio procedures, but with equicaloric corn oil solutions (0%, 1.4%, 2.8%, and 5.6%) this finding was replicated only in the fixed ratio procedure. Likewise, addition of 1.4% oil to 3% or 12.5% sucrose increased fixed ratio, but not progressive ratio, reinforcers received relative to those of sucrose alone. Finally, addition of 3% vanilla flavoring did not change self-administration of 3% sucrose or 3% sucrose+1.4% oil solutions. These data suggest that, calorie-for-calorie, sucrose is the dominant reinforcing component of novel foods that contain a mixture of fat, sucrose, and flavor.

The impact of a long-term reduction in dietary energy density on body weight within a randomized diet trial

We examined the effect of dietary energy density change on body weight in participants of a randomized trial. Intervention participants markedly increased fruit and vegetable intake while reducing energy intake from fat. Participants were 2,718 breast cancer survivors, aged 26-74 yr, with baseline mean body mass index of 27.3 kg/m(2) (SD = 6.3). We assessed dietary intake by sets of four 24-h dietary recalls and validated with plasma carotenoid concentrations. Weight and height were measured at baseline, 1 yr, and 4 yr. Dietary energy density was calculated using food but excluding beverages. Intervention participants significantly reduced dietary energy density compared to controls and maintained it over 4 yr -- both in cross-sectional (P < 0.0001) and longitudinal (Group x Time interaction, P < 0.0001) analyses. Total energy intake or physical activity did not vary between groups. The intervention group had a small but significant weight loss at 1 yr (Group x Time interaction, P < 0.0001), but no between-group weight difference was observed at 4 yr. Our study showed that reducing dietary energy density did not result in a reduction in total energy intake and suggests that this strategy alone is not sufficient to promote long-term weight loss in a free-living population.

Low-energy-density diets are associated with higher diet quality and higher diet costs in French adults

Low-energy-density diets are often recommended for weight control. Such diets have a higher nutrient content than do high-energy-density diets. This study tested the hypothesis that energy-dense diets have a relatively low monetary cost, whereas less energy-dense diets are more expensive. In this cross-sectional study, dietary intakes of 1,474 French adults (672 men, 802 women), aged 15 to 92 years, were assessed using 7-day diet records. Dietary energy density (kcal/g) was calculated by dividing total dietary energy by the edible weight of foods and caloric beverages consumed. Diet cost ($/7 days or $/2,000 kcal) was estimated using mean national food prices for 895 foods. The relationship between dietary energy density and diet cost was examined in a linear regression model. Within each quintile of energy intakes, the more energy-dense diets were associated with lower diet quality and with lower diet costs (r(2)=0.38 to 0.44). In a regression model, the more energy-dense diets cost less, whereas low-energy-density diets cost substantially more, adjusting for energy intakes, sex, and age. The finding that energy-dense diets cost less per 2,000 kcal may help explain why the highest rates of obesity are observed among groups of limited economic means. The finding that low-energy-density diets are associated with higher diet costs suggests that lasting improvements in diet quality may require economic as well as behavioral interventions.

Intense sweeteners, energy intake and the control of body weight

Replacing sugar with low-calorie sweeteners is a common strategy for facilitating weight control. By providing sweet taste without calories, intense sweeteners help lower energy density of beverages and some foods. Reduced dietary energy density should result in lower energy intakes--but are the energy reduction goals, in fact, achieved? The uncoupling of sweetness and energy, afforded by intense sweeteners, has been the focus of numerous studies over the past two decades. There are recurring arguments that intense sweeteners increase appetite for sweet foods, promote overeating, and may even lead to weight gain. Does reducing energy density of sweet beverages and foods have a measurable impact on appetite and energy intakes, as examined both in short-term studies and over a longer period? Can reductions in dietary energy density achieved with intense sweeteners really affect body weight control? This paper reviews evidence from laboratory, clinical and epidemiological studies in the context of current research on energy density, satiety and the control of food intake.

Energy-dense diets are associated with lower diet costs: a community study of French adults

Objective:

High consumption of energy-dense foods has been linked to high energy intakes and excess weight gain. This study tested the hypothesis that high energy density of the total diet is associated with lower diet costs.

Design:

Dietary intakes of 837 French adults, aged 18–76 years, were assessed using a dietary history method. Dietary energy density (MJ kg−1) was calculated by dividing total energy by the edible weight of foods consumed. Daily diet cost (€day−1) was estimated using mean national food prices for 57 food items. The relationship between dietary energy density and diet cost at each level of energy intake was examined in a regression model, adjusted for gender and age.

Results:

The more energy-dense refined grains, sweets and fats provided energy at a lower cost than did lean meats, vegetables and fruit. Within each quintile of energy intake, diets of lower energy density (MJ kg−1) were associated with higher diet costs (€day−1).

Conclusion:

In this observational study, energy-dense diets cost less whereas energy-dilute diets cost more, adjusting for energy intakes. The finding that energy-dilute diets are associated with higher diet costs has implications for dietary guidelines and current strategies for dietary change.

Higher satiety ratings following yogurt consumption relative to fruit drink or dairy fruit drink

OBJECTIVES

To compare the satiating power of semisolid and liquid yogurts with fruit beverages and dairy fruit drinks.

DESIGN AND PROCEDURES

Thirty-two volunteers (16 men and 16 women), ages 18 to 35 years, consumed a 200-kcal preload stimulus on four separate occasions. A tray lunch was presented 90 minutes after the preload and food consumption was measured.

METHODS

The stimuli were: a semisolid yogurt containing pieces of peach and eaten with a spoon (378 g), the same yogurt in a drinkable homogenized form (378 g), a peach-flavored dairy beverage (400 mL), and a peach juice beverage (400 mL). Participants rated hunger, thirst, satiety, and desire to eat at baseline and at 20-minute intervals after ingestion.

RESULTS

The two yogurts (semisolid and liquid) led to lower hunger and higher fullness ratings as compared with the fruit drink or dairy fruit drink. There was no difference in satiety profiles between the yogurt that was eaten with a spoon and the drinkable version. Energy intakes at lunch were the same across all four conditions (mean+/-standard deviation, 806+/-43 kcal).

CONCLUSIONS

The two yogurts were more satiating than the two beverages. However, lower hunger and higher fullness ratings after yogurt consumption did not lead to energy compensation at the next meal.

High monetary costs of dietary patterns associated with lower body mass index: a population-based study

INTRODUCTION

Food choice is strongly influenced through economic constraints. The monetary costs for foods, especially those foods associated with a lower risk of obesity, have considerably increased during the last years. The purpose of this study was to determine the cost differences between low and high adherence to two dietary patterns which have been inversely associated with body mass index (BMI) and obesity.

METHODS

The subjects were Spanish men (n=1547) and women (n=1615) aged 25-74 years who were examined in 1999-2000, in a population-based cross-sectional survey in the northeast of Spain (Girona). Dietary intake was assessed using a food frequency questionnaire. Two dietary quality indices, namely the Mediterranean Diet Score (MDS) and the Healthy Eating Index (HEI), were created. Average food prices were calculated. Anthropometric variables were measured.

RESULTS

Adjusted linear regression analysis revealed that an increase in 1 Euro (1.25$) of monetary diet costs per day was associated with a change of 0.46 units (P<0.001) and 2.03 units (P<0.001) in the MDS and HEI, respectively. The magnitude of the association was similar for both scores after standardization. Subjects who closely adhered to the MDS and HEI paid daily 1.2 Euro (1.50$) (P<0.001) and 1.4 Euro (1.75$) (P<0.001) more for food consumption, respectively, than those who weakly adhered to these dietary patterns. Multiple linear regression analysis adjusted for several confounders showed an inverse association of the MDS (P=0.011) and the HEI (P<0.001) with BMI. The risk of obesity (BMI> or =30) significantly decreased across quartile distribution of MDS (P=0.004) and HEI (P=0.001).

CONCLUSION

Data showed that a high adherence to the MDS and HEI, both inversely associated with BMI and obesity, led to higher monetary costs as compared to a low adherence. This might be of importance for public health policies in an effort to develop strategies to promote healthy diets preventing weight gain.

A new proposed guidance system for beverage consumption in the United States

The Beverage Guidance Panel was assembled to provide guidance on the relative health and nutritional benefits and risks of various beverage categories. The beverage panel was initiated by the first author. The Panel's purpose is to attempt to systematically review the literature on beverages and health and provide guidance to the consumer. An additional purpose of the Panel is to develop a deeper dialog among the scientific community on overall beverage consumption patterns in the United States and on the great potential to change this pattern as a way to improve health. Over the past several decades, levels of overweight and obesity have increased across all population groups in the United States. Concurrently, an increased daily intake of 150-300 kcal (for different age-sex groups) has occurred, with approximately 50% of the increased calories coming from the consumption of calorically sweetened beverages. The panel ranked beverages from the lowest to the highest value based on caloric and nutrient contents and related health benefits and risks. Drinking water was ranked as the preferred beverage to fulfill daily water needs and was followed in decreasing value by tea and coffee, low-fat (1.5% or 1%) and skim (nonfat) milk and soy beverages, noncalorically sweetened beverages, beverages with some nutritional benefits (fruit and vegetable juices, whole milk, alcohol, and sports drinks), and calorically sweetened, nutrient-poor beverages. The Panel recommends that the consumption of beverages with no or few calories should take precedence over the consumption of beverages with more calories.

Dietary recommendations for children and adolescents: a guide for practitioners

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of children's cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.