Learning about the energy density of liquid and semi-solid foods.

BACKGROUND: People learn about a food's satiating capacity by exposure and consequently adjust their energy intake. OBJECTIVE: To investigate the effect of energy density and texture on subsequent energy intake adjustments during repeated consumption. DESIGN: In a randomized crossover design, participants (n=27, age: 21±2.4 years, body mass index: 22.2±1.6 kg m(-2)) repeatedly consumed highly novel foods that were either low-energy-dense (LE: 30 kcal per 100 g) or high-energy-dense (HE: 130 kcal per 100 g), and either liquid or semi-solid, resulting in four product conditions. In each condition, a fixed portion of test food was consumed nine times as an obligatory part of breakfast, lunch and dinner on 3 consecutive days. All meals continued with an ad libitum buffet; food items for evening consumption were provided and the intake (kcal per day) was measured. RESULTS: Buffet intake depended on energy density and day of consumption of the test foods (day*energy interaction: P=0.02); daily buffet intake increased from day 1 (1745±577 kcal) to day 3 (1979±567 kcal) in the LE conditions; intake did not change in the HE conditions (day 1: 1523±429 kcal, day 3: 1589±424 kcal). Food texture did not affect the intake (P=0.56). CONCLUSIONS: Intake did depend on energy density of the test foods; participants increased their buffet intake over days in response to learning about the satiating capacity of the LE foods, but did not change buffet intake over days when repeatedly consuming a HE food as part of their meal. The adjustments in intake were made irrespective of the food texture.

Repeated consumption of a large volume of liquid and semi-solid foods increases ad libitum intake, but does not change expected satiety.

Food intake and a food's expected satiating effect initially rely on sensory attributes. People will learn about the food's satiating capacity by exposure. We investigated whether repeated consumption changed the expected satiety effects and intake of iso-energetic liquid and semi-solid foods. In a randomised cross-over study, participants (n=53; age: 21±2.9 y; BMI: 21.8±2.0 kg/m²) consumed one of two iso-energetic dairy foods (liquid or semi-solid) for breakfast in each 5-day test condition. Expectations regarding satiety were measured on days 1, 2, and 5. Foods were offered ad libitum on days 1 and 5 and in a fixed volume on days 2-4. Appetite sensations were rated up to 180 min after the start of the session on fixed time points. Expected satiety effects of the semi-solid food were higher than of the liquid food on all days (p<0.0001). Ad libitum intake of the liquid food was higher than of the semi-solid food on day 1 (liquid: 391±177 g, semi-solid: 277±98 g; p<0.0001) and day 5 (liquid: 477±161 g, semi-solid: 375±148 g; p<0.0001). On day 2, hunger was rated lower and fullness rated higher after the semi-solid compared with the liquid food; on day 4, no differences were observed (significant product∗ exposure interaction AUC). Changes in hunger and fullness indicated that the fixed volumes of liquid and solid food were perceived to be equally satiating after repeated consumption, but this did not result in the anticipated changes: expected satiety effects remained lower, and ad libitum intake higher for the liquid compared with the semi-solid food. The effect of texture on a food's expected satiety effects and its ad libitum intake appears to be large, also after repeated consumption. Expectations based on sensory cues are not easily changed.

Child-care use and the association with body mass index and overweight in children from 7 months to 2 years of age.

OBJECTIVES: Studies regarding the association of child-care use with body mass index (BMI), overweight or obesity development show contradictory results. This study examined the relationship between child-care use and BMI z-scores and overweight, as well as associates of child-care use in children up to 2 years old. METHODS: Longitudinal data originated from the Dutch KOALA Birth Cohort Study. Questionnaires assessed child-care use at ages 7 months and 1 and 2 years (N=2396). Height and weight assessed at 1 and 2 years were used to calculate BMI z-scores. Overweight was defined as a BMI z-score of ≥85th percentile. The influence of child-care use on weight development was tested using backward linear and logistic regression analyses. Outcomes were: (1) BMI z-score at 1 and 2 years; (2) change in BMI z-score between 1 and 2 years; (3) overweight vs non-overweight at 1 and 2 years; and (4) change from normal weight to overweight vs remaining normal weight between 1 and 2 years. The association between child-care use and parental background characteristics was tested using backward logistic regression analyses. RESULTS: Child-care use (no/yes) at 1 and 2 years positively predicted BMI z-scores at age 2 years, as well as change in BMI z-score between 1 and 2 years. These associations were adjusted for various covariates (for example, parental working hours). Furthermore, child-care use significantly increased the odds of being overweight at age 1 year. There were few differences in BMI or overweight between intensive (>16 h per week) and limited child-care use (≤16 h). Child-care use was positively associated with various parental characteristics, including parental working hours and maternal educational level. CONCLUSION: The findings suggest a small influence of child-care use on weight development in very young children. The child-care setting could have an important role in preventive interventions against overweight and obesity development in young children.

Child-care environment and dietary intake of 2- and 3-year-old children.

BACKGROUND: Previous research has shown that children in child-care do not comply with dietary intake recommendations (i.e. either exceeding or not meeting recommendations), which may be attributable to specific features of the child-care environment. The present study explored the relationship between the social and physical child-care (day-care) environment and dietary intake of 2- and 3-year-olds in Dutch child-care centres. METHODS: The dietary intake of 135 children, aged 2 and 3 years, who were in child-care was assessed by observing randomly selected children at three meals (morning snack, lunch and afternoon snack) to determine dietary intake (i.e. saturated fat, dietary fibre and energy intake). The environment was observed using the Environment and Policy Assessment and Observation checklist, a structured instrument assessing the physical and social environment. RESULTS: Children consumed a mean of 486 kJ (116 kcal) during the morning snack, 2043 kJ (488 kcal) during lunch and 708 kJ (169 kcal) during the afternoon snack. There were some gender and age differences in dietary intake. Several environmental factors (e.g. serving style and staff's model dietary behaviour) were significantly associated with the children's dietary intake. CONCLUSIONS: Overall, energy intake was in the upper range of recommended intake for children in child-care. The associations of several environmental factors with dietary intake stress the importance of the child-care environment for children's dietary behaviour. Intervening in this setting could possibly contribute to the comprehensive prevention of childhood obesity.

Long-term effect of nutritional counseling: a study in family medicine.

This paper reports research using data in the Nijmegen Family Practice Monitoring Project. One part of the research is follow-up, after 17 y, of a 1977 trial of dietary advice for patients with hypertension or a family history of premature cardiovascular disease. In the intervention group, 840 patients were given health education every 2 mo by trained practice nurses for 1 y. There were 497 patients with similar coronary risk factors in the control group, who received usual care. One year after the intervention a significant decrease was found (and published) in serum cholesterol concentrations and blood pressure in the intervention group. By the time of the 1995 reexaminations, however, there were no differences in coronary risk factors between the two groups. Blood pressures had come down, more so in the control group, and the percentage of smokers had decreased equally in both groups. There were no significant differences in intake of dietary fat or in type of fat. The lack of difference was still found when the groups were divided into those with serum cholesterol concentrations > and < 6.5 mmol/L. A second part of the research was to investigate in 1995 the relation between patients' stage of change of fat intake and their dietary intake. It was found that those in stage 5 (sustaining desired changes in behavior) had the lowest saturated fat intake. Since 1977 both groups have been treated equally if hypertension was diagnosed. The two groups were not managed differently with regard to dietary advice after 1977.

Nutrition knowledge and attitudes towards high-fat foods and low-fat alternatives in three generations of women.

OBJECTIVES: To assess family resemblance in food habits in three generations of maternally related family members. DESIGN AND SUBJECTS: Ninety-seven adult women, their mothers and grandmothers were asked about nutrition knowledge, attitudes and fat intake. Nutrition knowledge and attitudes were determined by means of a self-administered questionnaire. A food frequency questionnaire was used to assess fat intake. RESULTS: Mean percentage energy derived from fat was 39% for the younger generation, and 40% for their mothers and grandmothers. Generations differed in their nutrition knowledge score (P <0.0001), the grandmothers having a lower nutrition knowledge than the other generations. Correlations of nutrition knowledge scores were 0.30 (95% confidence limits (c.l.) 0.10 and 0.48) between the younger and middle generations, 0.35 (95% c.l. 0.16 and 0.52) between the middle and older generations, and 0.14 (95% c.l. -0.06 and 0.34) between the younger generation and their grandmothers. For attitudes towards high-fat foods and their low-fat alternatives these figures were 0.27 (95% c.l. 0.07 and 0.45), 0.22 (95% c.l. 0.01 and 0.41), and 0.17 (95% c.l. - 0.03 and 0.36), respectively, while for energy percentage of fat intake the correlations were only 0.19 (95% c.l. -0.01 and 0.37), -0.02 (95% c.l. -0.22 and 0.18), and 0.12 (95% c.l. limits - 0.08 and 0.31), respectively. Within generations the correlations between attitudes and nutrition knowledge or percentage energy derived from fat were found to be higher in the middle generation than in other generations. No statistically significant correlations were found between nutrition knowledge and percentage energy derived from fat. CONCLUSIONS: From this study it can be concluded that mothers and their adult daughters resemble each other in nutrition knowledge and attitudes.

Family resemblance in fat intake in The Netherlands.

OBJECTIVES: To assess family resemblance in fat intake in a representative sample of Dutch families. DESIGN AND SUBJECTS: Households (n = 1077) with children between 1 and 30 y old were selected from the data set of the Dutch National Food Consumption Survey 1992. Two-day diet records were available for all household members. RESULTS: Pearson correlation coefficients for fat and fatty acid intakes (En%) ranged from r = 0.51 to r = 0.61 between parents, and from r = 0.52 to r = 0.72 between siblings. The mean associations in fat and fatty acid intake (En%) between mothers or fathers and children ranged from r = 0.37 to r = 0.50, and they were surprisingly similar for children from 1-3 y of age up to children above 21 y of age. Associations were consistently high for foods eaten at home, and weak for foods eaten outside of the home. Similar within-family associations were found in a set of 1052 households of the Dutch National Food Consumption Survey of 1987. Reported adherence to a therapeutic diet by one of the parents did not erase within-family intake correlations, suggesting that family resemblance is a dynamic phenomenon. CONCLUSION: Dutch parents and children living together resemble each other in short term intake of fats and fatty acids. SPONSORSHIP: This study was supported by the Ministry of Agriculture, Nature Management and Fisheries. DESCRIPTORS: Fat intake; dietary intake; social environment; family resemblance.

[Dentures and food selection. A survey in elderly women]. / Gebitsprothese en voedselkeuze. Een onderzoek bij oudere vrouwen.

Having complete dentures can have a negative influence on dietary intake and dietary composition, which can lead to an unhealthy situation, particularly for the elderly. In order to get more information on this subject, 86 women between 54 and 74 years old, who were treated at an university clinic, completed questionnaires about their chewing of and preference for various foodstuffs. From the results of this study the dietary intake of dietary fibres, protein and iron appeared to be lower in women with complete dentures. After correction for the total intake of energy these differences disappeared. The former group also indicated that they had more difficulties chewing bread, tough and soft meat, raw vegetables, apples and snacks. No differences were found concerning preference.

Maternal smoking during pregnancy and childhood overweight and fat distribution: the KOALA Birth Cohort Study.

UNLABELLED: What is already known about this subject There is an association between maternal smoking during pregnancy and higher body mass index (BMI) and overweight in childhood. What this study adds The association between maternal smoking during pregnancy and childhood overweight develops with age, starting with a lower birth weight, followed by weight catch-up in the first year after birth, finally leading to overweight at school age. Children of mothers who had smoked during pregnancy had a higher risk of exceeding the 85th percentile of BMI, waist circumference and total skinfold thickness at school age. BACKGROUND: Maternal smoking during pregnancy is associated with childhood overweight, but the association with fat distribution is not clear. OBJECTIVE: To explore the longitudinal association between smoking during pregnancy and childhood overweight and fat distribution. METHODS: In the KOALA Birth Cohort Study, repeated questionnaires were administered to 2698 mother-child pairs, including questions on smoking at 14 and 34 weeks of pregnancy. Main outcomes were birth weight, weight gain in the first year, body mass index (BMI) z-scores and overweight (BMI ≥85th percentile) at 1, 2, 4-5 and 6-7 years (n = 1730) and waist circumference and four skinfold thicknesses measured at home visits at age 6-7 years in a subgroup (n = 418). We used multivariable linear and logistic regression, with generalized estimating equations (GEE) for repeated measurements. RESULTS: Maternal smoking was associated with lower birth weight, higher weight gain in the first year and increasing overweight after infancy (change with age P = 0.02 in the GEE). Maternal smoking vs. non-smoking during pregnancy was associated with a higher risk of the child exceeding the 85th percentile of BMI (adjusted odds ratio [aOR] 3.72; 95% CI 1.33-10.4), waist circumference (aOR 2.65; 95% CI 1.06-6.59) and sum of skinfold thicknesses (aOR 4.45; 95% CI 1.63-12.2) at the age of 6-7 years. CONCLUSIONS: Maternal smoking during pregnancy is associated with lower birth weight, weight catch-up and development of overweight into childhood.

Effect of viscosity on learned satiation.

A higher viscosity of a food leads to a longer orosensory stimulation. This may facilitate the learned association between sensory signals and metabolic consequences. In the current study we investigated the effect of viscosity on learned satiation. In two intervention groups a low viscosity (LV) yogurt (n=24) and a high viscosity (HV) yogurt (n=22) was offered ad libitum for breakfast. In a learning period of 4 weeks, subjects consumed ad libitum a novel flavoured high energy density (HED) yogurt (150 kcal/100 g) or low energy density (LED) yogurt (50 kcal/100 g), with 10 exposures to each yogurt on alternate days. Over the repeated exposures, an interaction effect of exposure timeenergyviscosity on intake was seen (F(1,771)=4.12; p=0.04). In the HV intervention group a borderline significant interaction between exposure and energy density was observed (F(1,369)=3.61; p=0.06); after 10 exposures, the LED yogurt resulted in a 46+/-16 g higher intake compared with the HED yogurt. In the LV group, no significant interaction between exposure and energy density was seen (F(1,401)=1.04; p=0.31); after 10 exposures intake difference between the LED and HED yogurts was only 1.5+/-15 g. These results suggest that a higher viscosity facilitates learned satiation.

Eating behaviour and adherence to diet in patients with Type 2 diabetes mellitus.

AIM: To assess restrained, emotional and external eating behaviour in patients newly diagnosed with Type 2 diabetes compared with the general population, and to assess the relationship of eating behaviour to changes in fat and energy. METHODS: We assessed emotional, external, and restrained eating behaviour and measured fat and energy intake in a cohort of patients with newly diagnosed Type 2 diabetes. Data from a comparable sample of the general population served as reference figures. We calculated correlation coefficients of the three different types of eating behaviour at diagnosis between: (i) energy and fat intake at diagnosis and (ii) changes in energy and fat intake between diagnosis and both 8 weeks and 4 years later. In addition, we used a stepwise multiple regression model with energy and fat intake or changes in energy and fat intake as dependent variables. RESULTS: The distribution of the three types of eating behaviour was similar in patients with Type 2 diabetes and the general population. Emotional and external eating was associated with increased intake of energy and fat. Conversely, restrained eating showed an inverse correlation with energy and fat intake. External eating, but not emotional eating, showed a statistically significant relation with a decrease in energy intake in women. We found no statistically significant correlations between eating behaviour (measured at diagnosis) and changes in energy and fat intake between diagnosis and 4 years. CONCLUSIONS: Patients newly diagnosed with Type 2 diabetes have similar eating behaviour compared with the general population. At diagnosis, external eating behaviour and emotional eating behaviour are associated with high-energy intake and restrained eating behaviour with low-energy intake. Women with high scores for emotional eating behaviour seem to be less able to make initial dietary changes after being diagnosed and having received dietary advice.

Beliefs about the satiating effect of bread with spread varying in macronutrient content.

Beliefs about the satiating effect of foods varying in contents of proteins, fats, carbohydrates, and fibre were investigated by face-to-face interviews with a random telephone sample of 101 subjects. Respondents were presented with photographs of two slices of bread covered with common spreads. Fibre level was manipulated by using white bread or wholemeal bread. Levels of proteins, fats and carbohydrates were manipulated by using different kinds of spread. Low and high levels of proteins, fats and carbohydrates had similar energy contents. The results showed that protein-rich spreads (lean meat products) and high-fibre (wholemeal) bread were believed to have a strong satiating effect. The satiating effect of high-fat spreads (butter, bacon) was believed to be much smaller, whereas the sweet carbohydrate spreads (jam, honey) were believed to have no satiating effect.

Attitudes towards high-fat foods and their low-fat alternatives: reliability and relationship with fat intake.

Score on a scale of attitude towards the consumption of five high-fat foods and their low-fat alternatives was correlated with the energy percentage of fat in the diet across 419 subjects. Attitudes towards low-fat alternatives were more positive than towards high-fat foods. Mean energy percentage of fat in the diet was 38.8% (SD 7.1). The attitude scale explained 25% of the variance in percentage energy as fat. Test-retest reliability of the attitude scale (n = 25) was 0.92 (95% confidence limits 0.82 and 0.97). The reproducibility of energy percentage fat in the diet (n = 33) was 0.64 (95% confidence limits 0.38 and 0.81). Differences in attitude score were found between men and women, subjects following a dietary treatment and those who did not, and subjects with a fat intake according to the Dutch dietary guidelines and those who had not (p < 0.001). Fat intake (expressed as percentage of energy intake) differed between age groups (p < 0.05), and between subjects following a special diet and those who did not (p < 0.001). No difference in attitude score or energy percentage of fat was found for education level, occupation level, body mass index or household size. It is concluded that attitudes towards high-fat foods and their low-fat alternatives are useful in understanding fat intake.

Family resemblance in energy, fat, and cholesterol intake: a study among three generations of women.

BACKGROUND: Transfer of nutrition habits within the family may contribute to the establishment of a high-fat diet. Several studies show a significant correlation in nutrient intake between parents and children living in the same household. This study describes family resemblances in nutrient intake among adult women living apart. METHODS: Family resemblance in fat intake was assessed in three generations of adult women by means of a short food-frequency questionnaire. Data were collected on 291 maternally related family members (97 young adult women, their mothers, and their grandmothers). RESULTS: Weak correlations (0.13-0.27) were found between nutrient intake of the younger and middle generation. Correlations between the middle and older generation (-0.03-0.29) and between the younger and older generation (-0.03-0.33) tended to be lower. CONCLUSIONS: This study shows that family resemblance in nutrient intake is weak for adult women living apart. There seems to be more impact of middle-aged mother's eating habits on the fat intake of their adult daughters than of elderly women's eating habits on their middle-aged daughters.

Family resemblance in beliefs, attitudes and intentions towards consumption of 20 foods; a study among three generations of women.

Family resemblance in beliefs, attitudes and intentions towards the consumption of 20 foods that contribute to the fat intake was investigated in 97 adult women, their mothers and their grandmothers. Mean correlation for elements from the Fishbein and Ajzen theory of reasoned action between younger and middle generations ranged from 0.09 to 0.17 and between middle and older generations from 0.12 to 0.17. All significant correlations were positive. More statistically significant correlations were found for liking attitudes between the younger and middle generations (p < 0.05 for ten out of 20 correlations) than for other pairs. Between the older and younger generation the number of significant correlations could be due to chance alone. From the relative importance of liking and good/bad attitude on intention it appeared that liking contributed the most to the variance in intention scores. Health related beliefs and attitudes became of increasing importance in the older generations. From this study it can be concluded that mothers and their adult daughters resemble each other in beliefs, food preferences, attitudes and intentions, although resemblance is poor.