PACE: a Novel Eating Behavior Phenotype to Assess Risk for Obesity in Middle Childhood.

BACKGROUND: Behavioral phenotypes that predict future weight gain are needed to identify children susceptible to obesity. OBJECTIVES: This prospective study developed an eating behavior risk score to predict change in adiposity over 1 y in children. METHODS: Data from 6 baseline visits (Time 1, T1) and a 1-y follow-up visit (Time 2, T2) were collected from 76, 7- to 8-y-old healthy children recruited from Central Pennsylvania. At T1, children had body mass index (BMI) percentiles <90 and were classified with either high (n = 33; maternal BMI ≥30 kg/m2) or low (n = 43; maternal BMI ≤25 kg/m2) familial risk for obesity. Appetitive traits and eating behaviors were assessed at T1. Adiposity was measured at T1 and T2 using dual-energy x-ray absorptiometry, with a main outcome of fat mass index (FMI; total body fat mass divided by height in meters squared). Hierarchical linear regressions determined which eating measures improved prediction of T2 FMI after adjustment for covariates in the baseline model (T1 FMI, sex, income, familial risk, and Tanner stage). RESULTS: Four eating measures-Portion susceptibility, Appetitive traits, loss of control eating, and eating rate-were combined into a standardized summary score called PACE. PACE improved the baseline model to predict 80% variance in T2 FMI. PACE was positively associated with the increase in FMI in children from T1 to T2, independent of familial risk (r = 0.58, P < 0.001). Although PACE was higher in girls than boys (P < 0.05), it did not differ by familial risk, income, or education. CONCLUSIONS: PACE represents a cumulative eating behavior risk score that predicts adiposity gain over 1 y in middle childhood. If PACE similarly predicts adiposity gain in a cohort with greater racial and socioeconomic diversity, it will inform the development of interventions to prevent obesity. This trial was registered at clinicaltrials.gov as NCT03341247.

Poorer inhibitory control was related to greater food intake across meals varying in portion size: A randomized crossover trial.

Individuals eat more food when larger portions are served, and this portion size effect could be influenced by inhibitory control (the ability to suppress an automatic response). Inhibitory control may also relate to obesogenic meal behaviors such as eating faster, taking larger bites, and frequent switching between meal components (such as bites of food and sips of water). In a randomized crossover design, 44 adults ate lunch four times in the laboratory. Lunch consisted of a pasta dish that was varied in portion size (400, 500, 600, or 700 g) along with 700 g of water. Meals were video-recorded to assess meal duration and bite and sip counts, which were used to determine mean eating rate (g/min), mean bite size (g/bite), and number of switches between bites and sips. Participants completed a food-specific stop-signal task, which was used to calculate Stop-Signal Reaction Time (SSRT). Across participants, SSRT values ranged from 143 to 306 msec, where greater SSRT indicates poorer inhibitory control. As expected, serving larger portions increased meal intake (p < 0.0001); compared to the smallest portion, intake of the largest increased by 121 ± 17 g (mean ± SEM). SSRT did not moderate the portion size effect (p = 0.34), but individuals with poorer inhibitory control ate more across all meals: 24 ± 11 g for each one SD unit increase in SSRT (p = 0.035). SSRT was not related to eating rate or bite size (both p > 0.13), but poorer inhibitory control predicted greater switching between bites and sips, such that 1.5 ± 0.7 more switches were made during meals for each one SD unit increase in SSRT (p = 0.03). These findings indicate that inhibitory control can contribute to overconsumption across meals varying in portion size, potentially in part by promoting switching behavior.

Does 'portion size' matter? Brain responses to food and non-food cues presented in varying amounts.

Larger portions of food elicit greater intake than smaller portions of food, particularly when foods are high in energy density (kcal/g; ED). The neural mechanisms underlying this effect remain unclear. The present study used fMRI to assess brain activation to food (higher-ED, lower-ED) and non-food (office supplies) images presented in larger and smaller (i.e., age-appropriate) amounts in 61, 7-8-year-olds (29 male, 32 female) without obesity. Larger amounts of food increased activation in bilateral visual and right parahippocampal areas compared to smaller amounts; greater activation to food amount (larger > smaller) in this cluster was associated with smaller increases in food intake as portions increased. Activation to amount (larger > smaller) was stronger for food than office supplies in primary and secondary visual areas, but, for office supplies only, extended into bilateral parahippocampus, inferior parietal cortex, and additional visual areas (e.g., V7). Activation was greater for higher-vs. lower-ED food images in ventromedial prefrontal cortex for both larger and smaller amounts of food; however, this activation extended into left lateral orbital frontal cortex for smaller amounts only. Activation to food cues did not differ by familial risk for obesity. These results highlight potentially distinct neural pathways for encoding food energy content and quantity.

Food Properties and Individual Characteristics Influence Children's Intake Across Multiple Days of Weighed Assessments in Childcare Programs.

BACKGROUND: Because children often consume substantial proportions of their diets in childcare programs, it is critical to determine what they eat when served menus meeting dietary recommendations and how intake is related to individual characteristics. OBJECTIVES: Using weighed assessments, we characterized children's consumption across 15 daily menus and investigated the relationship between properties of the food consumed and child characteristics. METHODS: In 3 crossover trials in childcare centers that followed dietary guidelines, we provided and weighed all meals and snacks for 5 consecutive days. For this descriptive secondary analysis, we characterized primary outcomes (daily food weight, energy density, and energy intake) by including the most typical set of menus from each trial, yielding 603 daily intakes for 128 preschool children (15% with overweight or obesity). Physical activity was measured by accelerometry during childcare sessions. Children's appetitive traits were assessed by parental questionnaires. RESULTS: Both food properties and child characteristics were related to daily intake. More food was consumed from menus with greater food weight, and the energy density of consumed food was greater from menus with higher energy density (both P < 0.0001); these menu differences resulted in greater energy intake (P = 0.009). Children with overweight and obesity had greater energy intake as a proportion of requirements than did children with healthy weight (113 ± 6% versus 101 ± 2%; P = 0.039). Vegetable intake was 39 ± 2% of the recommended amounts and boys had lower consumption than girls (P = 0.004). Children with appetitive traits of lower satiety responsiveness or higher food responsiveness had greater daily energy intake (both P < 0.003). CONCLUSIONS: Weighed intakes showed that when children were served daily menus with substantial portions of foods that met dietary recommendations, they selectively consumed higher-energy-dense items and ate few vegetables. A particular concern was that children with overweight ate amounts that exceeded their energy needs. The trials were registered at clinicaltrials.gov (NCT02963987, NCT03010501, NCT03242863).

The impact of between-session habituation, within-session habituation, and weight gain on response to food exposure for adolescents with eating disorders.

OBJECTIVE: Exposure therapy is a promising treatment for eating disorders (EDs). However, questions remain about the effectiveness of exposure to feared foods during the weight restoration phase of treatment, and the importance of between-session and within-session habituation. METHOD: We recruited 54 adolescents from a partial hospitalization program (PHP) for EDs which included daily food exposure. Throughout treatment, participants provided subjective units of distress (SUDS) ratings before and after eating a feared food, and completed measures of ED symptomatology. RESULTS: Multilevel models found that pre-exposure SUDS decreased over time, providing some evidence that between-session habituation occurred. In contrast, the difference between pre-exposure and post-exposure SUDS did not decrease over time, indicating that within-session habituation did not occur. Weight gain predicted greater between-session habituation to feared foods, but did not predict within-session habituation. Between-session habituation, but not within-session habituation, predicted favorable treatment outcomes, including weight gain and improvements on the Children's Eating Attitudes Test and Fear of Food Measure. DISCUSSION: Partial hospitalization programs that include daily exposure to feared foods may be effective at decreasing anxiety about foods for adolescents with EDs who are experiencing weight restoration. Further research is warranted to replicate our findings challenging the importance of within-session habituation, and to better understand between-session habituation and inhibitory learning as mechanisms of change when conducting food exposure for EDs. PUBLIC SIGNIFICANCE: This study provides some evidence that PHPs that include food exposure may be useful for adolescents with EDs who are experiencing weight restoration. Between-session habituation, but not within-session habituation, predicted favorable treatment outcomes. Further research is needed to determine whether clinicians can disregard within-session habituation when conducting food exposure for EDs, and understand the importance of between-session habituation as a potential mechanism of food exposure.

Designing a childhood obesity preventive intervention using the multiphase optimization strategy: The Healthy Bodies Project.

BACKGROUND/AIMS: Preventing the development of childhood obesity requires multilevel, multicomponent, comprehensive approaches. Study designs often do not allow for systematic evaluation of the efficacy of individual intervention components before the intervention is fully tested. As such, childhood obesity prevention programs may contain a mix of effective and ineffective components. This article describes the design and rationale of a childhood obesity preventive intervention developed using the multiphase optimization strategy, an engineering-inspired framework for optimizing behavioral interventions. Using a series of randomized experiments, the objective of the study was to systematically test, select, and refine candidate components to build an optimized childhood obesity preventive intervention to be evaluated in a subsequent randomized controlled trial. METHODS: A 24 full factorial design was used to test the individual and combined effects of four candidate intervention components intended to reduce the risk for childhood obesity. These components were designed with a focus on (a) improving children's healthy eating behaviors and nutrition knowledge, (b) increasing physical activity and reducing sedentary activity in the childcare setting, (c) improving children's behavioral self-regulation, and (d) providing parental web-based education to address child target outcomes. The components were tested with approximately 1400 preschool children, ages 3-5 years in center-based childcare programs in Pennsylvania, the majority of which served predominantly Head-Start eligible households. Primary child outcomes included healthy eating knowledge, physical and sedentary activity, and behavioral self-regulation. Secondary outcomes included children's body mass index and appetitive traits related to appetite regulation. RESULTS: Four intervention components were developed, including three classroom curricula designed to increase preschool children's nutrition knowledge, physical activity, and behavioral, emotional, and eating regulation. A web-based parent education component included 18 lessons designed to improve parenting practices and home environments that would bolster the effects of the classroom curricula. A plan for analyzing the specific contribution of each component to a larger intervention was developed and is described. The efficacy of the four components can be evaluated to determine the extent to which they, individually and in combination, produce detectable changes in childhood obesity risk factors. The resulting optimized intervention should later be evaluated in a randomized controlled trial, which may provide new information on promising targets for obesity prevention in young children. CONCLUSION: This research project highlights the ways in which an innovative approach to the design and initial evaluation of preventive interventions may increase the likelihood of long-term success. The lessons from this research project have implications for childhood obesity research as well as other preventive interventions that include multiple components, each targeting unique contributors to a multifaceted problem.

Switching between bites of food and sips of water is related to food intake across meals varying in portion size.

Individuals eat more when served more food, but little is known about how this portion size effect is moderated by meal-related characteristics, particularly the inclusion of water served as a beverage. Patterns of eating and drinking as well as consumption of water could affect satiation by modifying exposure to the sensory qualities of food. In a crossover design, 44 adults ate lunch in the laboratory once a week for 4 weeks and intake was measured. The meal was a pasta dish that was varied in portion size (400, 500, 600, or 700 g) plus 700 g of water. Meals were video-recorded to count bites and sips and the number of switches between them. Sensory-specific satiety (SSS) was evaluated as the relative decline in hedonic ratings of the pasta after consumption. Serving larger portions led to a curvilinear increase in food intake (p < 0.0001). Neither switching between bites and sips nor water intake moderated the portion size effect. Independent of portion served, across all meals switching more frequently was related to greater food consumption (5.7 ± 1.8 g more food consumed for each additional switch, p = 0.004). Greater water intake was also related to greater food intake across portions (1.1 ± 0.5 g more food consumed for each additional 10 g of water, p = 0.025), but this effect was not significant after accounting for switching (p = 0.38). The magnitude of SSS was unaffected by switching, suggesting that switching allowed greater food intake for a given hedonic decline. At a meal with a single food, intake was greater when larger portions were served and also when there was more switching between bites and sips. Switching between food and water may promote energy intake by attenuating the development of SSS.

The effects of snack foods of different energy density on self-served portions and consumption in preschool children.

It is recommended that preschoolers serve themselves their own food portions; however, it is unclear what factors influence the amount they select for consumption, and particularly how their selected portions are influenced by food properties such as energy density, volume, and weight. We offered preschool children snacks differing in energy density (ED) and investigated the effects on the amounts they served and then consumed. In a crossover design, 52 children aged 4-6 y (46% girls; 21% overweight) ate an afternoon snack on 2 days in their childcare classrooms. Before each snack time, children served the amount they would like to eat of 4 snacks presented in equal volumes but differing in ED (higher-ED: pretzels, cookies; lower-ED: strawberries, carrots). Across the 2 sessions, children were given their self-served amount of either pretzels (3.9 kcal/g) or strawberries (0.3 kcal/g) and intake was measured. Later, children tasted all 4 snacks and rated liking. Results showed that the portions children served themselves were influenced by their liking ratings (p = 0.0006), but after accounting for liking, the volumes they served were similar for all 4 foods (p = 0.27). At snack time, children ate a greater proportion of self-served strawberries (92 ± 4%) than pretzels (73 ± 4%; p = 0.0003), but because of the ED difference they consumed 55 ± 4 kcal more from pretzels than strawberries (p < 0.0001). The difference in snack intake by volume was not attributable to liking ratings (p = 0.87). That children served a consistent volume of similarly-liked snacks suggests that their portions were affected more by visual cues than by weight or energy content. Despite eating a greater volume of lower-ED strawberries, children consumed more energy from the higher-ED pretzels, highlighting the contribution of energy density to children's energy intake.

Variety and portion size combine to increase food intake at single-course and multi-course meals.

Increases in food variety and portion size independently promote intake. Little is known about how these effects combine or how they depend on meal structure. In two randomized crossover experiments, once a week for four weeks, women ate a lunch meal that was varied in two properties: variety (low: three bowls of the favorite dish vs. high: three bowls, each with a different main dish) and portion size (small: 450 g vs. large: 600 g). In Experiment 1 (n = 42), dishes were served simultaneously and in Experiment 2 (n = 49), dishes were served sequentially over three courses. At each meal, the primary outcome of food intake was measured; additionally, we measured sensory-specific satiety (SSS; the relative hedonic decline of a food as it is eaten). In Experiment 1 (simultaneous structure) variety and portion size did not interact (p = 0.72) but both independently increased intake; participants consumed 15 ± 7 g more at meals with high variety compared to low and 57 ± 7 g more from large portions compared to small (both p < 0.03). Similarly, in Experiment 2 (sequential structure) variety and portion size did not interact (p = 0.99) but participants consumed 30 ± 8 g more at high-variety meals and 51 ± 8 g more from large portions (both p < 0.001). SSS was not influenced by portion size in either experiment (both p > 0.16) or by variety in Experiment 1 (p = 0.58), but SSS was smaller at high-variety meals in Experiment 2 (p = 0.001). Thus, variety and large portions promoted greater food intake for a similar or smaller hedonic decline, indicating these effects were facilitated by delayed SSS. At meals with either a simultaneous or sequential structure, high variety and large portions combined to increase intake, suggesting that these common properties act together to promote overconsumption.

Eating rate and bite size were related to food intake across meals varying in portion size: A randomized crossover trial in adults.

Serving larger portions leads to increased food intake, but behavioral factors that influence the magnitude of this portion size effect have not been well characterized. We investigated whether measures of eating microstructure such as eating rate and bite size moderated the portion size effect. We also explored how sensory-specific satiety (SSS; the relative hedonic decline of a food as it is eaten) was affected by eating microstructure and larger portions. In a randomized crossover design, 44 adults aged 18-68 y (66% women; 46% with overweight and obesity) ate lunch in the laboratory once a week for 4 weeks. The meal consisted of pasta that was varied in portion size (400, 500, 600, or 700 g) and 700 g of water. Meals were video-recorded to assess bite count and meal duration, which were used to calculate mean eating rate (g/min) and mean bite size (g/bite). At each meal participants also completed an assessment of SSS. The results showed that as larger portions were served, meal intake increased in a curvilinear manner (p < 0.0001). Measures of eating microstructure did not moderate the portion size effect but were related to intake across all portions; faster eating rate, larger bite size, higher bite count, and longer meal duration were associated with greater consumption at all meals (all p < 0.0001). SSS was not influenced by any measure of eating microstructure or by portion size (all p > 0.10). In summary, the portion size effect was not moderated by eating microstructure, but relatively faster eating rates and larger bite sizes at meals, along with large portions, combined to increase food intake.

Children with lower ratings of executive functions have a greater response to the portion size effect.

Deficits in executive functions (EFs), a set of cognitive processes related to self-regulation, are associated with the development of obesity. Prior studies from our group showed that lower food-cue related activation in brain regions implicated in self-regulation was related to a larger portion size effect. We tested the hypothesis that lower EFs in children would be positively related to the portion size effect. Healthy weight children aged 7-8 y (n = 88), who varied by maternal obesity status, participated in a prospective study. At baseline, the parent primarily in charge of feeding completed the Behavior Rating Inventory of Executive Function (BRIEF2) to assess child EFs, including Behavioral (BRI), Emotional (ERI), and Cognitive (CRI) indices. At 4 baseline sessions, children consumed meals in which the portion sizes of foods (pasta, chicken nuggets, broccoli, and grapes) varied by visit (total meal weight of 769, 1011, 1256, or 1492g). Intake increased with increasing portions in a linear trajectory (p < 0.001). EFs moderated the portion size effect such that lower BRI (p = 0.003) and ERI (p = 0.006) were associated with steeper increases in intake as portions increased. As amount of food increased, children in the lowest functioning tertiles for BRI and ERI increased intake by 35% and 36%, respectively, compared to children in the higher tertiles. Increases in intake among children with lower EFs were for higher- but not lower-energy-dense foods. Thus, in healthy weight children who varied by obesity risk, lower parentally reported EFs were associated with a larger portion size effect, and these results were independent of child and parent weight status. Therefore, EFs may be target behaviors that could be strengthened to help children moderate excess intake in response to large portions of energy-dense foods.

Portion size affects food selection in an immersive virtual reality buffet and is related to measured intake in laboratory meals varying in portion size.

A crucial step for validating the utility of an immersive virtual reality (iVR) buffet to study eating behavior is to determine whether variations in food characteristics such as portion size (PS) are relevant predictors of food selection in an iVR buffet. We tested whether manipulating PS in an iVR buffet affects the weight of food selected, and whether this response to PS is similar to participants' measured intake when PS varies at laboratory meals. In a randomized crossover design, 91 adults (18-71 y; 64 females; BMI = 25.3 ± 5.7) used their iVR remote to select lunch and dinner portions from an iVR buffet before consuming a standardized lab meal at two visits separated by one week. The PS in the iVR buffet and lab meals varied between a standard PS and a large PS. This design enabled comparisons of PS effects between iVR and lab settings, despite the scale difference in food weight between the environments. Portion size significantly affected food selection and food intake (p < 0.001). Subjects selected an additional 350 g in iVR and consumed an additional 154 g of food in the lab meals when offered the large portion compared to the small portion. The effect of PS showed a similar percentage increase in iVR (36.5%) and lab meals (39.2%). There was no significant difference in the effect of PS between iVR and lab meals after accounting for scale differences in food weight between the environments. The response to PS was not influenced by subject characteristics such as body mass index, sex, or age. These results demonstrate the utility of iVR for replicating real-world eating behaviors and enhancing our understanding of the intricate dynamics of food-related behaviors in a variety of contexts.

Children's Portion Selection Is Predicted by Food Liking and Is Related to Intake in Response to Increased Portions.

BACKGROUND: When children choose amounts of food to eat, it is unclear what influences the portions they select and whether their selections are related to the amounts they consume. OBJECTIVES: Using a computer survey, we investigated the effect of food liking on portion selection in middle childhood and examined how children's selections were related to measured intake at meals in which portions of all foods were varied across 4 test days. METHODS: Fifty-one children aged 7-10 y completed a computer survey of 20 common foods with a range of energy density. For each food, the survey presented sliding scales with 5 images varying in portion size and children indicated their liking and the amount they would eat at a specified meal or snack. On 4 test days in a randomized crossover design, children were served a meal of 6 foods from the survey with portions of 100%, 133%, 167%, or 200% of baseline amounts. Data were analyzed using random coefficients models. RESULTS: Across the 20 foods used in the survey, portion selection ratings were predicted by food liking ratings (P < 0.0001). After accounting for liking, portion selection ratings did not vary by food energy density (P = 0.50). At the meals, intake of all 6 foods increased when larger portions were served (P = 0.002). Furthermore, the selected portion of a food on the survey was positively related both to intake of that food at the 100%-portion meal (P = 0.014) and to increased intake as larger portions were served (P < 0.0001). CONCLUSIONS: Children aged 7-10 y were able to use a computer survey to choose food portions that predicted their measured intake in response to increased portions. The relation of liking to selection and intake indicates that to promote children's consumption of larger portions of low-energy-dense foods such as fruits and vegetables, these foods must be well liked by the children. This trial was registered at clinicaltrials.gov as NCT02759523.

Child meal microstructure and eating behaviors: A systematic review.

Observational coding of children's eating behaviors and meal microstructure (e.g., bites, chews) provides an opportunity to assess complex eating styles that may relate to individual differences in energy intake and weight status. Across studies, however, similar terms are often defined differently, which complicates the interpretation and replication of coding protocols. Therefore, this study aimed to compile methods of coding meal microstructure in children. To limit bias and ensure a comprehensive review, a systematic search was conducted in January 2021 across three databases (PubMed, PsychInfo, Web of Science) resulting in 46 studies that coded at least one meal-related behavior in healthy children (i.e., no medical/psychological disorders) who were able to self-feed (i.e., no spoon-, breast-, or bottle-feeding). While the majority of studies had good interrater reliability, the details reported about study foods and the clarity of the definitions used for behavioral coding varied considerably. In addition to reported microstructure behaviors, a non-exhaustive review of individual differences was included. While few studies reported individual differences related to age and sex, there was a larger literature related to weight status that provided evidence for an 'obesogenic' style of eating characterized by larger Bites, faster Eating and Bite Rates, and shorter Meal Durations. However, some studies may not have been optimally designed or powered to detect individual differences because they did not set out a priori to examine them. Based on this systematic review, best practices for the field are recommended and include reporting more details about foods served and coded eating behaviors to improve reproducibility. These suggestions will improve the ability to examine patterns of individual differences across studies, which may help identify novel targets for intervention.

Do children really eat what they like? Relationships between liking and intake across laboratory test-meals.

Liking plays a primary role in determining what and how much children eat. Despite this, the relationship between liking and intake of foods and beverages served as part of a meal is not often reported, even though pediatric feeding studies frequently collect such data. In addition, few studies have reported on the test-retest reliability of both hedonic ratings and laboratory intake among children. To address these gaps, this study was designed to assess the relationship between children's liking of items at a meal and subsequent intake. 61, 4-6 year-olds were recruited to participate in two identical laboratory sessions where liking of 7 foods (i.e., chicken nuggets, ketchup, potato chips, grapes, broccoli, cherry tomatoes, cookie) and 2 beverages (i.e., fruit punch, milk) was assessed (5-point hedonic scale) prior to ad libitum consumption of the same items at a meal. Spearman's correlations tested the relationship between liking and intake and intra-class correlations assessed inter-session reliability of both measures. Liking for potato chips (p < 0.01), grapes (p < 0.05), cherry tomatoes (p < 0.001), and fruit punch (p < 0.001) was positively associated with amount consumed, but no associations were found between liking and intake of other meal items. For the majority of meal items, test-retest reliability of liking and intake were significant (ranging from 0.34 for cookies to 0.93 for tomatoes). At a multi-component meal, children's hedonic ratings were both reliable and modestly predictive of subsequent intake, and the relationships were stronger for lower energy, less well-liked foods. Rather than eating what they like, these data are more consistent with the notion that children do not eat what they dislike.

Influence of exclusive breastfeeding on hippocampal structure, satiety responsiveness, and weight status.

Longer exclusive breastfeeding duration has been associated with differences in neural development, better satiety responsiveness, and decreased risk for childhood obesity. Given hippocampus sensitivity to diet and potential role in the integration of satiety signals, hippocampus may play a role in these relationships. We conducted a secondary analysis of 149, 7-11-year-olds (73 males) who participated in one of five studies that assessed neural responses to food cues. Hippocampal grey matter volume was extracted from structural scans using CAT12, weight status was assessed using age- and sex-adjusted body mass index (%BMIp85 ), and parents reported exclusive breastfeeding duration and satiety responsiveness (Children's Eating Behaviour Questionnaire). Separate path models for left and right hippocampus tested: (1) the direct effect of exclusive breastfeeding on satiety responsiveness and its indirect effect through hippocampal grey matter volume; (2) the direct effect of hippocampal grey matter volume on %BMIp85 and its indirect effect through satiety responsiveness. %BMIp85 was adjusted for maternal education, yearly income, and premature birth while hippocampal grey matter volume was adjusted for total intercranial volume, age, and study from which data were extracted. Longer exclusive breastfeeding duration was associated with greater bilateral hippocampal grey matter volumes. In addition, better satiety responsiveness and greater left hippocampal grey matter volume were both associated with lower %BMIp85 . However, hippocampal grey matter volumes were not associated with satiety responsiveness. Although no relationship was found between breastfeeding and child weight status, these results highlight the potential impact of exclusive breastfeeding duration on the hippocampal structure.

Preschoolers will drink their GREENS! Children accept, like, and drink novel smoothies containing dark green vegetables (DGVs).

Dark green vegetables (DGVs; e.g., spinach) are a nutrient rich source of essential vitamins and minerals; yet, children's intakes of DGVs fall well below dietary recommendations and creative solutions are needed. This study describes preschoolers (3-5 y) willingness to taste, liking, and intake of fruit-based smoothies containing DGVs (i.e., spinach, collards, kale), commonly referred to as "green smoothies," and explores individual differences in children's eating responses. Using a between-subjects design, preschoolers were randomized to either a FRUIT ONLY smoothie condition (n = 36) or FRUIT+DGV smoothie condition (n = 32). Children's acceptance and intake were collected in one tasting session and one ad libitum snack session, respectively. Parents reported on child food pickiness, food responsiveness, and approach, and children's intake of fruits and DGVs. Children self-reported on previous experience with the study fruits and DGVs. The initial tasting session revealed that the majority of children (84.3%) in the FRUIT+DGV condition willingly tasted all five green smoothies and rated the green smoothies as moderately liked (2.3 ± 0.1). Children in the FRUIT+DGV condition consumed 225.7 ± 31.4 g (9.0 ± 1.3 oz; 1.1 ± 0.2 cups; 91.9 ± 12.9 kcals) of their most preferred green smoothie, providing 18.3 ± 3.7 g (or 0.7 ± 0.1 cups) of DGVs. Children's willingness to try, liking, and intake did not differ by smoothie condition. Individual differences in children's intake are reported. In conclusion, children were willing to try fruit smoothies supplemented with DGVs. Children rated the green smoothies as moderately-liked and children's intake during snack met 31% of their weekly USDA recommendations for DGVs. Adding DGVs to fruit-based smoothies may compliment other effective feeding strategies for increasing children's vegetable consumption.

Promoting vegetable intake in preschool children: Independent and combined effects of portion size and flavor enhancement.

This study investigated the independent and combined effects on preschool children's vegetable intake of serving a larger portion of vegetables and enhancing their flavor. In a crossover design, lunch was served in childcare centers once a week for four weeks to 67 children aged 3-5 y (26 boys, 41 girls). The meal consisted of two familiar vegetables (broccoli and corn) served with fish sticks, rice, ketchup, applesauce, and milk. Across the four meals, we varied the portion of vegetables (60 or 120 g total weight, served as equal weights of broccoli and corn) and served them either plain or enhanced (6.6% light butter and 0.5% salt by weight). All meals were consumed ad libitum and were weighed to determine intake. Doubling the portion of vegetables led to greater consumption of both broccoli and corn (both p < 0.0001) and increased meal vegetable intake by 68% (mean ± SEM 21 ± 3 g). Enhancing vegetables with butter and salt, however, did not influence their intake (p = 0.13), nor did flavor enhancement modify the effect of portion size on intake (p = 0.10). Intake of other meal components did not change when the vegetable portion was doubled (p = 0.57); thus, for the entire meal, the increase in vegetable consumption led to a 5% increase in energy intake (13 ± 5 kcal; p = 0.02). Ratings indicated that children had similar liking for the plain and enhanced versions of each vegetable (both p > 0.31). All versions of vegetables were well-liked, as indicated by ≥ 76% of the children rating them as "yummy" or "just okay". Serving a larger portion of vegetables at a meal was an effective strategy to promote vegetable intake in children, but when well-liked vegetables were served, adding butter and salt was not necessary to increase consumption.

Development and validation of the Reasons Individuals Stop Eating Questionnaire (RISE-Q): A novel tool to characterize satiation.

A variety of factors can influence satiation, and individual differences in reasons for meal termination may help to explain variability in food intake and susceptibility to overconsumption. We developed and validated a questionnaire to characterize the Reasons Individuals Stop Eating (RISE-Q). The initial RISE-Q was created by reviewing the published literature and identifying 47 reasons why individuals might stop eating. The RISE-Q asks respondents to rate how often each reason influences why they stop eating at a typical dinner meal by using a seven-point scale. Adults (N = 477, 77% women) from a participant database completed a survey online that included the initial RISE-Q and the satiation-related Satiety Responsiveness and Food Responsiveness scales of the Adult Eating Behavior Questionnaire (AEBQ). Self-reported height and weight were collected to calculate body mass index (BMI). The survey also assessed self-reported typical meal size. After factor analysis, the RISE-Q retained 31 items and identified five distinct scales of reasons for stopping eating: Decreased Food Appeal (mean ± SD: 2.6 ± 0.05, Cronbach's α = 0.89), Physical Satisfaction (5.0 ± 0.04, α = 0.85), Planned Amount (4.4 ± 0.05, α = 0.82), Self-Consciousness (2.4 ± 0.05, α = 0.88), and Decreased Priority of Eating (2.3 ± 0.04, α = 0.69). Thus, the most frequently reported reasons for meal termination were related to Physical Satisfaction and Planned Amount. Each RISE-Q scale was significantly correlated with at least one of the satiation-related AEBQ scales, suggesting that the RISE-Q has construct validity. RISE-Q scales were also correlated with BMI and measures of typical meal size. The RISE-Q provides a novel tool to assess differences across individuals in reported reasons for eating cessation. The RISE-Q can aid in further understanding risk factors for overconsumption and has potential clinical utility in the design of targeted weight-management interventions.

Using association rules mining to characterize loss of control eating in childhood.

Childhood loss of control (LOC)-eating, the perceived inability to stop or control eating, is associated with increased risk for binge-eating disorder and obesity. However, the correlates of LOC-eating in childhood remain unclear. A secondary analysis of 177, 7-12-year-old children from five laboratory feeding studies was performed to investigate potential family (e.g., frequency of meals together, feeding practices), parental (e.g., education, weight status), and child (e.g., weight status, appetite traits) correlates of LOC-eating. Association rules mining (ARM1), a data-driven approach, was used to examine all characteristics that were common across studies to identify which were associated with LOC-eating. Results showed LOC-eating was characterized by a combination of child appetitive behaviors and parental feeding practices. In particular, LOC-eating was associated with low parental pressure to eat in combination with a high propensity to want to eat all the time and frequent refusal or dislike of novel foods. This pattern of both food approach (i.e., wanting to eat all the time) and avoidant behaviors (i.e., food fussiness) highlights the need for more research to characterize the complex patterns of appetitive traits associated with LOC-eating. In contrast, the absence of LOC-eating was associated with a low propensity to want to eat all the time, greater family income, and infrequent emotional overeating. Therefore, propensity to want to eat all the time, a single question from the Children's Eating Behavior Questionnaire, characterized both the presence and absence of LOC-eating, highlighting the need for more research to determine if this question captures clinically relevant individual differences. Future studies addressing these questions will advance our understanding of pediatric LOC-eating and may lead to interventions to reduce risk for more severe eating disorder symptomology.