Dietary patterns in infancy are associated with child diet and weight outcomes at 6 years.

OBJECTIVE: To assess whether patterns of dietary exposures at 9 months are associated with child diet and weight at 6 years. METHODS: Data for this study were from the Infant Feeding Practices Study II and Year 6 Follow-Up Studies. All data were self-reported monthly. Results of a previous latent class analysis revealed five dietary patterns varying in milk and solid food intake. These five infant dietary patterns were used in the current study to predict child diet and weight outcomes at 6 years, while controlling for confounding variables. RESULTS: Infants with dietary patterns higher in fruit and vegetable intake at 9 months had higher fruit and vegetable intake at 6 years. Similarly, infants with the dietary pattern characterized by foods high in energy density (that is, French Fries and sweet desserts) continued to have higher consumption of these foods at 6 years, and had a higher prevalence of overweight at 6 years (43%) compared with the other classes. Formula-fed infants had higher sugar-sweetened beverage intake and fewer met the dietary guidelines for fruit and vegetable intake at 6 years than breastfed infants, controlling for factors such as income. CONCLUSIONS: Early decisions about milk-feeding, and the types of solid foods offered in infancy can foreshadow dietary patterns and obesity risk later in childhood. Infants who were offered energy-dense foods had higher intake of these foods at 6 years of age.

External influences on children's self-served portions at meals.

OBJECTIVE: Large portions promote intake among children, but little is known about the external influences of the eating environment on children's self-selected portion sizes. This research experimentally tested effects of the amount of entree available and serving spoon size on children's self-served entree portions and intakes at dinner meals. A secondary objective was to identify child and family predictors of self-served entree portion sizes. DESIGN: A 2 × 2 within-subjects design was used, in which the amount of a pasta entree available for self-serving (275 vs 550 g) and the serving spoon size (teaspoon vs tablespoon) were systematically varied. The serving bowl size and portion sizes of all other foods offered were held constant across conditions. Conditions were spaced 1 week apart and randomly assigned. Weighed self-served entree portions and food intakes as well as demographics, maternal feeding styles and child/maternal anthropometrics were measured. SUBJECTS: Participants were 60 ethnically diverse children aged 4-6 years and their mothers. RESULTS: Mixed models revealed that children served themselves 40% more entree when the amount available was doubled (P<0.0001) and 13% more when the serving spoon size was tripled (P<0.05). Serving spoon size and the amount of entree available indirectly influenced children's intake, with larger self-served portion sizes related to greater entree intakes (P<0.0001). Greater self-served portions and energy intakes at the meal were seen among those children whose mothers reported indulgent or authoritarian feeding styles (P<0.001). CONCLUSION: Children's self-served portion sizes at meals are influenced by size-related facets of the eating environment and reflect maternal feeding styles.

Parental influence on children's early eating environments and obesity risk: implications for prevention.

Most childhood obesity prevention efforts have focused on school-age children and adolescents and have had limited success. We argue that the first years of life, including the prenatal period, the postnatal suckling period and the transition to the modified adult diet, may provide opportunities for preventive interventions. These early periods are characterized by high plasticity and rapid transitions, and parents have a high degree of control over children's environments and experiences. Observational and experimental evidence reveal persistent effects of early environments on eating behavior and obesity risk, suggesting that interventions should be tested during these early periods. The central task parents have in early development points to their potential as key targets and agents of change in early preventive interventions. In this paper, we review evidence of early environmental effects on children's eating and obesity risk, highlighting ways that parental feeding practices and parents' own behaviors impact these outcomes and calling for further experimental research to elucidate whether these factors are indeed promising targets for childhood obesity preventive interventions.

Preventing childhood obesity: what works?

Rates of overweight in North American children and adolescents have increased dramatically since the 1970s. Childhood obesity has reached epidemic proportions and calls for prevention and treatment programs to reverse this trend have been made. However, the evidence base needed for effective action is still incomplete, especially for childhood obesity prevention programs. This paper focuses on primary prevention of childhood obesity and has three aims: (1) to briefly describe current primary prevention approaches for childhood obesity and the evidence for their impact; (2) to elucidate promising, but untested intervention strategies using an ecological framework and evidence from experimental and epidemiological research on factors influencing children's eating and weight status; and (3) to introduce a multiphase strategy for screening intervention components and building and evaluating potent interventions for childhood obesity. Most childhood obesity prevention programs have focused on school-aged children and have had little success. We suggest that, given these findings, prevention efforts should be expanded to explore other contexts in which children live as possible settings for intervention efforts, including the family and childcare settings. Given that 25% of preschool children are already overweight, intervening with children before school entry should be a priority. A review of experimental research on the developing controls of food intake in infancy and childhood suggests possible intervention strategies, focusing on parenting and aspects of the feeding environment. Epidemiological findings point to even earlier modifiable risk factors, including gestational weight gain, maternal prepregnancy weight, and formula feeding. However, the potential impact of altering these risk factors remains to be evaluated. In response to this problem, we suggest a new, multiphase method for accomplishing this, including screening intervention components, refining intervention designs and confirming component efficacy to build and evaluate potent, optimized interventions.

Alternatives to restrictive feeding practices to promote self-regulation in childhood: a developmental perspective.

Intake of energy-dense snack foods is high among US children. Although the use of restrictive feeding practices has been shown to be counterproductive, there is very limited evidence for effective alternatives to restriction that help children moderate their intake of these foods and that facilitate the development of self-regulation in childhood. The developmental literature on parenting and child outcomes may provide insights into alternatives to restrictive feeding practices. This review paper uses a model of parental control from the child development and parenting literatures to (i) operationally define restrictive feeding practices; (ii) summarize current evidence for antecedents and effects of parental restriction use on children's eating behaviours and weight status, and (iii) highlight alternative feeding practices that may facilitate the development of children's self-regulation and moderate children's intake of palatable snack foods. We also discuss recent empirical evidence highlighting the role of child temperament and food motivation related behaviours as factors that prompt parents to use restrictive feeding practices and, yet, may increase children's dysregulated intake of forbidden foods.

Behavioral science research in diabetes: lifestyle changes related to obesity, eating behavior, and physical activity.

Lifestyle factors related to obesity, eating behavior, and physical activity play a major role in the prevention and treatment of type 2 diabetes. In recent years, there has been progress in the development of behavioral strategies to modify these lifestyle behaviors. Further research, however, is clearly needed, because the rates of obesity in our country are escalating, and changing behavior for the long term has proven to be very difficult. This review article, which grew out of a National Institute of Diabetes and Digestive and Kidney Diseases conference on behavioral science research in diabetes, identifies four key topics related to obesity and physical activity that should be given high priority in future research efforts: 1) environmental factors related to obesity, eating, and physical activity; 2) adoption and maintenance of healthful eating, physical activity, and weight; 3) etiology of eating and physical activity; and 4) multiple behavior changes. This review article discusses the significance of each of these four topics, briefly reviews prior research in each area, identifies barriers to progress, and makes specific research recommendations.

Childhood overweight: a contextual model and recommendations for future research.

The prevalence of overweight among children has doubled within the past two decades. Increases in the rate of childhood overweight are of particular concern due to the negative health and psychological effects noted among overweight children. As shown by previous research, the development of childhood overweight involves a complex set of factors from multiple contexts that interact with each other to place a child at risk of overweight. This multifaceted system can be conceptualized using Ecological Systems Theory (EST). EST highlights the importance of considering the context(s), or ecological niche, in which a person is located in order to understand the emergence of a particular characteristic. In the case of a child, the ecological niche includes the family and the school, which are in turn embedded in larger social contexts including the community and society at large. In this review, EST is used as a framework with which to summarize research assessing predictors of childhood overweight. Specifically, child characteristics that place children at risk of the development of overweight (including dietary intake, physical activity, and sedentary behaviour) will be reviewed while taking into consideration the influence of the familial environment, the school environment, and the community and larger social environments. It is concluded that future research needs to adopt a broader contextual approach in order to understand and intervene against the processes leading to the development of overweight among children and that the use of theories or paradigms such as EST will facilitate developing and testing models of causal processes.

Mothers' child-feeding practices influence daughters' eating and weight.

BACKGROUND: Childhood overweight has increased dramatically, particularly among young girls. Genetic and environmental factors produce the overweight phenotype. Nonshared environments appear to account for a substantial proportion of the population variance in overweight but remain largely unspecified and unmeasured. OBJECTIVE: Our goal was to evaluate the influence of maternal control in feeding, an aspect of nonshared family environment, on daughters' eating and relative weight. DESIGN: Structural equation modeling was used to test models that describe maternal influences on daughters' eating and relative weight. The participants were 197 white, non-Hispanic families with 5-y-old daughters. The mothers' own dietary restraint and their perceptions of their daughters' risk of overweight were used to predict maternal control in feeding, which was used to predict the daughters' eating and weight outcomes. RESULTS: Maternal body mass index was a modest predictor of daughters' relative weight. The addition of the family-environment pathway provided a good fit and showed additional, independent prediction of daughters' relative weight. Mothers' dietary restraint and perceptions of their daughters' risk of overweight predicted maternal child-feeding practices, which in turn predicted daughters' eating and relative weight. CONCLUSIONS: Child-specific aspects of the family environment, including mothers' child-feeding practices and perceptions of their daughters' risk of overweight, may represent important, nonshared, environmental influences on daughters' eating and relative weight. The environmental effects noted were modest but comparable in magnitude to the direct association between maternal and child weight, which indicates that measuring family environmental factors can enhance our understanding of the etiology of childhood overweight.

Restricting access to palatable foods affects children's behavioral response, food selection, and intake.

BACKGROUND: Restricting children's access to palatable foods may appeal to parents as a straightforward means of promoting moderate intakes of foods high in fat and sugar; however, restricting access to palatable foods may have unintended effects on children's eating. The efficacy of restricting children's access to palatable foods as a means of promoting patterns of moderate intake of those foods is unknown. OBJECTIVE: Two experiments were conducted to test the hypothesis that restricting access to a palatable food enhances children's subsequent behavioral responses to, selection of, and intake of that restricted food. DESIGN: Both experiments used a within-subjects design to examine the effects of restricting access to a palatable food on children's subsequent behavior, food selection, and food intake. The first experiment examined the effects of restriction within and outside the restricted context and the second experiment focused on the effects within the restricted context. RESULTS: In both experiments, restricting access to a palatable food increased children's behavioral response to that food. Experiment 2 showed that restricting access increased children's subsequent selection and intake of that food within the restricted context. CONCLUSIONS: Restricting access focuses children's attention on restricted foods, while increasing their desire to obtain and consume those foods. Restricting children's access to palatable foods is not an effective means of promoting moderate intake of palatable foods and may encourage the intake of foods that should be limited in the diet.

Effects of a nonenergy fat substitute on children's energy and macronutrient intake.

To determine whether children adjusted their energy intake in response to covert manipulations in the proportion of energy from dietary fat, 24-h food intake of 29 2- to 5-y-old children was measured over four 2-d blocks. In this within-subject crossover design, in the first three meals of the first day of each block, children consumed foods containing dietary fat or a nonenergy fat substitute, which provided 10% of total daily energy intake. Children compensated for the missing energy; cumulative energy intake differed by only 100 kJ over 2 d. Substitution for dietary fat reduced the percent of energy from fat from 38.7% to 36.4%. Children's intake at individual meals was highly variable (mean CV 24.7%) relative to the variability of total daily energy intake (CV = 8.6%). To produce this pattern, children adjusted energy intake across successive meals. Use of a fat substitute at 10% of energy from dietary fat did not significantly reduce 24-h energy intake.

Like mother, like daughter: familial patterns of overweight are mediated by mothers' dietary disinhibition.

BACKGROUND: Obese parents are more likely to have obese children. Parents provide both the genes and eating environment for their children and familial patterns of adiposity are the result of gene-environment interactions. Environmental factors are implicated in the rapid increases in prevalence of childhood overweight that have occurred in the past 2 decades. Examination of aspects of the family environment may provide insight into increases in childhood overweight over time. OBJECTIVE: We examined parental characteristics associated with overweight and eating behaviors in preschool children. DESIGN: Seventy-five preschool children and their parents were recruited from local daycare centers. Information was obtained on parents' body mass indexes (BMIs), dietary restraint, and dietary disinhibition. A behavioral index of disinhibited eating in children was used to measure children's eating when given free access to palatable snack foods in the absence of hunger. Children's weight-for-height values were also calculated. RESULTS: Maternal dietary disinhibition (R2 = 0.35, P < 0.01) and maternal BMI (R2 = 0.19, P < 0.05) positively predicted daughters' overweight. Maternal disinhibition (R2 = 0.35, P < 0.05) mediated the relation between mothers' BMI and daughters' overweight when both maternal disinhibition and maternal BMI were used to predict daughters' overweight. Furthermore, when both mothers' disinhibition and daughters' free access intakes were used to predict daughters' overweight, mothers' disinhibition (P < 0.05) showed independent prediction. CONCLUSIONS: These findings suggest that familial influences on child overweight differ according to parent and child sex. Also, these results suggest that mothers' dietary disinhibition mediates familial similarities in degree of overweight for mothers and daughters.

Infant dietary experience and acceptance of solid foods.

OBJECTIVE: To examine the effects of dietary experience and milk feeding regimen on acceptance of their first vegetable by 4- to 6-month-old infants. DESIGN: Longitudinal study, of 26-days duration, observing infants aged 4 to 6 months at the start of the study. Random assignment to treatments, within-subject control. SETTING: General community in a medium-sized midwestern town. SUBJECTS: Thirty-six infants and their mothers. Subjects were solicited through birth records and advertisements in local newspapers. INTERVENTIONS: Infants were randomly assigned to be fed one vegetable on 10 occasions, either salted or unsalted peas or green beans, for a 10-day period. OUTCOME MEASURES: Infant intake of the vegetable consumed during the 10-day exposure period; intake of salted and unsalted versions: (1) before the 10-day exposure period, (2) immediately after the exposure period; and (3) after a 1-week period of delay. Intake of a control food was also measured before and after repeated consumption of the vegetable. Adult ratings of the infants' videotaped responses during test feedings were also obtained before and after the exposure period. RESULTS: After 10 opportunities to consume the vegetable, all infants significantly increased their intake (P < .001). Although they did not differ initially, infants fed breast milk showed greater increases in intake of the vegetable after exposure and had an overall greater level of intake than formula-fed infants. Adult ratings of the infants' nonverbal responses correlated positively with infant intake. CONCLUSIONS: Infants increase their acceptance (reflected both in changes in intake and in behavioral response) of a novel food after repeated dietary exposure to that food. Relative to formula-feeding, breast-feeding may facilitate the acceptance of solid foods.

Parents' and children's adiposity and eating style.

OBJECTIVE: To investigate children's ability to self-regulate energy intake and to determine whether individual differences in the precision of food intake regulation are related to children's anthropometric measures. We collected information pertaining to parental adiposity and dieting practices, as well as mothers' child-feeding practices. Of special interest was the degree of control imposed by mothers over their children's food intake. Our intent was to explore whether these variables might influence children's regulation of energy intake. SUBJECTS AND SETTING: Seventy-seven 3-5-year-old children who attended a university preschool setting and their parents participated in this experiment. MEASUREMENTS AND MAIN RESULTS: Children completed controlled, two-part meals used to estimate their ability to adjust food intake in response to changes in caloric density of the diet. An eating index, reflecting children's precision in the ability to regulate energy intake, was correlated to children's anthropometric measures. These correlations provided evidence for a relation between children's body fat stores and their responsiveness to caloric density cues: Pearson correlation coefficients revealed that children with greater body fat stores were less able to regulate energy intake accurately. The best predictor of children's ability to regulate energy intake was parental control in the feeding situation: mothers who were more controlling of their children's food intake had children who showed less ability to self-regulate energy intake (r = -.67, P < .0001). CONCLUSIONS: These findings suggest that the optimal environment for children's development of self-control of energy intake is that in which parents provide healthy food choices but allow children to assume control of how much they consume.

Help me make it through the night: behavioral entrainment of breast-fed infants' sleep patterns.

The study objective was to investigate whether exclusively breast-fed infants could be taught to sleep through the night (defined from 12:00 AM to 5:00 AM) during the first 8 weeks of life. The design was short-term longitudinal, from the last trimester of pregnancy until the eighth week after birth. Twenty-six first-time parents and their newborn were randomly assigned to treatment and control groups (13 in each group). Treatment parents were instructed to offer a "focal feed" (between 10 PM and 12 AM) to their infants every night, to gradually lengthen intervals between middle-of-the-night feeds by carrying out alternative caretaking behaviors (eg, reswaddling, diapering, walking), and to maximize environmental differences between day and nighttime. All parents kept 72-hour diaries of their infants' feeding and sleeping patterns every week from birth to 8 weeks of age and rated their infants' temperament at birth and at 8 weeks. By 3 weeks, treatment infants showed significantly longer sleep episodes at night. By 8 weeks 100% of treatment infants were sleeping through the night compared to 23% of control infants. Treatment infants were feeding less frequently at night but compensated for the relatively long nighttime interval without a feed by consuming more milk in the early morning. Milk intake for 24-hour periods did not differ between groups. Treatment infants were rated as more predictable on Bates' Infant Characteristics Questionnaire. It is concluded that parents can have a powerful influence on the development of their infants' sleep patterns. Frequent night waking in breast-fed infants often results in early termination of lactation.(ABSTRACT TRUNCATED AT 250 WORDS)

Development of eating behaviors among children and adolescents.

The prevalence of obesity among children is high and is increasing. We know that obesity runs in families, with children of obese parents at greater risk of developing obesity than children of thin parents. Research on genetic factors in obesity has provided us with estimates of the proportion of the variance in a population accounted for by genetic factors. However, this research does not provide information regarding individual development. To design effective preventive interventions, research is needed to delineate how genetics and environmental factors interact in the etiology of childhood obesity. Addressing this question is especially challenging because parents provide both genes and environment for children. An enormous amount of learning about food and eating occurs during the transition from the exclusive milk diet of infancy to the omnivore's diet consumed by early childhood. This early learning is constrained by children's genetic predispositions, which include the unlearned preference for sweet tastes, salty tastes, and the rejection of sour and bitter tastes. Children also are predisposed to reject new foods and to learn associations between foods' flavors and the postingestive consequences of eating. Evidence suggests that children can respond to the energy density of the diet and that although intake at individual meals is erratic, 24-hour energy intake is relatively well regulated. There are individual differences in the regulation of energy intake as early as the preschool period. These individual differences in self-regulation are associated with differences in child-feeding practices and with children's adiposity. This suggests that child-feeding practices have the potential to affect children's energy balance via altering patterns of intake. Initial evidence indicates that imposition of stringent parental controls can potentiate preferences for high-fat, energy-dense foods, limit children's acceptance of a variety of foods, and disrupt children's regulation of energy intake by altering children's responsiveness to internal cues of hunger and satiety. This can occur when well-intended but concerned parents assume that children need help in determining what, when, and how much to eat and when parents impose child-feeding practices that provide children with few opportunities for self-control. Implications of these findings for preventive interventions are discussed.

Nutritional guidance is needed during dietary transition in early childhood.

OBJECTIVE: To assess dietary nutritional quality during dietary transition to a modified adult-style diet in the second year of life. DESIGN: A total of 55 children from 12 to 18 months old and their parents were studied. Dietary intake and indices of growth were measured monthly. Dietary data were collected monthly and tabulated using the Minnesota Nutrient Data System. Data were evaluated using repeated-measures analysis of variance, time trend, and correlational analyses. RESULTS: Mean energy intake increased from 12 to 18 months of age (926+/-24 kcal to 1062+/-33 kcal) with contributions from energy-yielding macronutrients remaining relatively constant. Throughout the study, fat intakes were below 30% of energy for 22% to 33% of the sample. Micronutrient intake patterns were diverse with intake for some nutrients (vitamins A, C, B(6), B(12), and D and calcium) remaining above recommended levels despite changes over the course of the study. Folate intakes increased from 79% of the recommended value at 12 months old to approximately 100% at 18 months old. Zinc and vitamin E intakes were well below recommended levels throughout the study, and iron decreased markedly from 96% of the recommended level at 12 months old to 76% at 18 months old. APPLICATIONS/CONCLUSIONS: These data show that intakes of some key nutrients are low during the period of dietary transition in early childhood, and intakes for some nutrients actually decrease despite increases in energy intake. Furthermore, because a considerable portion of children studied were consuming low-fat diets, it is clear that many parents are not following the only pediatric nutrition recommendations that currently exist. These findings argue strongly for the development of dietary guidance that not only addresses fat restriction, but also assists parents in selecting diets that support optimum growth and development in young children.nutrient intake, infants, dietary density.

Children's preferences for high-fat foods.

Many high-fat foods are highly preferred by adults, and children soon acquire these preferences. The circumstances and mechanisms that contribute to establishing children's preferences for high-fat foods are the subject of this review.

Effects of experience on the modification of food acceptance patterns.

Parallels have been drawn between persons at the two extremes of the life span: the very young and the very old. Some of these purported similarities, including referring to the latter portion of the life span as a "second childhood," are clearly unsupported by the data. The view presented above, however, suggests that experience with food continues to modify food acceptance patterns across the life span through associative conditioning. To the extent that the young and old have similar experiences with food, we can expect similar patterns of change in food acceptance to emerge. Research has been reviewed on the effects of experience on the development and modification of food acceptance patterns in children. Two aspects of this research--the associative conditioning of food cues to consequences and the effects of exposure on preference for novel foods--are particularly relevant to developing hypotheses regarding how experience with food could shape food acceptance patterns in the elderly. Research should be directed to exploring the social contexts and consequences of eating as possible contributors to reduced food acceptance among the elderly.

Food intake regulation in children. Fat and sugar substitutes and intake.

A series of experiments exploring children's responsiveness to manipulations of energy density and macronutrient content of foods have been reviewed to assess the nutritional impact of macronutrient substitutes on children's intake. In these experiments, the focus is on the extent to which the energy content of foods was a salient factor influencing children's food intake, and macronutrient substitutes were used as tools to investigate this issue. Therefore, although several different macronutrient substitutes have been used in this research, we do not have a parametric set of experiments systematically assessing the impact of a variety of macronutrient substitutes. Given this, what can we conclude from the existing data? When the energy density and macronutrient content of foods is altered through the use of macronutrient substitutes that reduce the energy content of foods, children tend to adjust for the missing energy, although this adjustment may be partial and incomplete. This suggests the possibility that when macronutrient substitutes are used to reduce the energy content of foods, children's energy intake may be reduced. This adjustment, however, will most likely be less than a "calorie for calorie" reduction. In addition, even among young children, there are individual differences in the extent to which children adjust their intake in response to macronutrient and energy manipulations. The data are more extensive and particularly clear for cases in which CHO manipulations are used to alter energy density, but there is evidence for adjustments in energy intake in response to alterations of the fat content of the diet. The compensation for energy is not macronutrient specific; that is, when the fat content of food is reduced to reduce energy density of foods, children do not selectively consume fat in subsequent meals. This means that manipulations of macronutrient content of foods that reduce foods' energy content may not result in alterations of energy intake, but because these adjustments in energy intake are not macronutrient specific, changes in the overall macronutrient composition of children's diets can be obtained. There does not appear to be anything unique or special about the effects of macronutrient substitutes on children's intake; their effects are similar to those produced by other manipulations of macronutrient and energy content accomplished without macronutrient substitutes (e.g., augmenting foods with fat or carbohydrate to produce macronutrient differences). The research also indicates that under conditions that minimize adult attempts to control how much and what children eat, children can adjust their food and energy intake in response to the alterations of macronutrient and energy content of foods. Whether or not young children adjust food intake to compensate for energy-density changes depends upon their opportunity to control their own food intake as opposed to having their intake controlled by others. Young children's ability to adjust intake in response to alterations in the energy density of foods can be readily disrupted by the imposition of controlling child-feeding practices that attempt to regulate what and how much children eat. We believe that early experiences, including child-feeding practices imposed by parents, are major factors contributing to the etiology of individual differences and gender differences in the behavioral controls of food intake that can occur in response to the energy content of foods. The extent to which children respond to energy density of the diet has major implications for the effects of fat and sugar substitutes on children's intake. If children who are responsive to energy density consume substantial amounts of foods containing macronutrient substitutes, they should show some adjustments in intake to compensate for reduced energy, so that the impact of macronutrient substitutes on energy intake may be relatively small. However, changes in macronutrient com

Conditioned preferences: young children prefer flavors associated with high dietary fat.

In two experiments, 20 2-5-year-old children participated in a series of 8 conditioning trials to investigate whether they acquired conditioned preferences based on the fat content of a food. On different days, each child consumed fixed quantities of novelly flavored yogurts that were high or low in fat and energy density (220 or 110 kcal/serving). After conditioning, patterns of ad lib consumption data provided evidence of caloric compensation in response to the energy density differences in the preloads. Children consumed more following the low- than the high-fat preloads. Preference assessments, performed pre- and postconditioning, revealed conditioned flavor preferences based on fat content: children increased their preference for the high-density paired flavor, but no change in preference was noted for the low-density paired flavor. These data suggest that such conditioned flavor preferences based on energy density may be contributing to children's preferences for foods high in dietary fat.