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.

Six-month effects of modified Atkins diet implementation on indices of cardiovascular disease risk in adults with epilepsy.

BACKGROUND/AIMS: Ketogenic diet therapies (KDTs) offer a needed therapeutic option for patients with drug-resistant epilepsy. The current study investigated biochemical and anthropometric indices of cardiovascular disease (CVD) risk in adults with epilepsy treated with KDT over 6 months. METHOD: 65 adults with epilepsy naïve to diet therapy were enrolled in a prospective longitudinal study and instructed on modified Atkins diet (MAD) use. Seizure frequency, anthropometric measures, blood levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoproteins A1 and B, and lipoprotein sub-fractions were assessed at baseline, 3 months, and 6 months. RESULTS: Subsequent to study enrollment, 34 participants were lost to follow-up, elected not to start, or stopped MAD prior to study completion, leaving a total of 31 participants in the study at 6 months. Compared to baseline, participants on MAD showed significant reductions in median seizure frequency/week, weight, body mass index, waist and hip circumference, and percent body fat at 3 and 6 months. Compared to baseline, participants on MAD for 3 months showed significantly increased levels of total, small and medium LDL particles, ApoB and ApoB/A1 ratio. At 6 months, only small LDL particles and ApoB levels remained elevated and levels of ApoA1 had risen, suggesting possible compensatory adaptation over time. CONCLUSIONS: This study provides evidence demonstrating the efficacy and cardiovascular safety of 6 months of MAD use by adults with epilepsy. It also highlights an index of CVD risk - small LDL particles - that should be closely monitored.Trial registration: ClinicalTrials.gov identifier: NCT02694094..

Multidisciplinary Management of Ataxia Telangiectasia: Current Perspectives.

Ataxia telangiectasia (A-T) is a rare autosomal recessive disease caused by mutations in the ataxia telangiectasia mutated (ATM) gene. In the absence of a family history, the diagnosis of A-T is usually not made until the child is older and symptomatic. Classic A-T is characterized by a constellation of clinical symptoms including progressive ataxia, oculocutaneous telangiectasias and sinopulmonary disease and is usually associated with absence of ATM protein. Other laboratory features associated with A-T include elevated serum levels of alpha-fetoprotein (AFP) and increased chromosomal breakage with in vitro exposure to ionizing radiation. Sinopulmonary symptoms can occur to varying degrees across the lifespan. Some children will also have hypogammaglobulinemia and impaired antibody responses requiring supplemental gamma globulin. People with hypomorphic ATM mutations are often considered to have mild A-T with onset of ataxia and neurological progression occurring later in life with less impairment of the immune system. The risk of malignancy, however, is significantly increased in people with either classic or mild A-T. While hematological malignancies are most common in the first two decades of life, solid organ malignancies become increasingly common during young adulthood. Deterioration of neurologic function with age is associated with dysphagia with aspiration, growth faltering, loss of ambulation and decline in pulmonary function, morbidities that contribute to shortened life expectancy and decreased quality of life. Premature death is often due to malignancies or chronic respiratory insufficiency. A-T is currently managed with supportive care and symptomatic treatment. Current clinical trials, however, represent progress and hope towards disease-modifying therapies for A-T.

Growth in ataxia telangiectasia.

BACKGROUND: Ataxia telangiectasia (A-T) is a DNA repair disorder that affects multiple body systems. Neurological problems and immunodeficiency are two important features of this disease. At this time, two main severity groups are defined in A-T: classic (the more severe form) and mild. Poor growth is a common problem in classic A-T. An objective of this study was to develop growth references for classic A-T. Another objective was to compare growth patterns in classic A-T and mild A-T with each other and with the general population, using the CDC growth references. A final objective was to examine the effects of chronic infection on height. RESULTS: We found that classic A-T patients were smaller overall, and suffered from height and weight faltering that continued throughout childhood and adolescence. When compared to the CDC growth references, the median heights and weights for both male and female patients eventually fell to or below the 3rd centile on the CDC charts. Height faltering was more pronounced in females. Birthweight was lower in the classic A-T group compared to mild A-T and the general population, whereas birth length was not. Finally, we investigated height and BMI faltering in relation to number of infections and found no association. CONCLUSIONS: Classic A-T appears to affect growth in utero. Although children appear to grow well in very early life, faltering begins early, and is unrelenting.

Dietary intake of adults with and without diabetes: results from NHANES 2013-2016.

INTRODUCTION: Diet is a critical aspect of the management of adults with diabetes. This paper aims to compare dietary intakes of key macronutrients and micronutrients of US adults with and without diabetes and across the spectrum of diabetes. RESEARCH DESIGN AND METHODS: We compared absolute and energy-adjusted dietary intake of major macronutrients and micronutrients among those with and without diabetes and across the spectrum of glycemic control using a 24-hour dietary recall from a cross-sectional, nationally representative sample of 9939 US adults, 20+ years old (National Health and Nutrition Examination Survey 2013-2016). Diabetes was defined as an glycohemoglobin A1c (HbA1c)≥6.5%, fasting glucose ≥126 mg/dL, serum glucose at 2 hours following a 75 g glucose load (oral glucose tolerance test) ≥200 mg/dL, any diagnosis of diabetes or use of diabetes medication (self-reported). RESULTS: Percent of calories from macronutrients was similar for those with and without diabetes (p>0.05, energy adjusted and adjusted for age, race, and sex). In both groups, sugar accounted for about 20% of calories. Those with diabetes consumed about 7% more calcium (p=0.033), about 5% more sodium (p=0.026), and had lower diet quality (Healthy Eating Index-2015, p=0.021) than those without diabetes. Among those with diabetes, those with an HbA1c>9.0% consumed about 4% less magnesium (p-analysis of variance=0.007) than those with an HbA1c<6.5%. Results were similar within strata of age, race, and sex. Macronutrient intake did not vary consistently by HbA1c level. CONCLUSIONS: In this nationally representative sample, there were no substantial or consistent differences in the dietary intake of macronutrients or micronutrients between US adults with and without diabetes. Improving the diets of those with diabetes will likely require enhanced targeted efforts to improve the dietary intake of persons with diabetes, as well as broad efforts to improve the dietary intake of the general population.

Sweet taste perception is greater in non-Hispanic black than in non-Hispanic white adults.

OBJECTIVE: Research suggests a difference in sweet taste perception between non-Hispanic black (NHB) and non-Hispanic white (NHW) adults; however, limited research has examined sweet taste perception in relation to the dietary intake of sweet products. The aim of this study was to examine sweet taste perception and the consumption of sweet foods, beverages, and sugar in NHB and NHW adults, and to evaluate whether sweet taste perception is associated with dietary intake. METHODS: This cross-sectional study examined the association between race, sweet taste perception and sweet food, beverages, and sugar consumption in healthy, NHB and NHW adults. Seven day food records were analyzed in Nutrition Data System for Research software. Intensity of sweet taste perception was tested and the general labeled magnitude scale method was used to facilitate group comparisons. Independent t tests, Mann-Whitney tests, and Pearson correlations were used to assess associations. RESULTS: Participants were NHB (n = 98) and NHW (n = 90) adults, 41 ± 1 y of age (mean ± SEM) with energy intake of 2271 ± 53 kcal. Body mass index was higher in NHBs than in NHWs (36 ± 1 versus 32 ± 1 kg/m2, P = 0.048), but no differences were observed in age, energy consumption, or total sugar intake. Sweet taste perception rating (median [interquartile range] NHB: 73.5 [63.9-83], NHW: 52.1 [46.4-57.7]; P = 0.001) and added sugar intake (NHB: 39.4 g/1000 kcal [36.3-42.4], NHW: 30 g/1000 kcal [26.7-33.4]; P < 0.001) were greater in NHB. Perceived sweet taste intensity was positively associated with consumption of servings of sweet products among NHBs (R2 = 0.057, P = 0.018) but not NHWs (R2 = -0.012, P = 0.314). CONCLUSIONS: NHBs have a higher intensity of sweet taste perception than NHWs. The positive association of sweet taste perception and sweet product consumption in NHBs suggests that a higher intensity of sweet taste perception may be associated with an increased proportion of energy consumption from added sugars.

Perceived Exertion during Exercise Is Associated with Children's Energy Intake.

PURPOSE: To examine the individual-level factors that predict energy intake (EI) after imposed exercise (EX) and sedentary time (SED) in children. METHODS: Healthy-weight children ages 9-12 yr (n = 20) reported to the laboratory for one baseline and two experimental visits (EX and SED) each separated by 1 wk in a randomized crossover design. Percent body fat, weight (kg), and height (m) were used to calculate fat-mass index (FM index) and fat-free mass index (FFM index; kg·m). On the EX day, children exercised at 70% estimated V˙O2peak for 30 min on a cycle ergometer, whereas cardiovascular responses and RPE were measured. Objective EI (kcal) was measured at identical meals (breakfast, lunch, snack, and dinner) on the EX and SED days. RESULTS: Total EI was not statistically different between the EX and SED days (t = 1.8, P = 0.09). FFM index was positively associated with EI on the EX day (r = 0.54, P < 0.05). RPE was also positively associated with EI on the EX day (r = 0.82, P < 0.001). Together, FFM index and RPE explained 77% of the variability in EX day EI (F(2,17) = 26.4, P < 0.001). For each unit increase in RPE, children consumed approximately 270 more calories on the EX day. A similar pattern of associations was observed on the SED day. CONCLUSIONS: FFM index was positively associated with EI on the EX day. Despite experiencing the same 70% relative exercise intensity, increased perceived difficulty predicted greater EI on both the EX and SED day. These findings demonstrate a role for both FFM and RPE in explaining EI variability in children.

Impact of imposed exercise on energy intake in children at risk for overweight.

BACKGROUND: Exercise not only has a direct effect on energy balance through energy expenditure (EE), but also has an indirect effect through its impact on energy intake (EI). This study examined the effects of acute exercise on daily ad libitum EI in children at risk for becoming overweight due to family history. METHODS: Twenty healthy-weight children (ages 9-12 years, 12 male/8 female) with at least one overweight biological parent (body mass index ≥ 25 kg/m2) participated. Children reported to the laboratory for one baseline and two experimental visits (EX = exercise, SED = sedentary) each separated by 1 week in a randomized crossover design. Two hours into the EX day session, children exercised at 70 % estimated VO2max for 30 min on a cycle ergometer. Objective EI (kcal) was measured at a standard breakfast (~285 kcal) and ad libitum lunch, snack and dinner. Meals were identical on the EX and SED days. Activity-related EE (kcal) was estimated with accelerometers worn on the non-dominant wrist and ankle. Relative EI (kcal) was computed as the difference between Total EI and Activity-related EE for each testing day. Paired t-tests were performed to test differences in Total EI, Activity-related EE and Relative EI between the EX and SED days. RESULTS: Across all meals, Total EI was not statistically different between the EX and SED days (t = 1.8, p = 0.09). Activity-related EE was greater on the EX day compared to the SED day (t = 10.1, p < 0.001). By design, this difference was predominantly driven by activity during the morning (t = 20.4, p < 0.001). Because children consumed a similar number of kcal on each day, but had greater Activity-related EE on the EX day, Relative EI was lower (t = -5.15, p < 0.001) for the EX day (1636 ± 456 kcal) relative to the SED day (1862 ± 426 kcal). CONCLUSIONS: Imposed exercise was effective in reducing Relative EI compared to being sedentary. Morning exercise may help children at risk for becoming overweight to better regulate their energy balance within the course of a day.

Feeding Strategies Derived from Behavioral Economics and Psychology Can Increase Vegetable Intake in Children as Part of a Home-Based Intervention: Results of a Pilot Study.

BACKGROUND: Behavioral economics and psychology have been applied to altering food choice, but most studies have not measured food intake under free-living conditions. OBJECTIVES: To test the effects of a strategy that pairs positive stimuli (ie, stickers and cartoon packaging) with vegetables and presents them as the default snack. DESIGN: A randomized controlled trial was conducted with children who reported consumption of fewer than two servings of vegetables daily. Children (aged 3 to 5 years) in both control (n=12) and treatment (n=12) groups received a week's supply of plainly packaged (ie, generic) vegetables, presented by parents as a free choice with an alternative snack (granola bar), during baseline (Week 1) and follow-up (Week 4). During Weeks 2 and 3, the control group continued to receive generic packages of vegetables presented as a free choice, but the treatment group received vegetables packaged in containers with favorite cartoon characters and stickers inside, presented by parents as the default choice. Children in the treatment group were allowed to opt out of the vegetables and request the granola bar after an imposed 5-minute wait. STATISTICAL ANALYSIS: General Linear Model repeated measures analysis of variance was conducted to compare vegetable and granola bar intake between control and treatment groups across the 4-week study. Both within- and between-subjects models were tested. RESULTS: A time×treatment interaction on vegetable intake was significant. The treatment group increased vegetable intake from baseline to Week 2 relative to control (P<0.01), but the effects were not sustained at Week 4 when the treatment was removed. Granola bar intake decreased in the treatment group at Week 2 (P≤0.001) and Week 3 (P≤0.005) relative to baseline. CONCLUSIONS: Parents were able to administer feeding practices derived from behavioral economics and psychology in the home to increase children's vegetable intake and decrease intake of a high-energy-density snack. Additional studies are needed to test the long-term sustainability of these practices.