Glutamic acid intake by formula-fed infants: are acceptable daily intakes appropriate?

The 2017 European Food Safety Authority (EFSA) recommendation of an acceptable daily intake (ADI) of 30 mg glutamic acid/kg bw/day did not take into consideration the primary energy sources during infancy, including infant formulas. In the present study, we determined total daily intakes of glutamic acid in a contemporary cohort of healthy infants who were fed either cow milk formula (CMF) or extensive protein hydrolysate formula (EHF); the formulas differed substantially in glutamic acid content. The infants (n = 141) were randomized to be fed either CMF or EHF. Dietary intakes were determined from weighed bottle methods and/or prospective diet records, and body weights were measured on 14 occasions from 0.5 to 12.5 months. Secondary data analysis determined the glutamic acid content of the diet over time. The trial was registered at  http://www. CLINICALTRIALS: gov/ as NCT01700205, 3 October 2012. Glutamic acid intake from formula and other foods was significantly higher in infants fed EHF when compared to CMF. As glutamic acid intake from formula decreased, intake from other nutritional sources steadily increased from 5.5 months. Regardless of formula type, every infant exceeded the ADI of 30 mg/kg bw/day from 0.5 to 12.5 months.   Conclusion: Given that the ADI recommendation was not based on actual intake data of primary energy sources during infancy, the present findings on the growing child's ingestion of glutamic acid from infant formula and the complementary diet may be of interest when developing future guidelines and communications to parents, clinical care providers, and policy makers. WHAT IS KNOWN: • The 2017 re-evaluation of the safety of glutamic acid-glutamates and the recommended acceptable daily intake (ADI) of 30 mg/kg bw/d by the European Food Safety Authority (EFSA) did not include actual intake data of the primary energy sources during infancy. WHAT IS NEW: • During the first year, glutamic acid intake from infant formula and other food sources exceeded the ADI of 30 mg/kg bw/day.

Glutamic Acid Intake by Formula-Fed Infants: Are Acceptable Daily Intakes Feasible?

PURPOSE: The 2017 European Food Safety Authority (EFSA) recommendation of an acceptable daily intake (ADI) of 30 mg glutamic acid/kg bw/d did not take into consideration the primary energy sources during infancy, including infant formulas. In the present study, we determined total daily intakes of glutamic acid in a contemporary cohort of healthy infants who were fed either cow milk formula (CMF) or extensive protein hydrolysate formulas (EHF); the formulas differed in glutamic acid content (262.4 mg/100ml, CMF; 436.2 mg/100ml, EHF). METHODS: The infants ( n = 141) were randomized to be fed either CMF or EHF. Daily intakes were determined from weighed bottle methods and/or prospective diet records, and body weights and lengths were measured on 15 occasions from 0.5 to 12.5 months. The trial was registered on http://www. CLINICALTRIALS: gov/ as trial registration number NCT01700205 on 3 October 2012. RESULTS: Glutamic acid intake from formula and other foods was significantly higher in infants fed EHF when compared to CMF. As glutamic acid intake from formula decreased, intake from other nutritional sources steadily increased from 5.5 months. Regardless of formula type, every infant exceeded the ADI of 30 mg/kg bw/d from 0.5 to 12.5 months. CONCLUSIONS: Faced with the knowledge that the EFSA health-based guidance value (ADI) was not based on actual intake data and did not account for the primary energy sources during infancy, EFSA may reconsider the scientific literature on growing children's intakes from human milk, infant formula, and the complementary diet to provide parents and health care providers with revised guidelines.

Factors Affecting BMI Changes in Mothers during the First Year Postpartum.

We tested the hypotheses that mothers of infants who exclusively breastfed would differ in the trajectories of postpartum BMI changes than mothers of infants who exclusively formula fed, but such benefits would differ based on the maternal BMI status prepregnancy (primary hypothesis) and that psychological eating behavior traits would have independent effects on postpartum BMI changes (secondary hypothesis). To these aims, linear mixed-effects models analyzed measured anthropometric data collected monthly from 0.5 month (baseline) to 1 year postpartum from two groups of mothers distinct in infant feeding modality (Lactating vs. Non-lactating). While infant feeding modality group and prepregnancy BMI status had independent effects on postpartum BMI changes, the benefits of lactation on BMI changes differed based on prepregnancy BMI. When compared to lactating women, initial rates of BMI loss were significantly slower in the non-lactating women who were with Prepregnancy Healthy Weight (ß = 0.63 percent BMI change, 95% CI: 0.19, 1.06) and with Prepregnancy Overweight (ß = 2.10 percent BMI change, 95% CI: 1.16, 3.03); the difference was only a trend for those in the Prepregnancy Obesity group (ß = 0.60 percent BMI change, 95% CI: -0.03, 1.23). For those with Prepregnancy Overweight, a greater percentage of non-lactating mothers (47%) gained ≥ 3 BMI units by 1 year postpartum than did lactating mothers (9%; p < 0.04). Psychological eating behavior traits of higher dietary restraint, higher disinhibition, and lower susceptibility to hunger were associated with greater BMI loss. In conclusion, while there are myriad advantages to lactation, including greater initial rates of postpartum weight loss regardless of prepregnancy BMI, mothers who were with overweight prior to the pregnancy experienced substantially greater loss if they breastfed their infants. Individual differences in psychological eating behavior traits hold promise as modifiable targets for postpartum weight management.

Portion size can be used strategically to increase intake of vegetables and fruits in young children over multiple days: a cluster-randomized crossover trial.

BACKGROUND: Although dietary guidelines recommend that vegetables and fruits make up half the diet, it is unclear whether serving vegetables and fruits in larger portions will have sustained effects on children's intake over multiple days. OBJECTIVES: This study tested the effects on children's intake of 2 strategies for increasing the proportion of vegetables and fruits: either adding or substituting extra portions as side dishes at meals and snacks over 5 d. METHODS: In a cluster-randomized crossover design with 3 periods, we provided all meals and snacks for 5 d to 53 children aged 3-5 y in classrooms in their childcare centers. In the Control condition, we served typical portions for all food groups. In the Addition condition we increased portions of low-energy-dense vegetables and fruits by 50%, and in the Substitution condition we increased portions of vegetables and fruits by 50% and also reduced portions of other foods by an equivalent weight. RESULTS: For vegetables, the Addition strategy increased daily intake compared with Control by 24% (mean ± SEM = 12 ± 3 g/d; P = 0.0002), and the Substitution strategy increased intake compared with Control by 41% (22 ± 3 g/d; P < 0.0001). For fruits, consumption increased by similar amounts: Addition by 33% (60 ± 6 g/d) and Substitution by 38% (69 ± 8 g/d; both P < 0.0001). Both strategies increased vegetable and fruit intakes compared with Control across all 5 days (all P < 0.004), although the increase in fruit consumption with Addition declined over time (P < 0.0001). Daily energy intake compared with Control increased by 5% with Addition (57 ± 17 kcal; P = 0.001) but decreased by 6% with Substitution (-64 ± 21 kcal; P = 0.004). CONCLUSIONS: Both the Addition and Substitution strategies promoted increases in vegetable and fruit intake over 5 d in preschool children. When excess energy intake is a concern, substituting vegetables and fruits for other foods is a better option than simply serving more.This trial was registered at http://www.clinicaltrials.gov as NCT03242863 (https://clinicaltrials.gov/ct2/show/NCT03242863), where the protocol is available.

Effects of Early Weight Gain Velocity, Diet Quality, and Snack Food Access on Toddler Weight Status at 1.5 Years: Follow-Up of a Randomized Controlled Infant Formula Trial.

This study followed children who participated in a feeding trial in which the type of randomized infant formula fed from 2 weeks significantly affected weight gain velocity during the first 4 months and weight-for-length Z (WLZ) scores up to 11.5 months. We focused on measures of anthropometry, dietary intakes, and parenting related to the provision of snack foods that were collected at the end of the trial (1 year) and the 1.5 years follow-up visit. We not only describe what toddlers are eating, but we also determined the independent and/or interactive effects of randomized formula group, early weight gain velocity, the nutrient content of the post-formula diet, and maternal snack food practices, on toddlers' weight status. Diet quality underwent drastic changes during this 6-month period. As infant formula disappeared from the diet, fruit and 100% fruit juice intake increased slightly, while intake of "What We Eat in America" food categories sweetened beverages and snacks and sweets more than doubled. Added sugars accounted for 5% of energy needs at 1 year and 9% at 1.5 years. Generalized linear mixed models revealed that, independent of the randomized formula group, greater velocities of weight gain during early infancy and lower access to snacks as toddlers predicted higher WLZ and a greater proportion of toddlers with overweight at 1.5 years. Energy and added sugar intake had no significant effects. These findings add to the growing body of evidence that unhealthy dietary habits are formed even before formula weaning and that, along with improving early diet, transient rapid weight gain and parental feeding practices are modifiable determinants that may reduce risks for obesity.

Impact of early rapid weight gain on odds for overweight at one year differs between breastfed and formula-fed infants.

BACKGROUND: Early rapid weight gain (RWG) increases, whereas longer durations of breastfeeding decreases, odds for later obesity. OBJECTIVES: To determine the independent and interactive effects of early weight gain and diet on infant weight status trajectories and odds for overweight at 1 year. METHODS: We conducted secondary analysis on data from two longitudinal trials with repeated anthropometric measures. One trial consisted of predominantly or exclusively breastfed (BF, n = 97) infants, whereas the other consisted of exclusively formula-fed (FF, n = 113) infants. Weight-for-length z-score (WLZ) change from 0.5 to 4.5 months was used to categorize early weight gain as slow (<-0.67; SWG), normal (-0.67 to 0.67; NWG) or rapid (>0.67; RWG). Linear-mixed effects models were fit to examine the independent effects and interaction of early diet (BF, FF) and weight gain (SWG, NWG, RWG) groups on WLZ trajectories; logistic regression was used to assess odds for overweight at 1 year. RESULTS: While similar percentages (41%) of BF and FF infants experienced RWG, we found a significant diet × early weight gain group interaction (P < .001) on weight status. At 1 year, the WLZ of FF infants with RWG (1.57 ± 0.99) was twice that of BF infants with RWG (0.83 ± 0.92). Using BF infants with NWG as the reference group, FF infants with RWG had increased odds [OR: 25.3 (95% CI: 3.21, 199.7)] for overweight at 1 year, whereas BF infants with RWG did not. CONCLUSIONS: Early diet interacts with early weight gain and influences weight status trajectories and overweight risk at 1 year.

Portion size has sustained effects over 5 days in preschool children: a randomized trial.

BACKGROUND: Although short-term studies have found that serving larger portions of food increases intake in preschool children, it is unknown whether this portion size effect persists over a longer period or whether energy intake is moderated through self-regulation. OBJECTIVES: We tested whether the portion size effect is sustained in preschool children across 5 consecutive days, a period thought to be sufficient for regulatory systems to respond to the overconsumption of energy. METHODS: With the use of a crossover design, over 2 periods we served the same 5 daily menus to 46 children aged 3-5 y in their childcare centers. In 1 period, all foods and milk were served in baseline portions, and in the other period, all portions were increased by 50%. The served items were weighed to determine intake. RESULTS: Increasing the portion size of all foods and milk by 50% increased daily consumption: weighed intake increased by a mean ± SEM of 143 ± 21 g/d (16%) and energy intake increased by 167 ± 22 kcal/d (18%; both P < 0.0001). The trajectories of intake by weight and energy across the 5-day period were linear and the slopes did not differ between portion conditions (both P > 0.13), indicating that there were sustained increases in intake from larger portions without compensatory changes over time. Children differed in their response to increased portions: those with higher weight status, lower ratings for satiety responsiveness, or higher ratings for food responsiveness had greater increases in intake from larger portions (all P < 0.03). CONCLUSIONS: This demonstration that preschool children failed to adjust their intake during prolonged exposure to larger portions challenges the suggestion that their self-regulatory behavior is sufficient to counter perturbations in energy intake. Furthermore, overconsumption from large portions may play a role in the development of overweight and obesity, as the magnitude of the effect was greater in children of higher weight status. This trial was registered at www.clinicaltrials.gov as NCT02963987.

Both increases and decreases in energy density lead to sustained changes in preschool children's energy intake over 5 days.

BACKGROUND AND OBJECTIVE: To investigate preschool children's ability to self-regulate their energy intake, we assessed their response to increases or decreases in dietary energy density (ED) over 5 consecutive days, a period likely long enough for compensatory behavior. METHODS: Using a crossover design, over 3 periods we served the same 5 daily menus to 49 children aged 3-5 y in their childcare centers. During each 5-day period, 3 main dishes and 1 snack per day were systematically varied in ED, from baseline ED to either higher ED (increased by 20%) or lower ED (decreased by 20%). All of the served items were weighed to determine individual intakes. RESULTS: Modifying the ED of 4 dishes per day had a significant and sustained effect on preschool children's daily energy intake across 5 days. In the baseline condition, children's intakes were similar to daily energy needs (98 ±â€¯2%), but serving higher-ED foods increased energy intake by 84 ±â€¯16 kcal/d (to 105 ±â€¯2% of needs) and serving lower-ED foods decreased energy intake by 72 ±â€¯17 kcal/d (to 89 ±â€¯2% of needs; both P < .0001). The patterns of daily energy intake over the 5 days did not differ across conditions (P = .20), thus there was no evidence that either surfeits or deficits in energy intake led to adjustment over this time period. Furthermore, the response to ED varied, as children with a higher weight status had greater amounts of overconsumption when served higher-ED foods and of underconsumption when served lower-ED foods compared to children with a lower weight status. CONCLUSIONS: These findings counter the suggestion that preschool children's regulatory systems can be relied on to adjust intake in response to energy imbalances. Increasing or decreasing the ED of several foods per day leads to sustained changes in the energy intake of preschool children.

Potential moderators of the portion size effect.

AIM: The robust effect of portion size on intake has led to growing interest in why individuals consume more food when served larger portions. A number of explanations have been proposed, and this review aims to provide insight into potential underlying factors by summarizing recent studies testing moderators of the portion size effect. SUMMARY OF FINDINGS: Provision of portion size information, such as through labeling or training in portion control, failed to attenuate food intake in response to increasing meal size. This indicates that a lack of knowledge about appropriate portions may not be sufficient to explain the portion size effect. In contrast, there is evidence for a role of decision making in the response to large portions, with value being one consideration of importance. The portion size effect may be more closely related to the inherent value of food than monetary value, since provision of the opportunity to take away uneaten food after a meal, which can reduce food waste, attenuated the portion size effect but variations in pricing did not. A number of studies also support an influence of orosensory processing on the portion size effect; large portions have been shown to relate to increased bite size and faster eating rate. Reduced oral processing time when consuming large portions could contribute to the effect by delaying sensory-specific satiety. Findings from a recent study supported this by demonstrating that sensory-specific satiety did not differ between larger and smaller portions despite substantial differences in intake. CONCLUSIONS: A number of moderators of the portion size effect have been identified, including factors related to the environment, the food, and the individual. It is likely that multiple variables contribute to the response to large portions. Future research should aim to determine the relative contribution of explanatory variables across different contexts and individuals.

Doggy bags and downsizing: Packaging uneaten food to go after a meal attenuates the portion size effect in women.

Serving larger portions leads to increased food and energy intake, but little is known about strategies to moderate this response. This study tested how the effect of portion size on meal intake was influenced by providing the option to take away uneaten food in a "doggy bag" (to-go container). Women were randomly assigned to one of two subject groups: a To-Go Group (n = 27) that was informed before each meal that their leftover food would be packaged to take away after the meal, and a Control Group (n = 26) that was not given this option. In a crossover design, subjects came to the lab once a week for four weeks to eat a dinner composed of five foods. Across meals, the portion size of all foods was varied (100%, 125%, 150%, and 175% of baseline). Results showed that the portion size effect, defined as the trajectory of intake across the weight of food served, differed significantly by subject group (P ≤ 0.025). In the Control Group, increasing the portion size of all foods led to substantial increases in intake (P < 0.0001); for every 100 g added to the baseline portion, women in this group consumed an additional mean (±SEM) of 64 ±â€¯12 g of food and 90 ±â€¯19 kcal, until intake leveled off. In contrast, intake of women in the To-Go Group increased by only 17 ±â€¯12 g and 19 ±â€¯18 kcal for every additional 100 g served; these increases did not differ significantly from zero (P > 0.15). Thus, the effect of portion size on intake was attenuated in the To-Go Group compared to the Control Group. These data indicate that packaging uneaten food after a meal could be an effective strategy to reduce overconsumption from large portions.

Does the cost of a meal influence the portion size effect?

Serving larger portions leads to increased intake, but little is known about how the cost of a meal affects this response. Therefore, we tested whether the amount of money paid for a meal influenced the portion size effect at a lunch served in a controlled restaurant-style setting. In a crossover design, 79 adults (55 women; 24 men) came to the lab once a week for 4 weeks to eat a main dish of pasta with side dishes. Across weeks, the meal was varied in two factors: portion size of the main dish (400 g or 600 g) and cost of the meal (US$8 or $16). At discharge subjects completed questionnaires that assessed behaviors thought to influence the response to portion size and cost. Results showed that the portion size of the main dish had a significant effect on meal intake (P < 0.0001). The weight of food consumed at the meal increased by 18 ±â€¯2% (mean ±â€¯SEM 83 ±â€¯11 g) and energy intake increased by 20 ±â€¯2% (133 ±â€¯16 kcal) when the larger portion was served. These effects of portion size did not differ across the two levels of cost (both interactions P > 0.37) nor did meal cost have significant effects on meal intake (both P > 0.24). Subject scores for satiety responsiveness did, however, influence the effect of portion size on food intake (P = 0.0007). Serving larger portions led to increased intake in subjects with lower satiety responsiveness scores (P < 0.0001), but did not affect intake in those with higher scores. In summary, the effect of portion size on intake in a restaurant-style setting was not influenced by meal cost but was attenuated in individuals higher in satiety responsiveness.

Dietary Management of Obesity: Cornerstones of Healthy Eating Patterns.

Several dietary patterns, both macronutrient and food based, can lead to weight loss. A key strategy for weight management that can be applied across dietary patterns is to reduce energy density. Clinical trials show that reducing energy density is effective for weight loss and weight loss maintenance. A variety of practical strategies and tools can help facilitate successful weight management by reducing energy density, providing portion control, and improving diet quality. The flexibility of energy density gives patients options to tailor and personalize their dietary pattern to reduce energy intake for sustainable weight loss.