Association of cognitive dietary restraint and disinhibition with prediabetes--cross-sectional and longitudinal data of a feasibility study in German employees.

OBJECTIVE: To investigate the impact of eating behaviour traits on central obesity, prediabetes and associated major dietary food patterns. DESIGN: Assessment of eating behaviour was based on the revised German version of the Three-Eating Factor Questionnaire using cross-sectional and longitudinal data of a feasibility study in employees. Data on lifestyle and nutrition were obtained by validated self-administered questionnaires. Baseline characteristics were analysed by the univariate χ2 test or the Mann-Whitney test. To quantify correlations linear regression analysis was used. SETTING: The Delay of Impaired Glucose Tolerance by a Healthy Lifestyle Trial (DELIGHT), which investigated measures to prevent type 2 diabetes mellitus in 2004-2008. SUBJECTS: Employees (21-64 years, 127 men, 157 women) with elevated waist circumference (men ≥ 94 cm, women ≥ 80 cm) of five medium-sized companies in northern Germany. RESULTS: At baseline (T0), BMI but particularly waist circumference showed a strong inverse correlation with flexible control (P < 0.0001) and a positive correlation with disinhibition (P < 0.0001) and rigid control (P = 0.063). Flexible control was also significantly inversely related to fasting plasma glucose (P = 0.040), energy intake (P < 0.0001), intake of meat and meat products (P = 0.0001), and positively associated with intake of fruit and vegetables (P < 0.0001) at baseline (T0). Changes in flexible control within the first year of intervention (T1 v. T0) predicted changes in central obesity (P < 0.0001) and fasting plasma glucose (P = 0.025). CONCLUSIONS: DELIGHT shows that flexible control characterizes individuals with a higher dietary quality, a lower waist circumference and a lower glucose level. Enhancing flexible control more than rigid control, and decreasing disinhibition, seems beneficial in terms of central adiposity and glucose levels.

Eating behaviour and eating disorders in students of nutrition sciences.

OBJECTIVE: Sometimes the suspicion is put forward that nutrition students show more disordered eating patterns, which may be among the motivating factors to study nutrition. At the same time, it is not clear whether the students' increasing knowledge about diet and nutrition is associated with a more healthy eating behaviour or with an unhealthy obsession with food choices. DESIGN: Cross-sectional comparison of nutrition students from German universities during the first year of their studies (n 123) and during higher semesters (n 96), with a control group from other study programmes (n 68 and n 46, respectively). Dietary restraint, disinhibition, the tendency towards orthorexia nervosa and healthy food choices were assessed using a questionnaire. RESULTS: Nutrition students showed higher levels of dietary restraint than the control group. Disinhibition and orthorexia nervosa did not differ between nutrition students and controls. Orthorexic tendencies were lower in the more advanced nutrition students. Healthy food choices did not differ among students in the first year. More advanced nutrition students showed healthier food choices, whereas the corresponding controls showed slightly more unhealthy food choices. CONCLUSIONS: Nutrition students, more than other students, tend to restrict their food intake in order to control their weight, but they do not have more disturbed or disordered eating patterns than other students. Moreover, during the course of their studies, they adopt slightly more healthy food choices and decrease their tendency to be obsessive in their eating behaviour.

Impact of different food label formats on healthiness evaluation and food choice of consumers: a randomized-controlled study.

BACKGROUND: Front of pack food labels or signpost labels are currently widely discussed as means to help consumers to make informed food choices. It is hoped that more informed food choices will result in an overall healthier diet. There is only limited evidence, as to which format of a food label is best understood by consumers, helps them best to differentiate between more or less healthy food and whether these changes in perceived healthiness result in changes of food choice. METHODS: In a randomised experimental study in Hamburg/Germany 420 adult subjects were exposed to one of five experimental conditions: (1) a simple "healthy choice" tick, (2) a multiple traffic light label, (3) a monochrome Guideline Daily Amount (GDA) label, (4) a coloured GDA label and (5) a "no label" condition. In the first task they had to identify the healthier food items in 28 pair-wise comparisons of foods from different food groups. In the second task they were asked to select food portions from a range of foods to compose a one-day's consumption. Differences between means were analysed using ANOVAs. RESULTS: Task I: Experimental conditions differed significantly in the number of correct decisions (p < 0.001). In the condition "no label" subjects had least correct decisions (20.2 +/- 3.2), in the traffic light condition most correct decisions were made (24.8 +/- 2.4). Task II: Envisaged daily food consumption did not differ significantly between the experimental conditions. CONCLUSION: Different food label formats differ in the understanding of consumers. The current study shows, that German adults profit most from the multiple traffic light labels. Perceived healthiness of foods is influenced by this label format most often. Nevertheless, such changes in perceived healthiness are unlikely to influence food choice and consumption. Attempts to establish the informed consumer with the hope that informed choices will be healthier choices are unlikely to change consumer behaviour and will not result in the desired contribution to the prevention of obesity and diet related diseases.

Food offerings on board and dietary intake of European and Kiribati seafarers - cross-sectional data from the seafarer nutrition study.

BACKGROUND: Overweight and cardiovascular risk factors are a common phenomenon in seafarers. According to internal observation particularly crew members from the Pacific Island State of Kiribati are exposed to a high risk. However, in mixed crews, cultural background plays an important role, influencing food choice, and the actual risk. METHODS: The Seafarer Nutrition Study (SeaNut study) compared dietary factors in 48 Kiribati and 33 European male seafarers recruited from four merchant ships with a high level of Kiribati manning within a German shipping company. Analysis encompassed the assessment of dietary quality on board, satisfaction with prepared dishes, and individual food intake obtained from 24-h recalls in comparison with nutritional recommendations. RESULTS: The overall supply of meat, fat and eggs was more than double, whereas the proportions of fruits, vegetables, dairy products and cereals were much lower than recommended. Based on the reported food choices, both groups, but notably Kiribati seafarers, did not reach reference values as to macronutrient, micronutrient and fiber intake. In addition, satisfaction with the meals served, food preferences and knowledge about a healthy diet varied markedly between Kiribati and Europeans. CONCLUSIONS: The present analysis of the SeaNut study revealed the necessity of future health intervention programs, including the quality of the food supply as well as information about a healthy diet and adequate food selection. In mixed crews, culture-specific differences should be considered, in order to facilitate the long-term success of interventions. TRIAL REGISTRATION: German Clinical Trials Registry DRKS00010819 retrospectively. Registered 18 July 2016 (www.germanctr.de).

Cultural differences in food and shape related attitudes and eating behavior are associated with differences of Body Mass Index in the same food environment: cross-sectional results from the Seafarer Nutrition Study of Kiribati and European seafarers on merchant ships.

BACKGROUND: Overweight and obesity is quite prevalent among seafarers. The present study examined differences in BMI and their association with weight, shape and nutrition related attitudes and perceptions among seafarer from Kiribati, a Pacific Island Group, and European origin. METHODS: The Seafarer Nutrition Study compared 48 Kiribati and 33 European male seafarers from 4 commercial merchant ships. BMI was calculated from measured weight and height. Attitudes to weight, shape and nutrition and disinhibition of control as a characteristic of eating behavior were assessed in a structured interview. Differences between the two groups were examined using t-tests and Chi-square-tests as appropriate. Associations between the variables were examined using Multiple Regression Analysis (MRA) and correlations. RESULTS: Kiribati seafarer had significantly higher BMI than Europeans (30.3 ± 4.2 vs. 25.6 ± 3.4; p < 0.001). However, MRA indicated that Kiribati were choosing thinner shapes as being "most similar" to their appearance than Europeans with the same BMI (B = - 1.14; p < 0.05). In addition, Kiribati had significantly higher scores of disinhibition than Europeans (5.6 ± 2.2 vs. 4.3 ± 2.1; p < 0.01), and disinhibition correlated with BMI in the Kiribati (r = 0.39; p < 0.01), but not in the European group (r = 0.17; n.s.). CONCLUSIONS: For Kiribati seafarers the nutrition situation on board represents a highly tempting westernized food environment. Their tendency to disinhibited eating facilitates overconsumption and weight gain, and self-evaluation of their shapes as being thinner than comparable Europeans may hamper appropriate weight control behavior.

Three- and five-year follow-up of a combined inpatient-outpatient treatment of obese children and adolescents.

Aim. "The combined DAK therapy for obesity in children and adolescents" combines a 6-week inpatient with a 10.5-month outpatient treatment. The aim of the study is to evaluate whether the therapeutic achievements are maintained two and four years after intervention. Method. All subjects who had participated in the 12-month program in 2004/2005 were included in the follow-up study. Body weight, height, and physical fitness were assessed through direct measurements, behaviour, and quality of life by self-report questionnaires. Statistical analysis is based on an intention-to-treat analysis. Results. The response rate after three years was 63.4% and 42.2% after five years. Within three years, participants reduced their BMI-SDS significantly by 0.20 (SD 0.49) and by 0.15 (SD 0.51) within five years. Significant positive changes could be observed with respect to the participants eating behaviour. Similarly, the food intake, particularly the consumption of calorie-reduced beverages, increased significantly while that of nonrecommended foods decreased. Improvement was also seen in the subjective quality of life as well as several aspects of self-perception. Conclusion. Compared to baseline data, significant reduction of BMI-SDS and positive changes of health-related behaviours could be observed even three and five years after the start of the initial program.

Cognitive and weight-related correlates of flexible and rigid restrained eating behaviour.

OBJECTIVES: Examine the association between components of restrained eating, cognitive performance and weight loss maintenance. METHODS: 106 women, all members of a commercial slimming organisation for at least 6 months (mean±SD: 15.7±12.4 months), were studied who, having lost 10.1±9.7 kg of their initial weight, were hoping to sustain their weight loss during the 6 month study. Dietary restraint subcomponents flexible and rigid restraint, as well as preoccupying cognitions with food, body-shape and diet were assessed using questionnaires. Attentional bias to food and shape-related stimuli was measured using a modified Stroop test. Working memory performance was assessed using the N-back test. These factors, and participant weight, were measured twice at 6 month intervals. RESULTS: Rigid restraint was associated with attentional bias to food and shape-related stimuli (r=0.43, p<0.001 resp. r=0.49, p<0.001) whereas flexible restraint correlated with impaired working memory (r=-0.25, p<0.05). In a multiple regression analyses, flexible restraint was associated with more weight lost and better weight loss maintenance, while rigid restraint was associated with less weight loss. CONCLUSIONS: Rigid restraint correlates with a range of preoccupying cognitions and attentional bias to food and shape-related stimuli. Flexible restraint, despite the impaired working memory performance, predicts better long-term weight loss. Explicitly encouraging flexible restraint may be important in preventing and treating obesity.

The hyperactivity/inattention subscale of the Strengths and Difficulties Questionnaire predicts short- and long-term weight loss in overweight children and adolescents treated as outpatients.

OBJECTIVE: The success of treatment for pediatric obesity is variable and often unsatisfactory. This study elucidates the influence of inattention and hyperactivity/impulsivity on short- and long-term weight loss and maintenance after outpatient treatment. METHODS: We included 8- to 16-year-old overweight and obese participants treated in 17 multidisciplinary outpatient treatment centers in a nationwide observational study. All treatment centers that reported long-term (1-year) follow-up weight data of at least 60% of the participants were included. At the beginning and end of treatment and at 1 year follow-up weight and height were measured at the center. Inattention and hyperactivity/impulsivity were assessed with the hyperactivity/inattention subscale (HI) of the parent-rated Strengths and Difficulty Questionnaire (SDQ). General linear models were used with the standard deviation scores of the BMI (BMI-SDS) as dependent variable and HI scores as main independent variable adjusting for age, sex, baseline BMI-SDS, and center. RESULTS: 394 participants were included (57% female, age: 11.7± 2.0 years, baseline BMI-SDS 2.32 ±.46 kg/m(2)). HI scores were significantly associated with short- and long-term BMI-SDS (p < 0.0005), with higher baseline HI scores predicting less weight loss. CONCLUSIONS: Our results indicate that inattention and hyperactivity/impulsivity are linearly associated with reduced short- and long-term weight loss. Implications for treatment are discussed.

Age and gender dependent profile of food choice.

Several studies have described remarkable differences in food choice between men and women. Consistently, women are reported to have higher intakes of fruit and vegetables, higher intakes of dietary fiber and lower intakes of fat. In accordance with such more healthy food choice, women usually attach greater importance to healthy eating. In addition, the motivation of weight control is more prominent in women and they are more likely to diet or restrain their eating behavior. Recently, studies found that health beliefs and weight control motivation may explain up to 50 percent of gender differences in food choice. In addition, less healthy food choice profiles of men may be related to their poorer nutritional knowledge. However, health beliefs, eating attitudes and dieting appear to be phenomena which vary throughout the life span. In growing older, changes in the chemosensory perceptual systems play an important role in food choice. The decline of gustatory and--perhaps even more pronounced--in olfactory function may lead to a decrease of the pleasantness of food, thus limiting the reinforcing properties of food intake which eventually results in a decrease of appetite, often reported in elderly people. In addition, there are some indications that sensory-specific satiety diminishes with age. Sensory-specific satiety is the reduction in the pleasantness of food as it is consumed. This decrease of pleasantness usually motivates the choice of other foods and therefore, a varied diet. Therefore, the decrease of sensory-specific satiety may in part explain the limited variety of the diet sometimes seen in elderly people. However, lifestyle, socio-economic situation and other variables may limit the influence of such physiological changes and help to maintain an adequate food intake despite these age-related processes.

Establishing dietary habits during childhood for long-term weight control.

OBJECTIVE: To review psychosocial research with respect to relevance for the development of nutritional education strategies for optimal weight control during childhood and the longer term. RESULTS: Recent decades have witnessed changes in the social context of eating, with a trend away from family meals towards grazing and eating alone. At the same time, the prevalence of overweight and obesity is increasing amongst both children and adults, with even young children deliberately practising weight control measures, ranging from selective food choice to self-induced vomiting. Such behaviour is motivated by unrealistic perceptions of healthy body weight and shape. Successful long-term management of healthy body weight is supported by flexible control of eating behaviour and long-term educational strategies. Children are interested in learning about a wide range of nutrition topics. However, to be effective, nutrition education should be appropriate to the stage of cognitive development according to the age of the child, and be placed in the context of the direct, perceivable and immediate benefits resulting from good nutrition. CONCLUSION: Educational strategies should focus on consumption of a balanced diet, coupled with provision of a variety of foods, including a range of nutrient-dense "healthy" food and encouraging children to taste unfamiliar dishes. They should provide a stable and predictive pattern of social eating occasions to promote the social meaning and importance of eating, and to enable social learning of food preferences. Educational strategies should provide orientation and reassurance regarding the range of healthy and acceptable body weights and shapes. They should also encourage flexible control of eating behaviour to enable children to maintain their weight within this healthy range.

PASSCLAIM--mental state and performance.

BACKGROUND: The intake of food and drink can influence brain functions, which in turn may have effects on mental state and performance. Therefore, in principle claims to improve mood or specific aspects of cognitive performance by the consumption of functional foods are possible and indeed are currently found on the market. AIM: The paper reviews existing methodologies, which may be used to substantiate and validate such claims of desirable effects of foods on mental state and performance. RESULTS: Mood, arousal, activation, vigilance, attention, sleep, motivation, effort, perception, memory and intelligence have been identified as relevant aspects of mental state and performance. The basic scientific concepts within this field as well as the methodologies to measure these concepts have been reviewed and described. CONCLUSIONS: From this review it is concluded that, in principle, the phenomena in these fields are no different to those in other fields of life science. The scientific methods and protocols described in this report can positively demonstrate the effects of foods on mental state and performance in a scientifically valid way. A claim on mental state and performance like other claims must be based on scientific evidence. This report confirms that methodologies do exist to generate sound scientific evidence in this area. Therefore, claims on the enhancement of specific mental functions can and should be substantiated and validated using the methodologies described in this review.