The feasibility and acceptability of two methods ofsnack portion control in United Kingdom (UK) preschool children: reduction and replacement.

Large portions of high energy dense (HED) snacks are offered to children from a young age and are pervasive in our food environment. This study aimed to explore the feasibility, acceptability, and preliminary efficacy of two strategies of snack portion control: reduction and replacement. Forty-six mother-child dyads aged 22⁻56 months (36.6 ± 9.5 m, 48% female) completed a three-week intervention. In week 1 (baseline) no changes were made to the child's diet; week 2 (acclimation) children received a standardised selection of HED snacks, and in week 3 (intervention) participants were randomly assigned to snack replacement (n = 24) or snack reduction (n = 22). Snack replacement involved swapping HED snacks for fruits and vegetables, whilst snack reduction involved reducing the size of HED snacks by 50%. Food and energy intake were measured using a weighed food diary for four consecutive days. Snack replacement resulted in more positive changes to children's diets; vegetable intake increased (p < 0.01), and total daily energy intake decreased when compared to snack reduction (p < 0.05). Mothers expressed a more favourable attitude to snack replacement, although snack reduction was also well received by mothers. Despite increased preliminary efficacy of snack replacement on dietary intake, both strategies were feasible and acceptable. The current pilot study provides the necessary information to inform the design of future interventions

Effects of chewing on appetite, food intake and gut hormones: A systematic review and meta-analysis

Aim: To conduct a systematic review of the effects of chewing on appetite, food intake and gut hormones, and a meta-analysis of the effects of chewing on self-reported hunger. Objectives: To seek insights into the relationship between chewing, appetite, food intake and gut hormones, and to consider potentially useful recommendations to promote benefits of chewing for weight management. Materials and methods: Papers were obtained from two electronic databases (Medline and Cochrane), from searches of reference lists, and from raw data collected from the figures in the articles. A total of 15 papers were identified that detailed 17 trials. All 15 papers were included in the systematic review; however, a further five studies were excluded from the meta-analysis because appropriate information on hunger ratings was not available. The meta-analysis was conducted on a total of 10 papers that detailed 13 trials. Results: Five of 16 experiments found a significant effect of chewing on satiation or satiety using self-report measures (visual analogue scales, VASs). Ten of 16 experiments found that chewing reduced food intake. Three of five studies showed that increasing the number of chews per bite increased relevant gut hormones and two linked this to subjective satiety. The meta-analysis found evidence of both publication bias and between study heterogeneity (IA2=93.4%, tau2=6.52, p<0.001) which decreased, but remained, when covariates were considered. Analysis of the heterogeneity found a substantial effect of the fasting period where the duration of fasting influenced the decrease in hunger due to chewing. Prolonged mastication significantly reduces self-reported hunger levels (hunger: -2.31 VAS point, 95% CI [-4.67, -1.38], p<0.001). Conclusions: Evidence currently suggests that chewing may decrease self-reported hunger and food intake, possibly through alterations in gut hormone responses related to satiety. Although preliminary, the results identify a need for additional research in the area. Focused, uniform, experimental designs are required to clearly understand the relationships that exist between mastication, appetite, satiety, food intake and, ultimately, body weight

Understanding the science of portion control and the art of downsizing

Offering large portions of high-energy-dense (HED) foods increases overall intake in children and adults. This is known as the portion size effect (PSE). It is robust, reliable and enduring. Over time, the PSE may facilitate overeating and ultimately positive energy balance. Therefore, it is important to understand what drives the PSE and what might be done to counter the effects of an environment promoting large portions, especially in children. Explanations for the PSE are many and diverse, ranging from consumer error in estimating portion size to simple heuristics such as cleaning the plate or eating in accordance with consumption norms. However, individual characteristics and hedonic processes influence the PSE, suggesting a more complex explanation than error or heuristics. Here PSE studies are reviewed to identify interventions that can be used to downsize portions of HED foods, with a focus on children who are still learning about social norms for portion size. Although the scientific evidence for the PSE is robust, there is still a need for creative downsizing solutions to facilitate portion control as children and adolescents establish their eating habits

Understanding infant eating behaviour – Lessons learned from observation

Observations of human infants during feeding presents a rich source of data to identify the ways in which hunger, appetite and satiety are communicated in early life. Infants signal appetite through their interest or disinterest in food using a series of communication cues from rapid and transient facial expressions to subtle or potent gestures and bodily movements through to vocalisations and eventually speech. Even in the first days of life facial expressions in response to basic tastes are clearly demonstrated and shared between human infants, other primates and the rat. These sensory typical reactions are said to have biological significance since the positive affective response to sweet taste secures a safe and useful source of energy whilst an aversive response to bitter may protect against toxicity. However, beyond these shared responses to basic tastes, the human infant has a sophisticated communication system to demonstrate readiness to eat, avid or waning appetite and satiety. Video capture and behavioural coding of infant communication and caregiver responses during meals reveal the dynamic nature of mealtime interactions. Responsiveness to infant cues is influenced by maternal characteristics and mode of feeding. Breastfeeding facilitates communication by enhancing maternal responsiveness and increasing the frequency of engagement and disengagement cues of the infant. This demonstrates the bi-directionality and interdependence of infant communication during a feed, namely that more responsive feeding for example, through breastfeeding, is associated with more proficient communication by the infant. Overall, observational methods have revealed the complex ways in which infants signal energy needs to their caregivers, and in turn these same methods have captured on film the ways in which carers recognise and react to these signals as part of responsive feeding. Potential applications of these methods includes developing interventions to facilitate infant self-regulation through responsive feeding

Associations between nutritional properties of food and consumer perceptions related to weight management

Consumer perceptions of food (for example, how filling or healthy) influence eating behaviour and appetite control. Therefore approaches to understand the global nutritional attributes of foods that predict the strength of consumer perceptions are of academic and commercial interest. The current research describes the development of a flexible platform for systematically mapping the global nutritional attributes of foods (both objective and perceived) to consumer perceptions of those foods. The platform consists of a database of standardised UK food images (currently n= 300), linked to a catalogue of detailed perceptual, nutritional, sensory, cost, and psychological information ('nutritional attributes'). The platform also incorporates demographic and psychometric questionnaires to examine the importance of nutritional attributes on consumer perceptions within or between relevant target groups. In the current study, the platform was applied to a sample of dieting and non-dieting British men and women (n= 887) to examine the global attributes of a subset of foods (n= 75) and their association with successful weight management (i.e. supportive of weight loss, weight loss maintenance or prevention of weight gain). Generalised linear models identified energy density, cost (£/kcal), perceived energy content and satiating capacity as the main nutritional attributes underlying dieters' and non-dieters' perception of successful weight management food. Additionally, pleasantness, and desire not to (over) eat were uniquely associated with dieters' perception of food as good for weight management; pleasantness was positively associated with weight management and desire to eat was negatively associated with weight management. Therefore, global nutritional attributes of foods can predict and distinguish the extent consumers' perceive a food to be related to successful weight management. This platform will be extended to increase the variety of foods and specificity of nutritional attributes in the database suitable for a range of commercial, academic or clinical research applications

Set points, settling points and some alternative models: theoretical options to understand how genes and environments combine to regulate body adiposity

The close correspondence between energy intake and expenditure over prolonged time periods, coupled with an apparent protection of the level of body adiposity in the face of perturbations of energy balance, has led to the idea that body fatness is regulated via mechanisms that control intake and energy expenditure. Two models have dominated the discussion of how this regulation might take place. The set point model is rooted in physiology, genetics and molecular biology, and suggests that there is an active feedback mechanism linking adipose tissue (stored energy) to intake and expenditure via a set point, presumably encoded in the brain. This model is consistent with many of the biological aspects of energy balance, but struggles to explain the many significant environmental and social influences on obesity, food intake and physical activity. More importantly, the set point model does not effectively explain the &lsquo;obesity epidemic' - the large increase in body weight and adiposity of a large proportion of individuals in many countries since the 1980s. An alternative model, called the settling point model, is based on the idea that there is passive feedback between the size of the body stores and aspects of expenditure. This model accommodates many of the social and environmental characteristics of energy balance, but struggles to explain some of the biological and genetic aspects. The shortcomings of these two models reflect their failure to address the gene-by-environment interactions that dominate the regulation of body weight. We discuss two additional models - the general intake model and the dual intervention point model - that address this issue and might offer better ways to understand how body fatness is controlled

Learning to Eat Vegetables in Early Life: The Role of Timing, Age and Individual Eating Traits

Vegetable intake is generally low among children, who appear to be especially fussy during the pre-school years. Repeated exposure is known to enhance intake of a novel vegetable in early life but individual differences in response to familiarisation have emerged from recent studies. In order to understand the factors which predict different responses to repeated exposure, data from the same experiment conducted in three groups of children from three countries (n = 332) aged 4–38 m (18.9±9.9 m) were combined and modelled. During the intervention period each child was given between 5 and 10 exposures to a novel vegetable (artichoke puree) in one of three versions (basic, sweet or added energy). Intake of basic artichoke puree was measured both before and after the exposure period. Overall, younger children consumed more artichoke than older children. Four distinct patterns of eating behaviour during the exposure period were defined. Most children were “learners” (40%) who increased intake over time. 21% consumed more than 75% of what was offered each time and were labelled “plate-clearers”. 16% were considered “non-eaters” eating less than 10 g by the 5th exposure and the remainder were classified as “others” (23%) since their pattern was highly variable. Age was a significant predictor of eating pattern, with older pre-school children more likely to be non-eaters. Plate-clearers had higher enjoyment of food and lower satiety responsiveness than non-eaters who scored highest on food fussiness. Children in the added energy condition showed the smallest change in intake over time, compared to those in the basic or sweetened artichoke condition. Clearly whilst repeated exposure familiarises children with a novel food, alternative strategies that focus on encouraging initial tastes of the target food might be needed for the fussier and older pre-school children

A low energy dense diet in the context of a weight management program improves appetite control in overweight and obese women

Background: Low energy density foods (LED) reduce energy intake (EI); whether this effect is sustained over time and during weight loss is unknown. Objective: This trial examined the effects of LED compared to high energy density (HED) meals on appetite, EI and control over eating in the laboratory and during a weight management program that encourages unrestricted intake of LED foods [Slimming World, UK (SW)] compared to a self-led Standard Care program [NHS weight loss plan (SC)]. Methods: Overweight and obese women (n=96;age:41.03±12.61 years; BMI:34.00±3.61 kg/m2) were recruited from SW- or SC-program. Primary outcomes included appetite, food preferences (liking and wanting for LED and HED foods), cravings and evening meal EI (LED, HED) in response to calorie-matched LED (≤0.8 kcal/g) and HED (≥2.5 kcal/g) breakfast and lunch meals. Probe day tests were conducted at weeks 3 and 4 and repeated at weeks 12 and 13 in a within-day cross-over design. Secondary outcomes including body weight and program experience were measured from week 1 to 14 in a parallel-group design. Dietary compliance was monitored using weighed food diaries at weeks 3 and 12. Results: Intention-to-treat (ITT) and completers-analyses showed SW lost more weight compared to SC [ITT:-5.9% (95%CI:-4.7, -7.2) versus -3.5% (-2.3,-4.8), p<0.05; completers:-6.2% (-4.8,-7.6) versus 3.9% (-2.5,-5.2), p<0.05]. SW reported greater control over eating and more motivation to continue the program compared to SC. LED meals increased sensations of fullness and reduced hunger on probe days (p<0.001). Total-day-EI was 1057±73 kcal less (95% CI:912, 1203;36%) under LED compared to HED (p<.001). Liking for LED and HED foods and wanting for HED foods were lower pre-lunch under LED compared to HED conditions and liking decreased to a greater extent after the LED-lunch. SW reported fewer cravings under LED compared to HED conditions (p<0.05). On probe days, appetite and EI outcomes did not differ between weeks 3 and 12 or SW- and SC-groups. Conclusion: LED meals improve appetite control in women attempting weight loss and the effect is sustainable. Consumption of LED meals likely contributed to weight loss in the SW-program.ClinicalTrials.gov #NCT02012426

A step-by-step introduction to vegetables at the beginning of complementary feeding. The effects of early and repeated exposure

Breastfeeding (BF) is associated with willingness to accept vegetables. This may be due to the variety of flavours delivered via breast milk. Some mothers add vegetables to milk during complementary feeding (CF) to enhance acceptance. The present study tested a step-by-step exposure to vegetables in milk then rice during CF, on intake and liking of vegetables. Just before CF, enrolled mothers were randomised to an intervention (IG, n = 18; 6 BF) or control group (CG, n = 18; 6 BF). IG infants received 12 daily exposures to vegetable puree added to milk (days 1-12), then 12 × 2 daily exposures to vegetable puree added to rice at home (days 13-24). Plain milk and rice were given to CG. Then both received 11 daily exposures to vegetable puree. Intake was weighed and liking rated on days 25-26 and 33-35 after the start of CF in the laboratory, supplemented by the same data recorded at home. Vegetables were rotated daily (carrots, green beans, spinach, broccoli). Intake, liking and pace of eating were greater for IG than CG infants. Intake and liking of carrots were greater than green beans. However, at 6m then 18m follow up, vegetable (carrot > green beans) but not group differences were observed. Mothers reported appreciation of the structure and guidance of this systematic approach. Early exposure to vegetables in a step-by-step method could be included in CF guidelines and longer term benefits assessed by extending the exposure period