The effect of food type on the portion size effect in children aged 2-12 years: A systematic review and meta-analysis.

Visual cues such as plate size, amount of food served and packaging are known to influence the effects of portion size on food intake. Unit bias is a well characterised heuristic and helps to determine consumption norms. In an obesogenic environment where large portions are common place, the unit or segmentation bias may be overridden promoting overconsumption of both amorphous or unit foods. The aim of this review was to investigate the impact of offering unit or amorphous food on the portion size effect (PSE) in children aged 2-12 years. A systematic search for literature was conducted in Medline, PsycInfo and Web of Science in February 2018. A total of 1197 papers were retrieved following the searches. Twenty-one papers were included in the systematic review, of which 15 provided requisite statistical information for inclusion in a random effects meta-analysis. Increasing children's food portion size by 51-100% led to a significant increase in intake (SMD = 0.47, 95% CI: 0.39-0.55). There was no evidence to suggest that increases in consumption were related to food type (p = 0.33), child age (p = 0.47) or initial portion size served (p=0.14). Residual heterogeneity was not significant (p=0.24). The PSE was demonstrated in children aged 2-12 years when offered both unit and amorphous food items. The effect was not restricted by food type, child age or influenced by initial portion size served. Of the studies included in the meta-analysis between study heterogeneity was low suggesting minimal variation in treatment effects between studies, however, more research is required to understand the mechanisms of the PSE in preschool children. Future research should determine feasible methods to downsize portion sizes served to children.

Dietary patterns of university students in the UK: a cross-sectional study.

BACKGROUND: University represents a key transition into adulthood for many adolescents but there are associated concerns about health and behaviours. One important aspect relates to diet and there is emerging evidence that university students may consume poor quality diets, with potential implications for body weight and long-term health. This research aimed to characterise dietary patterns of university students in the UK and their sociodemographic and lifestyle antecedents. METHODS: An online, cross-sectional survey was undertaken with a convenience sample of 1448 university students from five UK universities (King's College London, Universities of St Andrews, Southampton and Sheffield, and Ulster University). The survey comprised a validated food frequency questionnaire alongside lifestyle and sociodemographic questions. Dietary patterns were generated from food frequency intake data using principal components analysis. Nutrient intakes were estimated to characterise the nutrient profile of each dietary pattern. Associations with sociodemographic variables were assessed through general linear modelling. RESULTS: Dietary analyses revealed four major dietary patterns: 'vegetarian'; 'snacking'; 'health-conscious'; and 'convenience, red meat & alcohol'. The 'health-conscious' pattern had the most favourable micronutrient profile. Students' gender, age, year of study, geographical location and cooking ability were associated with differences in pattern behaviour. Female students favoured the 'vegetarian' pattern, whilst male students preferred the 'convenience, red meat & alcohol' pattern. Less healthful dietary patterns were positively associated with lifestyle risk factors such as smoking, low physical activity and take-away consumption. The health-conscious pattern had greatest nutrient density. The 'convenience, red meat & alcohol' pattern was associated with higher weekly food spending; this pattern was also identified most consistently across universities. Students reporting greater cooking ability tended towards the 'vegetarian' and 'health-conscious' patterns. CONCLUSIONS: Food intake varied amongst university students. A substantial proportion of students followed health-promoting diets, which had good nutrient profiles obviating a need for dietary intervention. However, some students consumed poor diets, incurred greater food costs and practised unfavourable lifestyle behaviours, which may have long-term health effects. University policy to improve students' diets should incorporate efforts to promote student engagement in cooking and food preparation, and increased availability of low cost healthier food items.

Childhood obesity and socioeconomic status: a novel role for height growth limitation.

OBJECTIVE: To assess prevalence and socioeconomic context of overweight and obesity in a cohort of Scottish children. DESIGN: Cross-sectional study. SETTING: Primary schools in Dundee, Angus, and Fife, Eastern Scotland, UK. PARTICIPANTS: A total of 1240 boys and 1214 girls aged between 4-10 y. MAIN OUTCOME MEASURE: Weight, height and body mass index (weight/height2). RESULTS: Overall overweight or obesity prevalence was 24.6%, while prevalence of obesity alone was 6.1%. Individuals from schools with a high level of low-income families were 65% more likely to be overweight as judged by BMI. However, these children weighed the same as more affluent children of the same age, but were 1.26 cm shorter. CONCLUSION: These data confirm the continued increase in childhood obesity in the UK and reveal a role for height-growth limitation in the absence of overall growth restriction, among children from low-income groups. This observation raises important questions regarding socioeconomic environmental factors in promoting the currently increasing levels of obesity.

The Pro12Ala and C-681G variants of the PPARG locus are associated with opposing growth phenotypes in young schoolchildren.

AIMS/HYPOTHESIS: Peroxisome proliferator-activated receptor gamma is an important regulator of adiposity in mouse and man, and common variation in the PPARG gene has been associated with birthweight, adult obesity, insulin sensitivity and type 2 diabetes. We hypothesised that these variants may be associated with childhood obesity. METHODS: Height and weight were recorded for 2454 prepubertal children aged between 4 and 10 years, who were then genotyped for three common variants of the PPARG locus: C-681G, Pro12Ala and C1431T. RESULTS: No single variant of PPARG was significantly associated with height, weight or BMI. However, when modelling the variants together we detected an opposing interaction between the -681G and the Ala12 variants in height and weight, but not BMI (p=0.018, 0.013 and 0.119 respectively). The data were consistent with the Ala12 carriers being deficient in energy storage/utilisation, leading to reduced growth. In contrast, the -681G variant, which has been associated with increased adult height, was associated with accelerated growth. The two variants were in strong linkage disequilibrium. However, rare individuals bearing the isolated variants demonstrated the greatest variation from the mean, the most contrasting genotypes being associated with a variation of 7 kg in weight and 6 cm in height, standardised to 7.4-year-olds (p=0.006 and p=0.02 respectively). CONCLUSIONS/INTERPRETATION: This study demonstrates that quantitative trait analysis of energy balance/growth and the PPARG locus is complex and requires the use of multiple genetic markers.

Investigation into the role of cephalic stimulation of acid secretion on gastric emptying and appetite following a soup meal using the gastric acid inhibitor omeprazole.

We previously showed that oral administration of a liquid soup preload was associated with a slower rate of gastric emptying and suppressed appetite more compared with intragastric administration of the same soup [Appetite 31(1998)377]. The present study was designed to investigate whether these results could be explained by the cephalic stimulation of acid secretion induced by oral administration. Eight healthy male subjects took part in a double-blind placebo controlled study comparing the effects of omeprazole and placebo on gastric emptying, appetite ratings and subsequent food intake following the ingestion of a liquid soup. Subjects were administered with a single oral dose of 80 mg omeprazole or placebo 3 h prior to ingesting the radiolabelled soup preload (400 kcal; 425 ml) over 15 min. Ratings of hunger, desire to eat and fullness were recorded over 135 min and gastric emptying was measured by scintigraphy. Food intake was evaluated from a test meal (yoghurt drink) given 120 min after the end of the soup ingestion. Analysis of data showed that there was no significant difference between omeprazole and placebo in gastric emptying, appetite or subsequent energy intake from the test meal. The results suggest that gastric acid secretion is not responsible for the differences in gastric emptying and appetite observed between intragastrically infused and orally administered soup preloads.

Association of the Pro12Ala and C1431T variants of PPARG and their haplotypes with susceptibility to Type 2 diabetes.

AIMS/HYPOTHESIS: The Pro12Ala polymorphism of peroxisome proliferator-activated receptor (PPAR)gamma has been consistently associated with Type 2 diabetes. The rare Ala12 variant is estimated to reduce the risk of developing Type 2 diabetes by 20 percent. This variant is in linkage disequilibrium with another common variant, T1431. Both have opposing associations with body weight. We therefore examined the association of specific haplotypes marked by these two variants with susceptibility to Type 2 diabetes. METHODS: We determined the PPARG genotype of a large Scottish cohort of Type 2 diabetic patients ( n=1997) and compared allele frequencies with a cohort of local children ( n=2444) and a middle-aged, population-based cohort from Scotland ( n=1061). RESULTS: Frequency of the Ala12 allele was slightly lower in the Type 2 diabetic cohort than in the children [odds ratio (OR)=0.91, p=0.1]. In contrast, the Ala12 variant was under-represented in the Type 2 diabetic population when compared with similarly aged non-diabetic adults (OR=0.74, p=0.0006). When the Ala12 variant was on a haplotype not bearing the 1431T variant, it conferred greater protection (OR=0.66, p=0.003). However, when it was present in haplotypes containing the 1431T variant (70% of Ala12 carriers), this protection was absent (OR=0.99, p=0.94). CONCLUSIONS/INTERPRETATION: We replicated the finding that the Ala12 variant of PPARgamma affords protection from Type 2 diabetes, and suggest that this protection is modulated by additional common variation at the PPARG locus.

Oral, gastric and intestinal influences on human feeding.

Direct infusion of specific nutrients or foods into different areas of the gastrointestinal tract, and techniques to distend the stomach, are useful tools enabling eating behaviour to be studied without the influence of orosensory factors. Using these techniques, the role of nutrients on gastrointestinal mechanisms of satiation as well as the interactions between the various systems in the control of feeding can be examined. Recent research in humans investigating the relative contribution of signals arising from different areas of the gastrointestinal tract has demonstrated that optimal control of appetite occurs only when orosensory signals are coupled with signals arising from the stomach and intestine. Interactions between gastric and intestinal signals do however combine to produce a more potent suppression of appetite and food intake than when either of these sites is stimulated alone. Gastric distension probably exerts a predominate influence on appetite suppression compared with intestinal stimulation, whereas nutrient stimulation of the intestine may function to modulate the sensations arising from gastric distension to elicit a meal-like sensation of satiety. In addition, these studies have highlighted that previous hypotheses concerning differential fat and carbohydrate satiation may require an orosensory component and probably do not reflect an inherent difference in the physiological effects of these macronutrients at the level of the GI tract. The interaction of orosensory influences, such as palatability, with negative feedback signals arising from the GI tract can be further studied using a combination of these techniques with measurement of microstructure of feeding in humans.

Comparison of the effects of a high-fat and high-carbohydrate soup delivered orally and intragastrically on gastric emptying, appetite, and eating behaviour.

To investigate the effects of fat and carbohydrate on appetite, food intake and gastric emptying with and without the influence of orosensory factors, a group of nine healthy, fasted male subjects took part in two separate paired experiments involving high-fat and high-carbohydrate radiolabelled soup preloads. In the first experiment subjects received direct intragastric isocaloric infusions of either a high-fat tomato soup or a high-carbohydrate tomato soup (400 kcal in 425 mL) over 15 min, on two occasions. In the second paired experiment subjects ingested the same high-fat and high-carbohydrate soup over 15 min. In both experiments ratings of hunger and fullness were recorded over a period of 135 min and gastric emptying was measured by scintigraphy. Food intake was evaluated from a test meal (yoghurt drink) given 2 h after the end of the soup infusion/ingestion. When soup was administered intragastrically (Experiment 1) both the high-fat and high-carbohydrate soup preloads suppressed appetite ratings from baseline, but there were no differences in ratings of hunger and fullness, food intake from the test meal, or rate of gastric emptying between the two soup preloads. When the same soups were ingested (Experiment 2), the high-fat soup suppressed hunger, induced fullness, and slowed gastric emptying more than the high-carbohydrate soup and also tended to be more effective at reducing energy intake from the test meal. The results of these studies demonstrate that orosensory stimulation plays an important role in appetite regulation, and also indicate that subtle differences in orosensory stimulation produced by particular nutrients may profoundly influence appetite and gastrointestinal responses.

Effects of intragastric infusions of fat and carbohydrate on appetite ratings and food intake from a test meal.

Previous studies using meal preloads have indicated that carbohydrate has a greater satiating power than fat. To investigate the effects of macronutrients on ingestion and satiety, without the influence of meal design and orosensory factors, two groups of ten healthy, fasted male volunteers took part in two separate experiments involving rapid direct intragastric infusions of macronutrients. In the first experiment volunteers received isocaloric infusions of either Intralipid, or 1:1 Intralipid and glucose mixture or saline over 15 min on three separate occasions. In a second experiment volunteers received isocaloric infusions of either Intralipid or glucose. For both studies, appetite ratings were recorded for the first two hours of the study and energy and macronutrient intakes were evaluated from a test meal given 1.5 h after the infusion. Food diaries were used to monitor food intake for the remainder of the study day. In the first experiment, both Intralipid and the Intralipid/glucose mixture suppressed appetite ratings and reduced energy intake at lunch compared with saline but had no effect on energy intake during the remainder of the study day. No differences were found between nutrient conditions in suppressing appetite ratings or energy intake. In the second experiment there were no differences between the effects of Intralipid and glucose on hunger, fullness or on energy intake from the test meal or intake over the remainder of the day. Taken together, these results suggest that intragastric infusions of either Intralipid, glucose or a mixture of the two, reduced hunger and increased fullness, but they failed to confirm the hypothesis that different macronutrients have different satiating capacities.

Relative contributions of intestinal, gastric, oro-sensory influences and information to changes in appetite induced by the same liquid meal.

To investigate the contribution of oral, gastric and intestinal factors in the control of appetitc, 425 ml (400 kcal) tomato soup was administered either orally, intragastrically (covertly and overtly) or intraduodenally (overtly) to nine healthy, fasted, male volunteers. Ratings of fullness, hunger and desire to eat were recorded over a period of 2 h and gastric emptying was measured after soup fed orally and intragastrically. Infusion of the soup into the small intestine at a rate commensurate with normal gastric emptying exerted no significant suppression of ratings of hunger and desire to eat and no significant production of fullness. Covert, intragastric infusion of the same soup suppressed appetite and this suppression was increased when the subjects were informed of the nature of the infusion, but there were no differences in gastric emptying profiles between covert and overt intragastric infusions of soup. Oral administration of the soup produced the greatest suppression of appetite compared with other conditions and also generated a slower rate of gastric emptying compared with both intragastric soup infusions. Strong correlations were observed between appetite ratings and both gastric and intestinal contents following intragastric infusions of the soup meal and these were enhanced following oral administration of soup. These results indicate how information, orosensory, gastric and intestinal factors can interact to elicit optimal expression of fullness and suppression of hunger. Specifically, the data not only demonstrate how the influence of gastric distension appears to overwhelm any direct influence of intestinal chemostimulation on appetite and how information modulates this effect, but the data also support an important role in appetite suppression for psychophysiological mechanisms stimulated by orosensory mechanisms.