Inequalities in education and national income are associated with poorer diet: Pooled analysis of individual participant data across 12 European countries.

BACKGROUND: Malnutrition linked to noncommunicable diseases presents major health problems across Europe. The World Health Organisation encourages countries to conduct national dietary surveys to obtain data to inform public health policies designed to prevent noncommunicable diseases. METHODS: Data on 27334 participants aged 19-64y were harmonised and pooled across national dietary survey datasets from 12 countries across the WHO European Region. Weighted mean nutrient intakes were age-standardised using the Eurostat 2013 European Standard Population. Associations between country-level Gross Domestic Product (GDP) and key nutrients and nutrient densities were investigated using linear regression. The potential mitigating influence of participant-level educational status was explored. FINDINGS: Higher GDP was positively associated with total sugar intake (5·0% energy for each 10% increase in GDP, 95% CI 0·6, 9·3). Scandinavian countries had the highest vitamin D intakes. Participants with higher educational status had better nutritional intakes, particularly within lower GDP countries. A 10% higher GDP was associated with lower total fat intakes (-0·2% energy, 95% CI -0·3, -0·1) and higher daily total folate intakes (14µg, 95% CI 12, 16) in higher educated individuals. INTERPRETATION: Lower income countries and lower education groups had poorer diet, particularly for micronutrients. We demonstrate for the first time that higher educational status appeared to have a mitigating effect on poorer diet in lower income countries. It illustrates the feasibility and value of harmonising national dietary survey data to inform European policy regarding access to healthy diets, particularly in disadvantaged groups. It specifically highlights the need for strong policies supporting nutritional intakes, prioritising lower education groups and lower income countries.

Weight loss maintenance in overweight subjects on ad libitum diets with high or low protein content and glycemic index: the DIOGENES trial 12-month results.

BACKGROUND: A high dietary protein (P) content and low glycemic index (LGI) have been suggested to be beneficial for weight management, but long-term studies are scarce. OBJECTIVE: The DIOGENES randomized clinical trial investigated the effect of P and GI on weight loss maintenance in overweight or obese adults in eight centers across Europe. This study reports the 1-year results in two of the centers that extended the intervention to 1 year. METHOD: After an 8-week low-calorie diet (LCD), 256 adults (body mass index >27 kg m(-)(2)) were randomized to five ad libitum diets for 12 months: high P/LGI (HP/LGI), HP/high GI (HP/HGI), low P/LGI (LP/LGI), LP/HGI and a control diet. During the first 6 months, foods were provided for free through a shop system and during the whole 12-month period, subjects received guidance by a dietician. Primary outcome variable was the change in body weight over the 12-month intervention period. RESULTS: During the LCD period, subjects lost 11.2 (10.8, 12.0) kg (mean (95% confidence interval (CI))). Average weight regain over the 12-month intervention period was 3.9 (95% CI 3.0-4.8) kg. Subjects on the HP diets regained less weight than subjects on the LP diets. The difference in weight regain after 1 year was 2.0 (0.4, 3.6) kg (P=0.017) (completers analysis, N=139) or 2.8 (1.4, 4.1) kg (P<0.001) (intention-to-treat analysis, N=256). No consistent effect of GI on weight regain was found. There were no clinically relevant differences in changes in cardiometabolic risk factors among diet groups. CONCLUSION: A higher protein content of an ad libitum diet improves weight loss maintenance in overweight and obese adults over 12 months.

Experience and acceptability of diets of varying protein content and glycemic index in an obese cohort: results from the Diogenes trial.

BACKGROUND/OBJECTIVES: To investigate acceptability and tolerability of diets of different protein and glycemic index (GI) content aimed at weight maintenance following a phase of rapid weight loss, as part of a large pan-European dietary intervention trial. SUBJECTS/METHODS: The Diogenes study (www.diogenes-eu.org) consisted of an initial 8-week rapid weight-loss phase (800-1000 kcal/day), followed by a 6-month weight maintenance intervention with five different diets varying in protein and GI content. Measurement of a range of outcomes relating to experience of the Diogenes diets in terms of acceptability, experience and mood were recorded via end of day questionnaires throughout the study. RESULTS: Weight change during the initial weight loss phase weakly, but positively correlated with acceptability of the programme (r range=-0.08 to 0.2, P 0.05, n=685 on four of five dimensions). Success at weight maintenance positively correlated with acceptance of the programme (r range=-0.21 to -0.34, P<0.001, n=540 for all five dimensions). The diets with higher protein content were more acceptable than the low protein (LP) diets, however, no differences between the high vs low GI diets were found concerning acceptability and tolerability. CONCLUSIONS: Results suggest that moderately high protein diets, compared with LP diets, are more acceptable diets for weight control in overweight individuals.

Decreased energy density and changes in food selection following Roux-en-Y gastric bypass.

BACKGROUND/OBJECTIVES: The main objective was to test the hypothesis that dietary energy density (DED) decreases after Roux-en-Y gastric bypass (gastric bypass). SUBJECTS/METHODS: A total of 43 patients (31 women and 12 men) aged 43 (s.d. 10) years, with body mass index (BMI) 44.3 kg/m(2) (4.9), were assessed preoperatively at 6 weeks and 1 and 2 years after gastric bypass. Self-reported energy intake (EI), food weight (FW) and food choice were assessed using a dietary questionnaire. DED was calculated by dividing EI by FW (kcal/g). Number of dropouts was 4 of 203 visits. RESULTS: Percent weight loss (%WL) was 13.5% at 6 weeks, 30.7% at 1 year and 31.8% at 2 years post surgery (P<0.001 for all). EI decreased from 2990 to 1774, 2131 and 2425 kcal after 6 weeks and 1 and 2 years postoperatively, respectively (P<0.001 at all time points). FW changed from 2844 to 1870 g/day at 6 weeks (P<0.001) and 2416 g/day after 1 year (P<0.05), but was not significantly different from baseline 2 years postoperatively (2602 g/day, P=0.105). DED decreased from 1.07 to 0.78 kcal/g at 6 weeks (P<0.001) and 0.90 kcal/g (P<0.001) and 0.96 kcal/g (P=0.001) after 1 and 2 years, respectively. All statistical comparisons were made from baseline. There was no correlation between changes in DED and %WL, neither after 1 year (r=-0.215; P=0.183) nor after 2 years (r=-0.046; P=0.775) post surgery. CONCLUSIONS: Besides substantial reduction in EI and large variation in FW, patients reported decreased DED over 2 years following gastric bypass. Despite lack of association between the reduction in DED and percentage weight loss, changes in food choice were overall nutritionally beneficial.

Alcohol and macronutrient intake patterns are related to general and central adiposity.

BACKGROUND/OBJECTIVES: Alcohol and dietary fat have high energy densities and may therefore be related to body weight and fat deposition. We studied associations between alcohol and macronutrient intake patterns and general and central adiposity. SUBJECTS/METHODS: A population-based cross-sectional study of 524 men and 611 women. The participants answered a dietary questionnaire describing habitual food consumption including intake of alcoholic beverages. Macronutrient intake was analysed in relation to anthropometric measures and dual energy X-ray absorptiometry determined body fat. RESULTS: In women, total alcohol intake was negatively associated with body fat percentage (ß:-0.67, P<0.01). In men, total alcohol intake was positively associated with sagittal abdominal diameter (SAD) (ß: 0.28, P=0.01). In addition, positive associations were found between intake of alcohol from spirits and body fat percentage (ß: 1.17, P<0.05), SAD (ß: 0.52, P<0.05) and waist circumference (ß: 2.29, P=0.01). In men, protein intake was positively associated with body mass index (BMI) (ß: 0.03, P=0.001), body fat percentage (ß: 0.04, P<0.05), SAD (ß: 0.02, P=0.01) and waist circumference (ß: 0.09, P<0.01). Also in men only, negative associations between fat intake and BMI (ß: -0.03, P<0.01), SAD (ß: -0.02, P<0.05) and waist circumference (ß: -0.05, P<0.05) were found. CONCLUSIONS: Alcohol intake was inversely associated to relative body fat in women whereas spirits consumption was positively related to central and general obesity in men. Macronutrient intakes, particularly protein and fat, were differently associated with obesity indicators in men versus women. This may reflect a differential effect by gender, or differential obesity related reporting errors in men and women.

Effects of bariatric surgery on disability pension in Swedish obese subjects.

BACKGROUND: Prospective controlled data on the long-term effects of bariatric surgery on disability pension are not available. This study prospectively compare disability pension in surgically and conventionally treated obese men and women. METHODS: The Swedish obese subjects study started in 1987 and involved 2010 obese patients who had bariatric surgery and 2037 contemporaneously matched obese controls, who received conventional treatment. Outcomes of this report were: (i) incidence of disability pension from study inclusion to 31 December 2006 in all subjects, and, (ii) number of disability pension days over 10 years in a subgroup of individuals (N=2901) followed for at least 10 years where partial pensions were recalculated to full number of days per year. Objective information on granted disability pension was obtained from the Swedish Social Insurance Agency and disability pension follow-up rate was 99.9%. RESULTS: In men, the unadjusted incidence of disability pension did not differ between the surgery and control groups (N=156 in both groups). When adjusting for baseline confounders in men, a reduced risk of disability pension was suggested in the surgery group (hazard ratio 0.79, 95% confidence interval 0.62-1.00; P=0.05). Furthermore, the adjusted average number of disability pension days was lower in the surgery group, 609 versus 734 days (P=0.01). In women, bariatric surgery was not associated with significant effects on incidence or number of days of disability pension. CONCLUSION: Bariatric surgery may be associated with favourable effects on disability pension for up to 19 years in men whereas neither favourable nor unfavourable effects could be detected in women.

Impact of weight change, secular trends and ageing on cardiovascular risk factors: 10-year experiences from the SOS study.

OBJECTIVE: Many short-term studies indicate that 5% weight loss in the obese is enough to induce significant improvements of cardiovascular risk factors. However, it is not known what degree of weight loss is required to improve risk factors over a more extended period of time or how ageing and secular trends per se are influencing risk factors during long-term follow-up. METHODS: Patients examined after 10 years in the intervention study Swedish Obese Subjects were used for the current analysis. Surgically treated subjects (n=959) and conventionally treated obese controls (n=842) were pooled to obtain a study group with a large range of weight changes. The patients were divided in 11 groups based on the amount of weight change. Analysis of covariance was used to determine the necessary weight change over 10 years for a significant alteration of a risk factor. In a linear regression of risk factor change by weight change, the y intercept was interpreted as the effect of 10 years ageing and secular trends on a given risk factor in the absence of weight change. RESULTS: The necessary weight loss for significant improvement of risk factors ranged from 10 to 44 kg. At zero weight change, 10 years of ageing was associated with significant increases in systolic blood pressure, pulse pressure, high-density lipoprotein cholesterol and glucose, and with significant decreases in diastolic blood pressure, total cholesterol, triglycerides and insulin. CONCLUSIONS: The necessary weight loss to maintain a favourable effect on risk factors in an obese population is larger than previously indicated by short-term studies. Treatment effects are influenced by non-weight change-dependant shifts in risk factor levels.

Objectively measured physical activity and obesity prevention in children, adolescents and adults: a systematic review of prospective studies.

This study aimed at synthesizing the prospective associations between measured physical activity (PA) and change in adiposity in children, adolescents and adults following from two previous reviews. Search terms were adapted and a systematic literature search was conducted (January 2000-September 2008) and later updated (up to October 2009), considering observational and intervention studies of weight gain that measured both PA and body composition. Sixteen observational studies (six comprising adults) and five trials (one comprising adults) were eligible. For consistency, whenever possible either baseline PA energy expenditure or accelerometer output (counts min(-1) ) and change in per cent body fat were the extracted exposure and outcome measures. Results of observational studies suggest that PA is not strongly prospectively related with adiposity: five studies on children and three on adults reported no association between baseline PA and change in adiposity, one study found a weak positive association and the other studies observed a weak negative association. Negative associations were more frequently observed in studies that analysed the association between change in the exposure and outcome. Intervention studies show generally no effect on either PA or adiposity. In conclusion, despite the well-established health benefits of PA, it may not be a key determinant of excessive gain in adiposity.

Developing a methodology for assigning glycaemic index values to foods consumed across Europe.

There is growing evidence that the glycaemic index (GI) of the diet is important with respect to body weight and metabolic disease risk. However, research is limited by the paucity of GI values for commonly consumed carbohydrate-rich foods in European countries. A new methodology has been developed for consistent assignment of GI values to foods across five European databases used in the Diogenes intervention study. GI values were assigned according to five decreasing levels of confidence (1) Measured values for specific foods; (2) Published values from published sources; (3) Equivalent values where published values for similar foods existed; (4) Estimated values assigned as one of three values representing low/medium/high GI ranges and (5) Nominal values assigned as 70, where no other value could be assigned with sufficient confidence. GI values were assigned to 5105 foods. In food records collected at baseline, the contribution to carbohydrate intake of foods assigned levels 1-2 ranged from 16% to 43% depending on country, and this increased to 53-81% including level 3 foods. The degree of confidence to assigned GI values differed across Europe. This standardized approach of assigning GI values will be made available to other researchers to facilitate further investigation into the effects of dietary GI on health.

Dietary strategy to manipulate ad libitum macronutrient intake, and glycaemic index, across eight European countries in the Diogenes Study.

The aim of this study was to describe the development and implementation of a multifaceted, low-fat, weight-loss strategy for a Pan-European randomized controlled dietary intervention study, Diogenes. There were 891 families with at least one overweight/obese parent who underwent screening. Eligible, overweight/obese adults followed an 8-week weight-loss phase with a fixed low-energy diet (800 kcal). On attaining weight loss of > or = 8%, families were randomized to a 6- or 12-month low-fat (25-30%E) diet either based on national dietary guidelines or one of four interventions: low protein (LP)/low glycaemic index (LGI), LP/high GI (HGI), high protein (HP)/LGI and HP/HGI. The impact of each diet in preventing weight (re)gain was tested. A points-based system was used to manipulate dietary protein and carbohydrate. Manipulating carbohydrate composition involved substituting foods with a relatively high or low GI. A questionnaire was designed and completed by study investigators, providing feedback on the dietary intervention methods used to inform future interventions. The points system allowed macronutrient manipulations without compromising dietary flexibility or enforcing energy restrictions. Reported centre/participant differences in the ease of implementing the intervention may reflect dietary diversity and personal preferences for specific weight-management strategies. The points system provides a useful starting point for designing improved experimental paradigms for the manipulation of dietary intake in future trials.

Reflections from a systematic review of dietary energy density and weight gain: is the inclusion of drinks valid?

The association between dietary energy density, increased energy intake and weight gain is supported by experimental evidence, but confirmation of an effect in free-living humans is limited. Experimental evidence supports a role of energy density in obesity through changes in food composition, not drinks consumption. The inclusion of drinks in the calculation creates a variable of questionable validity and has a substantive impact on the estimated energy density of the diet. We posit, based on the experimental evidence, that calculating the energy density of diets by excluding drinks and including calories from drinks as a covariate in the analysis is the most valid and reliable method of testing the relationship between energy density and weight gain in free-living humans. We demonstrate, by systematically reviewing existing observational studies of dietary energy density and weight gain in free-living humans, how current variation in the method for calculating energy density hampers the interpretation of these data. Reaching an a priori decision on the appropriate methodology will reduce the error caused by multiple comparisons and facilitate meaningful interpretation of epidemiological evidence to inform the development of effective obesity prevention strategies.

Should snacks be recommended in obesity treatment? A 1-year randomized clinical trial.

OBJECTIVE: To study the effect to recommend no snacks vs three snacks per day on 1-year weight loss. The hypothesis was that it is easier to control energy intake and lose weight if snacks in between meals are omitted. SUBJECTS/METHOD: In total 140 patients (36 men, 104 women), aged 18-60 years and body mass index>30 kg/m(2) were randomized and 93 patients (27 men, 66 women) completed the study. A 1-year randomized intervention trial was conducted with two treatment arms with different eating frequencies; 3 meals/day (3M) or 3 meals and 3 snacks/day (3+3M). The patients received regular and individualized counseling by dieticians. Information on eating patterns, dietary intake, weight and metabolic variables was collected at baseline and after 1 year. RESULTS: Over 1 year the 3M group reported a decrease in the number of snacks whereas the 3+3M group reported an increase (-1.1 vs +0.4 snacks/day, respectively, P<0.0001). Both groups decreased energy intake and E% (energy percent) fat and increased E% protein and fiber intake but there was no differences between the groups. Both groups lost weight, but there was no significant difference in weight loss after 1 year of treatment (3M vs 3+3M=-4.1+/-6.1 vs -5.9+/-9.4 kg; P=0.31). Changes in metabolic variables did not differ between the groups, except for high-density lipoprotein that increased in the 3M group but not in 3+3M group (P<0.033 for group difference). CONCLUSION: Recommending snacks or not between meals does not influence 1-year weight loss.

Eating habits in relation to body fatness and gender in adolescents--results from the 'SWEDES' study.

OBJECTIVE: To investigate if eating habits among adolescents are related to body fatness and gender. DESIGN: Cross-sectional study. SETTING: Obesity Unit, Huddinge University Hospital, Sweden, 2001-2002. SUBJECTS: Two hundred and seventy-five girls and 199 boys, aged 16-17 years. METHOD: Questionnaires were used for dietary intake and meal frequency, BodPod for measuring body fatness (BF%). In all, 169 girls and 128 boys were classified as adequate reporters (AR) of energy intake, and were used in the dietary analyses. The whole sample was used in the meal frequency analyses. RESULTS: The correlation between reported energy intake and weight in the AR group was 0.23 (P<0.01) for girls and 0.36 for boys (P<0.001). The correlations were inverse or not significant in the whole sample. The following variables correlated significantly with a high BF% (r (s)=+/-0.2): a low intake of milk in both girls and boys, a high intake of fibre and alcohol and a low intake of sugar in girls and a low intake of breakfast cereals in boys. Those with regular breakfast habits had healthier food choices than others, but this was not related to BF%. Boys had more meals per day (4.9 vs 4.6, P=0.02), especially early in the morning and late at night, whereas girls reported a higher relative intake of light meals and fruit and a lower intake of milk than boys. CONCLUSIONS: A few associations between eating habits and body fatness were found, but without any obvious patterns. The true differences in eating habits between lean and overweight adolescents are probably very small.

Snacking frequency in relation to energy intake and food choices in obese men and women compared to a reference population.

OBJECTIVE: To investigate snacking frequency in relation to energy intake and food choices, taking physical activity into account, in obese vs reference men and women. DESIGN: Cross-sectional, descriptive study. SUBJECTS: In total, 4259 obese, middle-aged subjects (1891 men and 2368 women) from the baseline examination of the XENDOS study and 1092 subjects (505 men and 587 women) from the SOS reference study were included. MEASUREMENTS: A meal pattern questionnaire describing habitual intake occasions (main meals, light meals/breakfast, snacks, drink-only), a dietary questionnaire describing habitual energy and macronutrient intake and a questionnaire assessing physical activity at work and during leisure time were used. RESULTS: The obese group consumed snacks more frequently compared to the reference group (P<0.001) and women more frequently than men (P<0.001). Energy intake increased with increasing snacking frequency, irrespective of physical activity. Statistically significant differences in trends were found for cakes/cookies, candies/chocolate and desserts for the relation between energy intake and snacking frequency, where energy intake increased more by snacking frequency in obese subjects than in reference subjects. CONCLUSION: Obese subjects were more frequent snackers than reference subjects and women were more frequent snackers than men. Snacks were positively related to energy intake, irrespective of physical activity. Sweet, fatty food groups were associated with snacking and contributed considerably to energy intake. Snacking needs to be considered in obesity treatment, prevention and general dietary recommendations.

A comparative controlled study of personality in severe obesity: a 2-y follow-up after intervention.

OBJECTIVE: The primary purpose was to examine 2-y effects of weight change on personality traits in severely obese subjects treated conventionally or surgically. We also assessed differences between the severely obese patients and a primarily normal-weight reference group. METHOD: Personality traits were assessed using 7 of 15 scales from the Karolinska Scales of Personality (KSP): Somatic Anxiety, Muscular Tension, Psychasthenia, Psychic Anxiety, Monotony Avoidance, Impulsiveness, and Irritability. A total of 1380 surgical candidates, 1241 conventionally treated patients and 1135 subjects from the SOS (Swedish Obese Subjects) reference study, representing the general population, completed the KSP. Data presented in this study were gathered twice from the patients (prior to treatment and after 2 y) and once from the reference subjects. Significance tests and effect sizes (ES) were calculated. RESULTS: At baseline, the obese were characterised as more anxiety prone, impulsive, irritable and less monotony avoiding than the reference group; surgery patients more so than the conventionally treated. At follow-up, it was found that anxiety proneness decreased and Monotony Avoidance increased with increasing weight loss. The conventionally treated were, on average, weight stable and, hence, only a small decrease was noted regarding Somatic Anxiety. The surgery group lost on average 28 kg, and differences between surgically treated and the reference group decreased on all scales except Impulsiveness, which remained unchanged. The largest improvement was in relation to Psychasthenia. CONCLUSIONS: Weight reduction maintained for 2 y was associated with changes on practically all personality traits in proportion to the magnitude of weight loss. In particular, Psychasthenia seemed to be alleviated, while Impulsiveness was unaffected.

Body composition in the SOS (Swedish Obese Subjects) reference study.

OBJECTIVE: The primary objective was to establish population-based, sex- and age-specific reference data with respect to body composition variables. Secondary objectives were to relate body mass index (BMI) to anthropometric measurements reflecting central adiposity and to body fat (BF). Another objective was to examine if secular changes in adipose tissue distribution occurred during the sampling period, 1994-1999. DESIGN: Sex- and age-specific data on anthropometric measurements and body composition were cross-sectionally collected in the reference study of Swedish Obese Subjects. SUBJECTS: In total, 1135 randomly selected subjects (524 men and 611 women), aged 37-61 y, BMI 17.6-45.4 kg/m(2). MEASUREMENTS: Measures of body fatness and fat distribution (by dual energy X-ray absorptiometry and anthropometry) were collected. RESULTS: At BMI 25 kg/m(2), relative (absolute) BF mass was 24% (19 kg) in men vs 36% (25 kg) in women, waist circumference was 90 vs 85 cm, and sagittal trunk diameter was 21 vs 19 cm. BF and measures of centralized adipose tissue distribution increased with age in both sexes (P<0.01). In women, waist circumference and sagittal diameter increased (P<0.01) over the sampling period while BMI did not. CONCLUSIONS: Sex- and age-specific reference data on body composition are reported from a randomly selected sample of Swedish men and women. At given BMIs, women had more BF but smaller waist circumference than men. Secular increases in indices of central obesity were found in women but not in men.

Severe obesity and personality: a comparative controlled study of personality traits.

OBJECTIVE: The primary purpose was to assess personality trait differences between the severely obese seeking treatment and a mainly non-obese reference group. We also investigated gender differences and differences between obese patients and obese not seeking treatment. METHOD: Personality traits were assessed using 7 of 15 scales from the Karolinska Scales of Personality (KSP): Somatic Anxiety, Muscular Tension, Psychastenia, Psychic Anxiety, Monotony Avoidance, Impulsiveness, and Irritability. Patients from the Swedish Obese Subjects (SOS) intervention study (n=3270, ages 37-57, 71% women) and the SOS reference study (n=1135, 54% women) completed the survey. Data presented in this study were gathered prior to treatment. Significance tests and effects sizes were calculated. RESULTS: Although statistically significant differences were found between obese patients and reference subjects on nearly all personality traits, effect sizes were at most moderate. Of the three scales with moderate effects sizes, differences on Somatic Anxiety and Psychastenia could be traced to items tapping condition-specific symptoms, e.g., problems with sweating and breathing as indicators of Somatic Anxiety. Moderate differences on the Impulsiveness scale (men alone) could not be explained by item composition. Further, the obese patients differed from obese in the reference group, and both obese and reference women reported significantly higher levels on Somatic Anxiety, Muscular Tension and Psychic Anxiety compared to men (effect size: small). CONCLUSIONS: Our results provided no evidence of a general obese personality profile, instead considerable heterogeneity in personality traits was observed across our obese samples (treatment seekers vs non-seekers, men vs women) and generally only small differences were noted compared to a reference study population. Further research is needed to investigate if the somewhat elevated levels of Impulsiveness, particularly among male obese patients, is affected by weight loss. When assessing personality traits in diseased groups consideration should be given to possible confounding from, e.g., somatic symptoms.

Intake of sweet foods and counts of cariogenic microorganisms in relation to body mass index and psychometric variables in women.

OBJECTIVE: As a part of the SPAWN (Stockholm Pregnancy and Women's Nutrition) study, the intake of sweet foods (habitual and pre-menstrual intakes) and the number of cariogenic microorganisms in saliva was analysed in relation to body mass index (BMI) and psychometric variables. DESIGN: A cross-sectional study. SUBJECTS: Three hundred and sixty-two women with a median BMI of 24.2 kg/m(2) (range 17.5-47.8) and 45 y of age (range 34-64). METHODS: A questionnaire of sweet food intake, salivary counts of mutans streptococci and lactobacilli and a self-rating scale on psychometric variables (CPRS-S-A). RESULTS: The number of mutans streptococci correlated with BMI (P<0.05), indirectly indicating a higher intake of sweet foods in obese women. The reported energy intake of sweet foods (more specifically the intake of chocolate), correlated with CPRS scores (P<0.01), indicating that women with more severe psychiatric symptomatology have higher intakes of sweet foods. CONCLUSIONS: This study suggests that women with higher CPRS score have higher energy intakes of sweet foods, indicating a possible link between mood regulation and the intake of sweet food. SPONSORSHIP: Karolinska Institute Research Funds.

Meal patterns and obesity in Swedish women-a simple instrument describing usual meal types, frequency and temporal distribution.

OBJECTIVE: To characterize meal patterns in relation to obesity in Swedish women using a simple instrument describing meal frequency, meal types and temporal distribution. DESIGN: Cross-sectional parallel group design. SUBJECTS: Eighty-three obese women from the Swedish Obese Subjects (SOS) study were compared with 94 reference women, randomly recruited from the population. METHOD: A new, simplified and self-instructing questionnaire was used to assess meal patterns. Usual meal pattern was reported as time and meal type for each intake episode during a typical day. RESULTS: The obese women consumed 6.1 meals/day compared with 5.2 meals/day among the reference women (P<0.0001). All types of meals except 'drink meals' were significantly more frequently consumed in the obese group. The obese women also displayed a different meal pattern across the day, consuming a larger number of meals later in the day. As a result a larger fraction of each obese woman's total meals were consumed in the afternoon and in the evening/night. There was no difference in the number of obese vs reference women consuming breakfast. Snack meals were positively associated with total energy intake in both groups. CONCLUSIONS: A new simplified method assessing meal pattern revealed that the number of reported intake occasions across a usual day was higher in obese women compared with controls and the timing was shifted to later in the day. These findings should be considered in the treatment of obesity.

Intake of sweet foods and counts of cariogenic microorganisms in obese and normal-weight women.

OBJECTIVE: To study the intake of sweet foods in obese and normal-weight women, while also taking menstrual cycle effects on eating behaviour into consideration. An objective test of the intake of sugar-containing foods was introduced by measuring salivary counts of mutans streptococci and lactobacilli. DESIGN: A cross-sectional comparison of the intake of sweet foods in obese and normal-weight women. The obese women were also studied longitudinally after 10 weeks in a weight reduction programme. SUBJECTS: Obese (n=72, body mass index (BMI) 42.0+/-5.2 kg/m2) and normal-weight women (n=67, BMI 22.2+/-1.6 kg/m2) participated. RESULTS: Mutans streptococci in saliva were higher in obese than in normal-weight women (P<0.0001), although the reported habitual daily intake of sweet foods did not differ. Of the menstruating women, 80% of the obese subjects and 62% of the normal-weight ones (P<0.05) reported periods during the menstrual cycle with an 'extra large' intake of sweet foods; these intakes were higher in obese than in normal-weight women (P<0.01). The obese women reduced their intake of sweet foods after 10 weeks of weight reduction, although these changes were not pronounced enough to significantly affect the counts of cariogenic microorganisms. CONCLUSIONS: In contrast to most previous cross-sectional studies, this study shows that obese women have a higher intake of sweet foods, especially pre-menstrually. This was indicated by higher salivary counts of cariogenic microorganisms. SPONSORSHIP: Karolinska Institute Research Funds.