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Biobehavioral Issues Influencing Food Choices and Energy Intake

Biobehavioral Issues Influencing Food Choices and Energy Intake. Susan B. Roberts, PhD Director, Energy Metabolism Laboratory USDA Human Nutrition Research Center on Aging at Tufts University. US Trend in Energy Intake .

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Biobehavioral Issues Influencing Food Choices and Energy Intake

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  1. Biobehavioral Issues Influencing Food Choices and Energy Intake Susan B. Roberts, PhD Director, Energy Metabolism Laboratory USDA Human Nutrition Research Center on Aging at Tufts University

  2. US Trend in Energy Intake • In 1997, per capita energy intake was 340 kcal/d higher than 1984 and 500 kcal/d higher than in 1977 • Reported energy intake by individuals also increased since 1984, by ~ 130-190 kcal/d.

  3. Dietary and Biobehavioral Factors in Food Choices and Energy Regulation DIETARY PATTERNS Palatability/Taste Variety within food groups Food choices Meal/snack patterns Meal size & interval DIETARY PROPERTIES Macronutrients: Physical Properties: Fat Energy Density Protein Fiber (& type) Carb (& type) Food structure (raw vs. cooked etc) Glycemic Index DIETARY BEHAVIOR Restraint/disinhibition Social eating Eating out Societal norms ENERGY INTAKE Body Weight

  4. What causes overeating and weight gain? • Variety • Palatability • Restaurant and other non-home foods • Eating behavior (restraint, disinhibition) • Portion size, Liquid calories • Dietary composition (fat/carbohydrate fiber, glycemic index, energy density, protein)

  5. Experimental Evidence for Dietary Variety Effects on Energy Intake - Animals 1st author, year Animals DV effect? Magnitude Le Magnen, 1956 * Mugford, 1977 ** Louis-Sylvestre, 1983 ** Rolls, 1983 ** Triet, 1983 * Rogers, 1984 ** Clifton, 1987 * DiBattista, 1993 * rats cats rats rats rats rats rats hamsters Yes Yes Yes Yes Yes Yes Yes Yes 72% 47% 46% 15-38% 50-70% 32% 26% 40-100% * Within meal ; ** Between meal

  6. Experimental Evidence for Dietary Variety Effects on Energy Intake - Humans Within or Between Meal 1st author, year Subjects DV effect? Magnitude Pliner, 1980 Bellisle, 1981 Rolls, 1981a Rolls, 1981b Beatty, 1982 Rolls, 1982 Berry, 1985 Speigel, 1990 Brown, 1997 adults adults adults adults adults adults adults adults infants W W W W W W W W B (4 d) Yes Yes Yes Yes Yes Yes Yes Yes Yes 22% 38% 20-33% 110% 120% (women) 0-14% 82% 17-31% 10%

  7. Association Between Dietary Variety and Energy Intake Within Food Groups(McCrory et al. Am J Clin Nutr 1999;69:440) • Dietary variety scores over 6 months were determined by FFQ for 71 U.S. men and women (20-80 y) accurately reporting EI (30% predicted energy requirements) • EI within all food groups studied was significantly related to variety within the food group Variety (% maximum)

  8. Dietary Variety and Body Fatness in the U.S.: Multiple Regression Models(McCrory et al. 1999) VEGETABLES HIGH ENERGY DENSE GROUP • Vegetable variety was inversely associated, and sweets, snacks, condiments, entrees, and carbohydrates variety was positively associated with body fatness • The Variety Ratio (ratio of vegetable to sweets, snacks, condiments, entrees, and carbohydrates variety) was significantly associated with body fatness, but % dietary fat was not

  9. Association of dietary factors and physical activity with body fatness in urban Chinese adults living in Beijing (Yao et al. 2003)

  10. US Trends in Food Supply Variety(McCrory et al. AJCN 1999;69:440, drawn from data in Flegal et al 1998, Gallo 1997) BMI (kg/m2) Prevalence of overweight and obesity (%)

  11. What causes overeating and weight gain? • Variety • Palatability • Restaurant and other non-home foods • Eating behavior (restraint, disinhibition) • Portion size, Liquid calories • Dietary composition (fat/carbohydrate fiber, glycemic index, energy density, protein)

  12. Palatability In dietary surveys, the primary reason why particular foods are chosen is taste, and varied diets are probably more palatable than restricted diets. Cross et al, 1994 Cross et al, 1995 Caltabiano and Shellshear, 1998 Glanz et al, 1998

  13. Palatability Effects on Blood Glucose Response to a Test Meal(Sawaya et al, 2001) Blood Glucose (µ/dl)

  14. What causes overeating and weight gain? • Variety • Palatability • Restaurant and other non-home foods • Eating behavior (restraint, disinhibition) • Portion size, Liquid calories • Dietary composition (fat/carbohydrate fiber, glycemic index, energy density, protein)

  15. Relationship Between Frequency of Restaurant Food Consumption and Body Fatness in U.S. Adults aged 19-80(McCrory et al. Obes Res 1999;7:564) • Assessed by the FHCRC/Block FFQ for the past 6 months, in subjects accurately reporting EI (30% predicted energy requirements) • Analyses are controlled for age, sex, smoking, alcohol intake, education level, and (in n=55) leisure time PAL

  16. Dietary Intake in Relation to Frequency of Consuming RestaurantFood(McCrory et al. Ob Res 1999;7:564) Freq of consuming restaurant food1,2 <4/mo 4-12/mo >12/mo r Total energy (MJ/d) (kJ/kg bw/d) Fat (% energy) Sat fat (% energy) Fiber (g/MJ/d) Alcohol (% energy) 0.58 * 0.42 * 0.28 * 7.9 (1.6) 129 (25) 33 (7) 9.1 (2.1) 135 (24) 35 (7) 10.4 (2.5) 151 (37) 38 (7) 0.29 * -0.45 * 0.06 13 (3) 2.0 (0.7) 2.8 (4.9) 15 (3) 1.6 (0.6) 3.1 (4.7) 12 (3) 2.5 (0.7) 3.4 (5.0) 1 Mean (SD) 2 n = 30, 29 and 14, respectively (71 total) *P < 0.03

  17. Percentage of Daily Meals and Energy Consumed at Home and Away From Home in Americans > 2yrs old Source: USDA/ERS Agricultural Information Bulletin No. 750

  18. What causes overeating and weight gain? • Variety • Palatability • Restaurant and other non-home foods • Eating behavior (restraint, disinhibition) • Portion size, Liquid calories • Dietary composition (fat/carbohydrate fiber, glycemic index, energy density, protein)

  19. Dietary Restraint, Disinhibition, and Hunger Restraint - tendency to restrict food intake to prevent weight gain/promote loss Disinhibition - tendency to overeat in the presence of particular stimuli (e.g. palatable foods, alcohol, emotional distress) Hunger - susceptibility to perceived body symptoms that signal the need for food • Measured using the Eating Inventory (Stunkard and Messick, 1985) • R: “I deliberately take small helpings as a means of controlling my weight.” • D: “I usually eat too much as social occasions, like parties and picnics.” • H: “I am always hungry enough to eat any time.”

  20. Current BMI in relation to tertiles of dietary disinhibition and restraint (Hays et al. 2002) 31.0 32 28.9 30 28.0 28 25.7 Body mass index (kg/m2) 25.6 26 25.3 24 23.3 23.3 23.2 High 22 Med Low 20 Disinhibition tertile Low Med High Restraint tertile Hays et al. 2001 (Am J Clin Nutr in press)

  21. Weight Change in Relation to Eating Behavior * in women between the age intervals 30-39 and 55-60 y (Hays et al, 2002) 20 17.2 18 15.1 16 14 10.3 12 9.6 Weight change (kg) 10 8.6 8.0 8 6 5.3 4 High 4.2 4.0 Med 2 Low Disinhibition 0 Low Med High Restraint

  22. What causes overeating and weight gain? • Variety • Palatability • Restaurant and other non-home foods • Eating behavior (restraint, disinhibition) • Portion size, Liquid calories • Dietary composition (fat/carbohydrate fiber, glycemic index, energy density, protein)

  23. Portion Size, Liquid Calories • Portion size: several studies show increased consumption within meal when portion is larger, even when subjects told more is available (adults, overweight adults, children) • Liquid calories: review by Mattes (1996) indicated 9% higher energy intake at next meal after liquid meal, compared to 64% less after solid meal and 21% less after semi-solid meal.

  24. Dietary Composition • Fat/carbohydrate/energy density • Fiber • Glycemic index • Protein

  25. WEIGHT LOSS WITH CALORIC RESTRICTION (ongoing Tufts EMET study of human caloric restriction) 110 Phase 3 Phase 2 Phase1 90 FASTING WEIGHT RANDOMIZATION 70 70% Modified Pyramid Diet 70% Low Glycemic Index diet 50 0 20 40 60 VISIT WEEK

  26. Dietary and Biobehavioral Factors in Energy Regulation DIETARY PATTERNS Palatability/Taste Variety within food groups Meal/snack patterns Meal size & interval DIETARY PROPERTIES Macronutrients: Physical Properties: Fat Energy Density Protein Fiber (& type) Carb (& type) Food structure (raw vs. cooked etc) Glycemic Index DIETARY BEHAVIOR Restraint/disinhibition Eating out Societal norms Social eating ENERGY INTAKE Body Weight

  27. Future Directions • How important is dietary composition vs. variety, eating out, use of very palatable foods, disinhibited eating patterns, etc? We still don’t know, and need to if effective recommendations are to be developed. • Does dietary composition matter if you want to lose weight? A fairly broad range of diets consistent with current recommendations for health can promote successful weight loss – but we still need to quantify whether these recommended compositions are more effective for weight loss than the dietary compositions (eg low fiber) people prefer to eat

  28. Summary of Outpatient Intervention Studies(Yao & Roberts 2001) • Intervention studies >1 months duration that recommended dietary change were summarized. Only those studies that provided advice and/or supplements but did not provide food were used • There was no effect of study duration on weight loss • Mean effects were greatest for studies making recommendations that increased fat and decreased fiber, and least for those that only increased fat 0.9 kg (n=7) 1.9 kg (n=12) 2.9 kg (n=17) Fat Fiber Fat+Fiber

  29. Dietary Variety and Body Fatness in the U.S.: Multiple Regression Models(McCrory et al. 1999) VEGETABLES HIGH ENERGY DENSE GROUP • Vegetable variety was inversely associated, and sweets, snacks, condiments, entrees, and carbohydrates variety was positively associated with body fatness • The Variety Ratio (ratio of vegetable to sweets, snacks, condiments, entrees, and carbohydrates variety) was significantly associated with body fatness, but % dietary fat was not

  30. Association of dietary factors and physical activity with body fatness in urban Chinese adults living in Beijing (Yao et al. 2003)

  31. Predictors of within-subject day-to-day variability in energy intake (Yao et al. 2003) Model 1 Variables Estimate SE PConstant 4.60 0.54 Energy density (KJ/g) 0.81 0.09 < 0.001 Meals at restaurant 0.47 0.18 0.011 (times/d) Gender1 men 2.36 0.37 < 0.001 1 Estimate = 0 for women

  32. What is the Glycemic Index (GI)? GI is the area under the blood glucose curve after a food amount containing 50 g carbohydrate is consumed. Examples GI White bread 100 Breakfast cereals 90-130 Cookies 90-100 Fruit 40-70 Legumes 30-60 Vegetables 10-60 Glucose 138 Honey 104 Sucrose 92 Fructose 32 HIGH GI LOW GI BLOOD GLUCOSE 0 1 2 TIME AFTER MEAL (HOURS)

  33. Glycemic Index and Subsequent Energy Intake (Roberts, 2000) • In approximately-controlled studies, energy intake after high-GI test meals averaged 29% more than after low GI test meals of the same macronutrient composition (P=0.005 by paired t test)

  34. Ecological Model Exercise Opportunities Exercise duration, intensity Energy Expenditure Geographical location, Society health belief, Food companies/profit, Restaurants, Working hours, Socio-economic status, Family infrastructure, Advertising, Government health programs, Consumer demand, Education Level Knowledge: health risks, nutrition, exercise & weight loss Skills: cooking, shopping, sports and exercise expertise Psychological / Social: self-efficacy, lifestyle, social support, stress and time management, environmental food and exercise norms Cost and Convenience Enjoyment: pleasure from exercise, specific foods Body Fatness Genes Energy Intake Good choices, types, portions Food availability

  35. Dietary Fat and Obesity * • The prevalence of overweight has risen while percent dietary energy from fat has fallen * BMI data from NHANES, food data from USDA surveys

  36. Summary of Outpatient Intervention Studies To Reduce Dietary Fat 0.9 kg (n=7 studies) • Intervention studies >1 months duration that recommended dietary change were summarized. Only those studies that provided advice but did not provide food were used • There was no effect of study duration on weight loss • Mean loss was small (0.9 kg) Fat Reduction

  37. Energy Intake From Covertly Fed Low-Fat vs. High-Fat Diets Matched for Energy Density (Saltzman et al, 1997) • The effects of high fat vs. low fat diets on energy intake were assessed when the diets were matched for energy density and palatability • In a randomized 9d cross-over design in 7 twin pairs there was no significant effect of dietary fat on energy intake

  38. Effect of Fiber on Energy Intake (studies >2 days with control treatment) (reviewed by Howarth et al. Nutr Rev 2001;59:129) • Among 19 studies of fiber and energy intake, 9 were compared to a control treatment and treatments were approximately controlled for other factors influencing EI • No difference between soluble and insoluble fibers. Significantly lower EI in high fiber groups overall (P=0.003) • Effect tended to be greater in obese vs. non-obese (82% of control vs. 94%)

  39. Summary of Fiber Effects on Weight Loss in Ad Libitum Studies (Howarth et al. Nutr Rev 2001;59:129) • In 12 studies >4 weeks duration, average fiber supplement of 12 g/d for 3.8 months was given • Mean weight loss (33 vs. 11 g/day, equivalent to difference of 1.9 kg/study) was greater for high fiber vs control treatments • There was no apparent difference between soluble vs. insoluble fibers, and use of whole foods vs. fiber supplements • Effects tended to be greater in obese than non-obese ((2.4 kg/study vs. 0.8 kg/study) P=0.003

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