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PubMed2005

Patterns of eating and abstinence in women treated for bulimia nervosa.

OBJECTIVE: The current study sought to determine whether there is an optimal pattern of eating leading to cessation of binge eating and purging in bulimic women. METHOD: Data on the number of meals and snacks consumed were obtained from the Eating Disorders Examination (EDE) pretreatment and posttreatment, for individuals participating in a randomized controlled study comparing cognitive-behavioral therapy and interpersonal therapy. Records were available for 158 participants. RESULTS: The numbers of meals and snacks eaten from pretreatment to posttreatment increased significantly. A pattern of eating with at least 80 meals combined with at least 21 afternoon snacks within a 28-day period was associated with an abstinence rate of 70%. In contrast, for subjects having 72-80 meals, those having greater than 11 evening snacks have an abstinence rate of 4%. CONCLUSION: The critical elements of the pattern of eating related to abstinence appear to be the total number of meals consumed and the timing of snacks.

Adult↗

PubMed1987

Vomiting in children following head injury.

The criteria for hospital admission of children who have suffered a minor head injury are highly subjective. Often the presence of post-traumatic emesis becomes an influential factor, but the mechanisms that trigger emesis following minor head injuries are not known. From a prospective study of 96 consecutive children with their first mild head injury (GCS 13-15) and a retrospective study of 29 consecutive more seriously injured children (GCS 8-12), we conclude that post-traumatic emesis is more common: (1) following minor head injuries than following more severe head injuries (P less than 0.05); (2) in children over 2 years old; (P less than 0.001); (3) in children injured within an hour of a meal or snack (p less than 0.001). The presence of a skull fracture or the site of the impact does not influence the incidence or duration of post-traumatic emesis. Retching and vomiting generally subside within 3 h in children injured within an hour of a meal or snack. When vomiting appears in children injured more than an hour after a meal or a snack, it may be quite protracted (mean = 7.5 h). Children over 2 years of age with post-traumatic emesis who are neurologically stable following a mild head injury that occurred within an hour of a meal or snack can be expected to improve quickly. Their counterparts injured more than an hour after a meal or snack are likely to remain distressed much longer and are best admitted to hospital.

Age Factors↗

PubMed2002

Severe catabolic state after prolonged fasting in cirrhotic patients: effect of oral branched-chain amino-acid-enriched nutrient mixture.

BACKGROUND: Cirrhotic patients frequently undergo various medical procedures, such as diagnostic gastrointestinal endoscopy, without taking breakfast. The aim of the present study was to clarify the effect of longer fasting (> 12 h) on energy metabolism, and to test whether supplementation of an oral branched-chain amino-acid-enriched nutrient mixture (BCAA mixture), which contains various nutrients in addition to BCAA, could improve the catabolic state. METHODS: Metabolic measurement was performed in 30 cirrhotic patients and 13 normal subjects, using indirect calorimetry. RESULTS: Compared with that in the normal subjects, the respiratory quotient (RQ) was significantly lower after an overnight fast in the cirrhotic patients, indicating accelerated fat oxidation and a catabolic state. In addition, RQ in cirrhotic patients (n = 7) decreased rapidly with longer fasting, whereas that in the normal subjects (n = 5) showed relatively stable values. These results indicate that special care should be taken with medical procedures that are carried out in patients who have fasted. The effect of oral glucose, a carbohydrate-rich snack (rice ball), and the BCAA mixture (each, 210 kcal) on RQ was studied in 6 normal subjects and 6 patients with liver cirrhosis after an overnight fast. Supplementation of the carbohydrate-rich snack and the BCAA mixture (210 kcal each) elevated RQ and blood glucose levels to a similar degree in the cirrhotic patients. Oral administration of glucose (210 kcal) led to significantly greater elevation of blood glucose levels than the other snacks, which may be unfavorable for cirrhotic patients, who frequently have glucose intolerance. In the 30 cirrhotic patients, supplementation with the BCAA mixture in the late evening significantly improved RQ in the early morning. CONCLUSIONS: Carbohydrate-rich meals are used as a late evening snack in cirrhotic patients, but our study indicates that supplementation with a BCAA mixture can also be used to reduce fat oxidation in the early morning, with results similar to those with carbohydrate-rich snacks.

Administration, Oral↗

PubMed1987

Predicting nocturnal hypoglycemia in patients with type I diabetes treated with continuous subcutaneous insulin infusion.

The incidence of low nocturnal blood glucose values (i.e., less than 65 mg/dl) was assessed in 20 insulin-dependent diabetic patients treated with continuous subcutaneous insulin infusion supported by capillary blood glucose monitoring before each meal and the evening snack. Patients were randomly assigned to a control or experimental group. Both groups followed an identical protocol for the first part of the study (baseline). Patients were instructed to determine capillary blood glucose measurements five times during the night for three consecutive nights. The same procedure was repeated one week later, but this time the subjects in the experimental group were instructed to have an extra snack if capillary blood glucose levels at 10:30 P.M. were 120 mg/dl or less. The control group continued with the usual routine of one evening snack at 9 P.M. At baseline, the incidence of capillary blood glucose values of less than 65 mg/dl was 13 percent. The ingestion of an extra snack at bedtime resulted in the absence of capillary blood glucose values of less than 65 mg/dl in the experimental group, whereas the incidence of capillary blood glucose values of less than 65 mg/dl in the control group remained 13 percent (p = 0.038). The capillary blood glucose concentration at 10:30 P.M. was highly predictive of the risk of nocturnal blood glucose values below 65 mg/dl (p = 0.015) and fasting capillary blood glucose values above 140 mg/dl (p = 0.0001). These data show that nocturnal hypoglycemia may be a considerable problem during continuous subcutaneous insulin infusion therapy even if the basal infusion rate is adjusted in the hospital on the basis of nocturnal blood glucose concentrations. The ingestion of an extra snack at bedtime for capillary blood glucose values below 120 mg/dl has the potential to minimize this risk. The capillary blood glucose concentration at 10:30 P.M. is a significant predictor of nocturnal hypoglycemia.

Adolescent↗

PubMed1990

Improving dietary habits of children: effects of nutrition education and correspondence training.

Evidence that a significant number of children are exposed to risk factors associated with coronary heart disease has prompted health care professionals to develop programs designed to encourage the early development of a healthy life style. The present study used a multiple baseline approach to examine the effects of two procedures on the snack selection behavior of 25 third grade children. In children who selected non-nutritious rather than nutritious snacks for more than 40% of the baseline observations, nutrition education alone had little or no impact on their selection of snacks. However, with the implementation of correspondence training, in which a reward was made contingent upon carrying out a stated intent to choose a nutritious snack, the children consistently chose nutritious snacks. These results indicate that correspondence training may be an efficient and cost-effective way to improve dietary habits of young people.

Behavior Therapy↗

PubMed2000

Parents' restrictive feeding practices are associated with young girls' negative self-evaluation of eating.

OBJECTIVE: This study was conducted to determine whether parents' restriction of young girls' access to palatable foods promotes the consumption of those foods while evoking negative self-evaluation. DESIGN: Girls' intake of 10 snack foods was measured immediately following a standard lunch, in a setting with free access to palatable snack foods. Girls' self-evaluation about their eating was assessed following the free access snack session. In addition, reports of parental restriction were obtained from mothers, fathers, and girls. PARTICIPANTS: Participants were 197 girls aged 4.6 to 6.4 years and their parents. STATISTICAL ANALYSIS: Structural equation modeling was used to test models describing relationships between parents' restriction and girls' eating. RESULTS: Following the standard lunch, girls' snack food intake during the 10-minute free access session ranged from 0 to 436 kcal, with a mean of 123 +/- 7 kcal. Approximately half of the girls reported negative self-evaluation about eating 1 or more of the 10 foods provided. The revised path model indicated that parents' restriction predicted both girls' snack food intake and girls' negative self-evaluation of eating. Girls' negative self-evaluation of eating was not associated with the amount of food that they consumed when not hungry, but was linked to their perceptions of being restricted from those foods. APPLICATIONS/CONCLUSIONS: These findings indicate that restricting young girls' access to palatable foods may promote the intake of restricted foods and may also generate negative feelings about eating restricted foods.

Child↗

PubMed2003

Is olestra consumption associated with changes in dietary intake, serum lipids, and body weight?

OBJECTIVES: There is considerable controversy regarding the effects of fat substitutes (such as the non-caloric fat substitute, olestra) on Americans' diet and health. This report gives associations of olestra consumption (in savory snacks) with changes in nutrient intake, serum lipid concentrations, and body weight 1 y after these snacks became available nationally in the United States. METHODS: Participants were 1178 adults recruited from three large U.S. cities. At baseline (before the availability of olestra), participants attended a clinic visit and completed questionnaires (including a food-frequency questionnaire), provided fasting blood samples, and had height and weight measured. The clinic visit was repeated about 1 y later, after the introduction of olestra-containing snacks in the marketplace. Olestra consumption was categorized as "none," "very low" (>0 to <0.4 g/d), "low" (>/=0.4 to <2.0 g/d), and "moderate/high" (>/=2.0 g/d). RESULTS: Twenty-five percent of participants reported consuming olestra-containing savory snacks in the preceding month, but only 2% were categorized as moderate/high consumers. Men reported nearly twice as much olestra consumption as women (1.22 versus 0.68 g/d, P = 0.01). Among moderate/high olestra consumers, total energy and carbohydrate intakes increased by 209 kcal/d and 37 g/d, compared with decreases of 87 kcal/d and 14 g/d, respectively, among non-consumers (both Ps for trend = 0.01), corresponding to non-significant changes in percentages of energy from carbohydrate and total fat. Olestra consumption was not associated with statistically significant changes in serum lipids or body weight. CONCLUSIONS: This study found very modest changes in total diet, but no changes in serum lipids or body weight, associated with consumption of olestra-containing savory snacks. However, the low use of olestra by the study sample limited the ability of this study to detect significant effects.

Adolescent↗

PubMed2005

Are child eating patterns being transformed globally?

OBJECTIVE: To examine the extent to which child dietary patterns and trends are changing globally. RESEARCH METHODS AND PROCEDURES: Diets of children 2 to 19 years of age were studied with nationally representative data from Russia and the United States, nationwide data from China, and regional data from metropolitan Cebu, Philippines. Twenty-four-hour dietary recalls were examined at several points in time to examine trends in calories consumed away from home, snacking behavior, and soft drink and modern fast food consumption. Urban-rural trends were compared. RESULTS: U.S. and Cebu youth consume more than one-third of their daily calories and a higher proportion of snack calories from foods prepared away from home. In contrast, away from home food consumption is minimal in Chinese and Russian children. U.S. and Cebu youth consume about one-fifth of their total daily energy from snacks, but snacks provide a much lower proportion of energy in Russia ( approximately 16%) and China (where snacks provide only approximately 1% of energy). Fast food plays a much more dominant role in the American diet ( approximately 20% of energy vs. 2% to 7% in the other countries), but as yet does not contribute substantially to children's diets in the other countries. Urban-rural differences were found to be important, but narrowing over time, for China and Cebu, whereas they are widening for Russia. DISCUSSION: This research suggests that globalization of the fast food and other modern food sectors is beginning to affect child eating patterns in several countries undergoing nutrition transition. However, the contribution of fast food and soft drinks to the diet of children remains relatively small in China, Russia, and Cebu, Philippines, relative to the United States.

Adolescent↗

PubMed2003

Moderate physical activity permits acute coupling between serum leptin and appetite-satiety measures in obese women.

OBJECTIVES: To investigate whether moderate physical activity or snack intake influence appetite sensations and subsequent food intake in obese women. Associations between serum leptin and appetite ratings were also investigated. METHODS: In all, 10 obese women (mean age+/-s.d.: 50.0+/-8.5 y; mean body mass index (BMI)+/-s.d.: 37.2+/-6.5 kg m(-2)) were submitted in random order to three trials: Moderate physical activity (20 min brisk walking), Snack (58.5 g chocolate-based) and Control (sitting, TV-watching). Appetite and satiety were assessed by visual analogue scales, and serum leptin, blood glucose and plasma free fatty acids were measured at baseline, pre- and postintervention and 1 h postintervention (ie, before dinner). A buffet-style dinner was provided subsequent to the three trials. RESULTS: The moderate physical activity and snack intake both produced lower appetite and higher satiety and fullness perceptions, compared to control, following the intervention. No significant differences were found in subsequent food intake. Serum leptin concentrations did not differ between trials. Serum leptin was not associated with appetite or satiety sensations at any time during the control or the snack trials, but was correlated following moderate physical activity (prospective food consumption r(s)=-0.83, P=0.003; hunger r(s)=-0.79, P=0.007; desire to eat r(s)=-0.69, P=0.02; satiety r(s)=0.71, P=0.02; fullness r(s)=0.66, P=0.04). These associations were not influenced by BMI or fat mass. CONCLUSIONS: Moderate physical activity and snack intake suppress the appetite of obese women acutely. The associations between circulating leptin and appetite-satiety ratings suggest leptin involvement in short-term appetite regulation in response to physical activity-induced factors.

Adult↗

PubMed2001

A brief dietary assessment instrument for assessing target foods, nutrients and eating patterns.

OBJECTIVE: To develop and validate a new dietary assessment tool, the focused recall, and to use this to measure co-consumption of carotenoid-containing fruits and vegetables with savory snacks. DESIGN: Participants completed a telephone-administered focused recall and a 24-hour recall on the same day. We compared mean estimates of fruit, vegetable, savory snack and carotenoid consumption from both instruments. We also assessed the ability of each method to measure co-consumption of carotenoids with full-fat, reduced/non-fat and olestra-containing savory snacks. SETTING AND SUBJECTS: Data are from 245 male and 244 female adult participants in the Olestra Post-Marketing Surveillance Study (OPMSS). RESULTS: The mean (=/- SD) intake of fruit was 1.8(1.1) servings day(-1) from the focused recall and 1.6 (1.4) servings day(-1) from the 24-hour recall (r=0.56). The mean vegetable intake was 2.1 (1.3) and 2.2 (1.7) servings day(-1) (r=0.42), respectively, from each instrument. Estimates of total carotenoid and beta-carotene intake were within 5% of each other (r= 0.63 for total carotenoids and r= 0.70 for beta-carotene). Both instruments estimated that approximately 14% of total daily carotenoids were co-consumed with savory snacks (r= 0.63). CONCLUSIONS: The focused recall provides valid information about fruit, vegetable and savory snack consumption and allows researchers to examine associated eating patterns more easily.

Adult↗

PubMed2006

Exploring changes in middle-school student lunch consumption after local school food service policy modifications.

OBJECTIVE: This study assessed the impact of changes in school food policy on student lunch consumption in middle schools. METHODS: Two years of lunch food records were collected from students at three middle schools in the Houston, Texas area. During the first year, no changes occurred in the school food environment. After that school year was completed, chips and dessert foods were removed from the snack bars of all schools by the Food Service Director. Students recorded the amount and source of food and beverage items consumed. Point-of-service purchase machines provided a day-by-day electronic data file with food and beverage purchases from the snack bars during the 2-year period. Independent t-tests and time series analyses were used to document the impact of the policy change on consumption and sales data between the two years. RESULTS: In general, student consumption of sweetened beverages declined and milk, calcium, vitamin A, saturated fat and sodium increased after the policy change. Snack chips consumption from the snack bar declined in year 2; however, consumption of snack chips and candy from vending increased and the number of vending machines in study schools doubled during the study period. Ice cream sales increased significantly in year 2. CONCLUSIONS: Policy changes on foods sold in schools can result in changes in student consumption from the targeted environments. However, if all environments do not make similar changes, compensation may occur.

Adolescent↗

PubMed1986

Changes in mood after carbohydrate consumption among obese individuals.

Two groups of obese individuals who consume excessive calories primarily as snack foods have been identified. Carbohydrate cravers consume most or all snacks as carbohydrate-rich foods despite the equal accessibility of protein-rich snacks. Noncarbohydrate cravers consume about equal amounts of protein- and carbohydrate-rich snack foods. Using standardized self-report questionnaires, we measured mood before and 2 h after consumption of a high-carbohydrate lunch (104 g CHO). Responses to the meal differed significantly: noncarbohydrate cravers reported feeling considerably less alert, more fatigued and sleepy, while carbohydrate cravers described little or no change in these aspects of mood. Moreover, noncarbohydrate cravers experienced an increase in depression, while carbohydrate cravers reported feeling less depressed. Findings suggest that snacking habits of obese individuals may be related to subsequent mood states.

Dietary Carbohydrates↗

PubMed1988

Calorie and nutrient intakes of elderly and young subjects measured under identical conditions.

The calorie and nutrient intakes of elderly and young healthy males and females were monitored for four days at the MIT Clinical Research Center. Subjects were free to select foods for meals and snacks from among a variety of high protein and high carbohydrate foods; when necessary, fat was added to make the foods isocaloric. The elderly subjects consumed significantly fewer calories, carbohydrates, and fat than the young subjects, both absolutely and when adjusted for differences in body weight (p less than .001). Mealtime protein intake when adjusted for body weight was similar among males of both age groups and significantly greater than the intakes of both young and elderly females (p less than .001). However, young males consumed more protein from snacks than young females or older adults and thus exhibited the highest daily protein intakes. The two age groups differed significantly in their pattern of food intake from meals and snacks. Elderly adults consumed almost 85% of their total calories from meals, whereas the younger adults consumed about 72% (p less than .001) from meals. Both groups snacked mainly on carbohydrate-rich foods. The elderly subjects consumed significantly fewer snacks than the young; their daily average consumption was 2.2 and that of the young, 4.5 (p less than .001). The persistence of different patterns of food intake between young and elderly individuals when measured under identical clinical conditions suggests that age per se, in addition to age-associated lifestyle changes, may affect eating behavior.

Adult↗

PubMed1997

Evaluation of the potential for olestra to affect the availability of dietary phytochemicals.

It has been hypothesized that phytochemicals found in fruits and vegetables are responsible for the inverse association observed between diets high in fruits and vegetables and risk of certain chronic diseases and cancer. This paper assesses the potential for olestra to affect the absorption of dietary phytochemicals and estimates the effect of olestra on the availability of carotenoids when olestra-containing snacks and foods containing carotenoids are eaten in free-living diets. Experimental data compiled on the effects of olestra on the availability of 29 compounds, mainly nutrients and oral medications, showed that olestra affects the availability of only molecules having octanol-water partition coefficients greater than approximately 7.5. Partition coefficients compiled for 382 dietary phytochemicals showed that only two classes of phytochemicals, phytosterols and carotenoids, contain molecules with octanol-water partition coefficients in the range in which olestra could potentially affect bioavailability. The potential effect on the bioavailability of phytosterols would be <10% and would not be expected to be of concern inasmuch as the hypothesized benefit of consuming pharmacological amounts of phytosterols is to reduce cholesterol availability, a function also of olestra. A 5.9% reduction in the average effective beta-carotene intake was calculated for individuals eating olestra-containing snack foods in free-living diets. The calculation was made by assuming that carotenoid bioavailability would be reduced to the extent measured in human clinical studies each time olestra-containing snacks and carotenoid-containing foods are eaten together and that all snacks eaten are made with olestra. Among individuals with low carotenoid intakes (the lowest 10%) the calculated reduction was 6.0%; for heavy snack eaters (the top 10%) it was 9.5%. These effects on carotenoid bioavailability are similar to those that can occur with other dietary factors.

Adolescent↗

PubMed2006

Meal patterns, dietary fat intake and pancreatic enzyme use in preadolescent children with cystic fibrosis.

OBJECTIVES: To describe the usual pattern of intake and adherence to cystic fibrosis (CF) food and pancreatic enzyme replacement therapy (PERT) recommendations in preadolescent children with CF and pancreatic insufficiency (PI). METHODS: Children, 8 to 11 years old, with CF and PI were assessed for PERT adherence ratio (number taken/number prescribed per day) and energy and fat intake for 7 days (weighed food records), adherence to PERT and dietary recommendations, pulmonary function, growth status and stool fat malabsorption. Using the PERT adherence ratio, children were divided into good (> or =80%), moderate (60% to 79%) and poor (<60%) adherence groups. RESULTS: Of the 75 children (age, 9.3 +/- 1.0 years; forced expiratory volume in 1 s, 95 +/- 14% predicted), 61% consumed less than 120% of energy intake, and 72% consumed less than 40% of calories as fat recommended for CF. Using the PERT adherence ratio (mean +/- SD, 75 +/- 14%), 29%, 61% and 9% of children had good, moderate and poor adherence, respectively. Better adherence to PERT was significantly associated with missing fewer snacks, higher energy intake, greater fat content of snacks and poorer growth status. About 85% of the children were in the 500 to 4000 lipase unit (LU) of PERT (LU/g fat per day) and 500 to 2500 LU/kg per body weight per meal guidelines, whereas only 58% to 68% were within the guidelines for snacks. Eleven percent of children always took PERT at an inappropriate time after meals. CONCLUSIONS: Most preadolescent children with CF and PI did not meet dietary recommendations. Future educational and behavioral interventions focused on increasing PERT adherence with snacks, fat content of meals and snacks, appropriate timing of enzymes and adjustment of PERT and meal fat content are suggested.

Anthropometry↗

PubMed1995

Between-meal eating, toothbrushing frequency and dental caries in 4-year-old children in the north of Sweden.

Two hundred and forty-nine 4-year-old children were examined for dental caries, and data were collected on frequency of toothbrushing, use of fluorides, and intake of nine different snack products. Dental caries experience of children who brushed once or twice daily with parental help was significantly lower than that of children who brushed irregularly. The intake of snacks was high. Buns and cakes, ice cream, and sweet beverages were consumed more often than sweets. Children who had high snack intakes and brushed irregularly had significantly higher caries experience than those with low snack intakes and regular toothbrushing. Therefore irregular toothbrushing was shown to potentiate the impact of frequent snacking.

Analysis of Variance↗

PubMed2005

Dietary habits and children's family lives.

PURPOSE: To investigate associations between 'less healthy eating' and 'unhealthy snacking' at age 11, and family life (family structure, meals and maternal employment status) together with potential socio-economic confounders and gender. METHODS: Children participated in a school-based survey, questionnaires also being completed by parents. Analyses were based on those with complete data, weighted to account for bias in return of parental questionnaires (N = 2146). Data from a dietary inventory, questions on food choice and snacks were used to classify 'less healthy eating' and 'unhealthy snacking'. RESULTS: Less healthy eating' (57%) and 'unhealthy snacking' (32%) were associated with greater deprivation, fewer maternal qualifications and being male. Compared with children of full-time homemakers, the likelihood of 'less healthy eating' was reduced among those whose mothers worked part-time (this effect remaining after socio-economic adjustment), full-time (effect removed after adjustment), or were unemployed, sick or disabled (effect emerging after adjustment). 'Unhealthy snacking' was not related to maternal employment, and neither measure was associated with family structure or daily meals. CONCLUSIONS: There was no evidence that family structure or meals were associated with children's diets, although maternal employment had a positive association. Contrasting with the size of these effects, relationships between diet and socio-economic status were strong.

Adolescent↗

PubMed2004

[Junk food consumption and child nutrition. Nutritional anthropological analysis].

The increasing consumption of junk food and snacks in Chile in recent years and its association with marketing strategies and prevalent diseases, is reviewed. In the context of world economy, junk food is a global phenomenon. The availability of junk food and snacks at low prices and marketing has triggered an evolution of consumption of foods that require neither the structure nor the preparation of a formal meal. Many studies have suggested that the increase in snack consumption is associated with an increase in obesity, tooth decay and other chronic diseases among children and adolescents. The hypothesis suggests a link between the pattern of snack consumption and an increase increase in the energy density of food consumed, a decrease in satiety, passive over consumption, and an increase in obesity. Between 1977 and 1996, the contribution: of snacks to daily energy intake among children between 2 and 5 years increased by 30% in the United States. In each age group in Chile the frequency of non-transmissible chronic diseases is increasing due primarily to a westernized diet that is high in fat, cholesterol, sodium, and sugar and a sedentary lifestyle. Education about junk food consumption and healthy eating habits in the family, starling since childbirth and public policies about healthy lifestyles should be strengthened.

Anthropology↗