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PubMedDate not supplied

Preprogrammed intravenous insulin infusion in diabetic humans: metabolic consequences of altering meal size.

New implantable, variable-rate, intravenous insulin infusion systems offer the possibility of increased dietary flexibility in the treatment of diabetes mellitus. However, the development of insulin infusion algorithms required to maintain near-normal glycemia in the presence of a nonconstant diet first requires information concerning the metabolic response to meals of varying size when the insulin dose is fixed. With this goal in mind, we studied five type I diabetics aged 16-40 yr who were treated for 3 wk with a portable intravenous insulin infusion system. Initially, the patient's usual prescribed diabetic diet was provided, and an individual waveform of insulin infusion resulting in diurnal normoglycemia was defined for each meal. Subsequently, small (12% of total daily calories) and large (36% of total daily calories) versions of the regular breakfast (24% of total daily calories) were provided without change in the insulin infusion waveforms, and the resulting metabolic profiles were studied. The overall mean fasting plasma glucose levels before the meals of varying size were not significantly different, but the incremental rises in plasma glucose with the small (31 +/- 5 mg/dl), regular (48 +/- 7 mg/dl), and large (64 +/- 5 mg/dl) breakfasts varied directly with the meal size. The subsequent mean plasma glucose levels before the regular lunch were significantly different (P less than .05) after the small (50 +/- 4 mg/dl) and large breakfasts (131 +/- 9 mg/dl), compared with the regular breakfast (81 +/- 7 mg/dl). Despite these differences, the plasma glucose levels before dinner were virtually identical. We conclude that large variations in meal size produce glycemic changes in keeping with the caloric content of the meal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1986

Potentiation by previous nutrients of glibenclamide-induced insulin release in man. An effect which is counteracted by meal-induced retardation of drug absorption.

We have studied the impact of a previous meal on insulin and glucose responses to the subsequent administration of glibenclamide. Healthy volunteers and NIDDM patients ingested a standard low-carbohydrate breakfast, and glibenclamide was administered 110-120 min later either as an intravenous bolus (12.5 micrograms/kg body wt), or as a tablet (5 mg HB 419). When glibenclamide was administered i.v. the drug raised insulin and lowered blood glucose levels, and previous breakfast potentiated these effects both in healthy volunteers and in NIDDM patients. Conversely when glibenclamide was given as a tablet the drug per se raised C-peptide and lowered blood glucose levels under fasting conditions, whereas the drug had no effect when ingested after breakfast. Measurements of glibenclamide in plasma revealed that previous breakfast delayed the systemic appearance of ingested glibenclamide. We conclude that nutrients sensitize insulin-releasing cells to subsequent stimulation by glibenclamide, thereby aggravate a blood-glucose-lowering effect of the drug. However this effect, which could potentially induce undesirable hypoglycaemia in sulphonylurea-treated diabetics, is counteracted when glibenclamide is taken orally because of a meal-induced decrease in drug absorption.

Adult↗

PubMed1986

Influence of food intake on bioavailability of oral 6-mercaptopurine in children with acute lymphoblastic leukemia.

Plasma levels of 6-mercaptopurine (6-MP) were measured after oral administration in 17 children with acute lymphoblastic leukemia (ALL). In the fasting state or after a breakfast consisting of 250 ml milk and 50 g biscuits, 6-MP was administered at a dose of 75 mg/m2. In patients studied in a fasting state, the mean time to plasma peak (tmax) level was 1.2 h, whereas in patient studied after breakfast the mean tmax was 2.3 h. This difference is statistically significant (p less than 0.001). Moreover, the 6-MP peak plasma concentration (cmax) and the areas under the plasma concentration time curves (AUC) were significantly reduced when the drug was administered after breakfast. The mean Cmax +/- SD were 0.98 +/- 0.54 microM and 0.63 +/- 0.48 microM, respectively (p less than 0.05). The mean 6-MP AUC +/- SD in patients studied in a fasting state and after breakfast were 143 +/- 69 microM min and 105 +/- 68 microM, respectively (p less than 0.01). These results indicated that 6-MP should be taken in a fasting state to optimize drug absorption in children undergoing chemotherapy for ALL.

Administration, Oral↗

PubMed2000

New property of vitamin A and beta-carotene on human iron absorption: effect on phytate and polyphenols as inhibitors of iron absorption.

One hundred and seventy four human subjects were studied to find out the interaction of vitamin A or beta-carotene with the inhibitors of iron absorption, from a basal breakfast containing bread from either 100 g of precooked corn flour or 100 g of white wheat flour, 50 g of cheese and 10 g of margarine. Bread was labeled with either 55Fe or 59Fe. This bread was made from commercially flours fortified with iron as ferrous fumarate and vitamins. It was noticed that the percentage of iron absorption from the breakfast prepared with precooked corn flour given alone and with different concentrations of coffee was practically the same, while the iron absorption from the breakfast prepared from wheat flour decreased from 6% when the breakfast was given alone, to less than 2% when it was given with different concentrations of coffee. The only ingredient present in precooked corn flour and not in wheat flour was vitamin A. This difference encouraged the authors to perform further experiments using precooked corn and wheat flours fortified only with ferrous fumarate. These studies demonstrated that vitamin A inhibits the effect of the polyphenol and partially inhibits the effect phytate on iron absorption. HPLC and spectrophotometric studies demonstrated an interaction between vitamin A and iron. Other experiments, which included 100 volunteers, were performed to test the effect of vitamin A and beta-carotene on iron absorption from corn, wheat and rice. The presence of vitamin A increased iron absorption up to 3 times for rice, 2.4 times for wheat and 1.8 times for corn. beta-carotene increased absorption almost 3 times for the three cereals tested, showing that both compounds were capable of preventing the inhibitory effect of phytates on iron absorption. This information suggest that vitamin A and beta-carotene form a complex with iron keeping it soluble in the intestinal lumen and preventing the inhibitory effect of phytates and polyphenols on iron absorption.

Antioxidants↗

PubMed2001

[Effects of alimentary loads on water-electrode balance].

We studied the effect of isocaloric protein, fat, carbohydrate and alcoholic breakfasts on diuresis, natriuresis, kaliuresis and serum aldosterone in sixteen 22-25-year-old healthy men in the hospital where they were exposed to hydration (20 ml/kg, in interval 2 hours) and after alimentary loads (in intervals 3-4 and 5-6 hours). It was found that diuresis increased by 37.12% and 18.77% after alcoholic and fat load (p < 0.001 and 0.05, respectively). Protein intake did not change diuresis considerably, while carbohydrates reduced diuresis by 27.23% (p < 0.01). Natriuresis grew after protein breakfast by 61.27% (p < 0.01), by 49.52% (p < 0.01) after alcoholic one, by 14.36% (p < 0.05) after fat breakfast and fell by 41.31% (p < 0.01) after carbohydrate one. Kaliuresis fell sharply after sugar intake to 41.65% of the initial level (p < 0.001). Fat and alcohol breakfasts lowered caliuresis by 14.98% (p > 0.05) and 22.23% (p > 0.05), respectively. Protein increased caliuresis by 28.24% (p > 0.05). Plasma aldosterone rose after any of the above loads.

Adult↗

PubMedDate not supplied

[FAMOTIDINE VERSUS PLACEBO IN NON ULCER DYSPEPSIA TREATMENT]

BACKGROUND: Non ulcer dyspepsia is an important health problem with a very high prevalence in the general population, being its pathophysiology still unclear and its association with H. pylori highly controversial. Many trials have been carried out assessing the effects of different drugs on the symptoms in dyspeptic patients, being one of the most common the use of H2 antagonist, even though the results have shown conflicting as far as efficacy is concerned. The goal of the present study is to determine the efficacy of famotidine (administered in three different regimens) as compared to placebo in relieving the symptoms of non ulcer dyspepsia.METHODS: Patients with chronic non ulcer dyspepsia were included and were selected by random in four groups; group I received famotidine 40 mg before breakfast, placebo before dinner and at bedtime; group II received famotidine 20 mg before breakfast and dinner and placebo at bedtime; group III received famotidine 40 mg at bedtime, placebo before breakfast and dinner; group IV received placebo before breakfast, dinner and at bedtime. A four week treatment period was completed. Endoscopy, measure of the gastric juice pH, and biopsy (including study for H.p) was done at the beginning of the study, at week 4 and at week 8. The patient was asked for a global assessment of improvement in the overall symptoms of dyspepsia at the end of weeks 1,4 and 8.RESULTS: Forty-eight patients (12 men and 36 women) participated in the study. There was not statistical difference between any of the four schemes of treatment and the effect over the pain and the symptoms during the study. Nevertheless there was a highly statistically difference (p<0.01) of the well being of the patient with all the groups of treatment received. There was a significant difference (p<0.05) between the pH of the groups II, III, IV, being the pH at fourth week, the one with a high mean value. There was not statistical difference in the pH value between patients that improve its symptoms and those that not H.p. presence was the same along the study in the group that showed improvement of pain and related symptoms and the group that did not improve. There was no significant changes in the histological pattern and the grade of inflammatory activity in relation to symptoms improvement. During the study there was not any clinical laboratory adverse experience.CONCLUSIONS: Non of the three schemes with famotidine used in this trial has proven to have any therapeutical benefit in non ulcer dyspepsia compared to placebo, even though patients improved their symptoms in all the four groups. It seems that gastric juice does not play a rol in the genesis of non ulcer dyspepsia. In this study, nor the presence of H.p. neither inflammatory activity are associated with the symptoms of non ulcer dyspepsia. More studies carefully designed are required not only to understand pathophysiological mechanism, also to identify effective treatments for this frequent entity.

Journal Article↗

PubMedDate not supplied

Blood glucose profiles in insulin-dependent Zambian diabetics.

Six male stable insulin dependent diabetics were admitted to the University Teaching Hospital (U.T.H.) to define the insulin regiment that best controls their fasting and 2 hr postprandial blood glucose. Lente and Soluble insulin regiments were evaluated. For this study, blood glucose was estimated in six control subjects and in the six diabetic patients before breakfast lunch and supper and two hours after each of these meals. Each diabetic was allowed three days to stabilise on his usual insulin regimen and for the next three days blood glucose was estimated at the times indicated. Then for the next three days the patient was given the other insulin regimen and then for the last three days and while still on this second regimen blood glucose was estimated at the time indicated. Lente insulin was given as a twice daily dose before breakfast and supper while soluble insulin was administered either as a twice daily dose before breakfast and supper or as a thrice daily dose before breakfast, lunch and supper. The overall control of blood glucose before and two hrs meals was better with soluble insulin regiment than with the Lente insulin regimen.

Adolescent↗

PubMed1976

Effects of solid food on blood levels of alcohol in man.

Forty-five ml of 95% alcohol, diluted to 150 ml with orange juice, was taken orally by six adult male volunteers under the following conditions: A (fasting), B (following a light breakfast), C (following a heavy breakfast), D (following a steak meal), E (alcohol 1 hr after a heavy breakfast), and F (alcohol 1 hr before a heavy breakfast). Using treatment A as a reference, the average area under the blood alcohol, time curve was reduced by 36, 63, 55, 56, and 18% for treatment B through F, respectively. The reduction in area is attributed to two factors: (a) food reduced the efficiency of absorption of alcohol; and (b) food reduced the rate of absorption of alcohol, which, coupled with the operation of Michaelis-Menten elimination kinetics, contributed to the reduction in area. The latter effect is a result of changes in the ratio: instantaneous rate of metabolism/amount of alcohol in the body, which results in a smaller area when the rate of absorption is slow than when the rate of absorption is rapid. Using treatment A as a reference, the ratio of the average peak alcohol concentrations were: 1.0, 0.72, 0.35, 0.50, 0.49 and 1.11 for treatments A through F, respectively.

Adult↗

PubMed2003

Humalog Mix25 improves 24-hour plasma glucose profiles compared with the human insulin mixture 30/70 in patients with type 2 diabetes mellitus.

OBJECTIVE: To compare the effects of Humalog Mix25 (Humalog Mix75/25 in the USA) (Mix25) and human insulin 30/70 (30/70) on the 24-hour inpatient plasma glucose (PG) profile in patients with type 2 diabetes mellitus (T2DM). DESIGN: A randomised, open-label, 8-week crossover study. Study insulins were injected twice daily, 5 minutes before breakfast and dinner. SETTING: Four-week outpatient (dose-adjustment) treatment phase, and 3-day inpatient (test) phase. PATIENTS: Twenty-five insulin-treated patients with T2DM (ages 40-66 years), mean (+/- standard error of the mean) (SEM) HbA1c 7.7% +/- 0.23%, and body mass index (BMI) 29.3 +/- 0.83 kg/m2. OUTCOME MEASURES: 24-hour PG profiles, PG excursions after meals, PG area under the curve (AUC), and 30-day hypoglycaemia rate. RESULTS: The 2-hour PG excursions following breakfast (5.5 +/- 0.34 v. 7.2 +/- 0.34 mmol/l, p = 0.002) and dinner (2.4 +/- 0.27 v. 3.4 +/- 0.27 mmol/l, p = 0.018) were smaller with Mix25 than with 30/70. PG AUC between breakfast and lunch was smaller with Mix25 than with 30/70 (77.6 +/- 3.8 v. 89.5 +/- 4.3 mmol/h/ml, p = 0.001). PG AUC between lunch and dinner, dinner and bedtime, and bedtime and breakfast did not differ between treatments. Pre-meal and nocturnal PG were comparable. The postprandial insulin requirement for lunch meals was supplied equally by the two insulin treatments. The thirty-day hypoglycaemia rate was low (Mix25 0.049 +/- 0.018 v. 30/70 0.100 +/- 0.018 episodes/patient/30 days, p = 0.586) for both treatments. CONCLUSION: In patients with T2DM, Mix25 improved the 24-hour PG profile with lower postprandial PG excursions than with human insulin 30/70.

Adult↗

PubMed1992

Effect of food on absorption and hydrolysis of erythromycin acistrate.

Effect of food on absorption of erythromycin acistrate (2'-acetyl erythromycin stearate, Erasis; CAS 96128-89-1) was studied in 14 healthy volunteers in a randomized cross-over design. The subjects were given 400 mg erythromycin acistrate enteric coated tablets b.i.d. for 4 days. On the 1st and 4th days the tablets were taken after an overnight fast or immediately after a light or a heavy breakfast. Erythromycin (E), 2'-acetyl-erythromycin (2AE), anhydroerythromycin and anhydro-2'-acetyl-erythromycin concentrations in plasma were analyzed chemically by HPLC. After a single dose the lag time of absorption (tlag) was significantly longer after both types of breakfasts as compared to fast. The tmax of E and 2AE were also somewhat delayed by food although tmax of 2AE after a heavy breakfast only differed statistically significantly from that of the fasting state. Food significantly delayed the absorption especially in some subjects since no drug was observed during the 12-h observation period in 2 and 5 of the subjects after a light and heavy breakfast, respectively. At steady state the delaying effect of food on absorption had almost disappeared. No significant differences were observed in Cmax- or AUC0-12-values between the fasting and the fed states both after a single dose or at steady state. It is concluded, that food does not affect the mean bioavailability of erythromycin acistrate neither the mean rate of absorption but in some subjects the absorption from enteric coated tablets might be significantly delayed.

Adult↗

PubMedDate not supplied

The use of low glycemic and high satiety index food dishes in Mexico: a low cost approach to prevent and control obesity and diabetes.

Obesity and diabetes are epidemics in Mexico and the prevalence is currently highest among the low-income population. The aim of the present study was to compare the action of different breakfasts on satiety and subsequent food intake among healthy women. Eight healthy women participated in the study. Participants were given four experimental breakfasts. Visual analogue rating scales were completed before and every 30 minutes for 3 hours after each experimental meal to record subjective feelings of satiety. Subjects were exposed to an ad libitum buffet 3 h after the experimental breakfast. Energy and macronutrient intakes were calculated at each meal. Mean +/- SD SAUC for white bread was 355 +/- 60, for rice and bananas: 405 +/- 108, for whole wheat bread and boiled beans: 446 +/- 83, and for fruit salad: 585 +/- 79 (Table II). Statistical differences were observed among the four experimental meals (p = 0,002). After the consumption of white bread, energy intake was the highest with 872 +/- 58 kcal, and after the consumption of fruit salad the intake of calories was the lowest: 461 +/- 51 kcal. Energy intake 4 h after each breakfast shows statistical differences (p = 0,0001). These results suggest the need to promote culturally based combined foods with high fiber and low GI, as well as foods with high volume and water content. This approach might contribute to the prevention of obesity by increasing satiety and reducing food consumption and energy intake.

Adult↗

PubMed1989

Influence of food on relative bioavailability of fluoride in man from Na2FPO3-containing tablets for the treatment of osteoporosis.

Aqueous solutions of NaF and sodium monofluorophosphate (Na2FPO3, MFP) and tablets containing MFP (Caflu, Tridin) were given as single oral doses to fasting healthy volunteers in an intra-individual crossover study. Serum fluoride (F) levels and urinary F concentrations were measured using an F-ion-sensitive electrode; 8 h profiles of F concentrations in serum and 24 h urinary F output were determined. F availability and pharmacokinetic data were identical for all items. In a second group of experiments, the subjects were given Caflu tablets under different experimental regimens: a) on a fasting stomach, b) together with breakfast, c) together with milk, d) together with breakfast and milk. Serum peak levels were reduced when the tablets were taken together with food. Intake together with breakfast did not affect F bioavailability, whereas milk reduced F availability by 28% compared with the fasting stomach experiment. This effect was partly abolished when milk was taken as part of the breakfast. It is suggested that entrapment of F in coagulation products of milk and formation of Ca-salts are important factors causing reduction of F availability, and that prolonged stay of the chyme after concomitant ingestion of food allows F to become liberated from bound forms and coagulation products by digestive processes.

Adult↗

PubMed1985

The course of blood pressure after a meal: a difference between young and elderly subjects.

The effect of a standardized breakfast (405 kcal) on blood pressure and heart rate was studied in 25 healthy elderly subjects (mean age 79.8 +/- 5.7 years) and in 20 healthy young volunteers (mean age 31.5 +/- 4.8 years). In the elderly the maximal fall of systolic blood pressure was 7.1 +/- 1.5% and of diastolic blood pressure 14.1 +/- 1.7% at 50 min after the start of the breakfast. In the younger group, blood pressure did not change significantly after breakfast. In both groups heart rate increased significantly. The postprandial blood pressure reduction in the elderly was correlated with preprandial blood pressure. There was also a significant correlation between blood pressure reduction and age if corrected for preprandial blood pressure. In conclusion, in contrast to the younger subjects, elderly healthy subjects showed a clear blood pressure reduction after breakfast.

Adult↗

PubMed1987

Assessment of the clinical efficacy and tolerance of two new alpha-glucosidase inhibitors in insulin-treated diabetics.

The present study aimed at investigating the metabolic effects and tolerance of two desoxynojirimycin derivatives with alpha-glucosidase inhibitory properties (BAY m 1099 and BAY o 1248). The study was performed in a double-blind cross-over manner on 7 insulin-treated outpatient diabetics (6 males, 1 female; mean age 43 +/- 14 years; mean duration of diabetes 5.8 +/- 4.2 years; all within +/- 10% of their ideal body weight). The usual diet containing 24.5 +/- 8 g dietary fibers and 52 +/- 22 g simple sugars was maintained throughout the study. After a 7-day run-in period, 4 consecutive periods of 7 days were considered for each patient. The patients were randomly allocated for 1 week to BAY o 1248 (20 mg with breakfast) or Bay m 1099 (50 mg with breakfast and dinner). After a 7-day wash-out period the patients underwent the alternate treatment. At the end of each period, the patients were admitted to the Metabolic Ward for detailed metabolic and hormonal investigations. No significant changes were observed in the daily insulin requirements (45 +/- 15 U/day). HbA1c did not change significantly. Residual insulin secretion was low (plasma C-peptide: 0.077 +/- 0.09 and 0.154 +/- 0.15 pmol/ml during fasting and 2 hours post-breakfast, respectively); it was not modified by the treatments. Increments in blood glucose were significantly lower after breakfast with both drugs. No differences were observed in plasma free insulin. A marked increase in breath hydrogen was observed after lunch with BAY o 1248 only. Clinical and biological tolerance was excellent for both compounds.(ABSTRACT TRUNCATED AT 250 WORDS)

1-Deoxynojirimycin↗

PubMed1978

Tolerance to lactose among lactase-deficient American Indians.

To determine the amount of lactose that could be tolerated in a meal, 59 lactase-deficient American Indians, ranging in age from 5 to 62, were given graded doses of lactose. The diagnosis of lactase deficiency had beeen documented previously by showing increased breath hydrogen after an oral lactose load (2 g per kg, maximum 50 g). With this load, 88% of the subjects had symptoms. On 6 consecutive mornings, each subject was given a breakfast that contained graded doses of lactose ranging from 0 to 18 g. The order of the breakfasts was randomized and the contents were double-blinded. Symptoms, which were assessed by a "blinded" observer, were present after 9% of the breakfasts at all dosage levels, including the lactose-free breakfast. Thus, under the conditions of this study, a modest amount of lactose, equivalent to that present in 1 to 1 1/2 glasses of milk, when taken with a meal, is well tolerated by the lactase-deficient American Indian.

Adolescent↗

PubMed1994

[Effect of acarbose on postprandial increase in blood glucose. Additive acute effect of once daily administration in insulin treated diabetes].

UNLABELLED: Only few controlled studies have been conducted on the influence of additive treatment with the glucosidase inhibitor acarbose on post-prandial blood sugar levels in insulin-dependent diabetics. To date, the behavior of blood sugar levels under treatment with acarbose has not been studied in insulin-dependent, type II diabetics. METHOD: Forty-six diabetics--36 insulin-dependent type II, and 10 type I--were enrolled in a double-blind, placebo-controlled randomized parallel group study with the aim of investigating the influence of acarbose on the primary variable maximum blood glucose increase following a standard breakfast eaten after 7 days of treatment. The patients were to have an HbA1 value of > 9%, and a post-prandial increase in blood glucose 90 minutes after a standardised breakfast (3 white bread units) of at least 50 mg/dl as compared with the fasting blood sugar during a one-week run-in period. INTERVENTION: The patients were randomized to treatment consisting of either one tablet of 100 mg acarbose or a single placebo tablet taken daily with breakfast. RESULTS: While the placebo group showed a mean further rise in maximum blood glucose levels after 7 days of treatment from 76.1 +/- 13.1 mg/dl to 84.3 +/- 17.8 mg/dl over the baseline value, there was a decrease in the acarbose group from 80.5 +/- 12.8 to 46.3 +/- 12.8 mg/dl. The difference between the two groups was statistically significant (p = 0.0001). No significant correlation was found between the treatment and type of diabetes. Mild adverse events such as meteorism, flatulence and diarrhea did not lead to any interruption of the study, and had cleared up by the end of the trial in all patients. CONCLUSION: The use of a single dose of 100 mg acarbose at breakfast time can result in a marked flattening of elevated post-prandial morning blood glucose profiles in both insulin-dependent type II and type I diabetics.

Acarbose↗

PubMed1994

Food-induced lowering of blood-ethanol profiles and increased rate of elimination immediately after a meal.

In a two-part crossover study, ten healthy men drank a moderate dose of ethanol (0.80 g/kg) in the morning after an overnight fast or immediately after breakfast. The breakfast consisted of orange juice (150 mL), fruit yogurt (250 mL), two cheese sandwiches, one boiled egg, and one cup of coffee with milk and sugar. Ethanol was determined in venous blood at various times after the start of drinking by headspace gas chromatography. All subjects felt less intoxicated when alcohol was ingested after breakfast compared with drinking on an empty stomach. The peak BAC (+/- SD) was 67 +/- 9.5 mg/dL (ethanol + food) compared with 104 +/- 16.5 mg/dL when the drinking occurred after an overnight fast (P < 0.001). The mean area under the alcohol concentration-time profile (0-->6h) was 398 +/- 56 mg/dL x h in the fasting state compared with 241 +/- 34 mg/dL x h when subjects drank alcohol after the meal (P < 0.001). The time required to metabolize the dose of ethanol was approximately two hours shorter after the subjects had eaten breakfast. These results suggest that food in the stomach before drinking not only leads to a lowering of the peak BAC and diminishes the feelings of intoxication, but also boosts the rate of ethanol metabolism. A food-induced increase in the rate of disposal of ethanol was also confirmed when subjects ate a meal 5 h after drinking, that is, when the postabsorptive phase of ethanol metabolism was well established. The mean rate of disappearance of alcohol from blood was increased by between 36 and 50%.

Adult↗

PubMed1996

Relationship between feeding pattern and body mass index in 220 free-living people in four age groups.

OBJECTIVE: To assess the relationship between feeding pattern and body mass index in free-living humans. DESIGN AND SUBJECTS: Feeding pattern was assessed from 220 7-day weighed dietary records. 187 records were obtained from three separate existing studies, and reanalysed. These studies contained data on three age groups in the British population; Elderly group (n = 88), Middle-aged group (n = 40), Working age group (n = 59). A separate study of 13-14 year olds living in Croydon was conducted from which 33 usable diet records were collected to produce a fourth, Adolescent group. RESULTS: 'Nibbling' and greater energy intakes at breakfast were associated with a lower body mass index (BMI) in the Adolescent group. In the Middle-aged group, greater energy intakes at breakfast and lower energy intakes during the evening were associated with a lower BMI. However, when diet records which produced unreasonably low energy intakes were removed from the analysis, these relationships disappeared except for energy intakes at breakfast and BMI in the Adolescent group. CONCLUSION: It is suggested that the relationship between feeding pattern and BMI observed in the Adolescent and Middle-aged groups was caused by underestimation of 'habitual' energy intake from snacks and the omission of breakfast by females and those who were overweight. The lack of relationship in the Working age group was attributed to the fact that more individuals in this group appeared to report valid diet records. Reported energy intake was directly related to BMI in the Working age group, but was not related to BMI in the other three age groups. It is concluded that feeding pattern is not a major factor in determining BMI in humans. Also, since snacks have a relatively high sugar and low fat composition compared with meals, it is suggested that biased under-reporting of snacks by the obese could produce spurious results from free-living studies which show that obesity is related to the proportion of energy from fat in the diet.

Adolescent↗