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Obesity, restrained eating and the cumulative intake curve.

The cumulative intake curves of 50 obese and 86 normal weight women during test meals were related to body mass index, age and the three factors of Stunkard & Messick's questionnaire (Journal of Psychosomatic Research, 29, 71-83), cognitive restraint, disinhibition and perceived hunger. Eating behaviour was monitored by a concealed camera and rate of intake via an electronic balance built into the table under the plate. The eating behaviour of each subject was very consistent over a series of three or six lunches of the same solid food consumed solitarily in a constant environment, with marked differences between subjects. Differences in body mass index over the whole sample were not related to the shape of the cumulative intake curve during test meals. In multiple regression analysis, the normal-weight subjects who scored high on disinhibition of restraint in response to emotions and external influences showed a more nearly constant rate of intake. In a separate multiple regression, the overweight subjects with the same characteristic showed a decelerating rate of intake. Susceptibility to hunger had no discernible relationship to the shape of the cumulative intake curve in either normal or overweight subjects. We conclude that the shape of the cumulative intake curve can be attributed more to cognitive than to biological factors.

Adult↗

Eating behavior in continuous ambulatory peritoneal dialysis and hemodialysis patients.

Three groups consisting of 12 subjects each (continuous ambulatory peritoneal dialysis [CAPD] patients, hemodialysis patients, and healthy controls) matched for age, sex, and body weight were invited to a test meal for the study of hunger, fullness, and food preferences. They were served an excess portion of hash served on a plate placed on a hidden scale ("VIKTOR"), which was connected to a computer registering the eating process on-line. The patients filled in visual analogue scales (VAS) concerning appetite and food preferences before and after the test meal. Mean total intake of food (+/- SD) was significantly higher for healthy controls (357 +/- 175 g) compared with hemodialysis patients (295 +/- 105 g), which in turn was higher than in CAPD patients (206 +/- 70 g). Eating velocity was lower in both dialysis groups compared with controls. CAPD patients experienced less hunger and desire to eat compared with hemodialysis patients and controls. The reason for the low eating drive in CAPD patients despite their great need for protein and calories is unknown, but might be explained by gastric retention, insufficient dialysis, metabolic effects of the high sugar load from the dialysate, or combinations of these factors.

Adult↗

Charitable food assistance as symbolic gesture: an ethnographic study of food banks in Ontario.

Community-based charitable food assistance programs have recently been established in several affluent nations to distribute public and corporate food donations to 'the needy'. In Canada, food banks comprise the primary response to hunger and food insecurity, but problems of unmet food need persist. We conducted an ethnographic study of food bank work in southern Ontario to examine the functioning of these extra-governmental, charitable food assistance programs in relation to problems of unmet need. Our results suggest that the limited, variable and largely uncontrollable supply of food donations shaped the ways in which food assistance was defined and the practices that governed its distribution. Workers framed the food assistance as a supplement or form of acute hunger relief, but generally acknowledged that the food given was insufficient to fully meet the needs of those who sought assistance. In response to supply limitations, workers restricted both the frequency with which individual clients could receive assistance and the amount and selection of food that they received on any one occasion. Food giving was essentially a symbolic gesture, with the distribution of food assistance dissociated from clients' needs and unmet needs rendered invisible. We conclude that, structurally, food banks lack the capacity to respond to the food needs of those who seek assistance. Moreover, the invisibility of unmet need in food banks provides little impetus for either community groups or government to seek solutions to this problem.

Charities↗

Heritability of diurnal changes in food intake in free-living humans.

OBJECTIVES: The time of day of meal ingestion, the number of people present at the meal, the subjective state of hunger, and the estimated before-meal contents in the stomach have been established as influences on the amount eaten in a meal, and this influence has been shown to be heritable. Because these factors intercorrelate, the possibility that the calculated heritabilities for some of these variables could result indirectly from their convariation with one of the other heritable variables was assessed. METHODS: The independence of the heritability of the influence of these four factors was investigated with 110 identical and 102 fraternal same-sex and 53 fraternal mixed-sex adult twin pairs who were paid to maintain 7-d food intake diaries. From the diary reports, the meal sizes were calculated and subjected to multiple regression analysis using the estimated before-meal stomach contents, the reported number of other people present, the subjective hunger ratings, and the time of day of the meal as predictors. Linear structural modeling was applied to the beta coefficients from the multiple regression to investigate whether the heritability of the influences of these four variables was independent. RESULTS: Significant genetic effects were found for the beta coefficients for all four variables, indicating that the heritability of their relationship with intake is to some extent heritable. CONCLUSIONS: These results suggest that the influences of multiple factors on intake are influenced by the genes and become part of the total package of genetically determined physiologic, sociocultural, and psychological processes that regulate energy balance.

Adult↗

Independence of heritable influences on the food intake of free-living humans.

OBJECTIVE: The time of day of meal ingestion, the number of people present at the meal, the subjective state of hunger, and the estimated before-meal contents in the stomach have been established as influences on the amount eaten in a meal and these influences have been shown to be heritable. Because these factors intercorrelate, the calculated heritabilities for some of these variables might result indirectly from their covariation with one of the other heritable variables. The independence of the heritability of the influence of these four factors was investigated with 110 identical and 102 fraternal same-sex and 53 fraternal mixed-sex adult twin pairs who were paid to maintain 7-d food-intake diaries. METHODS: From the diary reports, the meal sizes were calculated and subjected to multiple regression analysis using the estimated before-meal stomach contents, the reported number of other people present, the subjective hunger ratings, and the time of day of the meal as predictors. Linear structural modeling was applied to the beta-coefficients from the multiple regression to investigate whether the heritability of the influences of these four variables was independent. RESULTS: Significant genetic effects were found for the beta-coefficients for all four variables, indicating that the heritability of their relationship with intake is to some extent independent and heritable. CONCLUSIONS: This suggests that influences of multiple factors on intake are influenced by the genes and become part of the total package of genetically determined physiologic, sociocultural, and psychological processes that regulate energy balance.

Adult↗

Suppression of hepatic fatty acid oxidation and food intake in men.

We investigated the effects of the fatty acid oxidation inhibitor etomoxir (ETO) on food intake and on fat and carbohydrate metabolism in two double-blind crossover studies in male, normal-weight subjects. In study 1, ETO (75 mg [+]-racemate) or placebo was given orally 30 min after completion of a standardized, fat-enriched (total energy: 2698 kJ, 40% from fat) lunch. The subjects (n = 15) were isolated from external time cues and free to choose when to eat dinner from an oversized serving (total energy: 6656 kJ, 60% from fat). In study 2, subjects (n = 13) were selected for habitually high fat intake (mean: 44% of energy intake). ETO (150 mg) or placebo was given after an overnight fast, 2.5 h before offering an oversized high fat breakfast (6960 kJ, 72% from fat). In both studies, blood samples were taken and the respiratory quotient (RQ) was measured several times during each test period. In study 1, ETO (75 mg) did not affect the timing and size of the dinner or subjective feelings of hunger and satiety. Although ETO (75 mg) did not affect the RQ, it decreased plasma beta-hydroxybutyrate (BHB) and increased plasma lactate compared with placebo. Plasma triacylglycerols (TG), free fatty acids (FFA), glucose, and insulin were not affected by ETO. In study 2, ETO (150 mg) enhanced hunger feelings and increased the size of the breakfast by 22.7%. ETO did not affect the RQ, but baseline RQ was lower in study 2 than in study 1 (0.83 versus 0.89, P < 0.01). Compared with placebo, ETO (150 mg) decreased plasma BHB and increased plasma FFA and plasma lactate. Baseline plasma concentrations of BHB, FFA, and lactate were higher in study 2 than in study 1 (BHB: 242 versus 81 mumol/L, P < 0.001; FFA: 0.674 versus 0.406 mmol/L, P < 0.01; lactate: 1.08 versus 0.74 mmol/L, P < 0.05). Plasma concentrations of TG, glucose, and insulin were not affected by ETO. The results suggest that inhibition of hepatic fatty acid oxidation stimulates eating in men when baseline fatty acid oxidation is sufficiently high and markedly suppressed by the treatment.

3-Hydroxybutyric Acid↗

Wheat-fibre-induced changes of postprandial peptide YY and ghrelin responses are not associated with acute alterations of satiety.

Weight gain and risk of type 2 diabetes are inversely associated with a high intake of insoluble cereal fibres. Because nutrient-induced changes of 'satiety hormones' from the gut may play a role in this process, we evaluated the effects of purified insoluble fibres on postprandial responses of plasma peptide YY (PYY), serum ghrelin and satiety as secondary outcome measures of a study investigating effects of cereal fibres on parameters of glucose metabolism. Fourteen healthy women were studied on six occasions in a randomized, single-blind, controlled crossover design. After 24 h run-in periods and 10 h overnight fasts, subjects ingested isoenergetic and macronutrient matched portions of control white bread or fibre-enriched bread (wheat-fibre or oat-fibre) at 08.15 hours. Gut hormones and hunger scores were measured for 300 min. Basal PYY and ghrelin concentrations were not different between the test meals (P>0.15). Postprandial responses of PYY and ghrelin were blunted after the intake of wheat-fibre (total area under the curve (AUC) PYY, 177.9 (SEM 8.1) (pmol/l) min; P=0.016; ghrelin 51.0 (SEM 2.5) (pmol/l) min; P=0.003), but not after oat-fibre (PYY 226.7 (SEM 25.7) (pmol/l) min; P>0.15; ghrelin 46.2 (SEM 1.6) (pmol/l) min; P=0.127), compared to control (PYY 247.5 (SEM 25.6) (pmol/l) min; ghrelin 42.5 (SEM 1.3) (pmol/l) min). Postprandial hunger scores were unaffected by the different test meals (P>0.15). Thus, oat- and wheat-fibre consumption result in different postprandial responses of PYY and ghrelin, but interestingly do not differ in satiety effects.

Avena↗

The neuroendocrine responses and psychological effects of infusion of L-tryptophan in anorexia nervosa.

The secretion of prolactin and growth hormone (GH), together with subjective ratings of sedation and hunger, were determined in 13 in-patients with anorexia nervosa and 15 controls during the intravenous infusion of L-tryptophan (100 mg/kg). Prolactin responses were not different between groups but GH responses were markedly blunted in patients. In addition sedation responses in patients were attenuated compared with controls. Hunger ratings were reduced by the infusion in controls but were too variable to be interpreted in the patients. Plasma amino acid levels were also determined before and after infusion of L-tryptophan. Tryptophan levels were comparable in the two groups as were the levels of tyrosine, phenyl alanine, valine, leucine and iso-leucine. The results suggest that some aspects of 5-hydroxytryptamine function may be attenuated in anorexia nervosa. However, they undoubtedly contrast with the finding of enhanced hormonal responses in acute dieting and may be relevant to the interpretation of similar experiments in depressive illness.

Adult↗

Linked spike activity of neurons in the right and left lateral hypothalamus in conditions of food motivation.

Cross- and autocorrelation histograms were constructed to investigate the linkage of spike activity from neurons in the right and left lateral hypothalamus, recorded in conditions of restful waking, after 24-h food deprivation, and after satiation. In conditions of hunger, there was a preferred order in which neurons fired in these two hypothalamic regions: a significant majority of cases (59%) showed initial firing by a neuron in the left hypothalamus followed by a neuron in the right, with delays of up to 200 msec and peaks in the delay plot at 30 and 160 msec. The opposite firing order was seen less frequently (21% of cases). In conditions of hunger, linked spike activity showed an increase in the probability of detecting frequencies in the theta range (from 11% to 29%).

Animals↗

A single brain stem substrate mediates the motivational effects of both opiates and food in nondeprived rats but not in deprived rats.

Drug-naive and morphine-dependent rats both preferred places paired with morphine over unfamiliar neutral places. Morphine-dependent, but not naive, rats avoided places paired with the lack of morphine (i.e., withdrawal). Food-sated and food-deprived rats both preferred places paired with food over unfamiliar neutral places. Food-deprived, but not sated, rats avoided places paired with the lack of food (i.e., hunger). Lesions of the tegmental pedunculopontine nucleus (TPP) blocked the morphine- and food-conditioned place preferences in drug-naive and food-sated rats, respectively. TPP lesions failed to block morphine- and food-conditioned place preferences as well as morphine withdrawal-conditioned and hunger-conditioned place aversions in morphine-dependent and food-deprived rats, respectively. These results suggest that separate neural mechanisms subserve deprivation- and non-deprivation-induced motivation.

Animals↗

Influence of external and covert food stimuli on insulin secretion in obese and normal persons.

Exposure to food produces an increase in insulin secretion that is more pronounced in obese than in normal persons. We sought to replicate this finding as well as to determine whether insulin secretion could be influenced by thoughts about food and eating. Normal and obese subjects were presented in counterbalanced order with an external food stimulus or instructions to think about food and eating. Levels of insulin, salivary output, and hunger ratings were obtained prior to and immediately following stimulus presentation. All subjects displayed higher insulin levels following stimulus presentation, with the values for the obese higher than for normals. Although the insulin secretion of the obese was greater in response to the covert as opposed to the external stimulus, the difference was not significant. Salivary output following stimulus presentation was higher for the obese than normals, with hunger ratings increasing in both groups. These data support an expanded role of insulin as an appetite-inducing mechanism.

Adult↗

Nocturnal hyperphagia in the rat is characterized by decreased postprandial satiety.

Rats eat more at night than during the day. This work investigated whether this nocturnal hyperphagia is characterized by increased hunger, decreased postprandial satiety, or both. Rats were presented with liquid food after 3-hr food deprivation at the midpoint of the night or day phase of a 12:12 hr light/dark cycle. Quinine adulteration of food produced equal percentage suppression of first meal size (MS) and of 60-min intakes in the night and the day. This suggests that rats are equally hungry after 3-hr food deprivation in the night and the day. In contrast to apparently equal hunger, rats were less satiated by ingested food after 3 hr of food deprivation at night than during the day. This conclusion is based on the observations that the postprandial intermeal interval (IMI) was significantly shorter at night and that the satiety ratio (IMI/MS) was smaller at night. This nocturnal decrease in the satiating potency of ingested food was demonstrated for two specific preabsorptive satiety mechanisms: (a) the pregastric satiety mechanism(s) stimulated by sham feeding and (b) cholecystokinin, the putative satiety hormone released by food contacting the mucosal surface of the upper small intestine. All the results suggest that the diurnal variation of food intake in rats is primarily the result of diurnal variation in the potency of postprandial satiety mechanisms.

Animals↗

Effect of fat sources on satiety.

OBJECTIVE: There are inconsistent reports on the satiety value of different fatty acids. This study compared the appetitive effects of two fat sources rich in monounsaturated fatty acids (peanut oil and canola oil) with a source rich in saturated fatty acids (butter). RESEARCH METHODS AND PROCEDURES: After an overnight fast, lean participants completed a questionnaire eliciting information about hunger, fullness, desire to eat, and prospective consumption. They then consumed one of the preloads (muffins containing 40 g of each fat source or no fat) and 150 mL of water within 15 minutes. Questionnaires were completed again 30, 60, and 120 minutes after preload ingestion. Participants kept dietary records during the subsequent 24 hours. RESULTS: Canola and peanut oil muffins resulted in higher fullness, and butter, canola, and peanut oil muffins resulted in lower hunger ratings 30, 60, and 120 minutes after preload ingestion compared with the fat-free preload. No differences were observed among the fat-containing loads. Although energy intake 24 hours after consumption of the preloads was also comparable on days the three fat-containing loads were consumed, energy consumption after each study session was higher when the fat-free muffins were provided. However, total energy intake, including the calories provided by the preloads, was similar across treatments. DISCUSSION: These data do not support a differential satiety effect of fat sources rich in monounsaturated fatty acids relative to one rich in saturated fatty acids.

Adult↗

A new dental approach for reducing food intake.

OBJECTIVE: A behavioral recommendation for weight loss is reduction of size of bites of food. This "proof of concept" study tested the efficacy of a new, patented, dental approach, the DDS System, for reducing food intake. This removable tool is inserted into the upper palate of the mouth, reducing the size of the oral cavity, thereby potentially reducing bite size. RESEARCH METHODS AND PROCEDURES: Thirty-two adults (18 to 65 years) with BMI between 27 and 40 were randomly assigned to the control or experimental conditions. Participants ate all meals and stayed between meals at a research center. Day 1 served as baseline for both groups. On Day 2, experimental participants utilized the tool during meals. Changes in subjective ratings of hunger and satiety were measured using visual analog scales before and after each meal. RESULTS: Food intake difference scores were calculated for each participant (Day 2 - Day 1). Analysis of covariance on difference scores, using baseline as a covariate, showed that the experimental group ate significantly less (p < 0.05) on the second day (M = -659.2 kcal/d) compared with the control group (M = -125.9 kcal/d). Analysis of covariance, with ratings on Day 1 as a covariate, revealed that the experimental and control group did not differ on visual analog scale difference scores (premeal - postmeal) from Day 1 to Day 2. DISCUSSION: These findings suggest that use of this tool during meals significantly reduced food intake. This reduction of food intake was not associated with changes in ratings of hunger or satiety.

Adult↗

Exercise in dietary restrained women: no effect on energy intake but change in hedonic ratings.

OBJECTIVES: To investigate the short-term effects (one day) of exercise and diet composition on appetite control in restrained females. DESIGN: 2x2 repeated measures design, with exercise and lunch type used as the repeated factors. SETTING: The Human Appetite Research Unit at Leeds University Psychology Department. SUBJECTS: Twelve dietary restrained females, normal weight and regular exercisers INTERVENTIONS: A control (rest) and a bout of high intensity exercise (cycling 50 min., 70% VO2 max.) was followed by a free-selection lunch comprising high-fat (HF) or low-fat (LF) foods. Hunger and heart rate profiles were tracked. Energy Intake (EI) was monitored in the laboratory throughout the day. Post-meal hedonic ratings were completed after lunch and dinner. RESULTS: There was a significant effect of lunch type (HF vs LF) on EI following exercise and rest (P < 0.001) and on total 24 h EI (P < 0.05): EI increased during both HF conditions compared to the LF. A main effect of exercise on tastiness and pleasantness (P < 0.05) of the LF foods served at lunch was found. However, there was no effect of exercise on hunger, weight or energy value of food eaten. CONCLUSIONS: Exercise raises the perceived pleasantness of foods in dietary restrained women, but does not increase the drive to eat within 8 h of the cessation of exercise. The combination of physical activity and a low-fat diet could be used advantageously to control appetite, prevent overconsumption and protect against the development of obesity.

Adult↗

Appetite dysfunction in obese males: evidence for role of hyperinsulinaemia in passive overconsumption with a high fat diet.

OBJECTIVE: To test the hypothesis that caloric and fat intake in a pre-load meal have no subsequent effects upon blood glucose and insulin concentrations, perceived hunger, subsequent food intake and appetite control in lean and obese men. DESIGN: Lean and obese men reported to the laboratory in the morning in a fasted state where they were subject to an eating test based on the pre-load-test meal paradigm, using a double-blind protocol. The breakfast pre-load was either a reduced caloric low-fat (LF) meal or an overfeeding high-fat (HF) meal. LF was 20% of each individual's average daily energy requirement (ADER) and comprised 60% carbohydrate, 27% protein, and 13% fat, whilst HF was adjusted to yield 55% of the ADER, and comprised 45% carbohydrate, 22% protein and 43% fat. The pre-loads on both trials were administered as one single mean, and were given in a random order. After 5(1/2) h, an ad libitum test-lunch was given to determine how much energy was consumed. Between the two meals, blood samples were collected and subjective hunger ratings were assessed hourly. These variables were measured at 30-min intervals for 75 min after the ad libitum meal. STUDY PARTICIPANTS: Twelve healthy men, six of whom were lean (BMI 22. 50+/-1.08 kg.m2) and six of whom were obese (BMI 39.05+/-11.63 kg. m2) were recruited. RESULTS: When given 55% of their ADER in a HF pre-load meal, the obese group consumed more energy (5426+/-1126 kJ; F1,20=11.45, P<0.01), than the lean group did (3473+/-1114 kJ), accounting for 45% of the ADER in that meal setting. However, no differences between lean and obese intake were noted at the test meal following a LF pre-load. The lean group exhibited a significant inverse correlation (r=0.628, P<0.05) between serum insulin concentration before eating the test meal and the amount of energy consumed at the test meal, while such a relationship was absent in the obese group. CONCLUSION: The obese males were unable to compensate for the caloric overloading when fed a HF (55% ADER) pre-load at a subsequent test meal, whereas a calorically reduced pre-load (20% ADER) produced similar intakes to the lean control group. The inverse relationship noted in the lean group between insulin levels before the test meal and the energy intake at that test meal suggests that insulin may play a role in the regulation of appetite - satiety mechanism in lean males. The absence of such a relationship in the obese may suggest the site for possible appetite dysfunction contributing to obesity. These results further suggest that when obese individuals consume a high-fat meal they are prone to passive overconsumption, whereas lean study participants appear to be more resistant to such a phenomenon.

Adult↗

Effect of altering the variety of sensorially distinct foods, of the same macronutrient content, on food intake and body weight in men.

OBJECTIVE: To examine the effect of increasing the variety of sensorially distinct but nutritionally identical foods on appetite, food intake and body weight, over 7 days, in men. DESIGN: Six younger, lean men (mean (s.d.) age 27.0 (2.9) y; weight 74.7 (3.9) kg; height 1.78 (0.03) m; body mass index (BMI) 23.6 (1.1) kg/m2) and six older, overweight men (mean (s.d.) age 39.7 (2.9) y; weight 89.2 (4.4) kg; height 1.78 (0.04) m; BMI 28.1 (0.5) kg/m2) were each studied three times during a 9 day protocol, whilst resident in the Human Nutrition Unit. On days 1-2, subjects consumed a medium fat (MF) maintenance diet (40% fat, 13% protein and 47% carbohydrate by energy) calculated at 1.6 x resting metabolic rate (RMR). On days 3-9 subjects had ad libitum access to MF foods (550 kJ/100 g) with every item the same macronutrient composition and energy density. Subjects had continuous ad libitum access to 5, 10 or 15 food items per day on the low-variety (LV), medium-variety (MV) and high-variety (HV) treatments, respectively. The order of treatments was randomized across subjects. Subjective hunger was tracked hourly during waking hours using visual analogue scales (VAS). Body weight (as a proxy of changes in energy balance) was measured before eating and after voiding, each morning. RESULTS: Food and energy intake of the 12 men increased as the variety of foods increased, giving mean energy intakes of 10.13, 11.00 and 11.89 MJ/day on the LV, MV and HV treatments, respectively (F(2,20) = 10.32; P < 0.001). This effect was ascribable almost entirely to the lean men. Energy intake amounted to 1.57, 1.76 and 1.97 x RMR in the lean men and 1.33, 1.40 and 1.45 x RMR, for the overweight men on the LV, MV and HV diets, respectively. Weight changes amounted to -0.16, -0.28 and + 0.43 kg (lean) -1.03 and -1.52 kg and -0.66 kg (overweight), on the LV, MV and HV diets, respectively. The overweight men may have constrained their energy intake relative to expected requirements. This may have been due to a congnitive effect or an age effect. There was no significant group or diet effect on subjectively rated hunger. CONCLUSIONS: These data suggest that increasing the variety of sensorially distinct foods that are virtually identical in composition can increase food and energy intake and in the short to medium term can alter energy balance.

Adult↗

Influence of repeated consumption of beverages containing sucrose or intense sweeteners on food intake.

OBJECTIVE: To investigate the influence of ingestion of beverages with sucrose or with intense sweeteners on food intake (FI) and on hunger ratings in before and after a month of daily consumption of beverages. DESIGN: Experimental study. SETTING: Department of Physiology, University Hospital, Dijon, France. SUBJECTS: In all, 12 men and 12 women, aged 20-25 y. INTERVENTION: Four beverages contained either sucrose (E+:100 g/l, 1672 kJ) or intense sweeteners (E-: null energy content) and were flavoured with either orange (O) or raspberry (R). FI was measured in the lab during two 2-consecutive-day periods, carried out on 2 successive weeks (session 1). The subjects drank 2 l of either E+ or E- beverages on the first day of both weekly periods, according to a balanced randomised design. E+ was paired with O for 50% of subjects and with R for the other 50%. Subjects were then habituated over a 4-week period to both beverages, consuming 1 l of E+ beverage on odd days and 1 l of E- drink on even days. After this period, the measurements of session 1 were repeated (session 2, weeks 7-8). Finally, FI was measured for two more 2-day periods (weeks 9-10) after the association between flavour and energy content was reversed (session 3). RESULTS: The E- drinks were less palatable than the E+ drinks. Besides, we observed that FI was not reduced in response to a liquid extra caloric load and there was no change in hunger ratings after the beverages in any of the sessions. CONCLUSION: Ingestion of caloric beverages induced a positive energy balance and the continuous exposure phase to these beverages over 1 month did not improve FI adaptation in response to the extra energy provided by the beverages.

Adult↗