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Because children often consume substantial proportions of their diets in childcare programs, it is critical to determine what they eat when served menus meeting dietary recommendations and how intake is related to individual characteristics.

Background: Serving larger portions of low-energy-dense vegetables at a meal could have beneficial effects on children's food and energy intakes. Objective: We investigated whether increasing the portion size of vegetables served at the start of a meal leads to increased vegetable consumption and decreased meal energy intake in children. Design: In a crossover design, 3- to 5-y-old children in a daycare center were served a test lunch once a week for 4 wk (n = 51). In 3 of the meals, a first course of raw carrots varied in portion size (30, 60, or 90 g), and no first course was served in the control meal. Children consumed the first course ad libitum over 10 rain and then were served a main course of pasta, broccoli, applesauce, and milk, which was also consumed ad libitum. Results: Total vegetable consumption at the meal increased as the portion size of carrots increased (P < 0.0001). Doubling the portion size of the first course increased carrot consumption by 47%, or 12 [+ or -] 2 g (P < 0.0001). Tripling the portion size of carrots, however, did not lead to a further increase in intake (P = 0.61). Meal energy intake was not significantly affected by the amount of carrots served in the first course. The effect of portion size on intake was not significantly influenced by the children's age or body weight status. Conclusion: Increasing the portion size of a vegetable served as a first course can be an effective strategy for increasing vegetable consumption in preschool children. doi: 103945/ajcn.2009.29139.

Background: An increase in the proportion of vegetables at meals could help achieve recommended vegetable intakes and facilitate weight management. Objective: We investigated the effects on food and energy intakes of varying the portion size and energy density of a vegetable that was added to a meal or substituted for other foods. Design: In 2 experiments with crossover designs, men and women were served a meal of a vegetable, grain, and meat. Across the meals, the vegetable was served in 3 portion sizes (180, 270, or 360 g) and 2 energy densities (0.8 or 0.4 kcal/g) by altering the type and amount of added fat. In the addition study (n = 49), as the vegetable portion was increased, amounts of the grain and meat were unchanged, whereas in the substitution study (n = 48), amounts of the grain and meat decreased equally. Results: An increase in the vegetable portion size resulted in greater vegetable consumption in both studies (mean [+ or -] SE: 60 [+ or -] 5 g; P < 0.0001). The addition of more of the vegetable did not significantly affect meal energy intake, whereas substitution of the vegetable for the grain and meat decreased meal energy intake (40 [+ or -] 10 kcal; P < 0.0001). A reduction in vegetable energy density decreased meal energy intake independent of portion size (55 [+ or -] 9 kcal; P < 0.0001). By combining substitution with a reduction in energy density, meal energy intake decreased by 14 [+ or -] 3%. Conclusions: Serving more vegetables, either by adding more or substituting them for other foods, is an effective strategy to increase vegetable intake at a meal. However, to moderate meal energy intake, vegetables should be low in energy density; furthermore, the substitution of vegetables for more energy-dense foods is more effective than simply adding extra vegetables. Am J Clin Nutr 2010;91:913-22. doi: 10.3945/ajcn.2009.28801.

Background: The energy density (ED) of an entree affects children's energy intake at a meal consumed ad libitum. However, the effects in children of changing the ED of meals over multiple days are unknown. Objective: We aimed to test the effect of reducing the ED of multiple meals on the ad libitum energy intake of preschool-age children over 2d. Design: In this crossover study, 3- to 5-y-old children (n = 10 boys, 16 girls) were served manipulated breakfasts, lunches, and afternoon snacks 2 d/wk for 2 wk. Foods and beverages served at these meals during 1 wk were lower in ED than were those served during the other week. ED reductions were achieved by decreasing fat and sugar and by increasing fruit and vegetables. Dinner and an evening snack were sent home with children, but these meals did not vary in ED. The same 2-d menu was served in both conditions. Results: Children consumed a consistent weight of foods and beverages over 2 d in both conditions, and therefore their energy consumption declined by 389 [+ or -] 72 kcal (14%) in the lower-ED condition, a significant decrease (P < 0.0001). Differences in energy intake were significant at breakfast on day 1, and they accumulated at manipulated meals over 2 d (P < 0.01). Intake of the nonmanipulated meals was similar between conditions. Conclusions: Children's energy intake is influenced by the ED of foods and beverages served over multiple days. These results strengthen the evidence that reducing the ED of the diet is an effective strategy for moderating children's energy intake.

Background: Portion size influences children's energy intakes at meals, but effects on daily intake are unknown. Objective: Effects of large portions on daily energy intake were tested in 5-y-old Hispanic and African American children from low-income families. Maternal food intake data were collected to evaluate familial susceptibility to portion size. Design: A within-subjects experimental design with reference and large portion sizes was used in a study of 59 low-income Hispanic and African American preschool-aged children and their mothers. The portion size of 3 entrres (lunch, dinner, and breakfast) and an afternoon snack served during a 24-h period were of a reference size in one condition and doubled in the other condition. Portion sizes of other foods and beverages did not vary across conditions. Weighed food intake, anthropometric measures, and self-reported data were obtained. Results: Doubling the portion size of several entrees and a snack served during a 24-h period increased energy intake from those foods by 23% (180 kcal) among children (P < 0.0001) and by 21% (270 kcal) among mothers (P < 0.0001). Child and maternal energy intakes from other foods for which portion size was not altered did not differ across conditions. Consequently, total energy intakes in the large-portion condition were 12% (P < 0.001) and 6% (P < 0.01) higher in children and mothers, respectively, than in the reference condition. Child and maternal intakes of the portion-manipulated foods were not correlated. Conclusions: Large portions may contribute to obesigenic dietary environments by promoting excess daily intakes among Hispanic and African American children. KEY WORDS Portion size, energy intake, eating behavior, obesity

Background: Large portions of energy-dense foods are one feature of obesity-promoting dietary environments. Entree portion size has been shown to influence energy intake at meals by young children. The role of energy density (ED) in children's response to portion size, however, is unknown. Objective: We aimed to test the effects of portion size and ED on children's food and energy intakes at a meal. Design: Participants were 53 (28 girls and 25 boys; 15 Hispanic, 20 black, 16 white, 2 other race) 5- to 6-y-old children [mean ([+ or -] SD) body mass index percentile: = 61 [+ or -] 28]. A 2 x 2 within-subjects design was used to manipulate entree portion size (250 compared with 500 g) and ED (1.3 compared with 1.8 kcal/g). Fixed portions of other familiar foods were provided. Weighed intake, food preference, and weight and height data were obtained. Results: Effects of portion size (P < 0.0001) and ED (P < 0.0001) on entree energy intake were independent but additive. Energy intake from other foods at the meal did not vary across conditions. Compared with the reference portion size and ED condition, children consumed 76% more energy from the entree and 34% more energy at the meal when served the larger, more energy-dense entree. Effects did not vary by sex, age, entree preference, or body mass index z score. Conclusions: These findings provide new evidence that portion size and ED act additively to promote energy intake at meals among preschool-aged children. KEY WORDS Portion size, energy density, eating behavior, children, satiation

Background: Consuming foods low in energy density (kcal/g) decreases energy intake over several days, but the effectiveness of this strategy for weight loss has not been tested. Objective: The effects on weight loss of 2 strategies for reducing the energy density of the diet were compared over 1 y. Design: Obese women (n = 97) were randomly assigned to groups counseled either to reduce their fat intake (RF group) or to reduce their fat intake and increase their intake of water-rich foods, particularly fruit and vegetables (RF+FV group). No goals for energy or fat intake were assigned; the subjects were instructed to eat ad libitum amounts of food while following the principles of their diet. Results: After 1 y, study completers (n = 71) in both groups had significant decreases in body weight (P < 0.0001). Subjects in the RF+FV group, however, had a significantly different pattern of weight loss (P = 0.002) than did subjects in the RF group. After 1 y, the RF+FV group lost 7.9 [+ or -] 0.9 kg and the RF group lost 6.4 [+ or -] 0.9 kg. Analysis of all randomly assigned subjects also showed a different pattern of weight loss between groups (P = 0.021). Diet records indicated that both groups had similar reductions in fat intake. The RF+FV group, however, had a lower dietary energy density than did the RF group (P = 0.019) as the result of consuming a greater weight of food (P = 0.025), especially fruit and vegetables (P = 0.037). The RF+FV group also reported less hunger (P = 0.003). Conclusion: Reducing dietary energy density, particularly by combining increased fruit and vegetable intakes with decreased fat intake, is an effective strategy for managing body weight while controlling hunger. KEY WORDS Energy density, fruit and vegetables, water-rich foods, fat intake, obesity, weight management

Background: Dietary energy density (ED) reductions are associated with energy intake (EI) reductions. Little is known about influences on body weight (BW). Objectives: We examined the effects of behavioral interventions on ED values and explored how 6-mo ED changes relate to BW. Design: Prehypertensive and hypertensive persons were randomly assigned to 1 of 3 groups: the established group received an 18-session intervention implementing well-established hypertension recommendations (eg, weight loss, sodium reduction, and physical activity), the established + Dietary Approaches to Stop Hypertension (DASH) group received an 18-session intervention also implementing the DASH diet, and the advice group received 1 session on these topics. Two 24-h dietary recalls were collected (n = 658). Results: Each group had significant declines in EI, ED, and BW. The established and established+DASH groups had the greatest EI and BW reductions. The established+DASH group had the greatest ED reduction and the greatest increase in the weight of food consumed. When groups were combined and analyzed by ED change tertiles, participants in the highest tertile (ie, largest ED reduction) lost more weight (5.9 kg) than did those in the middle (4.0 kg) or lowest (2.4 kg) tertile. Participants in the highest and middle tertiles increased the weight of food they consumed (300 and 80 g/d, respectively) but decreased their EI (500 and 250 kcal/d). Conversely, those in the lowest tertile decreased the weight of food consumed (100 g/d), with little change in EI. The highest and middle tertiles had favorable changes in fruit, vegetable, vitamin, and mineral intakes. Conclusion: Both large and modest ED reductions were associated with weight loss and improved diet quality. KEY WORDS Energy density, obesity, weight management, food patterns, fruit and vegetables, PREMIER trial, Dietary Approaches to Stop Hypertension, DASH

Background: Laboratory-based investigations indicate that the consumption of foods with a low energy density (kcal/g) decreases energy intake. Although low-energy-dense diets are recommended for weight management, relations between energy density, energy intake, and weight status have not been clearly shown in free-living persons. Objectives: A representative US sample was used to determine whether dietary energy density is associated with energy intake, the weight of food consumed, and body weight and to explore the influence of food choices (fruit, vegetable, and fat consumption) on energy density and body weight. Design: A cross-sectional survey of adults (n = 7356) from the 1994-1996 Continuing Survey of Food Intakes by Individuals and two 24-h dietary recalls were used. Results: Men and women with a low-energy-dense diet had lower energy intakes ([approximately equal to] 425 and 275 kcal/d less, respectively) than did those with a high-energy-dense diet, even though they consumed more food ([approximately equal to] 400 and 300 g/d more, respectively). Normal-weight persons had diets with a lower energy density than did obese persons. Persons with a high fruit and vegetable intake had the lowest energy density values and the lowest obesity prevalence. Conclusions: Adults consuming a low-energy-dense diet are likely to consume more food (by weight) but to have a lower energy intake than do those consuming a higher-energy-dense diet. The energy density of a variety of dietary patterns, including higher-fat diets, can be lowered by adding fruit and vegetables, Our findings support the hypothesis that a relation exists between the consumption of an energy-dense diet and obesity and provide evidence of the importance of fruit and vegetable consumption for weight management. KEY WORDS Energy density, obesity, weight management, food patterns, fruit and vegetables, Continuing Survey of Food Intakes by Individuals, CSFII

Background: When the portion size and energy density (in kcal/g) of a food are varied simultaneously in a single meal, each influences energy intake independently. Objective: We aimed to determine how the effects of portion size and energy density combine to influence energy intake and satiety over multiple meals for 2 d. Design: In a crossover design, 24 young women were provided with meals and snacks for 2 consecutive days per week for 4 wk; all foods were consumed ad libitum. Across the 4 sessions, the subjects were served the same 2 daily menus, but all foods were varied in portion size and energy density between a standard level (100%) and a reduced level (75%). Results: Reducing the portion size and energy density of all foods led to significant and independent decreases in energy intake over 2 d (P < 0.0001). A 25% decrease in portion size led to a 10% decrease in energy intake (231 kcal/d), and a 25% decrease in energy density led to a 24% decrease in energy intake (575 kcal/d). The effects on energy intake were additive and were sustained from meal to meal. Despite the large variation in energy intake, there were no significant differences in the ratings of hunger and fullness across conditions over the 2 d. Conclusions: Reductions in portion size and energy density independently decreased ad libitum energy intake in women when commonly consumed foods were served over 2 d. Reductions in both portion size and energy density can help to moderate energy intake without increased hunger. KEY WORDS Portion size, energy density, energy intake, obesity prevention and control, satiety, humans, adult, clinical trial, crossover studies

The increase in the prevalence of obesity has coincided with an increase in portion sizes of foods both inside and outside the borne, suggesting that larger portions may playa role in the obesity epidemic. Although it will be difficult to establish a causal relationship between increasing portion size and obesity, data indicate that portion size does influence energy intake. Several well-controlled, laboratory-based studies have shown that providing older children and adults with larger food portions can lead to significant increases in energy intake. This effect has been demonstrated for snacks and a variety of single meals and shown to persist over a 2-d period. Despite increases in intake, individuals presented with large portions generally do not report or respond to increased levels of fullness, suggesting that hunger and satiety signals are ignored of overridden. One strategy to address the effect of portion size is decreasing the energy density (kilojoules per grato; kilocalories per grato) of foods. Several studies have demonstrated that eating low-energy-dense foods (such as fruits, vegetables, and soups) maintains satiety while reducing energy intake. In a clinical trial, advising individuals to eat portions of low-energy-dense foods was a more successful weight loss strategy than fat reduction coupled with restriction of portion sizes. Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while restricting energy intake for weight management. KEY WORDS Portion size, energy density, energy intake, body weight, weight management, obesity

Background: Increases in both the portion size and energy density of food have both been shown to increase energy intake, but the combined effects of such increases have not been investigated. Objective: The objective was to determine the combined effects of energy density and portion size on energy intake in women. Design: This study used a within-subjects design. Once a week for 6 wk, 39 women were served breakfast, lunch, and dinner ad libitum. The main entree at lunch was formulated in 2 versions that varied in energy density (5.23 or 7.32 kJ/g), each of which was served in 3 different portion sizes (500, 700, or 900 g). The 2 versions were matched for macronutrient composition and palatability. Breakfast and dinner were standard meals. Results: Increases in portion size and energy density led to independent and additive increases in energy intake (P Conclusions: The energy density and the portion size of a food act independently to affect energy intake. The findings indicate that large portions of foods with a high energy density may facilitate the overconsumption of energy. KEY WORDS Portion size, energy density, energy intake, food intake, obesity, women

Background: Whether large portion sizes affect children's eating behavior has rarely been studied. Objectives: Our objectives were 1) to determine the effects of repeated exposure to a large portion of an entree on preschoolaged children's awareness of portion size, self-selected portion size, and food intake and 2) to evaluate associations of children's responsiveness to portion size with weight status and overeating. Design: Energy intake, bite size, and comments about portion size were evaluated among 30 children at 2 series of lunches in which either an age-appropriate portion or a large portion of an entree was served. On separate occasions, the children's self-served portions, weight, height, and tendency to overeat were assessed. Results: Doubling an age-appropriate portion of an entree increased entree and total energy intakes at lunch by 25% and 15%, respectively. Changes were attributable to increases in the average size of the children's bites of the entree without compensatory decreases in the intake of other foods served at the meal. These increases were seen even though observational data indicated that the children were largely unaware of changes in portion size. Greater responsiveness to portion size was associated with higher levels of overeating. The children consumed 25% less of the entree when allowed to serve themselves than when served a large entree portion. Conclusions: Large entree portions may constitute an 'obesigenic' environmental influence for preschool-aged children by producing excessive intake at meals. Children with satiety deficits may be most susceptible to large portions. Allowing children to select their own portion size may circumvent the effects of exposure to large portions on children's eating. Am J Clin Nutr 2003:77:1164-70. KEY WORDS Portion size, children's eating behavior, food intake, preschool-aged children

Background: Large portions of food may contribute to excess energy intake and greater obesity. However, data on the effects of portion size on food intake in adults are limited. Objectives: We examined the effect of portion size on intake during a single meal. We also investigated whether the response to portion size depended on which person, the subject or the experimenter, determined the amount of food on the plate. Design: Fifty-one men and women were served lunch 1 d/wk for 4 wk. Lunch included an entree of macaroni and cheese consumed ad libitum. At each meal, subjects were presented with 1 of 4 portions of the entree: 500, 625,750, or 1000 g. One group of subjects received the portion on a plate, and a second group received it in a serving dish and took the amount they desired on their plates. Results: Portion size significantly influenced energy intake at lunch (P < 0.0001). Subjects consumed 30% more energy (676 kJ) when offered the largest portion than when offered the smallest portion. The response to the variations in portion size was not influenced by who determined the amount of food on the plate or by subject characteristics such as sex, body mass index, or scores for dietary restraint or disinhibition. Conclusions: Larger portions led to greater energy intake regardless of serving method and subject characteristics. Portion size is a modifiable determinant of energy intake that should be addressed in connection with the prevention and treatment of obesity. KEY WORDS Portion size, serving size, serving method, energy intake, food intake, obesity, adults

This study investigated the effect on fat and energy intakes of fat-free potato chips made with olestra compared with regular potato chips. Ninety-five participants (unrestrained and restrained males and females) were tested in 2 conditions. In the information condition, participants were given nutrition information about the chips and were aware that the chips differed in fat and energy contents. In the no-information condition, participants were not aware of the differences. In both conditions, participants ate either regular or fat-free potato chips ad libitum for an afternoon snack in a crossover design in two 10-d periods. To assess 24-h intake, participants completed food diaries twice in each 10-d period. The results showed that all groups significantly reduced their fat and energy intakes in the snack when eating the fat-free chips compared with the regular chips (P [is less than] 0.0001). Also, potato chip intake did not differ across time for either type of chip. Over 24 h all participants had lower fat intakes (P [is less than] 0.05) when eating the fat-free potato chips compared with the regular chips, but 24-h energy intake was not significantly different between groups. When information was provided, restrained participants ate more of the fat-free chips than the regular chips; however, this increase did not negate the reductions in fat and energy associated with eating the fat-free chips. This study showed that substituting fat-free (olestra-containing) potato chips for regular-fat chips can help reduce fat and energy intakes in short-term (within meal) situations and reduce fat intake over 24 h. Am J Clin Nutr 1998;68:282-90.

This study tested the hypothesis that the amount (weight or volume) of food consumed affects the satiating potency of a food, independent of its energy content. Normal-weight young men (n = 20) were tested in a within-subjects design. Subjects were served a milk-based drink or no drink (control), followed 30 min later by a self-selected lunch and [is greater than] 4 h later by a self-selected dinner. Milk drinks were equal in energy content (2088 kJ, or 499 kcal) and had similar proportions of fat (30.3%). carbohydrate (54.7%). and protein (15%) across three volumes: 300, 450, and 600 mL. Ratings of palatability, sensory properties, and energy content of the drinks and of hunger completed before consumption of the preloads were not significantly different among conditions. The results showed that preload volume affected energy intake at lunch (P [is less than or equal to] 0.009) such that energy intake was less after the 600-mL preload than after the 300-mL preload. This effect was still present when energy intake at dinner was included (P [is less than or equal to] 0.022). At lunch, including energy from the preload, subjects overate relative to the control condition (4323 [+ or -] 322 kJ) after the 300- (5263 [+ or -] 321 kJ) and 450-mL (5011 [+ or -] 300 kJ) preloads but not after the 600-mL (4703 [+ or -] 353 kJ) preload. Thus, the best adjustment for the energy in the preloads was with the largest, least energy-dense drink. Consistent with the effects on intake, the volume of the drinks affected ratings of hunger and fullness. These results indicate that the volume consumed is an important determinant of satiety after milk drinks under these conditions. Ant J Clin Nutr 1998; 67:1170-77.

This study examined the effect of energy density, independent of fat content and palatability, on food and energy intakes. With use of a within-subjects design, normal-weight women (n = 18) were provided with meals for 2 d during each of three test sessions. During lunch, dinner, and an evening snack, subjects were given free access to a main entree varying in energy density (low, medium, or high). The manipulated main entrees were similar in palatability to their counterparts across conditions. Low-energy compulsory (consumption required) side dishes accompanied each meal. Subjects also consumed a standard, compulsory breakfast. Results showed that subjects consumed a similar amount of food (by weight) across the three conditions of energy density. Thus, significantly more energy was consumed in the condition of high energy density (7532 [+ or -] 363 kJ, or 1800 [+ or -] 86 kcal) than in the medium- (6356 [+ or -] 281 kJ, or 1519 [+ or -] 67 kcal) and low- (5756 [+ or -] 178 kJ, or 1376 [+ or -] 43 kcal) energy-density conditions (P [is less than] 0.0001). There were no differences in hunger or fullness before meals, after meals, or over the 2 d across conditions. The results from this study indicate that energy density affects energy intake independent of macronutrient content or palatability, suggesting that the overconsumption of high-fat foods may be due to their high energy density rather than to their fat content. Am J Clin Nutr 1998;67:412-20.

Many reduced-fat foods retain the sensory properties of their high-fat counterparts through the use of fat substitutes. This study examined whether regulation of energy intake is affected when the nonabsorbable fat substitute olestra is used to uncouple the sensory properties of fat from fat absorption and metabolism. Cream of broccoli soups were developed in three versions: fat-free, fat-free + olestra (33.3 g olestra), and high-fat (33.3 g fat) (923 900 and 2150 kJ per serving, respectively). The olestra soup had the nutrient composition of the fat-free soup but the sensory properties of the high-fat soup. Subjects were grouped by sex, body weight, and dietary restraint (total n = 67). Subjects had either no preload (control) or a soup preload (465 g) followed by a self-selection lunch. Intake was measured at lunch, dinner, snack, and breakfast. At lunch, the response to the soup preloads was not affected by sex, dietary restraint, or body weight. Energy intake (soup + lunch) was significantly greater in the high-fat than in the control condition (P [is less than] 0.05), but energy intake in the fat-free, olestra, and high-fat soup conditions, was not significantly different from that in the control condition (3570, 3352, and 4457 kJ in control, fat-free, olestra, and high-fat soup condition, respectively), Thus, subjects compensated completely for the energy in the fat-free and olestra soups but not for the energy in the high-fat soup. No differences were found in the response to the two fat-free conditions, one with the fatty taste and one without. In this study the sensory properties of fat alone, ie, apart from the physiologic affects of fat, did not affect energy regulation.

The macronutrient composition of the diet can influence hunger, satiety, food intake, body weight, and body composition. Fat, not carbohydrate, is the macronutrient associated with overeating and obesity. Fat is overeaten because it is highly palatable and because it provides a high level of energy in a given volume of food. However, when given in equal volumes, carbohydrate (sugar) and fat have similar effects on hunger, satiety, and subsequent food intake when infused intragastrically or ingested in foods by normal-weight, unrestrained young men. In obese and restrained subjects, preloads of high-carbohydrate yogurts suppress subsequent food intake more than do high-fat yogurts, indicating a relative insensitivity to the satiety value of fat. Both the amount of fat in the diet and total energy intake should be managed in weight-loss regimens. Low-fat foods and fat substitutes can help to reduce fat intake. Although more data are required, currently the best dietary advice for weight maintenance and for controlling hunger is to consume a low-fat, high-carbohydrate diet with a high fiber content. Am J Clin Nutr 1995; 61(suppl):960S-7S.

Lean healthy males received either parenteral or enteral infusions of pure fat or carbohydrate (2092 kJ), or isotonic saline, to determine their influences on food intake and energy regulation in self-selected lunch and dinner meals. In the first study, six males received intravenous infusions for 3.5 h in the morning, followed by lunch 30 min after the infusion ended and dinner 6 h later. No compensation was seen for energy differences in intravenous infusions. In the second study, six males received intragastric infusions for 15 min or 3.5 h. Rapid intragastric infusions of fat or carbohydrate and slow infusions of fat significantly reduced intake at lunch, whereas slow carbohydrate infusions did not. In both studies, subjects reduced intake at lunch 30 min after 2092-kJ yogurt preloads varying in fat and carbohydrate, demonstrating their ability to respond to orally derived energy. These results support the existence of mechanisms in the gastrointestinal tract for the rapid detection of the energy content of ingested nutrients or foods in lean males. Am J Clin Nutr 1995;61:754-64.

Food intake, food selection, macronutrientintake, sensory-specific satiety, and ratings of hunger and satiety were measured after high- and low-energy salad preloads (2414 kJ, or 172 kJ) or no preload to determine whether patients with eating disorders compensate appropriately for different energy intakes. Subjects were female patients with a DSM-III-R diagnosis of anorexia nervosa with bulimic features or bulimia nervosa. or non patient, normal- weight, nondieters (n = 9/group).At a self-selected lunch 30 min after the preloads, all of the groups reduced intake after the high-energy preload, with the bulimics showing the best compensation. The anorexics chose low-energy foods and in some conditions ate a smaller proportion of fat than did the other groups. The bulimics ate more high-energy foods was than did the anorexics. The anorexics demonstrated sensory-specific satiety only after the high-energy salad and the bulimics only after the low- energy salad. Overall, these data suggest that while many of their responses to food are abnormal,patients with eating disorders have some capacity to respond to physiological hunger and satiety cues. Am J Clin Nutr1992;55:1093-1103.

Six subjects participated in a residential study assessing the effects of covert macronutrient and energy manipulations during three required-eating occasions (breakfast, lunch, and afternoon snack) on total macronutrient and energy intakes. Overall, energy content of the occasions varied between [nearly equal to] 3000 and [nearly equal to] 7000 kJ ([nearly equal to] 700 and [nearly equal to] 1700 kcal) with the major the differential derived from either fat or carbohydrate (CHO). Each condition (high, medium, and low fat; high, medium, and low CHO; and no required eating) was examined for 2 d. Subjects compensated for the energy content of the required occasions such that only under the low-cho condition (11 297 [+ or -] 3314 kJ) was total daily energy intake lower than that observed in the absence of required occasions (13 297 [+ or -] 1356 kJ). Only total energy intake under the high-fat condition (12 326 [+ or -] 2548 kJ) was significantly different from its matched CHO condition (high-cho condition: 14 665 [+ or -] 2686 kJ). In contrast to the clear evidence for caloric compensation, there were no differential effects of condition on macronutrient intake, ie, there was no macronutrient compensation. Am J Clin Nutr 1992;55: 331-42. KEYWORDS Fat, carbohydrate, caloric intake, food intake, compensation, humans, preloads

Smell and taste play an important role in the diet. People choose foods that smell and taste good to them. Elderly people rate food taste and flavor perception as the most important factors when they are selecting foods, yet older people tend to have less variety in their diet. It has been reported that the ability to smell decreases with aging, and that reduced ability to taste and smell leads to a decrease in food intake in the elderly. One study reported that adding flavor to food increases the intake of nutrient-rich foods in elderly people. This article describes the results of a study designed to evaluate the effects of age on sensory-specific satiety. The study included 24 adolescents (age 12 to 15), 24 young adults (age 22 to 35), 24 older adults (age 45 to 60) and 24 elderly adults (age 65 to 82). Each subject was presented with five different foods and was asked to rate the pleasantness of the smell and their desire to eat the food. This was done before and after each subject had eaten 300 grams of yogurt. When compared with the elderly subjects, the adolescents and young adults showed a decreased desire to continuing eating more of the same food and showed a greater desired to try one of the other foods. The results of this study indicate that sensory-specific satiety is reduced in elderly people. (Consumer Summary produced by Reliance Medical Information, Inc.)

There have been many conflicting reports about the effects of artificial sweeteners, such as aspartame and saccharin, on appetite, food intake and body weight. This article reviews the available scientific literature on aspartame in an attempt to clarify this issue. Several reports in the media have indicated that artificial sweeteners may increase hunger and food intake, and as a result may cause weight gain. However, the majority of scientific studies indicate that aspartame does not increase hunger or appetite. In the few studies that reported an increase in hunger after beverages containing aspartame were consumed, there was no evidence that food intake and body weight were affected, because food intake and body weight were not measured. Studies that measured food intake following consumption of aspartame-sweetened foods showed that aspartame either decreased food intake or had no effect on food intake. No studies have provided scientific evidence that aspartame increases food intake. Also, there is no evidence to support the claim that eating foods or consuming beverages with intense sweeteners increases food intake and weight gain in people who are dieting. In the future, more studies are needed to determine the long-term effects of artificial sweeteners on eating patterns and weight gain. Such studies are difficult to perform because patients may not be compliant with the diets, and it is difficult to measure the actual intake of the test substance. Based on the literature reviewed, it is concluded that intense sweeteners have never been shown to cause weight gain. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dietary fat comprises approximately 35 percent of the total daily caloric intake for most Americans. Excessive fat intake has been associated with heart disease, cancer and obesity. Nutritional experts recommend a total daily caloric intake that includes 30 percent fat. Reduced fat intake may be accomplished by decreasing the intake of foods high in fat content or by substituting a low-calorie, nonfat foods. Two groups of three subjects participated in a study to determine what effect the nutrient and caloric content of a required lunch meal would have on subsequent food intake. The lunches contained either 431 or 844 calories. The difference in the caloric content of the two lunches was created by altering the amounts of fat and carbohydrate. Four different lunches containing either high fat, high carbohydrate, low fat, or low carbohydrate were served for three consecutive days. Subjects were allowed to control their own pattern of food intake. There were no significant differences in total daily caloric intake among the four groups. These findings indicate that the subjects compensated for the caloric content of a lunch regardless of the nutrient content. The results suggest that substitution of low-calorie foods may not be sufficient for reducing total daily caloric intake, because compensatory changes in intake of higher caloric foods are likely to occur. (Consumer Summary produced by Reliance Medical Information, Inc.)

Eating in the absence of hunger (EAH) is a behavioral phenotype of pediatric obesity characterized by the consumption of palatable foods beyond hunger. Studies in children have identified EAH to be stable over time, but findings are unclear on whether it predicts the development of adiposity, particularly in middle childhood, a period of increased autonomy over food choices.

Behavioral phenotypes that predict future weight gain are needed to identify children susceptible to obesity.

Background: The results of previous studies indicated that energy density, independent of fat content, influences energy intake. In most studies, however, both fat content and energy density were lower than in typical American diets. Objective: We examined the influence of energy density on intake when fat content was above, below, or similar to the amount of fat typically consumed and when energy density was closer to that of American diets. Design: Lean (n = 19) and obese (n = 17) women consumed all meals daily in our laboratory during 6 experimental sessions. The main entrees, consumed ad libitum, were formulated to vary in fat content (25%, 35%, and 45% of energy) and energy density (5.23 kJ/g, or low energy density, and 7.32 kJ/g, or high energy density) but to have similar palatability. Results: Energy density influenced energy intake across all fat contents in both lean and obese women (P [is less than] 0.0001). Women consumed less energy in the low (7531 kJ) than in the high (9414 kJ) energy density condition. Despite this 20% lower energy intake, there were only small differences in hunger (7%) and fullness (5%). Women consumed a similar volume, but not weight, of food daily across conditions. Differences in intake by weight, but not volume, occurred because for some versions of manipulated foods, weight and volume were not directly proportional. Conclusions: Energy density affected energy intake across different fat contents and at levels of energy density comparable with those in typical diets. Furthermore, our findings suggest that cues related to the amount of food consumed have a greater influence on short-term intake than does the amount of energy consumed. KEY WORDS Energy density, fat content, energy intake, food intake, macronutrient composition, obesity, satiation, volume, weight management, women

Background: Studies showed that hormonal fluctuations that occur over the human menstrual cycle affect energy intake and expenditure. However, little is known about the possible effects on body weight regulation that may arise when these cyclic changes are suppressed with hormonal contraceptives. Objective: The aim of this study was to examine how a progestational contraceptive drug (depot medroxyprogesterone acetate) affects food intake, resting energy expenditure (REE), and body weight in young women. Design: Twenty normal-weight women were tested in a single-blind, placebo-controlled experiment. Body weight, REE, and 3-d food intake (food provided) were measured in the follicular and luteal phases of 2 menstrual cycles before a single injection of depot medroxyprogesterone or saline solution was administered. Measurements were also taken 4 times after injection: in the luteal and follicular phases of 2 cycles in the placebo group and 2 wk apart (to mimic timing of the menstrual phases) in the drug group. Results: Before injection, the phase of the menstrual cycle affected both energy intake and REE. The study participants consumed more energy (4.3%; P = 0.02) and expended more energy at rest (4.3%; P = 0.0002) in the luteal phase than in the follicular phase. Comparison of pre- and post-injection means showed that treatment with the contraceptive drug had no significant effects on energy intake, REE, or body weight. Conclusions: This study showed that, although phases of the menstrual cycle affected energy intake and REE, depot medroxyprogesterone acetate did not alter energy intake or expenditure or cause weight gain in young women. Am J Clin Nutr 2001 ;73:19-26. KEY WORDS Food intake, resting energy expenditure, menstrual cycle, depot medroxyprogesterone acetate, contraception, body weight

Background: Previous research indicated that increasing the volume of food by adding water can lead to reductions in energy intake. However, the addition of water affects not only the volume but also the energy density (kJ/g) of foods. No studies have examined the effect of volume independent of energy density on intake. Objective: We examined the effect of food volume independent of energy density on satiety. Design: In a within-subjects design, 28 lean men consumed breakfast, lunch, and dinner in the laboratory 1 d/wk for 4 wk. On 3 d, participants received a preload 30 min before lunch and on 1 d no preload was served. Preloads consisted of isoenergetic (2088 kJ), yogurt-based milk shakes that varied in volume (300, 450, and 600 mL) as a result of the incorporation of different amounts of air. Preloads contained identical ingredients and weighed the same. Results: The volume of the milk shake significantly affected energy intake at lunch (P [is less than] 0.04) such that intake was 12% lower after the 600-mL preload (2966 [+ or -] 247 kJ) than after the 300-mL preload (3368 [+ or -] 197 kJ). Subjects also reported greater reductions in hunger and greater increases in fullness after consumption of both the 450- and 600-mL preloads than after the 300-mL preload. Conclusions: Changing the volume of a preload by incorporating air affected energy intake. Thus, the volume of a preload independent of its energy density can influence satiety. Am J Clin Nutr 2000;72:361-8. KEY WORDS Air, energy density, energy intake, food intake, obesity, satiety, food volume, men

Background: Liquid-formula diets (LFDs) are useful in metabolic studies of the cholesterolemic effects of dietary lipids because they can be formulated with accuracy, facilitating precise delivery of fatty acids of interest. However, because of differences in composition and nutrient delivery between LFDs and solid-food diets (SFDs), there is a need to determine differences in their effects. Objective: Our objective was to compare lipid and lipoprotein responses to changes in total fat, saturated fatty acids (SFAs), and cholesterol in subjects consuming an SFD or LFD. Design: Twenty-one healthy subjects consumed controlled diets representative of an average American diet [AAD; 37% of energy from fat (15% from SFAs), and [is less than] 50 mg cholesterol/MJ] or a National Cholesterol Education Program (NCEP) Step II diet [26% fat (5% from SFAs) and [is less than] 25 mg cholesterol/MJ]. Other nutrients were similar between diets. Diets were consumed for 23 d in a randomized, crossover design. Results: For the AAD and NCEP Step II diet, there were no significant differences in lipids and apolipoproteins when the LFD or SFD versions were consumed. In contrast, consumption of the SFD was associated with significantly lower total cholesterol and triacylglycerols than was consumption of the corresponding AAD or Step II LFD (P [is less than] 0.05). Subjective ratings of satiety, hunger, and quality of life between diet forms did not differ significantly. Conclusions: Both LFDs and SFDs yield quantitatively similar cholesterolemic responses to changes in dietary fat, SFAs, and cholesterol. LFDs may offer advantages because they provide easily administered, complete, balanced nutrition without affecting satiety. Am J Clin Nutr 1999;70:839-46. KEY WORDS Liquid-formula diets, fat, saturated fat, blood cholesterol, satiety, human food intake, solid food, lipids

Background: Previous research showed that decreasing the energy density (kJ/g) of foods by adding water to them can lead to reductions in energy intake. Few studies have examined how water consumed as a beverage affects food intake. Objective: This study examined the effects of water, both served with a food and incorporated into a food, on satiety. Design: In a within-subjects design, 24 lean women consumed breakfast, lunch, and dinner in our laboratory 1 d/wk for 4 wk. Subjects received 1 of 3 isoenergetic (1128 kJ) preloads 17 min before lunch on 3 d and no preload on 1 d. The preloads consisted of 1) chicken rice casserole, 2) chicken rice casserole served with a glass of water (356 g), and 3) chicken rice soup. The soup contained the same ingredients (type and amount) as the casserole that was served with water. Results: Decreasing the energy density of and increasing the volume of the preload by adding water to it significantly increased fullness and reduced hunger and subsequent energy intake at lunch. The equivalent amount of water served as a beverage with a food did not affect satiety. Energy intake at lunch was 1209 [+ or -] 125 kJ after the soup compared with 1657 [+ or -] 148 and 1639 [+ or -] 148 kJ after the casserole with and without water, respectively. Subjects did not compensate at dinner for this reduction in lunch intake. Conclusion: Consuming foods with a high water content more effectively reduced subsequent energy intake than did drinking water with food. Am J Clin Nutr 1999;70:448-55.

Several dietary patterns, both macronutrient and food based, can lead to weight loss. A key strategy for weight management that can be applied across dietary patterns is to reduce energy density. Clinical trials show that reducing energy density is effective for weight loss and weight loss maintenance. A variety of practical strategies and tools can help facilitate successful weight management by reducing energy density, providing portion control, and improving diet quality. The flexibility of energy density gives patients options to tailor and personalize their dietary pattern to reduce energy intake for sustainable weight loss.

Food energy density (ED; kcal/g) is positively related to energy intake in numerous studies. A recent secondary analysis proposed that when the ED of consumed food is above a breakpoint, adults sense calories and adjust meal size to minimize overconsumption.

The ability to regulate energy intake is often assessed using a preloading paradigm to measure short-term energy compensation. In children, large variability exists with this paradigm both within- and across- studies that is poorly understood.

Roland L. Weinsier, M.D., Dr.P.H., devoted himself to the fields of nutrition and obesity for more than 35 years. He contributed outstanding work related to the treatment of obesity through dietary and lifestyle change; metabolic/energetic influences on obesity, weight loss, and weight regain; body composition changes accompanying weight loss and regain; the health benefits and risks of weight loss; nutrition education for physicians; and nutrition support of sick patients. He served on the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) National Task Force on Prevention and Treatment of Obesity, as Chair of the University of Alabama at Birmingham's Department of Nutrition Sciences, and as Founder and Director of its NIDDK‐funded Clinical Nutrition Research Center. He was a long‐time and active member of NAASO, serving in the roles of Councilor, Publications Committee Chair, Continuing Medical Education Course Director, Public Relations Committee Chair, and Membership Committee Co‐Chair, to name just a few. He was well respected as a staunch defender of NAASO's scientific integrity in these roles. Sadly, Roland Weinsier died on November 27, 2002. He will be missed and remembered by many as a revered and beloved teacher, mentor, healer, and scholar.

Background: Studies have shown that energy intake increases when both the fat content and energy density of the entire diet increases. When the fat content and energy density vary independently of one another, however, energy density, but not fat content, influences intake. Objective: The present study examined whether energy intake in lean and obese women is affected when either the energy density or the fat content of a portion of the diet is manipulated and palatability is held constant. Design: In a within-subjects design, 17 lean and 17 obese women consumed meals in the laboratory for four, 4-d test periods. In 3 of these test periods the energy density (4.4 and 6.7 kJ/g) or the fat content (16% and 36% of energy) of compulsory entrees representing 50% of each subject's usual energy intake was manipulated. Additional self-selected foods were consumed ad libitum at meals and as snacks. Results: There were no systematic differences in palatability of the manipulated foods across conditions. Obese and lean participants responded similarly to the dietary manipulations. Intake of self-selected foods at meals was reduced significantly by 16% for both lean and obese subjects in the low- compared with the high-energy-density condition. The fat content of the compulsory foods had no significant effect on energy intake. Ratings of hunger did not differ between diets. Conclusion: These results indicate that when a portion of the diet was manipulated, the energy density, but not the fat content, of the foods affected total energy intake at meals in both lean and obese women. Am J Clin Nutr 1999;69:863-71.

There has been a growing interest in examining dietary energy density (ED, kcal/g) as it relates to various health outcomes. Consuming a diet low in ED has been recommended in the 2010 Dietary Guidelines, as well as by other agencies, as a dietary approach for disease prevention. Translating this recommendation into practice; however, is difficult. Currently there is no standardized method for calculating dietary ED; as dietary ED can be calculated with foods alone, or with a combination of foods and beverages. Certain items may be defined as either a food or a beverage (e.g., meal replacement shakes) and require special attention. National survey data are an excellent resource for evaluating factors that are important to dietary ED calculation. The National Health and Nutrition Examination Survey (NHANES) nutrient and food database does not include an ED variable, thus researchers must independently calculate ED. The objective of this study was to provide information that will inform the selection of a standardized ED calculation method by comparing and contrasting methods for ED calculation. The present study evaluates all consumed items and defines foods and beverages based on both USDA food codes and how the item was consumed. Results are presented as mean EDs for the different calculation methods stratified by population demographics (e.g. age, sex). Using United State Department of Agriculture (USDA) food codes in the 2005-2008 NHANES, a standardized method for calculating dietary ED can be derived. This method can then be adapted by other researchers for consistency across studies.

Objective: The energy density (kilocalories per gram) of foods influences short‐term energy intake. This 1‐year clinical trial tested the effect on weight loss of a diet incorporating one or two servings per day of foods equal in energy but differing in energy density. Research Methods and Procedures: Dietitians instructed 200 overweight and obese women and men to follow an exchange‐based energy‐restricted diet. Additionally, subjects were randomized to consume daily either one or two servings of low energy‐dense soup, two servings of high energy‐dense snack foods, or no special food (comparison group). Results: All four groups showed significant weight loss at 6 months that was well maintained at 12 months. The magnitude of weight loss, however, differed by group (p= 0.006). At 1 year, weight loss in the comparison (8.1 ± 1.1 kg) and two‐soup (7.2 ± 0.9 kg) groups was significantly greater than that in the two‐snack group (4.8 ± 0.7 kg); weight loss in the one‐soup group (6.1 ± 1.1 kg) did not differ significantly from other groups. Weight loss was significantly correlated with the decrease in dietary energy density from baseline at 1 and 2 months (p= 0.0001) but not at 6 and 12 months. Discussion: On an energy‐restricted diet, consuming two servings of low energy‐dense soup daily led to 50% greater weight loss than consuming the same amount of energy as high energy‐dense snack food. Regularly consuming foods that are low in energy density can be an effective strategy for weight management.

Objective: Eating frequently in restaurants is one of the behaviors associated with obesity. This study examined whether increasing the portion size of an entrée affected energy intake at a restaurant meal. Research Methods and Procedures: In a cafeteria‐style restaurant on different days, the size of a pasta entrée was varied from a standard portion (248 g) to a large portion (377 g). The entrée price was not changed. Intake of the entrée was determined by covertly weighing each dish before and after the meal; intake of all other foods was determined by estimating the percent consumed. The 180 adult customers who purchased the entrée also completed a survey in which they rated characteristics of the meal, including the appropriateness of the entrée portion size and the amount that they ate compared with their usual meal. Results: Portion size had a significant effect on intake of the entrée (p< 0.0001). Compared with customers who purchased the standard portion, those who purchased the larger portion increased their energy intake of the entrée by 43% (719 kJ; 172 kcal) and of the entire meal by 25% (664 kJ; 159 kcal). There was no difference between the two groups of customers in ratings of the appropriateness of the portion size or of the amount that was eaten in relation to their usual meal. Discussion: In a restaurant setting, increasing the size of an entrée results in increased energy intake. These results support the suggestion that large restaurant portions may be contributing to the obesity epidemic.

This study compared meal-time behaviors in patients with anorexia nervosa to normal-weight controls and the effects of hospital treatment on these behaviors. Ten restricting-anorexics and six normal-weight controls were given a standard lunch and asked to eat the entire meal. Their behaviors were recorded via hidden camera. All participants were tested twice—anorexics before and after in-patient treatment, and controls at similar intervals. Videotapes of these sessions were analysed for occurrence and duration of eight categories of non-ingestive behaviors: food manipulation, food preparation, food moving, non-food manipulation, concealment, vigilance, passivity and physical activity. Food-ingestion patterns, including number of bites of food and switches between different kinds of food, were also recorded. Results indicated that anorexics spent significantly more time than controls in behaviors that were directly food-related, and exhibited more vigilance behavior. Pre-treatment anorexics spent significantly more time in these behaviors than did post-treatment anorexics. Few group differences or treatment effects were found in food-ingestion patterns, although there was an indication that both pre- and post-treatment anorexics avoided high-fat foods more than controls did. These results suggest that videotaping provides a useful technique for characterizing the behavior associated with eating disorders. Further studies should explore whether normalization of these behaviors is associated with a positive clinical outcome.