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Background: Low-calorie sweeteners are often used to moderate energy intake and postprandial glycemia, but some evidence indicates that they may exacerbate these aims., Objective: The trial's primary aim was to assess the effect of daily aspartame ingestion for 12 wk on glycemia. Effects on appetite and body weight were secondary aims., Methods: One hundred lean [body mass index (kg/m2): 18-25] adults aged 18-60 y were randomly assigned to consume 0, 350, or 1050 mg aspartame/d (ASP groups) in a beverage for 12 wk in a parallel-arm design. At baseline, body weight and composition were determined, a 240-min oral-glucose-tolerance test (OGTT) was administered, and measurements were made of appetite and selected hormones. Participants also collected a 24-h urine sample. During the intervention, the 0-mg/d ASP group consumed capsules containing 680 mg dextrose and 80 mg para-amino benzoic acid. For the 350-mg/d ASP group, the beverage contained 350 mg aspartame and the 1050-mg/d ASP group consumed the same beverage plus capsules containing 680 mg dextrose and 700 mg aspartame. Body weight, blood pressure, heart rate, and waist circumference were measured weekly. At weeks 4, 8, and 12, participants collected 24-h urine samples and kept appetite logs. Baseline measurements were repeated at week 12., Results: With the exception of the baseline OGTT glucose concentration at 60 min (and resulting area under the curve value), there were no group differences for glucose, insulin, resting leptin, glucagon-like peptide 1, or gastric inhibitory peptide at baseline or week 12. There also were no effects of aspartame ingestion on appetite, body weight, or body composition. Compliance with the beverage intervention was ∼95%., Conclusions: Aspartame ingested at 2 doses for 12 wk had no effect on glycemia, appetite, or body weight among healthy, lean adults. These data do not support the view that aspartame is problematic for the management of glycemia, appetite, or body weight. This trial was registered at www.clinicaltrials.gov as NCT02999321.

The sensory properties of foods and beverages are primary determinants of food choice. Some flavor components have an inherent hedonic valence that influences ingestive behavior. However, these hedonic impressions may be modified and others newly formed through their association with the post-ingestive consequences of food and beverage consumption. Flavor-active compounds, including spices, also modify digestive, absorptive and metabolic processes through direct activation of signaling pathways or via neurally-mediated cephalic phase responses. These may modify energy balance through effects on food digestion, energy absorption and metabolism. Thus, collectively, flavor has the potential to modify energy balance. Attempts to purposefully augment energy and nutrient intake have largely focused on the aging population where flavor fortification is posited to correct for diminishing sensory function. Evidence of efficacy is not strong, possibly due to methodological issues such as low statistical power and failure to match documented sensory limitations with the nature of the intervention. More rigorous testing should determine the viability of this therapeutic application of food flavors. The use of flavor compounds for weight reduction has yielded mixed results. Most trials have delivered the compounds via capsule precluding assessment of flavor to outcomes. Work with red pepper suggests there is an independent, albeit subtle, sensory effect on substrate oxidation coupled with a more general reduction of appetite and enhancement of energy expenditure. Flavor active compounds hold some promise for being more a part of the solution than the problem of disordered eating and unhealthy weight., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Peanuts and peanut butter are commonly consumed as a snack, meal component and ingredient in various commercial products. Their consumption is associated with reduced CVD risk and they pose little threat to positive energy balance. However, questions have arisen as to whether product form (e.g. whole nut v. butter) and processing properties (e.g. roasting and adding flavours) may compromise their positive health effects. The present study investigated the effects of peanut form and processing on two CVD risk factors: fasting plasma lipids and body weight. One hundred and eighteen adults (forty-seven males and seventy-one females; age 29.2 (sd 8.4) years; BMI 30.0 (sd 4.5) kg/m2) from Brazil, Ghana and the United States were randomised to consume 56 g of raw unsalted (n 23), roasted unsalted (n 24), roasted salted (n 23) or honey roasted (n 24) peanuts, or peanut butter (n 24) daily for 4 weeks. Peanut form and processing did not differentially affect body weight or fasting plasma lipid responses in the total sample. However, HDL-cholesterol increased significantly at the group level, and total cholesterol, LDL-cholesterol and TAG concentrations decreased significantly in individuals classified as having elevated fasting plasma lipids compared with those with normal fasting plasma lipids. These observations suggest that the processing attributes assessed in this trial do not compromise the lipid-lowering effects of peanuts, and do not negatively impact body weight. Further studies are warranted to determine the effects of form and processing on other health risk factors.

Objective: Concord grape juice (CGJ) is a rich source of phenolic antioxidants, with a range of putative health benefits. However, high beverage energy and fructose intake may lead to weight gain and insulin resistance, respectively. This study assessed the effects of CGJ consumption for 12 weeks on appetite, diet, body weight, lipid profile, and antioxidant status., Methods: Seventy-six men and women aged 18 to 50 years with a body mass index of 25.0 to 29.9 kg/m(2) consumed either 480 mL CGJ, 480 mL substitute (polyphenol-free) grape-flavored drink (SGD), or no beverage (NTG) daily for 12 weeks. Anthropometric indices were measured biweekly, dietary intake and appetite were assessed 4 times during the study, and plasma oxygen radical absorbance capacity, lipids, and oral glucose tolerance were assessed at baseline and week 12., Results: Compared to baseline, the SGD group reported a reduction in fullness (p < 0.005) and gained 1.6 kg (p < 0.05). No significant changes in body weight or composition were observed with CGJ or control (no beverage added to diet). Mean dietary compensation was 98.8% for SGD and 81.0% for CGJ. Serum glucose and insulin area under the curve (180 minutes) increased slightly, but this was significant only with CGJ. Plasma antioxidant capacity did not differ across groups, suggesting no effect of chronic CGJ ingestion on antioxidant status., Conclusions: Daily consumption of CGJ for 12 weeks did not lead to significant weight gain, but consumption of SGD did. The basis of this differential response could not be documented, but it is hypothesized to be a result of dietary compensation and effects of CGJ polyphenols on thermogenesis and substrate oxidation.

Obesity, with its comorbidities such as metabolic syndrome and cardiovascular diseases, is a major public health concern. To address this problem, it is imperative to identify treatment interventions that target a variety of short- and long-term mechanisms. Although any dietary or lifestyle change must be personalized, controlled energy intake in association with a moderately elevated protein intake may represent an effective and practical weight-loss strategy. Potential beneficial outcomes associated with protein ingestion include the following: 1) increased satiety--protein generally increases satiety to a greater extent than carbohydrate or fat and may facilitate a reduction in energy consumption under ad libitum dietary conditions; 2) increased thermogenesis--higher-protein diets are associated with increased thermogenesis, which also influences satiety and augments energy expenditure (in the longer term, increased thermogenesis contributes to the relatively low-energy efficiency of protein); and 3) maintenance or accretion of fat-free mass--in some individuals, a moderately higher protein diet may provide a stimulatory effect on muscle protein anabolism, favoring the retention of lean muscle mass while improving metabolic profile. Nevertheless, any potential benefits associated with a moderately elevated protein intake must be evaluated in the light of customary dietary practices and individual variability.

The global prevalence of overweight and obesity is growing. Correction of the problem through dietary intervention has been disappointing and has prompted research into variations of diet composition or pattern to promote negative energy balance. Limited research suggests that selected approaches, such as low-carbohydrate diets, augment weight loss and offer an advantage over conventional low-fat diets. This has led to the hypothesis that although in theoretical terms a calorie is a calorie, in practice this is not the case. Support for such views and plausible mechanisms exist. Although any advantage may augment weight management, reported discrepancies between theoretical and observed effects are small. Thus, energy-restricted diets should be based primarily on energy intake and expenditure.

The purpose of this study was to determine if the mixed evidence of almond consumption on HbA1c stems from testing people with different body fat distributions (BFD) associated with different risks of glucose intolerance. A 6-month randomised controlled trial in 134 adults was conducted. Participants were randomly assigned to the almond (A) or control (C) group based on their BFD. Those in the almond group consumed 1·5 oz of almonds with their breakfast and as their afternoon snack daily. Those in the control group continued their habitual breakfast and afternoon snack routines. Body weight and composition were measured and blood samples were collected for determination of HbA1c, glycaemia and lipaemia at 0 and 6 months. Appetite ratings, energy intake and diet quality were collected at 0, 2, 4 and 6 months. Participants consuming almonds ingested 816 (sem 364) kJ/d more than participants in the control group (P = 0·03), but this did not result in any differences in body weight (A: –0·3 (sem 0·4), C: –0·4 (sem 0·4); P > 0·3). Participants in the almond, high android subcutaneous adipose tissue (SAT) group had a greater reduction in android fat mass percentage (A: –1·0 (sem 0·6), C: 1·1 (sem 0·6); P = 0·04), preserved android lean mass percentage (A: 0·9 (sem 0·6), C: –1 (sem 0·6); P = 0·04) and tended to decrease android visceral adipose tissue mass (A: –13 (sem 53) g, C: 127 (sem 53) g; P = 0·08) compared with those in the control, high SAT group. There were no differences in HbA1c between groups (A: 5·4 (sem 0·04), C: 5·5 (sem 0·04); P > 0·05). Thus, BFD may not explain the mixed evidence on almond consumption and HbA1c. Long-term almond consumption has limited ability to improve cardiometabolic health in those who are overweight and obese but otherwise healthy. [ABSTRACT FROM AUTHOR]

Background Low-calorie sweeteners (LCSs) provide sweetness with little or no energy. However, each LCS's unique chemical structure has potential to elicit different sensory, physiological, and behavioral responses that affect body weight. Objective The purpose of this trial was to compare the effects of consumption of 4 LCSs and sucrose on body weight, ingestive behaviors, and glucose tolerance over a 12-wk intervention in adults (18–60 y old) with overweight or obesity (body mass index 25–40 kg/m2). Methods In a parallel-arm design, 154 participants were randomly assigned to consume 1.25–1.75 L of beverage sweetened with sucrose (n  = 39), aspartame (n  = 30), saccharin (n  = 29), sucralose (n  = 28), or rebaudioside A (rebA) (n  = 28) daily for 12 wk. The beverages contained 400–560 kcal/d (sucrose treatments) or <5 kcal/d (LCS treatments). Anthropometric indexes, energy intake, energy expenditure, appetite, and glucose tolerance were measured at baseline. Body weight was measured every 2 wk with energy intake, expenditure, and appetite assessed every 4 wk. Twenty-four-hour urine collections were completed every 4 wk to determine study compliance via para-aminobenzoic acid excretion. Results Of the participants enrolled in the trial, 123 completed the 12-wk intervention. Sucrose and saccharin consumption led to increased body weight across the 12-wk intervention (Δweight = +1.85 ± 0.36 kg and +1.18 ± 0.36 kg, respectively; P  ≤ 0.02) and did not differ from each other. There was no significant change in body weight with consumption of the other LCS treatments compared with baseline, but change in body weight for sucralose was negative and significantly lower compared with all other LCSs at week 12 (weight difference ≥ 1.37 ± 0.52 kg, P  ≤ 0.008). Energy intake decreased with sucralose consumption (P  = 0.02) and ingestive frequency was lower for sucralose than for saccharin (P  = 0.045). Glucose tolerance was not significantly affected by any of the sweetener treatments. Conclusions Sucrose and saccharin consumption significantly increase body weight compared with aspartame, rebA, and sucralose, whereas weight change was directionally negative and lower for sucralose compared with saccharin, aspartame, and rebA consumption. LCSs should be categorized as distinct entities because of their differing effects on body weight. This trial was registered at clinicaltrials.gov as NCT02928653. [ABSTRACT FROM AUTHOR]

Given the increasing evidence that supports the ability of humans to taste non-esterified fatty acids (NEFA), recent studies have sought to determine if relationships exist between oral sensitivity to NEFA (measured as thresholds), food intake and obesity. Published findings suggest there is either no association or an inverse association. A systematic review and meta-analysis was conducted to determine if differences in fatty acid taste sensitivity or intensity ratings exist between individuals who are lean or obese. A total of 7 studies that reported measurement of taste sensations to non-esterified fatty acids by psychophysical methods (e.g.,studies using model systems rather than foods, detection thresholds as measured by a 3-alternative forced choice ascending methodology were included in the meta-analysis. Two other studies that measured intensity ratings to graded suprathreshold NEFA concentrations were evaluated qualitatively. No significant differences in fatty acid taste thresholds or intensity were observed. Thus, differences in fatty acid taste sensitivity do not appear to precede or result from obesity. [ABSTRACT FROM AUTHOR]

The author discusses a study by E. Robinson and I. Kersbergen on the effect of food portion size and later food intake. Topics include background on interest in physiologic control of portion size to manage energy balance, hypotheses related to cognitive and learning effects, and factors needed in the prevention or treatment of eating-related disorders.

Tree nuts and peanuts are good sources of many nutrients and antioxidants, but they are also energy dense. The latter often limits intake because of concerns about their possible contribution to positive energy balance. However, evidence to date suggests that nuts are not associated with predicted weight gain. This is largely due to their high satiety value, leading to strong compensatory dietary responses, inefficiency in absorption of the energy they contain, a possible increment in resting energy expenditure, and an augmentation of fat oxidation. Preliminary evidence suggests that these properties are especially evident when they are consumed as snacks. [ABSTRACT FROM AUTHOR]

Background: The protein leverage hypothesis requires specific evidence that protein intake is regulated more strongly than energy intake. Objective: The objective was to determine ad libitum energy intake, body weight changes, appetite profile, and nitrogen balance in response to 3 diets with different protein-to-carbohydrate + fat ratios over 12 consecutive days, with beef as a source of protein. Design: A 3-arm, 12-d randomized crossover study was performed in 30 men and 28 women [mean ± SD age: 33 ± 16 y; body mass index (in kg/m²): 24.4 ± 4.0] with the use of diets containing 5%, 15%, and 30% of energy (En%) from protein, predominantly from beef. Results: Energy intake was significantly lower in the 30En%-protein condition (8.73 ± 1.93 MJ/d) than in the 5En%-protein (9.48 ± 1.67 MJ/d) and 15En%-protein (9.30 ± 1.62 MJ/d) conditions (P = 0.001), stemming largely from lower energy intake during meals (P = 0.001). Hunger (P = 0.001) and desire to eat (P = 0.001) ratings were higher and fullness ratings were lower (P = 0.001) in the 5En%-protein condition than in the 15En%-protein and 30En%-protein conditions. Nitrogen excretion was lower in the 5En%-protein condition (4.7 ± 1.5 g/24 h; P = 0.001) and was higher in the 30En%-protein condition (15.3 ± 8.7 g/24 h; P = 0.001) compared with the 15En%-protein condition (10.0 ± 5.2 g/24 h). Nitrogen balance was maintained in the 5En%-protein condition and was positive in the 15En%- and 30En%-protein conditions (P = 0.001). Conclusions: Complete protein leverage did not occur because subjects did not consume to a common protein amount at the expense of energy balance. Individuals did underconsume relative to energy requirements from high-protein diets. The lack of support for protein leverage effects on a low-protein diet may stem from the fact that protein intake was sufficient to maintain nitrogen balance over the 12-d trial. This trial was registered at clinicaltrials.gov as NCT01646749. [ABSTRACT FROM AUTHOR]

Beverage consumption has been implicated in weight gain, but questions remain about the veracity of the association, whether the relationship is causal and what property of beverages is responsible. It was hypothesized that food form is the most salient attribute. Thus, a randomized controlled trial of food form was conducted. Energy-matched beverage or solid forms of fruits and vegetables were provided to 34, lean or overweight/obese adults for two 8-week periods with a 3-week washout interspersed. Dietary compensation was incomplete (beverage 53%; solid 78%) and body weight increased after the beverage (1.95 ± 0.33 kg) (77% fat mass) and solid (1.36 ± 0.30 kg) (85% fat mass) treatments (both P < 0.0005). Differences between food forms were not significant. The lean group had the highest dietary compensation (119%) and no significant weight change (0.84 ± 0.53 kg) after consuming the solid fruits and vegetables whereas the overweight/obese group had lower compensation and significant weight gain during the solid arm (46%, 1.77 ± 0.32 kg, P < 0.0001). In contrast, incomplete dietary compensation and weight gain occurred in both the lean (43%, 1.61 ± 0.44 kg, P = 0.003) and overweight/obese (61%, 2.22 ± 0.47 kg, P < 0.0005) groups during the beverage arm. Secondary analyses revealed the obese group gained more weight than the lean and overweight groups during the beverage intervention (P = 0.024). These data demonstrate energy consumed as beverages may be especially problematic for weight gain. They also indicate that advice to increase fruit and vegetable consumption should emphasize total energy intake because the additional energy contributed may promote weight gain, especially among overweight and obese individuals. [ABSTRACT FROM AUTHOR]

Nuts (ground and tree) are rich sources of multiple nutrients and their consumption is associated with health benefits, including reduced cardiovascular disease risk. This has prompted recommendations to increase their consumption. However, they are also high in fat (albeit largely unsaturated) and are energy dense. The associations between these properties, positive energy balance, and body weight raise questions about such recommendations. This issue is addressed through a review of the literature pertaining to the association between nut consumption and energy balance. Epidemiological studies document an inverse association between the frequency of nut consumption and BMI. Clinical trials reveal little or no weight change with inclusion of various types of nuts in the diet over 1-6 mo. Mechanistic studies indicate this is largely attributable to the high satiety property of nuts, leading to compensatory responses that account for 65-75% of the energy they provide. Limited data suggest chronic consumption is associated with elevated resting energy expenditure resulting in dissipation of another portion of the energy they provide. Additionally, due to poor bioaccessibility, there is limited efficiency of energy absorption from nuts. Collectively, these mechanisms offset much of the energy provided by nuts. The few trials contrasting weight loss through regimens that include or exclude nuts indicate improved compliance and greater weight loss when nuts are permitted. This consistent literature suggests nuts may be included in the diet, in moderation, to enhance palatability and nutrient quality without posing a threat for weight gain. [ABSTRACT FROM AUTHOR]

Objective: The primary aim of this study was to assess the effects of dietary protein intake on energy restriction (ER)-induced changes in body mass and body composition. Clinical markers of metabolic and cardiovascular diseases were also measured.Design: 54 postmenopausal women, age 58 +/- 2 y, body mass index 29.6 +/- 0.8 kg/m(2), were assigned to one of four groups. For 9 weeks, three ER groups ate a 1000 kcal/d lacto-ovo vegetarian basal diet plus 250 kcal/d of either beef (BEEF, n = 14), chicken (CHICKEN, n = 15), or carbohydrate/fat foods (CARB (lacto-ovo), n = 14), while a control group (CON, n = 11) consumed their habitual diets.Results: Energy intake was lower in the ER groups compared to CON (BEEF, 1114 +/- 155 kcal/d, CHO: PRO: FAT, 46:24:30 % of energy intake; CHICKEN, 1098 +/- 203 kcal/d, 51:25:24; CARB 1158 +/- 341 kcal/d, 59:17:24; CON, 1570 +/- 633 kcal/d, 47:20:33), but did not differ among ER groups. For all ER subjects combined, body mass (-6.7 +/- 2.4 kg, 9 %), fat mass (-4.6 +/- 1.9 kg, 13 %), and fat-free mass (-2.1 +/- 1.1 kg, 5 %) decreased. These responses did not differ among the ER groups, except for body mass (CHICKEN -7.9 +/- 2.6 kg(a); BEEF -6.6 +/- 2.7 kg(a,b); CARB -5.6 +/- 1.8 kg(b); CON -1.2 +/- 1.2 kg(c); values with a difference superscript differ, p < 0.05). From PRE (week 0) to POST (week 9), total and LDL cholesterol decreased approximately 12%, with no differences among groups. Triacylglycerol, HDL cholesterol, C-reactive protein (CRP), glucose, insulin, leptin, and adiponectin were not changed over time or differentially affected by diet.Conclusions: Overweight postmenopausal women can achieve significant weight loss and comparable short-term improvements in body composition and lipid-lipoprotein profile by consuming either a moderate-protein (25% of energy intake) poultry- or beef-containing diet or a lacto-ovo vegetarian protein (17% of energy intake) diet. [ABSTRACT FROM AUTHOR]

Nuts are a nutrient-rich food group. Depending on the type, they may provide substantive concentrations of Vitamin E, magnesium, folate, essential fatty acids, fiber and protein to the diet. They also contain potentially important phytochemicals. By mechanisms yet to be identified, they are reported to improve postprandial lipid profiles and may hold other health benefits. However, they are also energy dense so a theoretical contributor to positive energy balance and weight gain. However, epidemiological studies have consistently revealed an inverse association between the frequency of nut consumption and BMI. Further, intervention trials demonstrate less than predicted weight gain following inclusion of nuts in the diet. The mechanisms for these observations are currently under study. Candidates include strong satiety effects, promotion of energy expenditure and/or inefficient energy utilization. Recent trials have revealed support for each. Inclusion of nuts in the diet results in strong satiety effects as revealed by robust compensatory dietary responses that offset approximately 65-75% of the energy they provide. Several trials note increased energy expenditure that may account for an additional 10% of their energy yield. Limited bioaccessibility results in a loss of 5-15% of energy. Taken together, these findings largely account for the energy provided by nuts and explain the epidemiological and clinical observations. Thus, current knowledge suggests moderate nut consumption does not pose a threat for weight gain. [ABSTRACT FROM AUTHOR]

Low calorie sweeteners (LCS) are prevalent in the food supply for their primary functional property of providing sweetness with little or no energy. Though tested for safety individually, there has been extremely limited work on the efficacy of each LCS. It is commonly assumed all LCS act similarly in their behavioral and physiological effects. However, each LCS has its own chemical structure that influences its metabolism, making each LCS unique in its potential effects on body weight, energy intake, and appetite. LCS may have different behavioral and physiological effects mediated at the sweet taste receptor, in brain activation, with gut hormones, at the microbiota and on appetitive responses. Further elucidation of the unique effects of the different commercially available LCS may hold important implications for recommendations about their use for different health outcomes. [ABSTRACT FROM AUTHOR]

Background Higher protein intake has been implicated in weight management because of its appetitive properties. However, the effects of protein intake on appetitive sensations such as fullness have not been systematically assessed. Meta-analysis is a useful technique to evaluate evidence of an intervention’s effect on testable outcomes, but it also has important limitations. Objective The primary aim of this study was to synthesize the available evidence on the effect of protein intake on fullness using a quantitative meta-analysis and a secondary directional analysis using the vote-counting procedure. A tertiary aim was to address limitations of meta-analyses as they pertain to findings from this meta-analysis. Design We searched multiple databases for interventional studies that evaluated the effect of increased protein intake on fullness ratings. Inclusion criteria for both analyses were as follows: healthy human participants, preload studies that utilized intact dietary protein, delivery of protein load orally, and studies reporting fullness as an outcome. For the meta-analysis, an additional criterion was that the studies also needed to report 2- to 4-hour area under the curve value for fullness. Results Five studies met all criteria for the meta-analysis. Twenty-eight studies met all criteria for the directional analysis. The meta-analysis indicated higher protein preloads have a greater effect on fullness than lower protein preloads (overall effect estimate: 2,435.74 mm.240 min, (95% CI 1,375.18 to 3,496.31 mm.240 min; P <0.0001). The directional analysis also revealed a positive effect on fullness with higher protein preloads ( P <0.01). Many related scientifically rigorous studies were excluded from the analysis because analytical criteria required a narrowly focused research question. Conclusions The present analyses show that higher protein preloads increase fullness ratings more than lower protein preloads under tightly defined conditions. Extrapolation of findings to common conditions outside the specified criteria of this analysis must be made cautiously, as must speculation about the influence of fullness sensations on ingestive behavior, body weight, and various health outcomes. [ABSTRACT FROM AUTHOR]

Findings from studies examining interactions between fat taste and dietary fat intake or body weight are mixed. A convenience sample of 735 visitors to the Denver Museum of Nature & Science ≥8 years old rated the taste intensity of edible taste strips impregnated with varying concentrations (%v/v) of linoleic acid (LA) (blank = 0.0, low = 0.06, medium = 0.15, high = 0.38). Percent body fat (BF%) was measured using bioelectrical impedance. Fat taste intensity was rated as significantly different across all concentrations (P < 0.001) except between the blank and low concentrations (P = 0.1). Ratings increased monotonically across concentrations. Children (<18 years; N = 180) rated all concentrations as more intense than adults (P < 0.001 for all). Women and girls rated the highest concentration as more intense than men and boys (P < 0.02 for all). BF% was not correlated with fat taste intensity ratings. Self-reported dietary intake indicated that obese individuals' intensity ratings for medium and high concentrations of LA were inversely related to recent mono- and poly-unsaturated fat exposure (r = -0.19 to -0.27; P < 0.03 for all). No such associations were observed in the nonobese group. Findings suggest that factors other than simple adiposity status influence fat taste intensity ratings, and that participants in fat taste studies should receive standardized meals prior to testing. [ABSTRACT FROM AUTHOR]