Low-energy Food Research Articles

Commentary: Control of Body Weight by Eating Behavior in Children.

Zandian and colleagues’ article on the control of body weight by eating behavior in children draws upon the experience of several disciplines. They reviewed the evidence for the impact of brain physiology, genetics, diet and exercise, and pharmacological interventions in counteracting the worldwide increase in pediatric body weight (1). The authors concluded that a reason for the limited success of these and other weight control interventions in the past has been the misinterpretation of where the locus of control lies – that is, “body weight is mainly under external control” as opposed to the viewpoint that cognition plays a predominant role. This and other conclusions in the article are not new per se, as the foundation for addressing “external control” factors is deeply rooted in public-health practice. Indeed, public-health interventions that have focused on policies, systems, and environmental changes in the community have become popular in recent years and have been used extensively by a number of health authorities in developed countries (2). In the United States, for example, growing number of federal initiatives are introducing non-traditional, non-medial strategies to address the rising weight of children. These strategies have included targeted efforts, such as land use policies that support walking in the community; joint use agreements between schools and community entities to increase open space for physical activity; implementation of active transportation policies to improve the walkability of neighborhoods; and mandatory nutrition guidelines in food venues across a range of settings to promote low-energy and low-sugar foods (3). In most cases, these multisector efforts targeted socioecological influences (2) or “external control” factors that Zandian and colleagues alluded to. However, the authors suggested that child obesity shared similarities with the physiological constructs of eating disorders, such as anorexia, and based on these similarities, they concluded that the speed of eating as controlled through computerized feedback technology could be featured in the fight against the obesity epidemic (1, 4). Although intriguing and supported by data from a randomized controlled trial (4), Zandian et al.’s recommendation requires clarification of context and further investigation, as the limited success of the aforementioned diet, exercise, and pharmacological interventions all share common problems – evidence of efficacy and proof-of-concept are available, but research on scale and spread, which affects real world implementation, are not (5). In short, although the authors’ effort to address the “external control” factors that drive the obesity epidemic aligns well with most health authorities’ approach to this public-health problem, their focus on using computerized feedback seems somewhat counterintuitive to their own conclusion. The latter remains focused on cognition and individual health education support, is health systems centric, and may not dramatically improve the actual food environments that influence consumer (parental) choice, especially for those who live in low socioeconomic status areas.

Sustained satiety induced by food foams is independent of energy content, in healthy adults

Our previous research demonstrated high, sustained satiety effects of stabilized food foams relative to their non-aerated compositions. Here we test if the energy and macronutrients in a stabilized food foam are critical for its previously demonstrated satiating effects. In a randomized, crossover design, 72 healthy subjects consumed 400 mL of each of four foams, one per week over four weeks, 150 min after a standardized breakfast. Appetite ratings were collected for 180 min post-foam. The reference was a normal energy food foam (NEF1, 280 kJ/400 mL) similar to that used in our previous research. This was compared to a very low energy food foam (VLEF, 36 kJ/400 mL) and 2 alternative normal energy foams (NEF2 and NEF3) testing possible effects of compositional differences other than energy (i.e. emulsifier and carbohydrate source). Appetite ratings were quantified as area under the curve (AUC) and time to return to baseline (TTRTB). Equivalence to NEF1 was predefined as the 90% confidence interval of between-treatment differences in AUC being within −5 to +5 mm/min.All treatments similarly affected appetite ratings, with mean AUC for fullness ranging between 49.1 and 52.4 mm/min. VLEF met the statistical criterion for equivalence to NEF1 for all appetite AUC ratings, but NEF2 and NEF3 did not. For all foams the TTRTB for satiety and fullness were consistently between 150 and 180 min, though values were shortest for NEF2 and especially NEF3 foams for most appetite scales.In conclusion, the high, sustained satiating effects of these food foams are independent of energy and macronutrient content at the volumes tested.

Mix of First- and Second-Generation Biofuels to Meet Multiple Environmental Objectives: Implications for Policy at a Watershed Scale

Biofuel mandates are being widely used by countries to achieve multiple objectives of energy security and climate change mitigation. The Renewable Fuel Standard (RFS) in the US specifies arbitrarily chosen volumetric targets for different types of biofuels in the US based on their greenhouse gas intensity only. Cellulosic biofuels from high yielding energy crops like miscanthus have the potential to co-generate multiple environmental impacts, including reducing nitrate runoff, being a sink for Greenhouse Gas (GHG) emissions and providing a given volume of biofuel with less diversion of land from food crop production than corn ethanol, but at a significantly higher cost. This paper quantifies the tradeoffs between profitability, food and fuel production, GHG emissions and nitrate runoff reduction with different types of biofuels in the Sangamon watershed in Illinois and analyzes the optimal mix of biofuels as well as the policies that should supplement the mandate to achieve multiple environmental outcomes. We find that a two-thirds share of cellulosic biofuel in the mandated level could reduce nitrate run-off by 20% while reducing GHG emissions by 88–100% but would reduce profits by 15–27% depending on whether a GHG policy or a Nitrate policy is used relative to the case where the mandate is met by corn ethanol alone. Additionally, the ratio of corn stover to miscanthus used to produce cellulosic biofuels is higher under a GHG policy compared to a Nitrate policy that achieves the same level of nitrate reduction. Our results show that the optimal mix of different types of biofuels and the policy to induce it depend on the environmental objectives and the tradeoffs that society is willing to make between low cost energy security, food production and various environmental benefits.

A tale of two basins: An integrated physical and biological perspective of the deep Arctic Ocean

A tale of two basins: An integrated physical and biological perspective of the deep Arctic Ocean

The effect of snacking and eating frequency on dietary quality in British adolescents.

To describe the effects of number of eating occasions and snacks on dietary quality (DQ), defined as adherence to dietary recommendations. A sample of 884 adolescents (11-18years) in the UK National Diet and Nutrition Survey (NDNS) were included. The Diet Quality Index for Adolescents (DQI-A) was implemented. The total number of eating occasions and snacks was frequency of food or beverages consumed over 24h and frequency of foods or beverages consumed outside of the three mealtimes, respectively. Results were generated with and without low-energy food under 210kJ (50kcal). Regression models were generated with DQ score as the outcome variable and number of eating occasions and snacks as predictors. The mean (95% CI) DQ score was 31.1% (30.2, 32.0). The mean number of eating occasions and snacks was 7.5 (7.3, 7.7) and 2.6 (2.6, 2.7) times/day, respectively. When low-energy events were excluded, the mean number of eating occasions and snacks reduced to 6.2 (6.1, 6.4) and 2.0 (2.0, 2.1) times/day, respectively. DQ score increased by 0.74 points (0.42, 1.05; p<0.01) and 0.55 points (-0.08, 0.69; p=0.17) for total eating occasions and snacks, respectively. When low-energy events were excluded, DQ score increased by 0.30 points (-0.84, 0.69; p=0.13) for each eating occasion and decreased by 1.20 points (-2.1, -0.3; p<0.01) for each snack. Eating more frequently improves dietary quality especially if some eating occasions are low in energy. A focus on replacing high-energy snacks with low-energy alternatives rather than reducing the number of eating occasions may result in improved dietary quality in adolescents.

The health impact of nighttime eating: old and new perspectives.

Nighttime eating, particularly before bed, has received considerable attention. Limiting and/or avoiding food before nighttime sleep has been proposed as both a weight loss strategy and approach to improve health and body composition. Indeed, negative outcomes have been demonstrated in response to large mixed meals in populations that consume a majority of their daily food intake during the night. However, data is beginning to mount to suggest that negative outcomes may not be consistent when the food choice is small, nutrient-dense, low energy foods and/or single macronutrients rather than large mixed-meals. From this perspective, it appears that a bedtime supply of nutrients can promote positive physiological changes in healthy populations. In addition, when nighttime feeding is combined with exercise training, any adverse effects appear to be eliminated in obese populations. Lastly, in Type I diabetics and those with glycogen storage disease, eating before bed is essential for survival. Nevertheless, nighttime consumption of small (~150 kcals) single nutrients or mixed-meals does not appear to be harmful and may be beneficial for muscle protein synthesis and cardiometabolic health. Future research is warranted to elucidate potential applications of nighttime feeding alone and in combination with exercise in various populations of health and disease.

Neural reactivity to visual food stimuli is reduced in some areas of the brain during evening hours compared to morning hours: an fMRI study in women.

The extent that neural responsiveness to visual food stimuli is influenced by time of day is not well examined. Using a crossover design, 15 healthy women were scanned using fMRI while presented with low- and high-energy pictures of food, once in the morning (6:30-8:30 am) and once in the evening (5:00-7:00 pm). Diets were identical on both days of the fMRI scans and were verified using weighed food records. Visual analog scales were used to record subjective perception of hunger and preoccupation with food prior to each fMRI scan. Six areas of the brain showed lower activation in the evening to both high- and low-energy foods, including structures in reward pathways (P < 0.05). Nine brain regions showed significantly higher activation for high-energy foods compared to low-energy foods (P < 0.05). High-energy food stimuli tended to produce greater fMRI responses than low-energy food stimuli in specific areas of the brain, regardless of time of day. However, evening scans showed a lower response to both low- and high-energy food pictures in some areas of the brain. Subjectively, participants reported no difference in hunger by time of day (F = 1.84, P = 0.19), but reported they could eat more (F = 4.83, P = 0.04) and were more preoccupied with thoughts of food (F = 5.51, P = 0.03) in the evening compared to the morning. These data underscore the role that time of day may have on neural responses to food stimuli. These results may also have clinical implications for fMRI measurement in order to prevent a time of day bias.

Effects of Malnutrition on Women Reproductive Health in Punjab

5 Abstract: In the maternal and child health nutrition plays a vital role. It has been noted that the poor maternal nutrition status is directly responsible for the adverse birth out come. The aim of the present study is to find out the effects of malnutrition on women reproductive health in Punjab. Multistage sampling techniques were used for data collection. At the first stage two Districts i.e. Faisalabad and Multan of Punjab province were selected randomly. At the second stage four tehsils, two from each district (Tehsil Faisalabad and Tehsil Jaranwala from District Faisalabad and Tehsil Multan and Tehsil Shujabad from District Multan) were selected randomly from the selected districts, than 12 localities, three from each tehsil (Chak No. 59/JB, 30/JB and 31/JB from Tehsil Faisalabad, Chak No. 60/GB, 55/GB and 54/GB from Tehsil Jaranwala and Khokhran, Mithal Shah and Gondian from Tehsil Shujabad and Ghalu, Sanhbai and Hasnabad from Tehsil Multan) were selected randomly. A sample of 300 respondents (25 from each locality) selected purposively. It was found that majority of the respondents were eating vegetables and less than a half of them were drinking milk on daily basis. A very few of the respondents were drinking juices and eating meat on daily basis. A ma jority of the sampled women were taking three meals in a day and about one-fourth of th e respondents were aware about balance diet. It is clear from the findings that the respondents had many health problems i.e., headache (61.7%), high blood pressure (60.3%), back pain (54.7%), swelling on different body parts (41.3%), irregular menses (33.0%), hand, facial swelling (32.7%), urinary complications (28.3%), cramps and abdominal pain (26.7%), vaginal bleeding (25.0%) and some of them had anemia and heavy bleeding. Less than a half of the respondents (45.0%) used any contraceptive method and one-fourth of them were observed its side effects. According to the research findings malnutrition had many bad impact on women and child health i.e., low weight baby, poor feeding practices, adverse pregnancy outcomes, low energy and nutrient dense foods, anemia, iron deficiency and poor physical activities. Main cause of malnutrition among the women were poverty, illiteracy, ignorance, socio-economic and environmental factors and poor water/sanitation and health services. Bi-variate analysis shows that education, income, age at marriage, eating pattern, awareness about balance diet, food security, household food expenditure were positively associated with reproductive health status and age and total no. of pregnancies were negatively associated with reproductive health status. There is a dire need to improve the health facilities available at government Health Centers especially at BHUs to address the reproductive health problems that will surely improve women's health status.

Functional brain response to food images in successful adolescent weight losers compared with normal-weight and overweight controls.

Research conducted with adults suggests that successful weight losers demonstrate greater activation in brain regions associated with executive control in response to viewing high-energy foods. No previous studies have examined these associations in adolescents. Functional neuroimaging was used to assess brain response to food images among groups of overweight (OW), normal-weight (NW), and successful weight-losing (SWL) adolescents. Eleven SWL, 12 NW, and 11 OW participants underwent functional magnetic resonance imaging while viewing images of high- and low-energy foods. When viewing high-energy food images, SWLs demonstrated greater activation in the dorsolateral prefrontal cortex (DLPFC) compared with OW and NW controls. Compared with NW and SWL groups, OW individuals demonstrated greater activation in the ventral striatum and anterior cingulate in response to food images. Adolescent SWLs demonstrated greater neural activation in the DLPFC compared with OW/NW controls when viewing high-energy food stimuli, which may indicate enhanced executive control. OW individuals' brain responses to food stimuli may indicate greater reward incentive processes than either SWL or NW groups.

Impact of eating dispositions on emotional and appetitive responses to high- and low-energy dense food images

Impact of eating dispositions on emotional and appetitive responses to high- and low-energy dense food images

The effect of a low-energy food foam on appetite measures during a 1-day reduced-energy meal plan.

We have previously shown that 500 ml of a foamed drink ('foam') significantly improved appetite versus a non-foamed control. The objectives of this research were to assess the effect of smaller volumes of foams on appetite, and the potential benefits of foam ingestion and its timing on appetite measures in a reduced-energy context. Two randomized, parallel design studies (pre- and main study) were conducted using healthy adult subjects. Pre-study: 133 subjects (age 18-50 years, body mass index (BMI) 20-32 kg m(-2)) each consumed either 10, 25, 50, 100, 150 or 250 ml foamed meal replacer (~0.2 kcal ml(-1)), 150 min after a fixed breakfast. Main study: four groups of subjects (n=134; age 18-60 years, BMI 22.5-35.0 kg m(-2)) consumed 200 ml/22 kcal foam (based on pre-study results) immediately after main meals (M), after snacks (S), in-between snacks and main meals (I) or not at all (control, C) within 1 day of a reduced-energy meal plan consisting of three main meals and three snacks. Measurements included self-reported appetite (six scales, reported as area under the curve (AUC)) and (main study only) end-of-day appetite questionnaire. Pre-study: the strongest effect on appetite was produced by 250 ml (consistent across scales), whereas 150 ml showed more pronounced effects than 100 and 50 ml in most scales. Volumes 10 and 25 ml had no effects on any scale. Main study: 200 ml foam reduced appetite AUC substantially in all treatments, particularly M (for example, hunger AUC reduced by 35% (P <0.001), 28% (P <0.05) and 20% (P=0.11) for M, S and I, respectively versus C). A strong reduction in 'appetite for a snack' was seen for all timings (all P <0.05). The end-of-day appetite ratings confirmed these findings. Modest amounts of a low-energy foam can reduce appetite measures during a 1-day reduced-energy meal plan.

Effects of food quality on trade‐offs among growth, immunity and survival in the greater wax mothGalleria mellonella

The resources available to an individual in any given environment are finite, and variation in life history traits reflect differential allocation of these resources to competing life functions. Nutritional quality of food is of particular importance in these life history decisions. In this study, we tested trade-offs among growth, immunity and survival in 3 groups of greater wax moth (Galleria mellonella) larvae fed on diets of high and average nutritional quality. We found rapid growth and weak immunity (as measured by encapsulation response) in the larvae of the high-energy food group. It took longer to develop on food of average nutritional quality. However, encapsulation response was stronger in this group. The larvae grew longer in the low-energy food group, and had the strongest encapsulation response. We observed the highest survival rates in larvae of the low-energy food group, while the highest mortality rates were observed in the high-energy food group. A significant negative correlation between body mass and the strength of encapsulation response was found only in the high-energy food group revealing significant competition between growth and immunity only at the highest rates of growth. The results of this study help to establish relationships between types of food, its nutritional value and life history traits of G. mellonella larvae.

Food preference and intake in response to ambient odours in overweight and normal-weight females

In our food abundant environment, food cues play an important role in the regulation of energy intake. Odours can be considered as external cues that can signal energy content in the anticipatory phase of eating. This study aims to determine whether exposure to olfactory cues associated with energy dense foods leads to increased food intake and greater preference for energy-dense foods. In addition, we assessed whether BMI and hunger state modulated this effect.Twenty-five overweight (mean BMI: 31.3kg/m2, S.E.: 0.6) and 25 normal-weight (mean BMI: 21.9kg/m2, S.E.: 0.4) females, matched on age and restraint score, participated. In 6 separate sessions they were exposed to odours of three different categories (signalling non-food, high-energy food and low-energy food) in two motivational states (hungry and satiated). After 10min of exposure food preference was assessed with a computerized two-item forced choice task and after 20min a Bogus Taste Test was used to determine energy intake (kcal and g).In a hungry state, the participants ate more (p<.001) and preferred high-energy products significantly more often (p<.001) when compared to the satiated state. A trend finding for the interaction between hunger and BMI suggested that the food preference of overweight participants was less affected by their internal state (p=.068). Neither energy intake (kcal: p=.553; g: p=.683) nor food preference (p=.280) was influenced by ambient exposure to odours signalling different categories.Future studies need to explore whether food odours can indeed induce overeating. More insight is needed regarding the possible influence of context (e.g. short exposure duration, large variety of food) and personality traits (e.g. restraint, impulsive) on odour-induced overeating.

Nutrients, phytochemicals and antioxidant activity in wild populations of Allium ampeloprasum L., a valuable underutilized vegetable

Wild Allium species with a long tradition of use, such as Allium ampeloprasum L. could provide interesting bioactive compounds to current diet. The nutrient and bioactive compound content of this wild vegetable has been scarcely known. Therefore, the aim of this work is to provide a detailed chemical quantification of nutrients, hydrophilic and lipophilic bioactive compounds and the antioxidant capacity of the edible parts of wild leek, as well as data about plant production and availability of the species in their natural habitats.Wild leek can be considered as a low energy food, being a good source of fiber and zinc, compared to its cultivated relatives, and has revealed a predominance of polyunsaturated fatty acids, linoleic acid being the main fatty acid. Additionally, the natural yield of this species, although lower than other cultivated Allium species, was found to be stable and well-adapted to human-disturbed environments. For these reasons, this non-conventional wild bulb should be revalorized as a good alternative to increase the diversity of vegetables consumed and enhance the quality of current occidental diets.

Repeated exposure more effective than flavour flavour learning as mechanism to increase vegetable consumption in pre-school children

Children’s habitual diets contain too much high-energy-dense food like lipids and carbohydrates, but little low-energy foods like vegetables. Promoting vegetable intake in children serves better nutritional standards and energy balance. However, since most children dislike vegetables, increasing their intake is a challenge. We investigated the relative effectiveness of repeated exposure (RE) and Flavour-Flavour-Learning (FFL) in increasing vegetable intake and acceptance in pre-schoolers (n = 39). During an intervention period of seven weeks, toddlers consumed vegetable crisps (freeze-dried red beet and parsnip) twice per week. Half of the group received red beet crisps with a dip of tomato-ketchup (C+), and parsnip with a neutral white-sauce (C−), whereas for the other half the order was reversed (red beet C−, parsnip C+). Outcome measures were preference and ad libitum consumption of both crisp flavours (without dip-sauces), measured before, shortly after the intervention, and two and six months following conditioning to assess longer-term effects. Intake increased significantly after the intervention for both vegetables (on average with 8g; an increase of approx. 300%), and this effect was persistent even six months afterwards. The increase was irrespective of crisps being offered with C+ or C− dip sauce. No changes in initial preference for either red beet or parsnip were found. This suggests a robust and persistent effect of RE but no effect of FFL. In conclusion, simply offering pure vegetable tastes repeatedly is sufficient to increase intake over time, rather than adding flavour to the food.

Obesity-Related Eating Behaviors Are Associated with Higher Food Energy Density and Higher Consumption of Sugary and Alcoholic Beverages: A Cross-Sectional Study

ObjectivesObesity-related eating behaviors (OREB) are associated with higher energy intake. Total energy intake can be decomposed into the following constituents: food portion size, food energy density, the number of eating occasions, and the energy intake from energy-rich beverages. To our knowledge this is the first study to examine the association between the OREB and these energy components.MethodsData were taken from a cross-sectional study conducted in 2008–2010 among 11,546 individuals representative of the Spanish population aged ≥18 years. Information was obtained on the following 8 self-reported OREB: not planning how much to eat before sitting down, eating precooked/canned food or snacks bought at vending machines or at fast-food restaurants, not choosing low-energy foods, not removing visible fat from meat or skin from chicken, and eating while watching TV. Usual diet was assessed with a validated diet history. Analyses were performed with linear regression with adjustment for main confounders.ResultsCompared to individuals with ≤1 OREB, those with ≥5 OREB had a higher food energy density (β 0.10; 95% CI 0.08, 0.12 kcal/g/day; p-trend<0.001) and a higher consumption of sugary drinks (β 7; 95% CI −7, 20 ml/day; p-trend<0.05) and of alcoholic beverages (β 24; 95% CI 10, 38 ml/day; p-trend<0.001). Specifically, a higher number of OREB was associated with higher intake of dairy products and red meat, and with lower consumption of fresh fruit, oily fish and white meat. No association was found between the number of OREB and food portion size or the number of eating occasions.ConclusionsOREB were associated with higher food energy density and higher consumption of sugary and alcoholic beverages. Avoiding OREB may prove difficult because they are firmly socially rooted, but these results may nevertheless serve to palliate the undesirable effects of OREB by reducing the associated energy intake.

Effect of a Low Energy Food Combining Versus Caloric Restriction Diet on Change in Body Weight among Overweight and Obese Indonesian Adults

Author(s): M.P. McCarthy, T. Cullen, M. Lasarev, J. Barry, D. Stadler; Food and Nutrition Serv, Oregon Hlth. & Sci. Univ., Portland, OR, Multnomah Athletic Club, Portland, OR, Dept of Public Health and Preventive Medicine, Oregon Hlth. & Sci. Univ., Portland, OR, Div of Urology and Abdominal Organ Transplantation, Oregon Hlth. & Sci. Univ., Portland, OR, Graduate Program in Human Nutrition, Oregon Hlth. & Sci. Univ., Portland, OR

Sex-based fMRI differences in obese humans in response to high vs. low energy food cues

Gender specific effects on human eating have been previously reported. Here we investigated sex-based differences in neural activation via whole-brain blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) in response to high energy-dense (high-ED) vs. low-ED visual and auditory food cues in obese men vs. women in both fed and fasted states. The results show that in response to high vs. low ED foods in the fed state, obese men (vs. women) had greater activation in brain areas associated with motor control regions (e.g. supplementary motor areas) whereas women showed greater activation in cognitive-related regions. In the fasted state, obese men had greater activation in a visual-attention region whereas obese women showed greater activation in affective and reward related processing regions (e.g. caudate). Overall the results support our a priori hypothesis that obese women (vs. men) have greater neural activation in regions associated with cognition and emotion-related brain regions. These findings may improve our understanding of sex specific differences among obese individuals in eating behavior.

Effects of Conspecifics on Feeder Choice by Northern Cardinals

Inter- and intra-specific competition are known to influence feeding decisions, but relatively little research has investigated how inter- and intra-sexual interactions can impact foraging. We studied foraging preferences of male and female Northern Cardinals (Cardinalis cardinalis) during winter and found they preferred sunflower seed to safflower seed when presented with paired feeders in the absence of conspecifics. Male cardinals avoided feeders occupied by other males and approached feeders occupied by females, regardless of feeder contents. Female cardinals avoided other females and especially males when choosing feeders. These changes in foraging behavior by male and female cardinals as a result of conspecific presence indicate inter- and intra-sexual interactions alter the attractiveness of a high or low energy food source.

Obesity-Related Eating Behaviors Are Associated with Low Physical Activity and Poor Diet Quality in Spain1–3

AbstractThis study examined the association of obesity-related eating behaviors (OREB) with physical activity, sedentariness, and diet quality. Data were taken from a cross-sectional study in 10,791 persons representative of the Spanish population who were ≥18 y of age in 2008–2010. The following self-reported information was collected on 12 OREB: not planning how much to eat before sitting down, not deciding the amount of food on the plate, skipping breakfast, eating precooked/canned food or snacks bought at vending machines or at fast-food restaurants, not choosing low-energy foods, not removing visible fat from meat or skin from chicken, eating while watching television or seated on a sofa or an armchair, and taking a short time for meals. Analyses were performed with linear or logistic regression, as appropriate,and adjusted for the main confounders. In comparison to participants with ≤1 OREB, those with ≥5 OREB performed less physical activity [β: –22.61 (95% CI: –4.44, –0.78); P-trend < 0.001] and spent more time watching television [β: 2.17 (95% CI: 1.39, 2.95); P-trend , 0.001]; furthermore, they had greater total energy intake [b: 160 (95% CI:115, 210); P-trend < 0.001] and were less likely to follow a Mediterranean diet [OR: 0.55 (95% CI: 0.41, 0.73);P-trend < 0.001]. In conclusion, the association between OREB and obesity is biologically plausible because OREB are associated with energy intake and poor accordance with the Mediterranean diet. Studies on the association between OREB and obesity should control for the confounding effect of physical activity and sedentariness.