Pre-meal Hunger Research Articles

Disturbed Appetite Patterns and Nutrient Intake in Peritoneal Dialysis Patients

Malnutrition is common among peritoneal dialysis (PD) patients. Reduced nutrient intake contributes to this. It has long been assumed that this reflects disturbed appetite. We set out to define the appetite profiles of a group of PD patients using a novel technique. Prospective, cross-sectional comparison of PD patients versus controls. Teaching hospital dialysis unit. 39 PD patients and 42 healthy controls. Visual analog ratings were recorded at hourly intervals to generate daily profiles for hunger and fullness. Summary statistics were generated to compare the groups. Food intake was measured using 3-day dietary records. Hunger and fullness profiles. Derived hunger and fullness scores. Controls demonstrated peaks of hunger before mealtimes, with fullness scores peaking after meals. The PD profiles had much reduced premeal hunger peaks. A postmeal reduction in hunger was evident, but the rest of the trace was flat. The PD fullness profile was also flatter than in the controls. Mean scores were similar despite the marked discrepancy in the profiles. The PD group had lower peak hunger and less diurnal variability in their hunger scores. They also demonstrated much less change in fullness rating around mealtimes, while the mean and peak fullness scores were little different. The reported nutrient intake was significantly lower for PD. The data suggest that PD patients normalize their mean appetite perception at a lower level of nutrient intake than controls, suggesting that patient-reported appetite may be misleading in clinical practice. There is a loss of the usual daily variation for the PD group, which may contribute to their reduced food intake. The technique described here could be used to assess the impact of interventions upon the abnormal PD appetite profile.

The effects of meal composition on subsequent craving and binge eating

This study investigated the effects of meals differing in macronutrient composition on subsequent food craving, bingeing, nutrient intake, and mood. Nine women who had prospectively demonstrated episodes of craving received one each of a high-protein, high-carbohydrate, and mixed meal on three separate days. Appetite and mood ratings were taken before and at four intervals up to 150 min after meal consumption. Subsequent ad libitum food intake was recorded in diaries. Premeal hunger, appetite and mood ratings were similar across meal type. After the protein-rich meal, craving for sweet, carbohydrate-rich foods was significantly higher than after the carbohydrate and mixed meals. Elevated negative mood state after the protein-rich meal and reduced vigor after the carbohydrate meal were not statistically significant. The first ad libitum eating episodes after the protein meal contained significantly higher absolute and proportional amounts of total carbohydrate and sucrose and were more likely to be categorized as a binge than were those after the carbohydrate and mixed meals. Those ad libitum eating episodes classified as a craving/binge were characterized by a higher energy and absolute carbohydrate, fat, and sucrose content. Evidence of macronutrient compensation after a protein-rich meal suggests that carbohydrate intake regulation may exist in certain individuals. Possibly via the effects of sensory-specific satiety, serotonergic function, or cognitive factors, a protein-rich meal may induce craving for sweet-tasting, palatable foods in susceptible individuals.

Eating Patterns in French Subjects Studied by the “Weekly Food Diary” Method

The “weekly food diary” was translated and adapted for use by French subjects. This validated method requires subjects to record every food and drink intake over 1 week, with several descriptors of the physical, psychological and social circumstances. Ten male [age 23·6±2·3 years, body mass index (BMI) 20·7±0·6] and 16 female (age 23·3±0·6 years, BMI 20±0·6) students completed four weekly diaries over 1 year, one per season. Data were processed using a specially designed software. Breakfast was important, (about 400 kcalories). Lunch and dinner were almost equal in energy content but alcohol was consumed mainly with dinner. Meal size correlated positively with premeal hunger, number of people present, duration of premeal interval and time of day. Postmeal satiety correlated positively with meal size, aftermeal stomach content, and negatively with time of day, postmeal hunger and duration of sleep the preceding night. These observations allow hypotheses to be developed about mechanisms of intake in a French population and cross-cultural comparisons to be made.

Untangling the effects of hunger, anxiety, and nausea on energy intake during intravenous cholecystokinin octapeptide (CCK-8) infusion

GREENOUGH, A., G. COLE, J. LEWIS, A. LOCKTON, J. E. BLUNDELL. Untangling the effects of hunger, anxiety, and nausea on energy intake during i.v. cholecystokinin octapeptide (CCK-8) infusion. PHYSIOL BEHAV 65(2) 303–310, 1998.— Infusions of cholecystokinin (CCK) may exert their effects on appetite by inducing feelings of nausea or anxiety. In this double blind, placebo controlled crossover study, the impact of these effects on appetite were examined. Fifteen male subjects received a 20 min i.v. infusion of cholecystokinin octapeptide (CCK-8) (4 ng/kg/min) or saline. The infusion commenced 20 min after a soup preload and 10 min before an ad libitum test meal. Visual analogue scales of appetite and mood were measured over 3 h, and subjects were instructed to report any other sensations they experienced over this time. CCK-8 significantly reduced premeal hunger, elevated premeal anxiety, and reduced energy intake at the ad libitum test meal. Meal duration and rate of eating (kcal/min) were also significantly reduced after CCK-8. After the smaller meal with CCK-8, hunger rose quickly to a higher level than with placebo. The return of hunger was commensurate with the smaller amount of energy consumed and indicated that CCK did not exert an enduring effect on hunger suppression. A significant correlation was found between the reduction in energy intake and hunger (r = 0.75 p < 0.01), but not with anxiety (r = 0.15 not significant). Analyses were performed separately on subjects who did ( n = 8), or did not ( n = 7) report gastrointestinal disturbance. Energy intake was reduced by 56.6% and 44.6%, respectively. These results indicate that, although feelings of anxiety and nausea may accompany CCK infusions, they are not necessary for the effects of CCK on appetite. These data provide support for a role of CCK in satiety.

Improved eating behavior in eating-disordered inpatients after treatment: documentation in a naturalistic setting.

Abnormalities of eating behavior are definitional components of eating disorders (ED), but are seldom observed directly. This study assessed abnormalities of eating behavior in ED patients before treatment and documented changes after multidisciplinary treatment. Thirty-three ED patients (13 ANR, 10 ANB, 10 BN) and 10 controls selected a lunch meal in a cafeteria before and after treatment with energy intake (kilocalories) and macronutrients covertly observed. Visual analog scales (VAS) measured hunger and satiety. Before treatment, all ED patient groups experienced low hunger and high fullness, compared to controls. After treatment, hunger increased and satiety decreased. ANR patients, after treatment, increased energy intake from 366 to 916.5 kcal (p < .001), while BN patients increased from 409.9 to 663 kcal (p = .03). ANB nonsignificantly increased. ANR chose significantly more fats (22.7% to 36.2%, p = .05). Treatment partially normalizes pre-meal hunger and satiety in ED patients and significantly improves eating behavior (total energy intake and fat content) in ANR and BN patients. Reasons for nonsignificant changes in ANB are not obvious. We recommend documentation of eating behavior by simple, inexpensive, observational methods in a naturalistic setting before and after treatment of ED patients.

Human intake and choice of foods at intervals after exercise

Thirteen college-age men and women were submitted weekly to submaximal exercise for 2 h. After each exercise session, they were presented with the same meal composed of two high-protein, one high-lipid and two high-carbohydrate foods. The meal was offered at random 0, 30, 60, or 120 min after the 2-h exercise or 60 min after a session without exercise. As compared to a situation without exercise, both the pre-meal hunger rating and caloric intake were substantially increased 60 min after an exercise session. Also, after such exercise, hunger ratings increased with time and the later the meal, the larger was the amount consumed, both in total energy and as intake from carbohydrates but not lipids or proteins.