Short-term Energy Compensation Research Articles

Inter-individual differences in children’s short-term energy compensation: a systematic review and meta-analysis

BackgroundThe 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 and is poorly understood. ObjectivesThis systematic review and meta-analysis aimed to better understand factors contributing to variability in children’s energy compensation. We tested 1) whether children demonstrated “good” energy compensation, defined as adjusting meal intake commensurate with preload intake and 2) differences in children’s energy compensation by child age, sex, and weight status (assessed both continuously and categorically). MethodsStandard guidelines for systematic review were followed to search PubMed, PsychInfo, and Web of Science. Data on study design (preload form, preload-to-meal interval, preload energy difference, study setting) and participant characteristics (sex, age, weight status) were extracted from 29 experiments meeting inclusion criteria, and 13 were included in meta-analyses. COMPx (energy compensation index), a linear transformation comparing food intake following a high- vs. low-energy preload, was the outcome. Hedge’s g was calculated, and random intercept-only models tested associations between COMPx and sex, age, and weight status. ResultsThe systematic review revealed mixed results regarding children’s energy compensation and the role of inter-individual differences. Meta-analytic models revealed that children undercompensated (overate) for preload energy (β = −0.38; P = 0.008). Sex (β = 0.11; P = 0.76), age (β = 0.03; P = 0.75), and weight (assessed continuously; β = −0.07, P = 0.37) were not related to compensation. Children with overweight/obesity (assessed categorically) undercompensated more than children with healthy weight (β = 0.18; P = 0.04). ConclusionsThe systematic review highlighted wide variability across studies, while the meta-analysis demonstrated differences in COMPx by child weight status but not by age or sex. Standardizing protocols across studies is recommended, along with designing adequately powered studies aiming to test inter-individual differences a priori. Alternative approaches to the use of COMPx are recommended to allow better characterization of children’s energy compensation ability.This study was registered at PROSPERO as CRD42020197748.

Examining the Role of Food Form on Children's Self-Regulation of Energy Intake.

Increasing childhood obesity rates in both the United States and worldwide demonstrate a need for better prevention and intervention strategies. However, little is understood about what factors influence children's ability to sense and respond to hunger and fullness cues, a critical component of self-regulation of energy intake and maintenance of a healthy body weight. Research in adults suggests that food form may influence self-regulation of energy intake. More specifically, beverages are not as satiating as solid foods when matched for factors such as energy content, energy density, and volume and therefore elicit poorer energy intake self-regulation. However, much less is known about the impact of food form on children's ability to regulate their energy intake. This report describes a study that will examine the relationship between biological, cognitive, and psychological factors and children's appetite self-regulation (ASR). In this registered report, we will examine the influence of food form on children's short-term energy compensation, a proxy indicator of energy intake self-regulation. The study will employ a within-subjects, crossover design in which children (n = 78) ages 4.5–6 years will attend five laboratory visits, each ~1 week apart. During each visit, children will be presented with one of five possible preload conditions: apple slices, apple sauce, apple juice, apple juice sweetened with non-nutritive sweetener (NNS), or no preload. The order of preload conditions will be pseudorandomized and counterbalanced across participants. Following consumption of the preload (or no preload), children will consume a standardized ad libitum test meal of common foods for this age group. We hypothesize that children will demonstrate poorer short-term energy compensation (greater meal intake) in response to the liquid and semi-solid preloads compared to the solid preload. Understanding how energy in various forms affects children's ability to self-regulate intake has implications for dietary recommendations and will help identify those who are most at-risk for poor intake regulation and the development of obesity.

Development and preliminary testing of a technology-enhanced intervention to improve energy intake regulation in children

Interventions designed to improve children's self-regulation of energy intake have yielded mixed results. We tested the efficacy of a technology-enhanced intervention designed to teach children to eat in response to internal hunger and fullness cues. Thirty-two children (mean age 4.9 ± 0.8 y) completed this within-subjects, pre-post design study that took place across 10 laboratory sessions, each scheduled approximately 1 week apart. The intervention was conducted across weeks 4–7 in small groups focused on teaching children how food travels through the body and how to respond to hunger and fullness signals. Children's short-term energy compensation, a measure of intake regulation, was collected at baseline and follow-up using a preloading protocol. Twenty-five minutes prior to receiving a standardized test meal, children consumed a low-energy (3 kcal) or high-energy (150 kcal) preload beverage, presented in random order at baseline and follow-up. Knowledge of intervention concepts was also assessed at baseline and follow-up. Linear mixed models were used to examine changes in short-term energy compensation and knowledge from baseline to follow-up. Knowledge related to the intervention improved from baseline to follow-up (3.5 ± 0.3 to 7.0 ± 0.3 correct responses out of a possible 10; P < 0.001). Children's energy compensation also improved from baseline to follow-up, as evidenced by a time-by-preload condition interaction (P = 0.02). However, this improvement was driven by boys who increased the adjustment for beverage energy content from baseline to follow-up (P = 0.04). Girls showed no change in energy compensation with the intervention (P = 0.58). The overall increase in knowledge, paired with the improvement in energy compensation in boys, suggests that this technology-enhanced intervention may be efficacious for some children. Further research is needed to determine whether boys and girls will benefit from different, personalized intervention strategies for obesity prevention.

No difference in compensation for sugar in a drink versus sugar in semi-solid and solid foods

It is claimed that sugar consumed in a drink is poorly compensated for by a reduction in subsequent energy intake, however very little research has tested directly the effect on appetite of adding sugar to a drink versus food. In this between subjects study, 144 participants (72 men) consumed preloads sweetened with either sucrose or the low-energy sweetener, sucralose (preload energy difference 162kcal) in the form of a blackcurrant drink, jelly or candy. The different preload viscosities were achieved by varying the amount of thickener (carrageenan) and water in the recipes. Participants completed hunger ratings before and 5, 10 and 20min after consuming their preload. After the 20-minute rating they were served a test-meal comprising an excess of bite-sized sandwiches and a sweet dessert. Energy intake measured for the same meal consumed the previous day (baseline day, no preload consumed) was used in the data analyses to control for individual differences in energy intake. Overall, there was 36% compensation for the energy difference in the preloads, but this did not vary with preload viscosity — if anything compensation was greater for the drink preload, and greater in men. The drink preload also showed an effect of sucrose versus sucralose for hunger. The lack of the predicted effect of viscosity on compensation could not be explained by differences in blood-glucose concentration 20min after the preload (measured in a separate study) or by differences in preload sweetness, flavour intensity, liking or familiarity. Comparison of baseline and test-meal food intakes indicated that, irrespective of energy content, the sweet drinks reduced the relative intake of sweet food. In conclusion, short-term energy compensation did not differ across a set of realistic drink and food stimuli.

Consumption of a high-fat soup preload leads to differences in short-term energy and fat intake between PROP non-taster and super-taster women

Taste blindness to the bitterness of PROP (6-n-propylthiouracil) has been used as a genetic marker for food selection and adiposity. We have shown that PROP non-taster (NT) women have higher BMIs and habitually consume more fat and energy than either medium-taster (MT) or super-taster (ST) women. These data imply that differences in dietary selection underlie the body weight differences among PROP taster groups. However, no studies investigated energy compensation in women classified by PROP status. We investigated if NTs would compensate less accurately for the calories and fat in a high-fat soup preload in a subsequent test meal compared to MTs and STs. Energy intake from a buffet meal was measured in 75 healthy non-diet-restrained, lean women 30 min after the ingestion of a high-fat soup preload (0.8 kcal/g; 55% calories from fat), calculated to represent 10% of resting energy expenditure for each subject, or the same volume of water. Subjects (n = 20–28/taster group) ate a standard breakfast followed 3 hr later by an ad-libitum buffet lunch, on two occasions. There were no differences in energy intake or macronutrient selection across taster groups after water. After soup, NTs consumed more energy than STs. Fat intake (as %-energy) was higher in NTs (46.4% ± 2.4) compared to either MTs (36.1 ± 1.9%) or STs (38.1% ± 2.3; p < 0.05). NTs overate by 11% ± 5 after the soup compared to MTs and STs who underrate by 16% ± 6 and 26% ± 10, respectively (p < 0.01). These data suggest that small discrepancies in short-term energy compensation and selection of fat after a mixed-nutrient, high-fat preload may play a role in positive energy balance and increased adiposity in women with the PROP non-taster phenotype.

Alcohol, Appetite and Loss of Restraint.

Alcoholic beverages have long been associated with feasts, celebration and marking special events. Today, it is commonplace to consume alcoholic beverages before, with and/or after a meal. Alcohol provides additional pleasure to the meal and enhances appetite. However, consuming an alcoholic beverage with or before a meal is associated with poor short-term energy compensation; energy from alcohol is additive to total energy intake with the added property of stimulating further eating. Limiting alcohol intake is an obvious means to reduce total energy intake for those who wish to lose weight. However, dieters and restrained eaters drink more and report greater binge drinking than unrestrained eaters despite employing cognitive strategies to reduce their intake. Increased intake may be attributable to greater attentional bias to alcohol related cues as well as to food cues, since these are more salient to those limiting intake. Alcohol increases energy intake in dieters, in part due to abandonment of restraint (disinhibition) and consumption of forbidden items including alcohol exacerbates attempts to resist temptation. Paradoxically, links between binge drinking or increased drinking frequency to overweight and obesity may be mediated by dietary restraint. Efforts to limit food and alcohol intake for weight control appear to be unsuccessful and have the net effect of promoting overconsumption. The potential role of restrained eating in the association between alcohol, appetite and obesity has been overlooked by much of the current research and further investigation of this is therefore warranted.

Reply to Discussion of “Influence of netball-based exercise on energy intake, subjective appetite and plasma acylated ghrelin in adolescent girls”

Reply to Discussion of “Influence of netball-based exercise on energy intake, subjective appetite and plasma acylated ghrelin in adolescent girls”

Age and experience predict accurate short-term energy compensation in adults

Many factors thought to influence the control of food intake have been investigated independently, but the relative importance of each of these factors remains unknown. This study investigated the concurrent role of 21 factors in accurate compensation for energy consumed 60 min previously. Energy compensation was assessed by measuring the difference in energy intake at an ad libitum test meal following two preloads of differing energy content, in 105 participants. Using regression, energy compensation was associated only with age ( B = −2.39, β = −0.345, p < 0.01), and accuracy of energy compensation was associated only with age ( B = 1.81, β = 0.376, p < 0.01) and order of preload presentation ( B = −21.80, β = −0.233, p = 0.01). These findings suggest that our ability to detect and/or adjust for energy intake deteriorates with age, and that individuals adjust more easily for missing, as opposed to additional, energy. Notably however, only these predictors were associated with energy compensation and they account for only 11–18% of total variance.

Are caloric beverages compensated for in the short-term by young adults? An investigation with particular focus on gender differences

The effect of liquid calories on short-term energy compensation is a topic that justifies further investigation. Whilst previous studies appear to vary widely in terms of protocol, design and outcomes, none have placed much focus on possible gender differences in compensation. This study investigated the impact of isocaloric (150kcal) portions of a sucrose sweetened fruit drink (SSD), orange juice (OJ) and semi-skimmed milk (M) on subjective hunger and food intake at a subsequent ad libitum buffet consisting of a large variety of foods, and compared their effects with a calorie free (artificially sweetened) fruit drink control (CTRL). Forty-seven young adults (24 females and 23 males) were provided a standard breakfast which was followed 3h later by the preload beverage and 1h later by lunch. Participants rated hunger, fullness and desire to eat throughout the study period. Compared to the CTRL, males demonstrated a good caloric compensation at lunch following all three treatment beverages, whilst females reduced food intake following M. Total energy intake (energy in preload+energy intake at lunch) by males was similar across all four beverage conditions whilst females showed an increased total energy intake following SSD compared to the CTRL. The study indicates that the consumption of caloric beverages may not be affecting total energy intake in males in the short-term even in the presence of a large selection of palatable foods. On the other hand, females appeared to show a possible dysregulation, which requires further investigation.

Variants of the peroxisome proliferator-activated receptor γ- and β-adrenergic receptor genes are associated with measures of compensatory eating behaviors in young children

Background: Young children can regulate energy precisely in the short term, showing the potential for an innate compensation mechanism of eating behavior. However, data suggest that precise compensation is attenuated as a function of increasing adiposity, parental feeding style, and age. Common variation in candidate obesity genes may account for some of the individual variation observed in short-term energy compensation. Polymorphisms in the peroxisome proliferator-activated receptor γ (PPARG) and β-adrenergic receptor (ADRB3) genes have been linked to increased body mass index (BMI; in kg/m2), obesity, and more recently dietary nutrients and preferences. In addition, common variation in ADRB3 interacts with PPARG to modulate adult body weight.Objective: This study investigated whether variants in these genes were associated with measurable effects on child eating behavior.Design: Children (n = 84) aged 4–10 y were prospectively selected for variants of the PPARG locus (Pro12Ala, C1431T). Heights and weights were measured. Energy intake from a test meal was measured 90 min after ingestion of a no-energy (NE), low-energy (LE), or high-energy (HE) preload, and the compensation index (COMPX) was calculated.Results: BMI differed significantly by gene model, whereby Pro12Ala was associated with a lower BMI. Poor COMPX was associated with the PPARG T1431 allele (P = 0.009). There was a significant interaction between COMPX and the ADRB3 Trp64Arg variant in modulating compensation (P = 0.003), whereas the Arg64 allele was associated with good compensation (P = 0.001).Conclusions: This is the first study to suggest that a genetic interaction involving ADRB3 and PPARG variants influences eating behavior in children.

Energy balance and food intake: The role of PPARγ gene polymorphisms

Mechanisms regulating energy balance involve complex interactions between genetic, environmental and behavioural (learnt and intrinsic) factors. Genotype may drive the partitioning of energy metabolism and predispose to site-specific adiposity, culminating in a state of energy imbalance. One candidate gene with a direct link to adiposity is the peroxisome proliferator-activated receptor γ ( PPARG) gene. PPARG is a cell nuclear receptor expressed almost exclusively in adipose tissue that regulates adipocyte differentiation, lipid metabolism and insulin sensitivity. PPARγ appears to be a key regulator of energy balance, with polymorphisms on the PPARG gene linked to obesity and effects on body composition. Our research has confirmed an association between the pro12ala allele and reduced incidence of obesity in pre-pubertal children and there are strong associations between genetic variation at the PPARG locus and percentage body fat. Moreover, our evidence suggests that PPARG C-681G and pro12ala polymorphisms display opposing effects in terms of growth phenotype, with pro12Ala associated with deficient energy utilisation, leading to reduced growth and the G-681 variant associated with accelerated growth compared with wildtypes. Common differences in this gene have also been associated with variations in body weight in response to dietary macronutrients. Preliminary evidence suggests that PPARG variants may even be involved in the control of short term energy compensation. Taken together these data suggest that the role of PPARG is varied and complex, influencing fat deposition and growth velocity early in life, with potential impact in the control of energy intake and appetite regulation, and could provide a key target for future research and anti-obesity agents.

Energy intakes of children after preloads: adjustment, not compensation

Young children accurately compensate for energy-dense preloads consumed before test meals. The accuracy of compensation seems to deteriorate as a function of age. The hypothesis that accurate energy compensation varies by age, body mass index, and individual characteristics of children and their mothers was tested. Energy intake (EI) from a test meal was measured in 74 children aged 6-9 y 90 min after the ingestion of no-energy (NE), low-energy (LE), or high-energy (HE) preload snacks. The NE preload consisted of 250 mL water, the LE preload consisted of a 56-g muffin + a 250-mL orange drink (783 kJ), and the HE preload consisted of a 56-g muffin + a 250-mL orange drink (1628 kJ). A significant dose-related reduction in EI was found after the preloads; younger children adjusted more effectively than did older children, although total EI (including preload energy) indicated that the adjustment was not accurate. The compensation index (COMPX) differed by preload and age group; COMPX scores were higher between the NE and LE preloads (younger children: 44.4 +/- 9.3%; older children: 57.0 +/- 11.6%) than between the NE and HE preloads (39.6 +/- 4.9%; 31.3 +/- 6.2%) and the LE and HE preloads (35.2 +/- 7.8%; 7.4 +/- 9.8%). This finding indicates a more consistent response across preloads and a greater sensitivity to energy load by younger than by older children. High interindividual variation and low intraindividual variation in COMPX was found. The tendency to over- or undereat in response to the preloads (deviation from perfect) correlated directly and positively with maternal concerns about child overweight, not with actual BMI. The children adjusted their EIs in response to different preloads, and the younger children did so more effectively than did the older children. Poor short-term energy compensation may constitute a behavioral marker for positive energy balance.

Energy intakes of children after preloads: adjustment, not compensation

Background: Young children accurately compensate for energy-dense preloads consumed before test meals. The accuracy of compensation seems to deteriorate as a function of age. Objective: The hypothesis that accurate energy compensation varies by age, body mass index, and individual characteristics of children and their mothers was tested. Design: Energy intake (EI) from a test meal was measured in 74 children aged 6–9 y 90 min after the ingestion of no-energy (NE), low-energy (LE), or high-energy (HE) preload snacks. The NE preload consisted of 250 mL water, the LE preload consisted of a 56-g muffin + a 250-mL orange drink (783 kJ), and the HE preload consisted of a 56-g muffin + a 250-mL orange drink (1628 kJ). Results: A significant dose-related reduction in EI was found after the preloads; younger children adjusted more effectively than did older children, although total EI (including preload energy) indicated that the adjustment was not accurate. The compensation index (COMPX) differed by preload and age group; COMPX scores were higher between the NE and LE preloads (younger children: 44.4 ± 9.3%; older children: 57.0 ± 11.6%) than between the NE and HE preloads (39.6 ± 4.9%; 31.3 ± 6.2%) and the LE and HE preloads (35.2 ± 7.8%; 7.4 ± 9.8%). This finding indicates a more consistent response across preloads and a greater sensitivity to energy load by younger than by older children. High interindividual variation and low intraindividual variation in COMPX was found. The tendency to over- or undereat in response to the preloads (deviation from perfect) correlated directly and positively with maternal concerns about child overweight, not with actual BMI. Conclusions: The children adjusted their EIs in response to different preloads, and the younger children did so more effectively than did the older children. Poor short-term energy compensation may constitute a behavioral marker for positive energy balance.

Familial aggregation of energy intake in children

Uncompensated overnutrition promotes obesity, but the controls of children's eating behavior are poorly understood. Insights may be achieved by testing whether the eating patterns of children are associated with demographic variables or whether they aggregate among family members. We tested whether children's total energy intake and macronutrient intake and their ability to compensate for earlier energy intake were associated with sociodemographic variables and anthropometric indexes. We also tested whether these behavioral traits aggregate among siblings. Thirty-two sibling pairs aged 3-7 y consumed a multi-item lunch preceded by a low-energy (12.55 kJ) or high-energy (627.60 kJ) preload drink. Mixed-models regression tested the associations between children's energy intake, demographic variables, and anthropometric measures. An intraclass correlation coefficient quantified the family correlation of the measures of children's eating. Children consumed significantly more total energy after consuming the low-energy preload ( +/- SD: 2237.39 +/- 1176.45 kJ) than after consuming the high-energy preload (1601.18 +/- 930.65 kJ). Compensation ability was unrelated to the children's age, sex, or ethnicity. Total energy and macronutrient intake, but not compensation propensity, were associated among siblings. The familial association of total energy and macronutrient intakes, independent of anthropometric measures, suggests genetic or home environmental influences specific to these behaviors. Short-term energy compensation, although very accurate within this sample, showed no significant familial correlation.

Pathophysiology of food intake during infection

It is claimed that sugar consumed in a drink is poorly compensated for by a reduction in subsequent energy intake, however very little research has tested directly the effect on appetite of adding sugar to a drink versus food. In this between subjects study, 144 participants (72 men) consumed preloads sweetened with either sucrose or the low-energy sweetener, sucralose (preload energy difference 162 kcal) in the form of a blackcurrant drink, jelly or candy. The different preload viscosities were achieved by varying the amount of thickener (carrageenan) and water in the recipes. Participants completed hunger ratings before and 5, 10 and 20 min after consuming their preload. After the 20-minute rating they were served a test-meal comprising an excess of bite-sized sandwiches and a sweet dessert. Energy intake measured for the same meal consumed the previous day (baseline day, no preload consumed) was used in the data analyses to control for individual differences in energy intake. Overall, there was 36% compensation for the energy difference in the preloads, but this did not vary with preload viscosity — if anything compensation was greater for the drink preload, and greater in men. The drink preload also showed an effect of sucrose versus sucralose for hunger. The lack of the predicted effect of viscosity on compensation could not be explained by differences in blood-glucose concentration 20 min after the preload (measured in a separate study) or by differences in preload sweetness, flavour intensity, liking or familiarity. Comparison of baseline and test-meal food intakes indicated that, irrespective of energy content, the sweet drinks reduced the relative intake of sweet food. In conclusion, short-term energy compensation did not differ across a set of realistic drink and food stimuli.