Effects of oral and gastric stimulation on appetite and energy intake

Introduction to the dietary management of obesity in adults

Obesity is a multifaceted and complex condition that requires holistic management. It currently affects nearly one in four adults in the UK, with the UK ranked 10th globally for the highest obesity rates. Obesity is projected to have an economic burden of ∼£2 billion per year by 2030 in the UK.1 Excess weight gain can coincide with myriad health concerns and multiple health conditions, which can be physical, metabolic or psychosocial. This includes type 2 diabetes mellitus (T2DM), hypertension, coronary heart disease, osteoarthritis, obstructive sleep apnoea, reproductive disorders, depression and cancer2; hence, there has been a significant emphasis on obesity prevention. Obesity is often associated with weight stigma, impacting psychological wellbeing and quality of life. This can influence an individual's likelihood of seeking support, delaying appropriate input from healthcare professionals, with a knock-on effect on pre-existing health conditions. This review explores the management of obesity from a nutritional perspective, because modifying dietary intake is essential to reduce the risk of non-communicable diseases, including those associated with obesity.

Impact of energy density on energy intake in children and adults: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

The energy density (ED) of a diet can be leveraged to prevent weight gain or treat overweight and obesity. By lowering the ED of the diet, energy intake can be reduced while maintaining portion size. However, a reliable meta-analysis of data from randomized controlled trials (RCTs) is missing. Therefore, this meta-analysis synthesized the evidence of ED manipulation on energy intake in RCTs.

METHODS

The systematic literature search of multiple databases according to PRISMA criteria considered RCTs investigating the objectively measured energy intake from meals with different ED (lower ED (median 1.1 kcal/g) versus higher ED (median 1.5 kcal/g)) under controlled conditions. Subgroup analyses for age (children versus adults), meal type (preload versus entrée design), and intervention length (1 meal versus > 1 meal) were performed to achieve the most homogeneous result.

RESULTS

The meta-analysis of 38 included studies demonstrated that lowering ED considerably reduced energy intake - 223 kcal (95% CI: - 259.7, - 186.0) in comparison to the higher ED interventions. As heterogeneity was high among studies, subgroup analyses were conducted. Heterogeneity decreased in subgroup analyses for age and meal type combined, strengthening the results. An extended analysis showed a positive linear relationship between ED and energy intake. Dietary ED did not affect the amount of food intake.

CONCLUSION

Manipulating ED substantially affects energy intake whereas food intake remains constant. Thus, this approach can be regarded as a powerful tool for weight management through nutrition therapy. Registration on 08/08/2021: CRD42021266653.

Acute effect of Melon Manis Terengganu peel powder on glycemic response, perceived satiety, and food intake: a randomized, placebo-controlled crossover trial in adults at risk of type 2 diabetes

BACKGROUND

Melon Manis Terengganu (MMT) peel has a high dietary fiber content, but there is no data examining its health benefits in adults at risk of type 2 diabetes. The objective of the study was to evaluate whether consumption of MMT peel powder improves glycemic response, satiety, and food intake in adults at risk of type 2 diabetes.

METHODS

An open-label, randomized, placebo-controlled, crossover design trial was conducted among adults (n = 30, ages 18-59 y) at risk of type 2 diabetes. They consumed Formulation 3 (formulated MMT peel powder) [A] and control (glucose) [B] with study breakfast based on randomly assigned treatment sequences (AB, BA) established by Research Randomizer ( www.randomizer.org ). Capillary blood glucose and perceived satiety were determined at baseline (0 min), 30, 60, 90 and 120 min, followed by a post-intervention food intake measurement.

RESULTS

The repeated measures analysis of variance (ANOVA) revealed significant time (F = 84.37, p <  0.001, η_p² = 0.744), condition (F = 22.89, p <  0.001, η_p² = 0.441), and time*condition effects (F = 24.40, p <  0.001, η_p² = 0.457) in blood glucose levels. Respondents (n = 30) who consumed Formulation 3 also had a significantly lower blood glucose 2-hour incremental area under the curve (iAUC) of 134.65 ± 44.51 mmol/L*min and maximum concentration (CMax) of 7.20 (7.10, 8.20) mmol/L with relative reduction of 26.8 and 13.3% respectively, when compared with control (p <  0.001). Besides, significantly greater perceived satiety, lower energy and fat intake as well as higher dietary fiber intake were also observed in the intervention group compared with the placebo group (p <  0.05). There were no marked side effects associated with the ingestion of the test products.

CONCLUSIONS

Short-term consumption of formulated MMT peel powder may improve glycemic response, increase perceived satiety and reduce food intake in adults at risk of type 2 diabetes with the potential to be utilized as a functional beverage. Medium-to long-term clinical trial is warranted to determine whether taking this formulated MMT peel powder on a daily basis has an influence on health outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05298111. Registered 28/03/2022.

The significance and potential of functional food ingredients for control appetite and food intake

Dramatically rising global levels of obesity have raised consumers’ commercial and public health interest in foods that may help control appetite and weight. The satiety cascade consists of sensory, cognitive, physical, and hormonal events following food intake, preventing overeating, and the desire to eat for a long time. Functional foods can be one of the most influential factors in reducing appetite as long as effective ingredients, such as fiber and protein, are used to design these products. Also, functional foods should be designed to reduce appetite at different levels of oral processing, stomach, small intestine, and large intestine by various mechanisms. Therefore, the satiety power of functional foods depends on the type of ingredients and their amount. Because each compound has a different mechanism of action, it is recommended to use different compounds to influence satiety in functional foods.

Gastrointestinal Interoception in Eating Disorders: Charting a New Path

PURPOSE OF REVIEW

Abnormal interoception has been consistently observed across eating disorders despite limited inclusion in diagnostic conceptualization. Using the alimentary tract as well as recent developments in interoceptive neuroscience and predictive processing as a guide, the current review summarizes evidence of gastrointestinal interoceptive dysfunction in eating disorders.

RECENT FINDINGS

Eating is a complex process that begins well before and ends well after food consumption. Abnormal prediction and prediction-error signals may occur at any stage, resulting in aberrant gastrointestinal interoception and dysregulated gut sensations in eating disorders. Several interoceptive technologies have recently become available that can be paired with computational modeling and clinical interventions to yield new insights into eating disorder pathophysiology. Illuminating the neurobiology of gastrointestinal interoception in eating disorders requires a new generation of studies combining experimental probes of gut physiology with computational modeling. The application of such techniques within clinical trials frameworks may yield new tools and treatments with transdiagnostic relevance.

Good taste or gut feeling? A new method in rats shows oro-sensory stimulation and gastric distention generate distinct and overlapping brain activation patterns

Satiation is influenced by a variety of signals including gastric distention and oro-sensory stimulation. Here we developed a high-field (9.4 T) functional magnetic resonance imaging (fMRI) protocol to test how oro-sensory stimulation and gastric distention, as induced with a block-design paradigm, affect brain activation under different states of energy balance in rats. Repeated tasting of sucrose induced positive and negative fMRI responses in the ventral tegmental area and septum, respectively, and gradual neural activation in the anterior insula and the brain stem nucleus of the solitary tract (NTS), as revealed using a two-level generalized linear model-based analysis. These unique findings align with comparable human experiments, and are now for the first time identified in rats, thereby allowing for comparison between species. Gastric distention induced more extensive brain activation, involving the insular cortex and NTS. Our findings are largely in line with human studies that have shown that the NTS is involved in processing both visceral information and taste, and anterior insula in processing sweet taste oro-sensory signals. Gastric distention and sucrose tasting induced responses in mesolimbic areas, to our knowledge not previously detected in humans, which may reflect the rewarding effects of a full stomach and sweet taste, thereby giving more insight into the processing of sensory signals leading to satiation. The similarities of these data to human neuroimaging data demonstrate the translational value of the approach and offer a new avenue to deepen our understanding of the process of satiation in healthy people and those with eating disorders.

The Satiation Framework: Exploring processes that contribute to satiation

Satiation has been described as a process that leads to the termination of eating and controls meal size. However, studies have shown that the termination of eating can be influenced by multiple behavioral and biological processes over the course of a meal as well as those related to the context in which the meal is consumed. To expand understanding of how individuals experience satiation during a meal, we recently developed the Reasons Individuals Stop Eating Questionnaire (RISE-Q). The development of the RISE-Q revealed five distinct factors reported to contribute to meal termination: Planned Amount, Self-Consciousness, Decreased Food Appeal, Physical Satisfaction, and Decreased Priority of Eating. Thus, we define satiation as a series of dynamic processes that emerge over the course of a meal to promote meal termination. We suggest that each of the factors identified by the RISE-Q represents a distinct process, and illustrate the contribution of each process to meal termination in the Satiation Framework. Within this framework the prominence of each process as a reason to stop eating likely depends on meal context in addition to individual variability. Therefore, we discuss contexts in which different processes may be salient as determinants of meal termination. Expanding the definition of satiation to include several dynamic processes as illustrated in the Satiation Framework will help to stimulate investigation and understanding of the complex nature of meal termination.

COVID 19-Induced Smell and Taste Impairments: Putative Impact on Physiology

Smell and taste impairments are recognized as common symptoms in COVID 19 patients even in an asymptomatic phase. Indeed, depending on the country, in up to 85-90% of cases anosmia and dysgeusia are reported. We will review briefly the main mechanisms involved in the physiology of olfaction and taste focusing on receptors and transduction as well as the main neuroanatomical pathways. Then we will examine the current evidences, even if still fragmented and unsystematic, explaining the disturbances and mode of action of the virus at the level of the nasal and oral cavities. We will focus on its impact on the peripheral and central nervous system. Finally, considering the role of smell and taste in numerous physiological functions, especially in ingestive behavior, we will discuss the consequences on the physiology of the patients as well as management regarding food intake.

Cracker shape modifies ad libitum snack intake of crackers with cheese dip

Food and energy intake can be effectively lowered by changing food properties, but little is known whether modifying food shape is sufficient to influence intake. This study investigated the influence of cracker shape and cheese viscosity on ad libitum intake of cracker–cheese combinations. Forty-four participants (thirteen males, 23 (sd 3) years, BMI 21 (sd 2) kg/m2) participated in four late afternoon snack sessions (2 × 2 randomised crossover design). Iso-energetic crackers were baked into flat squares and finger-shape cylindrical sticks and combined with a cheese dip varying in viscosity. Approximately eighty crackers and 500 g cheese dip were served in separate large bowls. Participants consumed crackers with cheese dip ad libitum while watching a movie of 30 min. Dipping behaviour and oral processing behaviour were measured simultaneously by hidden balances under the cheese bowls and video recordings. Cracker intake (28 (sem 1) crackers) of cracker–cheese combinations was not influenced by cracker shape. Cheese intake of cracker–cheese combinations was 15 % higher for flat-squared than finger-shape crackers (131 kJ, P = 0·016), as a larger amount of cheese was scooped with flat-squared crackers (2·9 (sem 0·2) v. 2·3 (sem 0·1) g cheese per dip, P < 0·001) and showed higher eating rate and energy intake rate (P < 0·001). Eating rate over snacking time decreased by reducing bite frequency (P < 0·001) while cheese dip size remained fairly constant (P = 0·12). Larger energy intake from condiments was facilitated by increased cracker surface, and this did not trigger earlier satiation. Changing food carrier surface may be a promising approach to moderate energy intake of often high energy dense condiments, sauces and toppings.

The Role of Fiber in Energy Balance

Excessive energy intake is linked with obesity and subsequent diet-related health problems, and it is therefore a major nutritional challenge. Compared with the digestible carbohydrates starch and sugars, fiber has a low energy density and may have an attenuating effect on appetite. This narrative review attempts to clarify the net energy contributions of various fibers, and the effect of fiber on satiety and thus appetite regulation. Fibers, broadly defined as nonstarch polysaccharides, are a varied class of substances with vastly different physicochemical properties depending on their chemical arrangement. Thus, net energy content can vary from more than 10 kJ/g for soluble, nonviscous, and easily fermentable fibers such as those in many fruits, to less than zero for viscous fibers with anti-nutritive properties, such as certain types of fibers found in rye and other cereals. Likewise, some fibers will increase satiety by being viscous or contribute to large and/or swollen particles, which may facilitate mastication and increase retention time in the stomach, or potentially through fermentation and an ensuing satiety-inducing endocrine feedback from the colon. Thus, fibers may clearly contribute to energy balance. The metabolizable energy content is very often considerably lower than the commonly used level of 8 kJ per g fiber, and some fibers may reduce energy intake indirectly through satiety-inducing effects. A more precise characterization of fiber and its physicochemical effects are required before these beneficial effects can be fully exploited in human nutrition.

Exacting Responses: Lack of Endocrine Cephalic Phase Responses Upon Oro-Sensory Exposure

Oro-sensory exposure (OSE) to food plays an important role in the regulation of food intake. One proposed underlying mechanism is the occurrence of cephalic phase responses (CPRs). CPRs include the pre-digestive endocrine responses induced by food-related sensory input. Yet, whether OSE duration or sweetness intensity affects CPRs is unknown. The objective of this study was to determine the independent and interactive effects of oro-sensory duration (chewing) and stimulation intensity (sweetness) on endocrine CPRs and satiation. Eighteen males (22 ± 2 years, BMI 22 ± 2 kg/m2) participated in a 2 × 2 randomized study with a control condition. Each session participants performed modified sham feeding (MSF) with one of the four gel-based model foods. During the control session no MSF was performed. Model foods differed in chewing duration (hard or soft texture) and sweetness (low or high intensity). During each session, eight blood samples were collected up till 25 min after MSF onset. Subsequently, food intake from an ad libitum lunch was measured. No typical CPR was found for insulin, pancreatic polypeptide (PP), and ghrelin. However, the overall PP response was 1.1 times greater for the hard sweet MSF condition compared to control (p = 0.02). Overall ghrelin responses were 1.1 times greater for the hard model food compared to the soft model food conditions (p = 0.003). These differences in endocrine response were not associated with differences in food intake at the subsequent meal. Exploratory sub-analysis of the responsive insulin curves showed that after 2.5 min of MSF the hard texture model foods insulin concentrations were 1.2 greater compared to the soft texture. These findings indicate that texture hardness and sweetness increase the overall PP response and that MSF on hard texture increases the overall ghrelin response compared to soft texture model foods. However, MSF on model foods does not lead to a typical CPR. This study, among others, shows that there are major dissimilarities in the endocrine responses to food stimulation between individuals. This emphasizes the importance of considering cephalic responders and non-responders. More research is needed to understand CPRs in relation to food texture and taste properties.

Chewing Stimulation Reduces Appetite Ratings and Attentional Bias toward Visual Food Stimuli in Healthy-Weight Individuals

Based on the theory of incentive sensitization, the exposure to food stimuli sensitizes the brain’s reward circuits and enhances attentional bias toward food. Therefore, reducing attentional bias to food could possibly be beneficial in preventing impulsive eating. The importance of chewing has been increasingly implicated as one of the methods for reducing appetite, however, no studies to investigate the effect of chewing on attentional bias to food. In this study, we investigated whether chewing stimulation (i.e., chewing tasteless gum) reduces attentional bias to food as well as an actual feeding (i.e., ingesting a standardized meal) does. We measured reaction time, gaze direction and gaze duration to assess attentional bias toward food images in pairs of food and non-food images that were presented in a visual probe task (Experiment 1, n = 21) and/or eye-tracking task (Experiment 2, n = 20). We also measured appetite ratings using visual analog scale. In addition, we conducted a control study in which the same number of participants performed the identical tasks to Experiments 1 and 2, but the participants did not perform sham feeding with gum-chewing/actual feeding between tasks and they took a rest. Two-way ANOVA revealed that after actual feeding, subjective ratings of hunger, preoccupation with food, and desire to eat significantly decreased, whereas fullness significantly increased. Sham feeding showed the same trends, but to a lesser degree. Results of the visual probe task in Experiment 1 showed that both sham feeding and actual feeding reduced reaction time bias significantly. Eye-tracking data showed that both sham and actual feeding resulted in significant reduction in gaze direction bias, indexing initial attentional orientation. Gaze duration bias was unaffected. In both control experiments, one-way ANOVAs showed no significant differences between immediately before and after the resting state for any of the appetite ratings, reaction time bias, gaze direction bias, or gaze duration bias. In conclusion, chewing stimulation reduced subjective appetite and attentional bias to food, particularly initial attentional orientation to food. These findings suggest that chewing stimulation, even without taste, odor, or ingestion, may affect reward circuits and help prevent impulsive eating.

The Effects of Different Isocaloric Oral Nutrient Solutions on Psychophysical, Metabolic, Cognitive, and Olfactory Function in Young Male Subjects

Food intake influences human cognition, olfaction, hunger, and food craving. However, little research has been done in this field to elucidate the effects of different nutrients. Thus, the goal of our study was to investigate the effects of oral ingestion of different nutrient solutions on olfactory, cognitive, metabolic and psychophysical function. Twenty healthy men participated in our study employing a double-blind, cross-over, repeated measurement design. Participants were tested on four different study days. Each day participants received, in randomized order, one of three isocaloric (protein, carbohydrate or fat 600 kcal, 1,500 mL) solutions or a placebo. Olfactory and cognitive tests (monitoring only) were conducted three times, i.e., 60 min before the beginning of nutrient intake, following oral ingestion of the solution and 60, and 240 min after. Psychophysical and metabolic function tests (active grehlin, desacyl ghrelin, insulin, glucagon, glucose, triglyceride, urea) were performed 7 times on each examination day (observation period: −60 min, 0 = solution intake, +60, +120, +180, +240, and +300 min). Ratings of hunger and food craving significantly differed over the observation period with lowest ratings following application of the protein solution. Highest ratings of craving were found following placebo intake. We further observed a significant positive correlation of active grehlin with hunger and fat, protein and sweets craving for each nutrient solution. Active grehlin significantly correlated with carbohydrate craving for carbohydrate and fat solution and with vegetable craving for fat solution only. Hunger hormone levels, hunger and food craving ratings demonstrated that the hierarchical order that appears in satiating efficiencies of isovolumetric-isocaloric ingested macronutrients is protein > fat > carbohydrate. Our study reveals that the type of nutrient exerts a significant influence on metabolic parameters, hunger and food craving.

Self-reported eating rate is associated with weight status in a Dutch population: a validation study and a cross-sectional study

BACKGROUND

Observational studies performed in Asian populations suggest that eating rate is related to BMI. This paper investigates the association between self-reported eating rate (SRER) and body mass index (BMI) in a Dutch population, after having validated SRER against actual eating rate.

METHODS

Two studies were performed; a validation and a cross-sectional study. In the validation study SRER (i.e., 'slow', 'average', or 'fast') was obtained from 57 participants (men/women = 16/41, age: mean ± SD = 22.6 ± 2.8 yrs., BMI: mean ± SD = 22.1 ± 2.8 kg/m2) and in these participants actual eating rate was measured for three food products. Using analysis of variance the association between SRER and actual eating rate was studied. The association between SRER and BMI was investigated in cross-sectional data from the NQplus cohort (i.e., 1473 Dutch adults; men/women = 741/732, age: mean ± SD = 54.6 ± 11.7 yrs., BMI: mean ± SD = 25.9 ± 4.0 kg/m2) using (multiple) linear regression analysis.

RESULTS

In the validation study actual eating rate increased proportionally with SRER (for all three food products P < 0.01). In the cross-sectional study SRER was positively associated with BMI in both men and women (P = 0.03 and P < 0.001, respectively). Self-reported fast-eating women had a 1.13 kg/m2 (95% CI 0.43, 1.84) higher BMI compared to average-speed-eating women, after adjusting for confounders. This was not the case in men; self-reported fast-eating men had a 0.29 kg/m2 (95% CI -0.22, 0.80) higher BMI compared to average-speed-eating men, after adjusting for confounders.

CONCLUSIONS

These studies show that self-reported eating rate reflects actual eating rate on a group-level, and that a high self-reported eating rate is associated with a higher BMI in this Dutch population.

The Effects of a Normal Rate versus a Slow Intervalled Rate of Oral Nutrient Intake and Intravenous Low Rate Macronutrient Application on Psychophysical Function – Two Pilot Studies

Stomach distension and energy per time are factors influencing satiety. Moreover, different rates of nutrient intake induce different stomach distension. The goal of our studies was to elucidate the influence of different oral rates of nutrient intake (normal rate versus slow intervalled rate; study I) and intravenous low rate macronutrient application (protein, carbohydrate, fat) or placebo (study II) on psychophysical function. The pilot studies investigated the effects of 1) study I: a mixed nutrient solution (1/3 protein, 1/3 fat, 1/3 carbohydrates) 2) study II: intravenous macronutrient infusions (protein, carbohydrate, fat) or placebo on psychophysical function (mood, hunger, food craving, alertness, smell intensity ratings and hedonic ratings) in human subjects. In study I 10 male subjects (age range: 21–30 years) completed the study protocol participating in both test conditions and in study II 20 male subjects (age range: 19–41 years) completed the study protocol participating in all test conditions. Additionally, metabolic function was analyzed and cognitive and olfactory tests were conducted twice starting 100 min before the beginning of the intervention and 240 min after. Psychophysical (mood, hunger, fat-, protein-, carbohydrate-, sweets- and vegetable-craving), alertness and metabolic function tests were performed seven times on each examination day. Greater effects on hunger and food cravings were observed for normal rate of intake compared to slow intervalled rate of intake and intravenous low rate macronutrient application. Our findings potentially confirm that volume of the food ingested and a higher rate of energy per time contribute to satiety during normal rate of food intake, while slow intervalled rate of food intake and intravenous low rate macronutrient application showed no effects on satiation. Our results motivate the view that a certain amount of volume of the food ingested and a certain energy per time ratio are necessary to reduce hunger and food craving.

Appetite and Energy Intake Responses to Acute Energy Deficits in Females versus Males

Purpose

To explore whether compensatory responses to acute energy deficits induced by exercise or diet differ by sex.

Methods

In experiment one, 12 healthy women completed three 9-h trials (control, exercise-induced (Ex-Def) and food restriction–induced energy deficit (Food-Def)) with identical energy deficits being imposed in the Ex-Def (90-min run, ∼70% of V˙O_2max) and Food-Def trials. In experiment two, 10 men and 10 women completed two 7-h trials (control and exercise). Sixty minutes of running (∼70% of V˙O_2max) was performed at the beginning of the exercise trial. The participants rested throughout the remainder of the exercise trial and during the control trial. Appetite ratings, plasma concentrations of gut hormones, and ad libitum energy intake were assessed during main trials.

Results

In experiment one, an energy deficit of approximately 3500 kJ induced via food restriction increased appetite and food intake. These changes corresponded with heightened concentrations of plasma acylated ghrelin and lower peptide YY_3–36. None of these compensatory responses were apparent when an equivalent energy deficit was induced by exercise. In experiment two, appetite ratings and plasma acylated ghrelin concentrations were lower in exercise than in control, but energy intake did not differ between trials. The appetite, acylated ghrelin, and energy intake response to exercise did not differ between men and women.

Conclusions

Women exhibit compensatory appetite, gut hormone, and food intake responses to acute energy restriction but not in response to an acute bout of exercise. Additionally, men and women seem to exhibit similar acylated ghrelin and PYY_3–36 responses to exercise-induced energy deficits. These findings advance understanding regarding the interaction between exercise and energy homeostasis in women.

The Differential Role of Smell and Taste For Eating Behavior

Food choice and food intake are guided by both sensory and metabolic processes. The senses of taste and smell play a key role in the sensory effects on choice and intake. This article provides a comprehensive overview of, and will argue for, the differential role of smell and taste for eating behavior by focusing on appetite, choice, intake, and satiation. The sense of smell mainly plays a priming role in eating behavior. It has been demonstrated that (orthonasal) odor exposure induces appetite specifically for the cued food. However, the influence of odors on food choice and intake is less clear, and may also depend on awareness or intensity of the odors, or personality traits of the participants. Taste on the other hand, has a clear role as a (macro)nutrient sensing system, during consumption. Together with texture, taste is responsible for eating rate, and thus in determining the oral exposure duration of food in the mouth, thereby contributing to satiation. Results from these experimental studies should be taken to real-life situations, to assess longer-term effects on energy intake. With this knowledge, it will be possible to steer people's eating behavior, as well as food product development, toward a less obesogenic society.

Fast or slow-foods? Describing natural variations in oral processing characteristics across a wide range of Asian foods

The structural properties of foods have a functional role to play in oral processing behaviours and sensory perception, and also impact on the meal size and the experience of fullness.

The determinants of food choice

Health nudge interventions to steer people into healthier lifestyles are increasingly applied by governments worldwide, and it is natural to look to such approaches to improve health by altering what people choose to eat. However, to produce policy recommendations that are likely to be effective, we need to be able to make valid predictions about the consequences of proposed interventions, and for this, we need a better understanding of the determinants of food choice. These determinants include dietary components (e.g. highly palatable foods and alcohol), but also diverse cultural and social pressures, cognitive-affective factors (perceived stress, health attitude, anxiety and depression), and familial, genetic and epigenetic influences on personality characteristics. In addition, our choices are influenced by an array of physiological mechanisms, including signals to the brain from the gastrointestinal tract and adipose tissue, which affect not only our hunger and satiety but also our motivation to eat particular nutrients, and the reward we experience from eating. Thus, to develop the evidence base necessary for effective policies, we need to build bridges across different levels of knowledge and understanding. This requires experimental models that can fill in the gaps in our understanding that are needed to inform policy, translational models that connect mechanistic understanding from laboratory studies to the real life human condition, and formal models that encapsulate scientific knowledge from diverse disciplines, and which embed understanding in a way that enables policy-relevant predictions to be made. Here we review recent developments in these areas.

Empty calories and phantom fullness: a randomized trial studying the relative effects of energy density and viscosity on gastric emptying determined by MRI and satiety

BACKGROUND

Stomach fullness is a determinant of satiety. Although both the viscosity and energy content have been shown to delay gastric emptying, their relative importance is not well understood.

OBJECTIVE

We compared the relative effects of and interactions between the viscosity and energy density on gastric emptying and perceived satiety.

DESIGN

A total of 15 healthy men [mean ± SD age: 22.6 ± 2.4 y; body mass index (in kg/m(2)): 22.6 ± 1.8] participated in an experiment with a randomized 2 × 2 crossover design. Participants received dairy-based shakes (500 mL; 50% carbohydrate, 20% protein, and 30% fat) that differed in viscosity (thin and thick) and energy density [100 kcal (corresponding to 0.2 kcal/mL) compared with 500 kcal (corresponding to 1 kcal/mL)]. After ingestion, participants entered an MRI scanner where abdominal scans and oral appetite ratings on a 100-point scale were obtained every 10 min until 90 min after ingestion. From the scans, gastric content volumes were determined.

RESULTS

Overall, the gastric emptying half-time (GE t50) was 54.7 ± 3.8 min. The thin 100-kcal shake had the lowest GE t50 of 26.5 ± 3.0 min, followed by the thick 100-kcal shake with a GE t50 of 41 ± 3.9 min and the thin 500-kcal shake with a GE t50 of 69.5 ± 5.9 min, and the thick 500-kcal shake had the highest GE t50 of 81.9 ± 8.3 min. With respect to appetite, the thick 100-kcal shake led to higher fullness (58 points at 40 min) than the thin 500-kcal shake (48 points at 40 min).

CONCLUSIONS

Our results show that increasing the viscosity is less effective than increasing the energy density in slowing gastric emptying. However, the viscosity is more important to increase the perceived fullness. These results underscore the lack of the satiating efficiency of empty calories in quickly ingested drinks such as sodas. The increase in perceived fullness that is due solely to the increased viscosity, which is a phenomenon that we refer to as phantom fullness, may be useful in lowering energy intake. This trial was registered at www.trialregister.nl as NTR4573.

Variation in the Oral Processing of Everyday Meals Is Associated with Fullness and Meal Size; A Potential Nudge to Reduce Energy Intake?

Laboratory studies have demonstrated that experimental manipulations of oral processing can have a marked effect on energy intake. Here, we explored whether variations in oral processing across a range of unmodified everyday meals could affect post-meal fullness and meal size. In Study 1, female participants (N = 12) attended the laboratory over 20 lunchtime sessions to consume a 400-kcal portion of a different commercially available pre-packaged meal. Prior to consumption, expected satiation was assessed. During each meal, oral processing was characterised using: (i) video-recordings of the mouth and (ii) real-time measures of plate weight. Hunger and fullness ratings were elicited pre- and post-consumption, and for a further three hours. Foods that were eaten slowly had higher expected satiation and delivered more satiation and satiety. Building on these findings, in Study 2 we selected two meals (identical energy density) from Study 1 that were equally liked but maximised differences in oral processing. On separate days, male and female participants (N = 24) consumed a 400-kcal portion of either the "fast" or "slow" meal followed by an ad libitum meal (either the same food or a dessert). When continuing with the same food, participants consumed less of the slow meal. Further, differences in food intake during the ad libitum meal were not compensated at a subsequent snacking opportunity an hour later. Together, these findings suggest that variations in oral processing across a range of unmodified everyday meals can affect fullness after consuming a fixed portion and can also impact meal size. Modifying food form to encourage increased oral processing (albeit to a lesser extent than in experimental manipulations) might represent a viable target for food manufacturers to help to nudge consumers to manage their weight.

Dietary fiber and satiety: the effects of oats on satiety

This review examines the effect of β-glucan, the viscous soluble fiber in oats, on satiety. A literature search for studies that examined delivery of the fiber in whole foods or as an extract was conducted. Viscosity interferes with the peristaltic mixing process in the small intestine to impede digestion and absorption of nutrients, which precipitates satiety signals. From measurements of the physicochemical and rheological properties of β-glucan, it appears that viscosity plays a key role in modulating satiety. However, the lack of standardized methods to measure viscosity and the inherent nature of appetite make it difficult to pinpoint the reasons for inconsistent results of the effects of oats on satiety. Nevertheless, the majority of the evidence suggests that oat β-glucan has a positive effect on perceptions of satiety.

Effects of Oral Exposure Duration and Gastric Energy Content on Appetite Ratings and Energy Intake in Lean Men

Studies show that longer oral exposure to food leads to earlier satiation and lowers energy intake. Moreover, higher energy content of food has been shown to lead to higher satiety. Up to now, it has not been studied systematically how oral exposure duration and gastric energy content interact in satiety regulation. Thirty-seven men (22 ± 4 years, 22 ± 2 kg/m²) participated in a randomized cross-over trial, in which we independently manipulated: (1) oral exposure duration by modified sham feeding (MSF) for 1 or 8 min; and (2) energy content of gastric load (GL) by a nasogastric tube: 100 kcal/500 mL or 700 kcal/500 mL. Outcome measures were appetite ratings and subsequent energy intake from an ad libitum meal. Energy intake was 35% lower after the GLs with 700 kcal than with 100 kcal (p < 0.0001). All appetite ratings were lower in the 700 kcal than in the 100 kcal treatments (area under the curve (AUC); p-values ≤ 0.002); fullness was higher and prospective consumption was lower in the 8 min than in the 1 min MSF treatments (AUC; p-values ≤ 0.02). In conclusion, the current showed that a GL of 700 kcal/500 mL vs. 100 kcal/500 mL increased satiety and lowered energy intake. No additional effects of oral exposure duration could be observed, presumably due to the high contrast in energy between the manipulations. Future research should also focus on the role of oral exposure as such and not only the duration.

Sensory influences on food intake control: moving beyond palatability

The sensory experience of eating is an important determinant of food intake control, often attributed to the positive hedonic response associated with certain sensory cues. However, palatability is just one aspect of the sensory experience. Sensory cues based on a food's sight, smell, taste and texture are operational before, during and after an eating event. The focus of this review is to look beyond palatability and highlight recent advances in our understanding of how certain sensory characteristics can be used to promote better energy intake control. We consider the role of visual and odour cues in identifying food in the near environment, guiding food choice and memory for eating, and highlight the ways in which tastes and textures influence meal size and the development of satiety after consumption. Considering sensory characteristics as a functional feature of the foods and beverages we consume provides the opportunity for research to identify how sensory enhancements might be combined with energy reduction in otherwise palatable foods to optimize short-term energy intake regulation in the current food environment. Moving forward, the challenge for sensory nutritional science will be to assess the longer-term impact of these principles on weight management.

Food Liking Enhances the Plasma Response of 2-Arachidonoylglycerol and of Pancreatic Polypeptide upon Modified Sham Feeding in Humans

BACKGROUND

Food palatability increases food intake and may lead to overeating. The mechanisms behind this observation are still largely unknown.

OBJECTIVES

The aims of this study were the following: 1) to elucidate the plasma responses of endocannabinoids, N-acylethanolamines, and gastrointestinal peptides to a palatable (sweet), unpalatable (bitter), and sensory-acceptable (tasteless control) food, and 2) to verify whether some of these bioactive compounds can serve as plasma biomarkers of food liking in humans.

METHODS

Three puddings providing 60 kcal (35% from proteins, 62% from carbohydrates, and 3% from fats) but with different taste were developed. Twenty healthy subjects (11 women and 9 men; mean age 28 y and BMI 22.7 kg/m(2)), selected because they liked the puddings in the order sweet > control > bitter, participated in a randomized crossover study based on a modified sham feeding (MSF) protocol. Blood samples at baseline and every 5 min up to 20 min after the MSF were analyzed for gastrointestinal peptides, endocannabinoids, and N-acylethanolamines. Thirty minutes after the MSF, energy intake at an ad libitum breakfast was measured.

RESULTS

After the MSF, no response was observed in 7 of 9 gastrointestinal peptides measured. The plasma ghrelin concentration at 20 min after the sweet and bitter puddings was 25% lower than after the control pudding (P = 0.04), and the pancreatic polypeptide response after the sweet pudding was 23% greater than after the bitter pudding (P = 0.02). The plasma response of 2-arachidonoylglycerol after the sweet pudding was 37% and 15% higher than after the bitter (P < 0.001) and control (P = 0.03) puddings, respectively. Trends for greater responses of anandamide (P = 0.06), linoleoylethanolamide (P = 0.07), palmitoylethanolamide (P = 0.06), and oleoylethanolamide (P = 0.09) were found after the sweet pudding than after the bitter pudding. No differences in subsequent energy intake were recorded.

CONCLUSIONS

The data demonstrated that food palatability influenced some plasma endocannabinoid and N-acylethanolamine concentrations during the cephalic phase response and indicated that 2-arachidonoylglycerol and pancreatic polypeptide can be used as biomarkers of food liking in humans.

Physiological mechanisms by which non-nutritive sweeteners may impact body weight and metabolism

Evidence linking sugar-sweetened beverage (SSB) consumption to weight gain and other negative health outcomes has prompted many individuals to resort to artificial, non-nutritive sweetener (NNS) substitutes as a means of reducing SSB intake. However, there is a great deal of controversy regarding the biological consequences of NNS use, with accumulating evidence suggesting that NNS consumption may influence feeding and metabolism via a variety of peripheral and central mechanisms. Here we argue that NNSs are not physiologically inert compounds and consider the potential biological mechanisms by which NNS consumption may impact energy balance and metabolic function, including actions on oral and extra-oral sweet taste receptors, and effects on metabolic hormone secretion, cognitive processes (e.g. reward learning, memory, and taste perception), and gut microbiota.

Longer oral exposure with modified sham feeding does not slow down gastric emptying of low- and high-energy-dense gastric loads in healthy young men

BACKGROUND

A long oral exposure to food and a high-energy density of food have been shown to increase satiety feelings. The effect of energy density is predominantly caused by an inhibition of gastric emptying. It is hypothesized that prolonging oral exposure may have an additional effect on this inhibition of gastric emptying. However, little human data are available to support this hypothesis.

OBJECTIVE

The objective was to assess the effect of the duration of oral exposure to food on gastric emptying rate of gastric loads (GLs) low and high in energy density and on satiety feelings.

METHODS

Twenty-six healthy men [mean ± SD age: 22 ± 3 y; BMI (in kg/m(2)): 23 ± 1] participated in a randomized crossover trial with 4 treatments and a control. Treatments consisted of either 1- or 8-min modified sham feeding (MSF) of cake, and a GL of either 100 or 700 kcal infused in the stomach via a nasogastric tube (500 mL, 62.5 mL/min). The control consisted of no MSF and a GL of 500 mL of water. Gastric emptying rate was assessed with a (13)C breath test. Breath samples and satiety feelings were collected at fixed time points until 90 min after start of the treatment.

RESULTS

Gastric emptying rate and satiety feelings were not affected by duration of MSF (P ≥ 0.27). However, the 700-kcal GL treatments slowed gastric emptying [41% lower area under the curve (AUC)] and increased satiety feelings (22-31% higher AUC) compared with the 100-kcal GL treatments (P < 0.001). No interaction between MSF duration and energy density of GL was found (P ≥ 0.44).

CONCLUSIONS

Higher gastric energy density inhibited gastric emptying and increased satiety feelings in healthy young men. However, prolonging oral exposure to food did not have an additional effect. This study provides more insight in satiety regulation. This trial was registered at trialregister.nl as NTR3601.

A review of visual cues associated with food on food acceptance and consumption

Several sensory cues affect food intake including appearance, taste, odor, texture, temperature, and flavor. Although taste is an important factor regulating food intake, in most cases, the first sensory contact with food is through the eyes. Few studies have examined the effects of the appearance of a food portion on food acceptance and consumption. The purpose of this review is to identify the various visual factors associated with food such as proximity, visibility, color, variety, portion size, height, shape, number, volume, and the surface area and their effects on food acceptance and consumption. We suggest some ways that visual cues can be used to increase fruit and vegetable intake in children and decrease excessive food intake in adults. In addition, we discuss the need for future studies that can further establish the relationship between several unexplored visual dimensions of food (specifically shape, number, size, and surface area) and food intake.

Oral processing effort, appetite and acute energy intake in lean and obese adults

Chewing reportedly contributes to satiation and satiety signals. Attempts to document and quantify this have led to small and inconsistent effects. The present trial manipulated oral processing effort though required chewing of gums of different hardness and measured appetitive sensations, energy intake, gastric emptying, GI transit time, and concentrations of glucose, insulin, GLP-1, ghrelin and pancreatic polypeptide. Sixty adults classified by sex and BMI (15 each of lean females, obese females, lean males and obese males) were tested in a randomized, controlled, cross-over trial with three arms. They chewed nothing, soft gum or hard gum for 15 min while sipping grape juice (10% of individual energy needs) containing acetaminophen and lactulose on one day each separated by 7 days. Electromyographic recordings and self-reports were obtained during and after chewing to quantify oral processing effort. Blood was sampled through an indwelling catheter and appetite ratings were obtained at baseline and at 0, 15, 30, 45, 60, 90, 120, 180 and 240 min after chewing initiation. Breath samples were collected at 10 min intervals for the first 2h and at 30 min intervals for the next 2h. No effects of chewing were observed for appetitive sensations or gut peptide concentrations. Energy intake tended to decline in lean and increase in obese participants so that daily energy intake differed significantly between the two groups when chewing either gum, while no difference was observed on the non-chewing day. Serum glucose and insulin were significantly lower at selected time points 90-240 min after chewing compared to baseline and the non-chewing day. These data indicate chewing effort does not affect appetitive sensations or gut peptide secretion, but may exert a small differential effect on acute energy intake in lean and obese individuals and lead to greater post-prandial declines of serum glucose and insulin. The efficacy of gum chewing as a substitute for eating for weight management remains uncertain.

Texture and satiation: the role of oro-sensory exposure time

One of the characteristics of the current obesogenic food supply is the large availability of foods that can be ingested quickly. Controlled nutrition intervention studies have shown that the ingestion of simple energy containing beverages, which are consumed very quickly, do not lead to a lower compensatory intake of other foods. One of the theories behind this observation is that calories that are ingested quickly are not well sensed by the sense of taste, and do not lead to an adequate satiety response. This idea is confirmed by the results of a series of studies, where we have shown that the low satiation/satiety response of beverages can be largely attributed to their short oral residence time. Prolonging the oro-sensory exposure time to foods leads to earlier meal termination and/or a higher satiety response. The low satiation/satiety response to simple energy containing beverages is congruent with the observation from studies on the cephalic phase response to foods, i.e. the physiological response to sensory signals. Energy containing beverages do not lead to an adequate cephalic phase response. Various recent studies showed that slower eating leads to higher levels of satiety hormones. These results are in line with the idea that the sense of taste is a nutrient sensor which informs the brain and the gut about the inflow of nutrients. The sense of taste has an important contribution to the satiating effect of foods. One of the challenges in future research is to see whether or not these proofs of principles can be applied in longer term studies with regular commercial foods. This may make our obesogenic food supply more satiating, and may lead to a lower energy intake.