Added thermogenic and satiety effects of a mixed nutrient vs a sugar-only beverage

Diet order significantly affects energy balance for diets varying in macronutrients but not ultraprocessing in crossover studies without a washout period

BACKGROUND

Crossover studies can induce order effects, especially when they lack a washout period.

OBJECTIVES

We performed secondary analyses comparing groups of subjects randomly assigned to different diet orders in 2 inpatient crossover studies originally designed to compare within-subject differences in ad libitum energy intake. One study compared minimally processed low-carbohydrate (LC) compared with low-fat (LF) diets, and the other matched macronutrients and compared minimally processed food (MPF) with ultraprocessed food (UPF) diets.

METHODS

Diet order group comparisons of changes in body weight and body composition, and differences in energy expenditure and food intake were assessed over 4 wk in 20 adults randomly assigned to either the LC followed immediately by the LF diet (LC → LF) or the opposite order (LF → LC), and 20 adults randomly assigned to either the MPF followed by the UPF (MPF → UPF) diets or the opposite order (UPF → MPF).

RESULTS

Subjects randomly assigned to LC → LF lost 2.9 ± 1.1 kg more body weight (P <0.001) and 1.5 ± 0.6 kg more body fat (P = 0.03) than the LF → LC group, likely because the LC → LF group consumed 921 ± 304 kcal/d less than the LF → LC group (P = 0.003). These energy intake differences were driven by the last 2 wk (-1610 ± 312 kcal/d; P < 0.0001), perhaps because of carryover effects of gut adaptations during the first 2 wk arising from large differences in the mass of food (1296 ± 215 g/d; P <0.00001) and fiber consumed (58 ± 6 g/d; P <0.00001). There were no significant diet order effects on energy intake, body weight, or body composition changes between UPF → MPF and MPF → UPF groups.

CONCLUSIONS

Diet order significantly affected energy intake, body weight, and body fat in a 4-wk crossover inpatient diet study varying in macronutrients, but not in a similarly structured study varying in ultraprocessed foods. This trial was registered at clinicaltrials.gov as NCT03407053 and NCT03878108.

Lower Postprandial Thermogenic Response to an Unprocessed Whole Food Meal Compared to an Iso-Energetic/Macronutrient Meal Replacement in Young Women: A Single-Blind Randomized Cross-Over Trial

In contrast to ultra-processed foods that are associated with increased weight gain and obesity risk, nutritionally engineered dietary supplements, including meal replacement (MR) bars and shakes, are generally promoted as healthy. Limited data is available comparing the metabolic and hunger responses of whole food (WF) versus MR meals. The purpose of this study was to directly compare the thermic effect (TEM), respiratory exchange ratio (RER), hunger/taste ratings, and glucose response of two different breakfast meals containing MR and WF products in young healthy women. Eight volunteers completed two iso-caloric (529 kcals)/macronutrient (50% carbohydrates; 26% fat; 24% protein) test meals in a single-blind, randomized crossover design: (1) whole food meal; or (2) meal replacement. TEM was significantly higher following MR compared with WF (percent mean difference: 7.76 ± 3.78%; absolute mean difference: 0.053 ± 0.026 kcal/minute, p = 0.048), whereas WF substrate utilization demonstrated lower carbohydrate oxidation (RER) than MR (mean difference: -0.024 ± 0.008, p = 0.005). No differences existed for blood glucose response and feelings of hunger, desire to eat, and satiety among trials. Consumption of an MR meal increases postprandial thermogenesis and RER compared to a WF meal, which may impact weight control and obesity risk over the long-term.

Association Between Sugar-Sweetened Beverage Consumption as Meal Substitutes, Workload, and Obesity in Nurses: A Cross-Sectional Study

Background: High occupational stress has been associated with altered eating behaviors and obesity. Occupational stress is reported to be high in Asian countries. Furthermore, many Asian countries are increasingly consuming Western-type foods (e.g., incorporating drinks with meals) which collectively may also be contributing to obesity. Therefore, the aim of this study was to examine (a) associations between sugar-sweetened beverage (SSB) consumption as meal replacement and obesity and (b) associations between workload and substituting meals with SSB in nurses. Methods: A representative sample of 854 hospital-based nurses completed a structured questionnaire about SSB consumption, workload, and body mass index (BMI). Log binomial regression models were employed to test associations between SSBs and obesity rates and associations between workload and SSBs. Results: Most participants (57.6%) consumed SSBs as meal replacements during work. This was related to high workloads during shifts. Substituting SSBs for meals was significantly associated with increased likelihood of obesity (aPRR = 1.4, 95% CI (1.1, 1.7)). Workload was positively associated with SSB intake as meal substitutes (aPRR = 1.4, 95% CI (1.2, 1.6)). Conclusions: Our findings show that SSBs are used as meal substitutes and is due to the workload demands. Sugar-sweetened beverage consumption is also positively associated with the increased likelihood of obesity. Interventions that modify workloads and decrease SSB consumption may improve workers’ eating behaviors and health.

Assessing Physical Activity, Fruit, Vegetable, and Sugar-Sweetened Beverage Intake Patterns of College Students in Kansas

OBJECTIVE

To test the effectiveness of a 15-month intervention for reducing sugar-sweetened beverage (SSB) intake among college students and assess fruit and vegetable (F/V) intake and physical activity (PA) habits and their relationship to SSB intake.

DESIGN

Randomized, controlled study.

PARTICIPANTS

A total of 156 college students (aged 18-24 years) from a Kansas university, mostly female (72%), white (89%), and freshmen (51%).

INTERVENTION

Two-staged intervention included participants receiving: (1) 3 weekly stage-tailored messages on healthful behaviors for 10 weeks; and (2) 3 monthly stage-tailored messages and 1 monthly e-mail encouraging a visit to the portal page, after the 3-month physical assessment.

MAIN OUTCOME MEASURE(S)

Stages of change for PA and F/V intake, self-reported PA scores, self-reported F/V intake, and SSB intake habits.

ANALYSIS

Generalized linear mixed models and linear regression models were used to test changes and associations among outcome measures.

RESULTS

No significant decrease occurred in SSB consumption (P > .05) among intervention participants. Both control and intervention groups recorded low F/V intake and moderate PA scores.

CONCLUSIONS AND IMPLICATIONS

Low F/V intake and high SSB intake evident among study participants may pose risk for unwanted weight gain and obesity-related conditions. Furthermore, college campuses can continue to support an environment conducive for being physically active, while promoting healthy eating behaviors.

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.

The effect of increasing dairy calcium intake of adolescent girls on changes in body fat and weight

Background: Overweight is epidemic in adolescents and is a major concern because it tracks into adulthood. Evidence supports the efficacy of high-calcium, high-dairy diets in achieving healthy weight in adults. However, no randomized controlled trials of the effect of dairy food on weight and body fat in adolescents have been reported to our knowledge.Objective: The aim was to determine whether increasing calcium intake to recommended amounts with dairy foods in adolescent girls with habitually low calcium intakes would decrease body fat gain compared with girls who continued their low calcium intake. Participants had above-the-median body mass index (BMI; in kg/m²).Design: We enrolled 274 healthy postmenarcheal 13- to 14-y-old overweight girls who had calcium intakes of ≤600 mg/d in a 12-mo randomized controlled trial. Girls were randomly assigned in a 1:1 ratio to 1 of 2 groups within each of 3 BMI percentiles: 50th to <70th, 70th to <85th, and 85th to <98th. The assignments were 1) dairy, which included low-fat milk or yogurt servings providing ≥1200 mg Ca/d or 2) control, which included the usual diet of ≤600 mg Ca/d.Results: We failed to detect a statistically significant difference between groups in percentage of body fat gain over 12 mo (mean ± SEM: dairy 0.40% ± 0.53% > control; P < 0.45). The effect of the intervention did not differ by BMI percentile stratum. There was no difference in weight change between the 2 groups.Conclusion: Our findings that the dairy group gained body fat similar to the control group provide no support for dairy food as a stratagem to decrease body fat or weight gain in overweight adolescent girls. This trial was registered at clinicaltrials.gov as NCT01066806.

Assessing resting energy expenditure in overweight and obese adolescents in a clinical setting: validity of a handheld indirect calorimeter

BACKGROUND

Accurately determining energy requirements is key for nutritional management of pediatric obesity. Recently, a portable handheld indirect calorimeter, MedGem (MG) has become available to measure resting energy expenditure (REE). Our work aims to determine the clinical validity and usefulness of MG to measure REE in overweight and obese adolescents.

METHODS

Thirty-nine overweight and obese adolescents (16 male (M): 23 female (F), 15.2 ± 1.9 y, BMI percentile: 98.6 ± 2.2%) and 15 normal weight adolescents (7M: 8F, age 15.2 ± 2.0 y, BMI percentile: 39.2 ± 20.9%) participated. REE was measured with both MG and standard indirect calorimeter (VMax) in random order.

RESULTS

MG REE (1,600 ± 372 kcal/d) was lower than VMax REE (1,727 ± 327 kcal/) in the overweight and obese adolescents. Bland Altman analysis (MG -VMax) showed a mean bias of -127 kcal/d (95% CI = -72 to -182 kcal/d, P < 0.001), and a proportional bias existed such that lower measured REE by VMax was underestimated by MG, and higher measured REE by VMax were overestimated by MG.

CONCLUSION

MG systematically underestimates REE in the overweight and adolescent population, thus the MG portable indirect calorimeter is not recommended for routine use. Considering that it is a systematic underestimation of REE, MG may be clinically acceptable, only if used with caution.

The Effect of a Dairy-Based Recovery Beverage on Post-Exercise Appetite and Energy Intake in Active Females

This study was designed to assess the effect of a dairy-based recovery beverage on post-exercise appetite and energy intake in active females. Thirteen active females completed three trials in a crossover design. Participants completed 60 min of cycling at 65% V̇O2peak, before a 120 min recovery period. On completion of cycling, participants consumed a commercially available dairy-based beverage (DBB), a commercially available carbohydrate beverage (CHO), or a water control (H₂O). Non-esterified fatty acids, glucose, and appetite-related peptides alongside measures of subjective appetite were sampled at baseline and at 30 min intervals during recovery. At 120 min, energy intake was assessed in the laboratory by ad libitum assessment, and in the free-living environment by weighed food record for the remainder of the study day. Energy intake at the ad libitum lunch was lower after DBB compared to H₂O (4.43 ± 0.20, 5.58 ± 0.41 MJ, respectively; p = 0.046; (95% CI: -2.28, -0.20 MJ)), but was not different to CHO (5.21 ± 0.46 MJ), with no difference between trials thereafter. Insulin and GLP-17-36 were higher following DBB compared to H₂O (p = 0.015 and p = 0.001, respectively) but not to CHO (p = 1.00 and p = 0.146, respectively). In addition, glucagon was higher following DBB compared to CHO (p = 0.008) but not to H₂O (p = 0.074). The results demonstrate that where DBB consumption may manifest in accelerated recovery, this may be possible without significantly affecting total energy intake and subsequent appetite-related responses relative to a CHO beverage.

A Pilot Study: Dietary Energy Density is Similar between Active Women with and without Exercise-Associated Menstrual Dysfunction

Low energy availability (EA) (e.g., insufficient energy intake (EI) to match energy needs, including exercise energy expenditure) has been identified as a primary contributor to exercise-associated menstrual dysfunction (ExMD) in active women. For health reasons, active women may self-select diets lower in energy density (ED, kcal/g), which can inadvertently contribute to inadequate EI. Using data from two studies, we compared the ED of active women with ExMD (n = 9; 24 ± 6 years) to eumenorrheic (EU) active controls (EU: n = 18, 27 ± 6 years). ED was calculated from 6 to 7 days weighted food records using two methods: with/without beverages. ANOVA and Wilcoxon Rank-Sum were used to test group differences. ED was not different between groups, but there was a trend toward a lower median ED (10%) (p = 0.049 unadjusted; p = 0.098 adjusted) in the ExMD-group (Method 1-all beverages: ExMD = 1.01 kcal/g (range = 0.52-1.41), EU = 1.22 kcal/g (range = 0.72-1.72); Method 2-without beverages: ExMD = 1.51 kcal/g (range = 1.26-2.06), EU = 1.69 kcal/g (range = 1.42-2.54)). This lower ED represents a 9% decrease (~219 kcal/day) in EI (ExMD = 2237 ± 378 kcal/day; EU = 2456 ± 470 kcal/day; p > 0.05). EI and macro/micronutrient intakes were similar for groups. In the ExMD-group, low ED could contribute to lower EI and EA. Future research should examine the interaction of ED and exercise on appetite, EI, and EA in active women, especially those with ExMD.

Beverage Consumption: Are Alcoholic and Sugary Drinks Tipping the Balance towards Overweight and Obesity?

The role that energy-containing beverages may play in the development of overweight and obesity remains highly controversial, in particular the alcoholic and sugar-sweetened beverages (SSB). Both of these beverage formats have been increasing as a percentage of the westernized diet over the past 20 years, and both have contributed significantly to an increase in energy consumed in liquid form. Data from epidemiology and intervention studies however have long been contradictory, despite mechanistic evidence pointing towards poor compensation for addition of "liquid" energy from these two sources into the diet providing a strong rational for the balance to be tipped towards weight gain. Regulatory and government intervention has been increasing globally, particularly with respect to intake of SSBs in children. This narrative review presents evidence which both supports and refutes the link between alcohol and carbohydrate-containing liquids and the regulation of body weight, and investigates mechanisms which may underpin any relationship between increased beverage consumption and increased energy intake, body weight and adiposity.

No evidence of enhanced satiety following whey protein- or sucrose-enriched water beverages: a dose response trial in overweight women

BACKGROUND/OBJECTIVES

To compare the effect of low-dose whey protein-enriched and sucrose-enriched water beverages on postprandial satiety and energy intake.

SUBJECTS/METHODS

Sixty overweight and obese women were given water-based protein and carbohydrate (CHO) beverages or placebo on six different occasions in a double-blind, randomised cross-over study. The beverages were 2 (178 kJ) and 4% (348 kJ) protein-enriched water (Clear Protein8855), 2 (157 kJ), 4 (314 kJ) and 10% (785 kJ) sucrose-enriched water, and a sweetened water control. Beverages were matched for volume, colour, flavour and sweetness. A standardised evening meal was provided before each study day and a standardised breakfast upon arrival at the clinic at 0900 hours. The beverage preload was given midmorning at 1100 hours, and an ad libitum outcome lunch meal at 1300 hours. Subjective appetitive responses were recorded through the day until 1500 hours using visual analogue scales.

RESULTS

Fifty-five participants completed all six beverage conditions. Neither protein nor sucrose preloads decreased any of hunger, fullness, thoughts of food or satisfaction when compared with the sweetened water control beverage (all, P>0.05). There was also no significant effect on ad libitum energy or macronutrient intake at the outcome meal (P>0.05), with no compensation for the energy consumed within the preload beverages.

CONCLUSIONS

There was no evidence of increased postprandial satiety or compensation for energy content at an outcome lunch meal when a water beverage was supplemented with up to 4% (w/w) whey protein or 10% (w/w) sucrose, in a group of overweight but unrestrained young and middle-aged women.

A New Hand-Held Indirect Calorimeter to Measure Postprandial Energy Expenditure

OBJECTIVE

To verify the accuracy of a new hand-held metabolic rate measuring device (MedGem) in quantifying postprandial energy expenditure (PP EE). MedGem measurements were compared to measurements obtained with a conventional indirect calorimeter (Delta-Trac).

RESEARCH METHODS AND PROCEDURES

The resting metabolic rate of 15 healthy subjects was measured for 20 minutes using Delta-Trac followed by a 10-minute measurement period using MedGem. EE was again measured for 7 hours after consumption of a 2510-kJ breakfast. Measurements were read from the Delta-Trac for the initial 50 minutes of each hour followed by a single reading from the MedGem after 5 to 10 minutes of measurement. Measured EE was calculated as the average of the total measurement period for Delta-Trac and for eight readings using MedGem; PP EE was calculated as the average of all measurements obtained after breakfast consumption.

RESULTS

There was no difference in resting metabolic rate between the two methods (6455.1 +/- 417.6 vs. 6468.5 +/- 337.2 kJ/d for Delta-Trac and MedGem, respectively). Measured EE and PP EE values with Delta-Trac (7019.1 +/- 400.8 and 7099.8 +/- 399.2 kJ/d, respectively) and MedGem (6775.6 +/- 372.0 and 6819.5 +/- 379.9 kJ/d, respectively) were not significantly different. There was no bias detected in any of the measurements made with MedGem compared with those of Delta-Trac.

DISCUSSION

The new hand-held EE measuring device can accurately track PP EE relative to a conventional indirect calorimetry system and, therefore, provides a new opportunity to assess PP EE in research settings and large-scale trials.

Lycium barbarum increases caloric expenditure and decreases waist circumference in healthy overweight men and women: pilot study

BACKGROUND

Lycium barbarum (L. barbarum), a traditional Asian medicinal therapy for diabetes and other conditions, has been shown to increase metabolic rate and to reduce body-weight gains in rodent models, as well as to produce clinical improvements in general feelings of well-being including energy level.

OBJECTIVE

To investigate the impact of L. barbarum consumption on (1) caloric expenditure and (2) changes in morphometric parameters (waist circumference) in healthy human adults.

METHOD

Two separate randomized, double-blind, placebo-controlled, small clinical studies were conducted using a standardized L. barbarum fruit juice, GoChi, and assessing its effects on (1) resting metabolic rate (RMR) and postprandial energy expenditure (PPEE) as measured by indirect calorimetry after single-bolus intake of 3 doses of L. barbarum (30, 60, and 120 ml) and placebo; and (2) waist circumference and other morphometric changes in a 14-day intervention trial (120-ml daily intake) in the subjects (age = 34 years, body mass index = 29 kg/m(2)).

RESULTS

(1) A single bolus of L. barbarum intake increased PPEE 1 through 4 hours postintake over the baseline level in a dose-dependent manner and was significantly higher than the placebo group by 10% at 1 hour postintake of 120 ml (p < 0.05). (2) In a 14-day intervention trial, L. barbarum was found to significantly decrease waist circumference by 5.5 ± 0.8 cm (n = 15) compared with the preintervention measurements and placebo group at postintervention day 15 (p < 0.01). By contrast, the changes in the placebo group (n = 14) from preinterventions was 0.9 ± 0.8 cm, which was not statistically significant.

CONCLUSIONS

These results show that L. barbarum consumption increases metabolic rate and reduces the waist circumference, relative to placebo treated control subjects.

Sensitivity of ad libitum meals to detect changes in hunger. Restricted-item or multi-item testmeals in the design of preload appetite studies

The aims of the study were to determine whether restricted single-item or multi-item testmeals are better able to detect prior changes in hunger and fullness when assessing ad libitum eating behaviour. Thirty male participants were given a low- (L(E), 0.5 MJ) or high-energy (H(E), 4.0 MJ) breakfast preload designed to induce or suppress hunger, followed 3h later by a restricted-item (R(I)) or multi-item (M(I)) testmeal. The R(I) testmeal comprised pasta+meat sauce, whilst the M(I) testmeal comprised pasta+meat sauce plus bread, chicken, ham, cheese, salad, cake and fruit. The four conditions were (i) L(E)/R(I); (ii) L(E)/M(I); (iii) H(E)/R(I); (iv) H(E)/M(I). Visual analogue scales (VAS) were used to rate appetite sensations and EI was measured at the lunch testmeal. As expected, increasing the energy content of the preload significantly altered VAS ratings and decreased EI at the testmeal. Following both L(E) and H(E) breakfasts, EI was lower at the R(I) (L(E)=4566 kJ, H(E)=3583 kJ) compared with the M(I) (L(E)=6142 kJ, H(E)=5149 kJ) testmeal. However, the compensatory decrease in EI in response to the H(E) breakfast was not significantly greater at the R(I) testmeal (R(I): -983 kJ, 28.1% compensation; M(I): -993 kJ, 28.4% compensation). In preload studies measuring EI, increasing the variety of an ad lib testmeal may not decrease the sensitivity to detect changes in hunger and fullness.

Low-dose whey protein-enriched water beverages alter satiety in a study of overweight women

AIM

To determine the effect of low-dose whey protein-enriched water beverages on postprandial satiety and energy intake (EI).

METHODS

Fifty overweight and mildly obese women were given 500 mL water-based beverages on 4 different occasions in a double blind, cross-over study. The beverages were reasonably matched for colour, flavour, sweetness and contained 0% (water control, 0 g, 8 kJ), 1% (5 g, 93 kJ), 2% (10 g, 178 kJ) and 4% (20 g, 348 kJ) whey protein by weight (ClearProtein8855™). Following a standard evening meal and breakfast, beverages were consumed 120 min before an ad libitum lunch at which EI was measured. Feelings associated with hunger and fullness were also measured using visual analogue scales (VAS).

RESULTS

46 participants completed all 4 beverage conditions. There was a significant effect of beverage preload on hunger (beverage×time; P=0.0074), where each of the 1%, 2% and 4% w/w protein beverages decreased hunger compared to the water control (P<0.05). Suppression of hunger was also maintained for longer following the protein beverages (Friedman test, P=0.013). Fullness (beverage×time; P=0.0020) and satisfaction (beverage×time; P=0.0356) were both increased by the 1% and 4% protein beverages (P<0.05). EI at lunch decreased by up to 8 percent (control vs 4% protein, delta=-247 kJ, Tukey's post hoc, P>0.05) when escalating protein doses were added to the water preload (water control, 3028 kJ; 1%, 3080 kJ; 2%, 2924 kJ; 4%, 2781 kJ), only partial compensation for the added energy.

CONCLUSIONS

These low-dose, whey protein-enriched water beverages significantly altered short term postprandial satiety, however the effect was not sufficient to impact on food intake when assessed 2 h after consumption.

Is sugar consumption detrimental to health? A review of the evidence 1995-2006

Many countries set quantitative targets for added sugars, justifying this by expressing concern about the likely impact of sugar on weight control, dental health, diet quality, or metabolic syndrome. This review considers whether current intakes of sugar are harmful to health, and analyses recent literature using a systematic approach to collate, rank, and evaluate published studies from 1995-2006. Results from high quality obesity studies did not suggest a positive association between body mass index and sugar intake. Some studies, specifically on sweetened beverages, highlighted a potential concern in relation to obesity risk, although these were limited by important methodological issues. Diet adequacy appeared to be achieved across sugar intakes of 6 to 20% energy, depending on subject age. Studies on metabolic syndrome reported no adverse effects of sugar in the long-term, even at intakes of 40-50% energy. The evidence for colorectal cancer suggested an association with sugar, but this appeared to have been confounded by energy intake and glycemic load. There was no credible evidence linking sugar with attention-deficit, dementia, or depression. Regarding dental caries, combinations of sugar amount/frequency, fluoride exposure, and food adhesiveness were more reliable predictors of caries risk than the amount of sugar alone. Overall, the available evidence did not support a single quantitative sugar guideline covering all health issues.

Beverage consumption and adult weight management: A review

Total energy consumption among United States adults has increased in recent decades, and energy-containing beverages are a significant contributor to this increase. Because beverages are less satiating than solid foods, consumption of energy-containing beverages may increase energy intake and lead to weight gain; trends in food and beverage consumption coinciding with increases in overweight and obesity support this possibility. The purpose of this review is to present what is known about the effect of beverage consumption on short-term (i.e., meal) energy intake, as well as longer-term effects on body weight. Specific beverages addressed include water, other energy-free beverages (diet soft drinks, coffee and tea), and energy-containing beverages (soft drinks, juices and juice drinks, milk and soy beverages, alcohol). Existing evidence, albeit limited, suggests that encouraging water consumption, and substituting water and other energy-free beverages (diet soft drinks, coffee and tea) for energy-containing beverages may facilitate weight management. Energy-containing beverages acutely increase energy intake, however long-term effects on body weight are uncertain. While there may be health benefits for some beverage categories, additional energy provided by beverages should be compensated for by reduced consumption of other foods in the diet.

Sugar-Sweetened Beverage Intake Trends in US Adolescents and Their Association with Insulin Resistance-Related Parameters

The purpose of this study was to evaluate current sugar-sweetened beverage (SSB) consumption trends and their association with insulin resistance-related metabolic parameters and anthropometric measurements by performing a cross-sectional analysis of the NHANES data during the years 1988–1994 and 1999–2004. Main outcome measures included SSB consumption trends, a homeostasis model assessment of insulin resistance, blood pressure, waist circumference, body mass index, and fasting concentrations of total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides. Although overall SSB consumption has increased, our data suggest that this increase was primarily due to an increase in the amount of SSBs consumed by males in the high-SSB intake group alone. Multivariate linear regression analyses also showed that increased SSB consumption was independently associated with many adverse health parameters. Factors other than SSB consumption must therefore be contributing to the increasing prevalence of obesity and metabolic syndrome in the majority of US children.

Relationship between insulin resistance-associated metabolic parameters and anthropometric measurements with sugar-sweetened beverage intake and physical activity levels in US adolescents: findings from the 1999-2004 National Health and Nutrition Examination Survey

OBJECTIVE

To evaluate the relationship between insulin resistance-associated metabolic parameters and anthropometric measurements with sugar-sweetened beverage intake and physical activity levels.

DESIGN

A cross-sectional analysis of the National Health and Nutrition Examination Survey data collected by the National Center for Health Statistics.

SETTING

Nationally representative samples of US adolescents participating in the National Health and Nutrition Examination Survey during the years 1999-2004.

PARTICIPANTS

A total of 6967 adolescents aged 12 to 19 years.

MAIN EXPOSURE

Sugar-sweetened beverage consumption and physical activity levels.

OUTCOME MEASURES

Glucose and insulin concentrations, a homeostasis model assessment of insulin resistance (HOMA-IR), total, high-density lipoprotein, and low-density lipoprotein cholesterol concentrations, triglyceride concentrations, systolic and diastolic blood pressure, waist circumference, and body mass index (calculated as weight in kilograms divided by height in meters squared) percentile for age and sex.

RESULTS

Multivariate linear regression analyses showed that increased sugar-sweetened beverage intake was independently associated with increased HOMA-IR, systolic blood pressure, waist circumference, and body mass index percentile for age and sex and decreased HDL cholesterol concentrations; alternatively, increased physical activity levels were independently associated with decreased HOMA-IR, low-density lipoprotein cholesterol concentrations, and triglyceride concentrations and increased high-density lipoprotein cholesterol concentrations. Furthermore, low sugar-sweetened beverage intake and high physical activity levels appear to modify each others' effects of decreasing HOMA-IR and triglyceride concentrations and increasing high-density lipoprotein cholesterol concentrations.

CONCLUSIONS

Sugar-sweetened beverage intake and physical activity levels are each independently associated with insulin resistance-associated metabolic parameters and anthropometric measurements in adolescents. Moreover, low sugar-sweetened beverage intake and high physical activity levels appear to modify each others' effects on several health-related outcome variables.

Reduction in consumption of sugar-sweetened beverages is associated with weight loss: the PREMIER trial

BACKGROUND

Consumption of liquid calories from beverages has increased in parallel with the obesity epidemic in the US population, but their causal relation remains unclear.

OBJECTIVE

The objective of this study was to examine how changes in beverage consumption affect weight change among adults.

DESIGN

This was a prospective study of 810 adults participating in the PREMIER trial, an 18-mo randomized, controlled, behavioral intervention trial. Measurements (weight, height, and 24-h dietary recall) were made at baseline, 6 mo, and 18 mo.

RESULTS

Baseline mean intake of liquid calories was 356 kcal/d (19% of total energy intake). After potential confounders and intervention assignment were controlled for, a reduction in liquid calorie intake of 100 kcal/d was associated with a weight loss of 0.25 kg (95% CI: 0.11, 0.39; P < 0.001) at 6 mo and of 0.24 kg (95% CI: 0.06, 0.41; P = 0.008) at 18 mo. A reduction in liquid calorie intake had a stronger effect than did a reduction in solid calorie intake on weight loss. Of the individual beverages, only intake of sugar-sweetened beverages (SSBs) was significantly associated with weight change. A reduction in SSB intake of 1 serving/d was associated with a weight loss of 0.49 kg (95% CI: 0.11, 0.82; P = 0.006) at 6 mo and of 0.65 kg (95% CI: 0.22, 1.09; P = 0.003) at 18 mo.

CONCLUSIONS

These data support recommendations to limit liquid calorie intake among adults and to reduce SSB consumption as a means to accomplish weight loss or avoid excess weight gain. This trial was registered at clinicaltrials.gov as NCT00000616.

High-milk supplementation with healthy diet counseling does not affect weight loss but ameliorates insulin action compared with low-milk supplementation in overweight children

Milk consumption has decreased in children over the past years. This may play a role in the prevalence of pediatric obesity, because clinical studies have found a beneficial effect of milk consumption for weight management. The objectives of this study were to test whether high-milk consumption leads to greater weight loss and improvements in metabolic risk factors than low milk consumption during a 16-wk healthy eating diet. Overweight children aged 8-10 y were randomized to either high (4 x 236 mL/d) or low (1 x 236 mL/d) milk consumption. Children were provided dietary counseling on healthy eating at baseline and at wk 1, 2, 4, 6, 8, and 12. Serum glucose, insulin, and lipids were measured in fasting children at baseline and wk 8 and 16. An oral glucose tolerance test and body composition assessment by magnetic resonance imaging were conducted at baseline and endpoint. Body weight changes during the 16-wk study not differ between the high-milk (1.3 +/- 0.3 kg) and low-milk (1.1 +/- 0.3 kg) groups. There was no beverage x week interaction on any of the body composition and metabolic variables studied (blood pressure, serum lipids, glucose, and insulin). There was a beverage x week interaction (P = 0.044) on insulin area under the curve showing a trend toward reduced insulin output with a glucose challenge after high-milk consumption (P = 0.062). These data suggest that in overweight children, high-milk consumption in conjunction with a healthy diet does not lead to greater weight loss but may ameliorate insulin action compared with low-milk consumption.

The relationship between dietary energy density and energy intake

Much of the research in ingestive behavior has focused on the macronutrient composition of foods; however, these studies are incomplete, or could be misleading, if they do not consider the energy density (ED) of the diet under investigation. Lowering the ED (kcal/g) by increasing the volume of preloads without changing macronutrient content can enhance satiety and reduce subsequent energy intake at a meal. Ad libitum intake or satiation has also been shown to be influenced by ED when the proportions of macronutrients are constant. Since people tend to eat a consistent weight of food, when the ED of the available foods is reduced, energy intake is reduced. The effects of ED have been seen in adults of different weight status, sex, and behavioral characteristics, as well as in 3- to 5-year-old children. The mechanisms underlying the response to variations in ED are not yet well understood and data from controlled studies lasting more than several days are limited. However, both population-based studies and long-term clinical trials indicate that the effects of dietary ED can be persistent. Several clinical trials have shown that reducing the ED of the diet by the addition of water-rich foods such as fruits and vegetables was associated with substantial weight loss even when patients were not told to restrict calories. Since lowering dietary energy density could provide effective strategies for the prevention and treatment of obesity, there is a need for more studies of mechanisms underlying the effect and ways to apply these findings.

Effects of replacing the habitual consumption of sugar-sweetened beverages with milk in Chilean children

BACKGROUND

During the nutrition transition in Chile, dietary changes were marked by increased consumption of high-energy, nutrient-poor products, including sugar-sweetened beverages (SSBs). Obesity is now the primary nutritional problem in posttransitional Chile.

OBJECTIVE

We conducted a randomized controlled trial to examine the effects on body composition of delivering milk beverages to the homes of overweight and obese children to displace SSBs.

DESIGN

We randomly assigned 98 children aged 8-10 y who regularly consumed SSBs to intervention and control groups. During a 16-wk intervention, children were instructed to drink 3 servings/d (approximately 200 g per serving) of the milk delivered to their homes and to not consume SSBs. Body composition was measured by dual-energy X-ray absorptiometry. Data were analyzed by multiple regression analysis according to the intention-to-treat principle.

RESULTS

For the intervention group, milk consumption increased by a mean (+/- SEM) of 452.5 +/- 37.7 g/d (P < 0.0001), and consumption of SSBs decreased by -711.0 +/- 33.7 g/d (P < 0.0001). For the control group, milk consumption did not change, and consumption of SSBs increased by 71.9 +/- 33.6 g/d (P = 0.04). Changes in percentage body fat, the primary endpoint, did not differ between groups. Nevertheless, the mean (+/- SE) accretion of lean body mass was greater (P = 0.04) in the intervention (0.92 +/- 0.10 kg) than in the control (0.62 +/- 0.11 kg) group. The increase in height was also greater (P = 0.01) in the intervention group (2.50 +/- 0.21 cm) than in the control group (1.77 +/- 0.20 cm) for boys but not for girls.

CONCLUSION

Replacing habitual consumption of SSBs with milk may have beneficial effects on lean body mass and growth in children, despite no changes in percentage body fat. This trial was registered at clinicaltrials.gov as NCT00149695.

The role of sugar-sweetened beverage consumption in adolescent obesity: a review of the literature

Soft drink consumption has increased by 300% in the past 20 years, and 56-85% of children in school consume at least one soft drink daily. The odds ratio of becoming obese among children increases 1.6 times for each additional can or glass of sugar-sweetened drink consumed beyond their usual daily intake of the beverage. Soft drinks currently constitute the leading source of added sugars in the diet and exceed the U.S. Department of Agriculture's recommended total sugar consumption for adolescents. With the increase in adolescent obesity and the concurrent increase in consumption of sugar-sweetened beverages (SSB), the assumption infers a relationship between the two variables. SSB, classified as high-glycemic index (GI) liquids, increase postprandial blood glucose levels and decrease insulin sensitivity. Additionally, high-GI drinks submit to a decreased satiety level and subsequent overeating. Low-GI beverages stimulate a delayed return of hunger, thereby prompting an increased flexibility in amounts and frequencies of servings. Single intervention manipulation, elimination, or marked reduction of SSB consumption may serve to decrease caloric intake, increase satiety levels, decrease tendencies towards insulin resistance, and simplify the process of weight management in this population.

Sugar intake, soft drink consumption and body weight among British children: further analysis of National Diet and Nutrition Survey data with adjustment for under-reporting and physical activity

We investigated associations between body mass index (BMI) and intake of non-milk extrinsic sugars (NMES) and caloric soft drinks using weighed 7-day food records, nutrient intakes, BMI measurements and 7-day physical activity (PA) diaries from the UK National Dietary and Nutritional Survey of Young People (n=1,294 aged 7-18 years). NMES and caloric soft drinks (excluding 100% fruit juice) were quantified by their contribution to energy intake. BMI z-scores were calculated from UK reference curves and International Obesity Task Force (IOTF) cut-off values were used to define overweight. The BMI z-score was weakly inversely correlated with percentage energy from NMES after adjustment for under-reporting and dieting (r=-0.06, P=0.03). The percentage of energy from soft drinks was not associated with the BMI z-score or PA. After excluding under-reporters and dieters, the heaviest children (top quintile: Q5 of BMI z-scores) consumed more total energy (+1,220 kJ/day) than those in the lowest quintile (Q1), but only 60 kJ (5%) was from soft drinks. In logistic regression (adjusted for age and gender, under-reporting, and dieting), overweight was positively associated with energy intake (MJ) (odds ratio [OR]=1.58, confidence interval [CI]=1.42-1.77) and sedentary activity (h) (OR=1.11, CI=1.01-1.23), and inversely associated with moderate/vigorous activity (h) (OR=0.71, CI=0.58-0.86). In the macronutrient model, high fat and protein intake (top tertile vs lowest tertile, g/day) were positively associated with overweight (OR>2.5, P<0.001) while starch had less impact (OR=1.60, CI=1.0-2.55, P<0.05). Top tertile intakes of caloric soft drinks were weakly associated with overweight (OR=1.39, CI=0.96-2.0, P=0.08), while other sources of NMES showed no association (OR=0.81, CI=0.52-1.27, P=0.4). Risk associated with caloric soft drinks appeared non-linear with an increase in odds only for very high consumers (top quintile, mean 870 kJ/day; OR=1.67, CI=1.04-2.66, P=0.03). These data are not consistent with any specific role for NMES or caloric soft drinks in obesity among British children and adolescents, but point instead to a general role of overeating and physical inactivity. Evidence of successful interventions is urgently needed but these must use reliable measurements of exposure (diet and PA) and outcome (BMI z-score, body fat, waist circumference) and have a sufficient timescale.

Greater resting energy expenditure and lower respiratory quotient after 1 week of supplementation with milk relative to supplementation with a sugar-only beverage in children

Previous studies have linked overweight to lower milk and calcium consumption and have proposed a role of milk consumption on energy expenditure (EE). The goal of this study was to compare EE and food intake after a meal of either mixed-nutrient or single-nutrient beverage and examine whether supplementation with that beverage for 1 week will impact EE. This was a randomized, controlled crossover study testing the effect of 2 beverages, milk or fruit-flavored beverage, before and after a supplementation period of 1 week on EE. Food intake at a meal after a snack intake of each beverage was assessed at the end of each measurement period. Ten children, aged 9 to 10 years, participated in all of the testing sessions in the study. There was a significant beverage by testing day interaction on daily EE and thermic effect of food (TEF), whereby EE was greater with milk consumption relative to the fruit-flavored beverage on day 8 (P = .0014) and with fruit-flavored beverage consumption on day 1 vs day 8 (P = .01). Similarly, the TEF was greater with milk compared with fruit-flavored beverage consumption on day 8 (P = .0007) and with fruit-flavored beverage consumption on day 1 relative to day 8 (P = .0097). The TEF declined more rapidly during 6 hours after a fruit-flavored beverage than a milk meal (P = .0018). Food intake did not differ after snack consumption of each beverage before and after milk and fruit-flavored beverage supplementation periods. Over the longer term, consumption of milk beverages may have more favorable effects on energy balance in children than consumption of fruit-flavored beverages.

Is sugar-sweetened beverage consumption associated with increased fatness in children?

OBJECTIVE

We assessed whether sugar-sweetened beverage (SSB) consumption increases fatness in British children.

METHODS

Data from a subsample of the Avon Longitudinal Study of Parents and Children were analyzed. Diet was assessed at ages 5 y (n = 521) and 7 y (n = 682) using 3-d diet diaries. Beverages were categorized into SSB, low energy, fruit juice, milk, and water. Fat mass was measured at age 9 y using dual-energy x-ray absorptiometry. The association between consumption of SSB at each age and fatness was examined using linear regression adjusted for potentially confounding variables.

RESULTS

SSB accounted for 15% of all drinks consumed and 3% of total energy intake at both ages. There was no evidence of an association between SSB consumption at 5 or 7 y of age and fatness at age 9 y. There was a small positive correlation between low-energy drinks at age 5 and 7 y and fatness at 9 y (age 5 y, rho = 0.21, P < 0.001; age 7 y, rho = 0.16, P < 0.001), which was explained by existing overweight status at ages 5 and 7 y.

CONCLUSION

In this cohort of British children there was no evidence of an association between SSB consumption at age 5 or 7 y and fatness at age 9 y. The positive relation between consumption of low-energy beverages and fatness at 9 y, which was explained by overweight status at 5 and 7 y, suggests that heavier children may consume low-energy beverages as part of an ineffective weight-control program.

Increased satiety after intake of a chocolate milk drink compared with a carbonated beverage, but no difference in subsequent ad libitum lunch intake

The rising rate of obesity has been blamed on increased consumption of sugar-sweetened soft drinks, such as carbonated sodas, which fail to satisfy hunger. The objective of the present study was to compare the effect on appetite and energy intake of a sugar-sweetened beverage (cola) and a chocolate milk drink, matched for energy content and volume. It was hypothesised that chocolate milk may be more satiating because of its protein content. Twenty-two healthy young men (age 23 (sd 1·8) years) of normal weight (BMI 22·2 (sd 1·5) kg/m2) were recruited to the randomised cross-over study. Visual analogue scales were used to record subjective appetite ratings every 30 min on each of two test days. A drink of 500 ml cola or chocolate milk (900 kJ) was ingested 30 min before an ad libitum lunch. Satiety and fullness were significantly greater (P = 0·0007, P = 0·0004, respectively) 30 min after chocolate milk than after cola. Ratings of prospective consumption and hunger were significantly greater after cola than after chocolate milk, both immediately after preload intake (P = 0·008, P = 0·01, respectively) and 30 min afterwards (P = 0·004, P = 0·01, respectively). There was no significant difference (P = 0·42) in ad libitum lunch intake after ingestion of chocolate milk (3145 (sd 1268) kJ) compared with cola (3286 (sd 1346) kJ). The results support the hypothesis that sweetened soft drinks are different from milk products in their impact on short-term hunger and satiety, although differences in subjective appetite scores were not translated into differences in energy intake.

How much may I eat? Calorie estimates based upon energy expenditure prediction equations

How much may I eat? Most healthcare workers, when asked this question, have insufficient knowledge to educate their patients on a healthy energy intake level. In this review we examine the available methods for estimating adult energy requirements with a focus on the newly developed National Academy of Sciences/Institute of Medicine (NAS/IOM) doubly-labelled water total energy expenditure (TEE) prediction equations. An overview is first provided of the traditional factorial method of estimating energy requirements. We then extend this overview by exploring the development of the NAS/IOM TEE prediction models and their role in estimating energy requirements as a function of sex, age, weight, height and physical activity level. The NAS/IOM prediction models were developed for evaluating group energy requirements, although the formulas can be applied in individual 'example' patients for educational purposes. Potential limitations and interpretation issues of both the factorial and NAS/IOM methods are examined. This information should provide healthcare professionals with the tools and understanding to appropriately answer the question, 'How much may I eat?'

Intake of sugar-sweetened beverages and weight gain: a systematic review

Consumption of sugar-sweetened beverages (SSBs), particularly carbonated soft drinks, may be a key contributor to the epidemic of overweight and obesity, by virtue of these beverages' high added sugar content, low satiety, and incomplete compensation for total energy. Whether an association exists between SSB intake and weight gain is unclear. We searched English-language MEDLINE publications from 1966 through May 2005 for cross-sectional, prospective cohort, and experimental studies of the relation between SSBs and the risk of weight gain (ie, overweight, obesity, or both). Thirty publications (15 cross-sectional, 10 prospective, and 5 experimental) were selected on the basis of relevance and quality of design and methods. Findings from large cross-sectional studies, in conjunction with those from well-powered prospective cohort studies with long periods of follow-up, show a positive association between greater intakes of SSBs and weight gain and obesity in both children and adults. Findings from short-term feeding trials in adults also support an induction of positive energy balance and weight gain by intake of sugar-sweetened sodas, but these trials are few. A school-based intervention found significantly less soft-drink consumption and prevalence of obese and overweight children in the intervention group than in control subjects after 12 mo, and a recent 25-week randomized controlled trial in adolescents found further evidence linking SSB intake to body weight. The weight of epidemiologic and experimental evidence indicates that a greater consumption of SSBs is associated with weight gain and obesity. Although more research is needed, sufficient evidence exists for public health strategies to discourage consumption of sugary drinks as part of a healthy lifestyle.

Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: a randomized, controlled pilot study

OBJECTIVE

The role of sugar-sweetened beverages (SSBs) in promoting obesity is controversial. Observational data link SSB consumption with excessive weight gain; however, randomized, controlled trials are lacking and necessary to resolve the debate. We conducted a pilot study to examine the effect of decreasing SSB consumption on body weight.

METHODS

We randomly assigned 103 adolescents aged 13 to 18 years who regularly consumed SSBs to intervention and control groups. The intervention, 25 weeks in duration, relied largely on home deliveries of noncaloric beverages to displace SSBs and thereby decrease consumption. Change in SSB consumption was the main process measure, and change in body mass index (BMI) was the primary end point.

RESULTS

All of the randomly assigned subjects completed the study. Consumption of SSBs decreased by 82% in the intervention group and did not change in the control group. Change in BMI, adjusted for gender and age, was 0.07 +/- 0.14 kg/m2 (mean +/- SE) for the intervention group and 0.21 +/- 0.15 kg/m2 for the control group. The net difference, -0.14 +/- 0.21 kg/m2, was not significant overall. However, baseline BMI was a significant effect modifier. Among the subjects in the upper baseline-BMI tertile, BMI change differed significantly between the intervention (-0.63 +/- 0.23 kg/m2) and control (+0.12 +/- 0.26 kg/m2) groups, a net effect of -0.75 +/- 0.34 kg/m2. The interaction between weight change and baseline BMI was not attributable to baseline consumption of SSBs.

CONCLUSIONS

A simple environmental intervention almost completely eliminated SSB consumption in a diverse group of adolescents. The beneficial effect on body weight of reducing SSB consumption increased with increasing baseline body weight, offering additional support for American Academy of Pediatrics guidelines to limit SSB consumption.

Does the consumption of caloric and non-caloric beverages with a meal affect energy intake?

Beverages are frequently consumed with meals, but their influence on meal energy intake is not understood. We hypothesized that differences in the energy, nutrient content, and sensory properties of beverages consumed with a meal would affect intake. Forty-four women ate lunch in the laboratory once a week for 6 weeks. Lunch was consumed ad libitum, and was served with one of five beverages that were consumed in full, or no beverage. The beverages were 360 g of water, diet cola, regular cola, orange juice, and 1% milk. Results showed an effect of beverage type on meal intake (p<0.0001). Energy intake did not differ among the non-caloric and no-beverage conditions. Similarly, energy intake from lunch (including beverage) did not differ among the caloric beverage conditions. When a caloric beverage (156 kcal; 653 kJ) was consumed with the meal, energy intake was 104+/-16 kcal (435+/-67 kJ) greater than when a non-caloric beverage or no beverage was consumed. Subjects' ratings of fullness after lunch did not differ among the beverage conditions, but were lower for the no-beverage condition. These results show that when caloric beverages are consumed with a meal they add to energy intake from food, without significantly affecting satiety ratings.

Dairy Intake, Obesity, and Metabolic Health in Children and Adolescents: Knowledge and Gaps

There is an urgent need to identify nutrition-related risk factors for obesity and the metabolic syndrome, because the prevalence of these conditions continues to rise among children and adolescents. While some studies suggest that dairy and calcium intake may attenuate obesity and the metabolic syndrome, others do not support these findings. In addition, very little research has been done in children and adolescents, especially in minority youth, who are at the greatest risk for obesity and metabolic dysfunctions. Longitudinal studies examining the role of dairy intake in relation to changes in body composition and metabolic profiles during growth are also critically needed. Of the studies conducted thus far, part of the discrepancy in findings may be due to the uncertainty over whether the effect of dairy intake is independent of energy intake or other eating pattern variables. Further, there is no consensus on how to qualify (i.e., which foods) or quantify (i.e., which cutoffs and/or units) dairy consumption. The widespread problem of implausible dietary reporting in observational studies and the lack of compliance monitoring in intervention trials may also contribute to inconsistent findings. Given the lack of consensus on the effect of dairy, particularly in children and adolescents, more research is warranted before any recommendations can be made on dietary guidelines, policies, and interventions.

Changes in childhood food consumption patterns: a cause for concern in light of increasing body weights

Childhood obesity is currently at its highest: recent statistics show that 16% of children between the ages of 6 and 11 y are overweight [> or =95th percentile of body mass index (BMI; in kg/m(2)) for age] and that an additional 14.3% are at risk of becoming overweight (> or =85th percentile but < 95th percentile of BMI for age). As children's body weights have increased, so has their consumption of fast foods and soft drinks. The proportion of foods that children consumed from restaurants and fast food outlets increased by nearly 300% between 1977 and 1996. Children's soft drink consumption has also increased during those years, and now soft drinks provide soft drink consumers 188 kcal/d beyond the energy intake of nonconsumers. These changes in food intakes among children may partly explain the rise in childhood obesity observed in the past few years. Although the mechanism of appetite regulation will not be explored in this report, it is hypothesized that the greater energy intakes in children who consume large amounts of soft drinks and fast foods are not compensated for by increased physical activity or decreased energy intakes. Furthermore, overweight and obesity in childhood may predispose persons to morbidity in adulthood. Blood pressure and fasting insulin and cholesterol concentrations are higher in overweight children than in normal-weight children. This review focuses on current food patterns and eating habits of children, in an attempt to explain their increasing BMI. In addition, a critical review of food service and political practices regarding food choices for children at school is included.