Effect of the menstrual cycle on energy and nutrient intake

The Effect of the Menstrual Cycle on Energy Intake: A Systematic Review and Meta-analysis

CONTEXT

Energy intake may differ across the menstrual cycle, with some studies identifying greater energy intake in the luteal phase (LP) compared with the follicular phase (FP) and others finding no clear differences. To date, no study has systematically synthesized the available data to draw more definite conclusions while considering any methodological inconsistencies between studies.

OBJECTIVE

The aim was to conduct a systematic review/meta-analysis in an effort to determine if there are differences in energy intake between the FP and LP.

DATA SOURCES

A systematic search strategy was developed and the search was conducted in 5 databases for studies that investigated any changes in energy intake across menstrual phases.

DATA EXTRACTION

Using Covidence, studies were identified and included if they contained individuals between the ages of 18 and 45 years, maintained an average body mass index (BMI) of 18.5-25 kg/m2, had no history of disordered eating, and included energy intake and menstrual cycle measurements in the FP and LP.

DATA ANALYSIS

Effect sizes were calculated for each study and a random-effects model was used to pool the results of each study.

RESULTS

Fifteen datasets were included consisting of 330 female participants with a mean age of 26 ± 4 years and mean BMI of 22.4 ± 2.3 kg/m2. Overall, there was a statistically significant difference (standardized mean difference = 0.69; P = .039) with increased energy intake in the LP compared with the FP (crude 168 kcal⋅d-1 average difference between phases).

CONCLUSION

Energy intake was found to be greater in the LP compared with the FP, providing insight into the effect of the menstrual cycle on energy intake. However, there were repeated methodological inconsistencies and future work should strive to utilize best practices for both energy intake measurement and menstrual phase specification.

Changes in taste palatability across the estrous cycle are modulated by hypothalamic estradiol signaling

Food intake varies across the stages of a rat's estrous cycle. It is reasonable to hypothesize that this cyclic fluctuation in consumption reflects an impact of hormones on taste palatability/preference, but evidence for this hypothesis has been mixed, and critical within-subject experiments in which rats sample multiple tastes during each of the four main estrous phases (metestrus, diestrus, proestrus, and estrus) have been scarce. Here, we assayed licking for pleasant (sucrose, NaCl, saccharin) and aversive (quinine-HCl, citric acid) tastes each day for 5-10 days while tracking rats' estrous cycles through vaginal cytology. Initial analyses confirmed the previously-described increased consumption of pleasant stimuli 24-48 hours following the time of high estradiol. A closer look, however, revealed this effect to reflect a general magnification of palatability-higher than normal preferences for pleasant tastes and lower than normal preferences for aversive tastes-during metestrus. We hypothesized that this phenomenon might be related to estradiol processing in the lateral hypothalamus (LH), and tested this hypothesis by inhibiting LH estrogen receptor activity with ICI 182,780 during tasting. Control infusions replicated the metestrus magnification of palatability pattern; ICI infusions blocked this effect as predicted, but failed to render preferences "cycle free," instead delaying the palatability magnification until diestrus. Clearly, estrous phase mediates details of taste palatability in a manner involving hypothalamic actions of estradiol; further work will be needed to explain the lack of a flat response across the cycle with hypothalamic estradiol binding inhibited, a result which perhaps suggests dynamic interplay between brain regions or hormones.

Significance Statement

Consummatory behaviors are impacted by many variables, including naturally circulating hormones. While it is clear that consumption is particularly high during the stages following the high-estradiol stage of the rodent's estrous (and human menstrual) cycle, it is as of yet unclear whether this phenomenon reflects cycle stage-specific palatability (i.e., whether pleasant tastes are particularly delicious, and aversive tastes particularly disgusting, at particular phases). Here we show that palatability is indeed modulated by estrous phase, and that this effect is governed, at least in part, by the action of estradiol within the lateral hypothalamus. These findings shed light on the mechanisms underlying the adverse impact on human welfare due to irregularities observed across the otherwise cyclic menstrual process.

Proteomics of appetite-regulating system influenced by menstrual cycle and intensive exercise in female athletes: a pilot study

Female athletes who endure intense training are at risk of developing the 'female athlete triad,' making energy intake management crucial. However, the fluctuations in estradiol and progesterone levels throughout the menstrual cycle present a challenge in maintaining consistent energy intake. This study aimed to uncover the underlying factors associated with appetite regulation linked to menstrual phases and exercise using proteomic approach. Five female athletes engaged in 60 min of bicycle exercise, followed by 90 min of rest, during both the follicular and luteal phases. Serum samples were collected before, during, and after exercise, and the serum proteome was analyzed using 2D-gel electrophoresis. A total of 511 spots were detected in the subjects' serum profiles, with significant decreases observed in haptoglobin during the luteal phase and complement component 3 during bicycle training. Unsupervised learning with a generalized estimating equation analysis showed that serum peptide YY (PYY), an appetite suppressor, significantly influenced the fluctuations of serum proteins induced by exercise (p < 0.05). Regression analysis demonstrated a positive correlation between PYY and serum IgM (R = 0.87), implying that the intestinal environment and the immune response in female athletes may contribute to appetite regulation.

Resting energy metabolism and sweet taste preference during the menstrual cycle in healthy women

Differences in blood concentration of sex hormones in the follicular (FP) and luteal (LP) phases may influence energy metabolism in women. We compared fasting energy metabolism and sweet taste preference on a representative day of the FP and LP in twenty healthy women (25·3 (sd 5·1) years, BMI: 22·2 (sd 2·2) kg/m2) with regular self-reported menses and without the use of hormonal contraceptives. From the self-reported duration of the three prior menstrual cycles, the predicted FP and LP visits were scheduled for days 5-12 and 20-25 after menses, respectively. The order of the FP and LP visits was randomly assigned. On each visit, RMR and RQ by indirect calorimetry, sweet taste preference by the Monell two-series forced-choice tracking procedure, serum fibroblast growth factor 21 by a commercial ELISA (FGF21, a liver-derived protein with action in energy balance, fuel oxidation and sugar preference) and dietary food intake by a 24-h dietary recall were determined. Serum progesterone and oestradiol concentrations displayed the expected differences between phases. RMR was lower in the FP v. LP (5042 (sd 460) v. 5197 (sd 490) kJ/d, respectively; P = 0·04; Cohen effect size, d rm = 0·33), while RQ showed borderline significant higher values (0·84 (sd 0·05) v. 0·81 (sd 0·05), respectively; P = 0·07; d rm = 0·62). Also, in the FP v. LP, sweet taste preference was lower (12 (sd 8) v. 16 (sd 9) %; P = 0·04; d rm = 0·47) concomitant with higher serum FGF21 concentration (294 (sd 164) v. 197 (sd 104) pg/ml; P < 0·01; d rm = 0·66). The menstrual cycle is associated with changes in energy expenditure, sweet taste preference and oxidative fuel partitioning.

Exploring the relationship between nutritional intake and menstrual cycle in elite female athletes

This study aimed to examine potential variations in nutritional intake among female athletes, including top-level, throughout the menstrual cycle. A total 122 female athletes participated in the study, documenting their food consumption over a 3-day period. The menstrual status of female athletes was also assessed, and using the survey results, the phase of the menstrual cycle (the follicular, early luteal, or late luteal) during which each meal was recorded was determined. Consequently, the meal records were categorized into the respective three phases. The findings of this study indicated that there were no notable disparities in nutritional intake, encompassing energy, protein, fat, carbohydrate, calcium, iron, and fiber, across the three phases of the menstrual cycle. The results imply that female athletes may experience comparatively smaller variations in nutrient intake related to the menstrual cycle. This could be attributed to the higher energy requirements of female athletes because of their rigorous training. This study underscores the significance of accounting for the population when examining nutrient intake changes associated with the menstrual cycle.

Dietary energy intake across the menstrual cycle: a narrative review

Females are often underrepresented in the scientific literature, but awareness of the need for female-specific research is increasing. Review articles have been published on the effects of the menstrual cycle on aspects of exercise performance and physiology, yet to date no research has reviewed the effect of menstrual cycle phase on dietary energy intake. Fluctuations in endogenous sex hormones across the menstrual cycle influence a range of physiological processes, including those involved in nutritional status. Observational research typically quantifies female athletes' nutritional intakes at a single time point; however, this may provide inaccurate information if dietary intake fluctuates across the menstrual cycle. Similarly, this may have implications for interventional research, where dietary intake is often poorly controlled or monitored. This review aimed to synthesize the published literature on dietary energy intakes of naturally menstruating females in various phases of the menstrual cycle. The review critiques the relevant literature in light of recent publications on good practice for female research, explores the impact of the menstrual cycle on energy intake, identifies gaps within the evidence base, and informs future research. Overall, energy intake appears to be lower in the follicular phase compared with the luteal phase, with a particular decrease in the days leading up to and including ovulation. The magnitude of these fluctuations is not yet clearly quantifiable and most likely varies, both between individuals, and from cycle to cycle. This review notes the lack of high-quality research investigating the energy intakes of females across the menstrual cycle, and the very limited data available for female athletes and others who undertake large amounts of physical activity. It also highlights the need for researchers to take into consideration anovulatory cycles and the potential effects of premenstrual disorders on dietary intake.

The exercise-induced suppression of acylated ghrelin is blunted in the luteal phase of the menstrual cycle compared to the follicular phase following vigorous-intensity exercise

Limited work examining woman's appetite-regulatory response to exercise has been focused on the follicular phase (FP) of the menstrual cycle. This is an important limitation as estradiol (E₂) and progesterone (P₄) fluctuate across phases with greater concentrations in the luteal phase (LP).

OBJECTIVE

To examine the appetite-regulatory response to vigorous-intensity continuous exercise (VICT) in the FP and LP.

METHODS

Twelve women completed 30 min of VICT at 80% V˙O_2max in the FP and LP. E₂, P₄, acylated ghrelin, active peptide tyrosine-tyrosine (PYY), active glucagon-like peptide-1 (GLP-1), and appetite perceptions were measured pre-exercise, 0-, 30-, and 90-min post-exercise. Energy intake was recorded for a 2-day period (day before and of each session). A series of two-way repeated measure ANOVA were used to compare all dependent variables.

RESULTS

Pre-exercise E₂ (P = 0.005, d = 1.00) and P₄ (P < 0.001, d = 1.41) concentrations were greater in the LP than the FP and exercise increased both at 0- and 30-min post-exercise (E₂: P < 0.009; P₄: P < 0.001, d = 0.63). Acylated ghrelin was lower in the FP versus LP at pre-exercise as well as 0-min (P = 0.006, d = 0.97) and 90-min (P = 0.029, d = 0.72) post-exercise. There were no differences of menstrual phase on PYY (P = 0.359, η_p² = 0.092), GLP-1 (P = 0.226, η_p² = 0.130), or overall appetite (P = 0.514, η_p² = 0.066). Energy intake was greater on the day of in the LP versus the FP (P = 0.003, d = 1.2).

CONCLUSION

Acylated ghrelin was lower in the FP compared to the LP and though there were no differences in anorexigenic hormones or subjective appetite, energy intake was greater on the day of the session in the LP suggesting important differences across the menstrual cycle where greater concentrations of ovarian hormones in the LP may blunt the exercise response.

Ambulatory Glucose Profile According to Different Phases of the Menstrual Cycle in Women Living With Type 1 Diabetes

CONTEXT

Some women living with type 1 diabetes complain of changes in glucose values according to the different phases of menstruation.

OBJECTIVE

To evaluate this variability through continuous glucose monitoring (CGM) data in type 1 diabetes patients.

DESIGN

Observational study.

SETTING

Ambulatory data, recruitment in 2 centers in the Paris region.

PATIENTS

Twenty-four women with type 1 diabetes having spontaneous menstrual cycles.

INTERVENTION

Collection of CGM data for 62 spontaneous menstrual cycles, with evaluation of five 3-day phases during each cycle: (1) early follicular (menstruations), (2) mid-follicular, (3) peri-ovulatory, (4) mid-luteal, and (5) late luteal.

MAIN OUTCOME MEASURE

Time in range (TIR, prespecified).

RESULTS

TIR decreased for each consecutive phase (61 ± 18%; 59 ± 18%; 59 ± 20%; 57 ± 18%; and 55 ± 20%, P = 0.02). The linear mixed model highlighted a decrease in TIR in the mid-luteal (P = 0.03) and late luteal (P < 0.001) phases compared with the early follicular phase. Time above range was significantly higher during the late luteal phase than the early follicular phase (P = 0.003). Time below range was significantly higher during the mid-follicular phase than in the early follicular phase.

CONCLUSION

In most of the study population, glucose levels rose linearly throughout the menstrual cycle, reaching a maximum in the late luteal phase. A sharp decrease was seen for most participants at the beginning of menstrual bleeding. This should be taken into consideration in daily care of type 1 diabetes patients to avoid hypoglycemia.

Is It Worth It? Obesity Affects Snack Food Valuation Across the Menstrual Cycle

Background

The importance of menstrual cycle physiology in appetite and obesity is poorly understood. We investigated the effects of body mass index (BMI), menstrual cycle phase and sweet and salty taste on monetary valuation of snack foods.

Methods

We recruited 72 women and after the application of in- and exclusion criteria 31 participants with healthy weight and 25 with obesity remained. The participants completed a willingness to pay (WTP) task to measure subjective value of 30 snack food items in the pre-ovulatory and mid-luteal cycle phases.

Results

Generalized linear mixed model (GLMM) analysis revealed that BMI, cycle phase and snack taste interacted to influence WTP (−0.15 [−0.22, −0.03], p = 0.002). Hence, WTP was inversely related to BMI, but the strength of the relation depended on cycle phase and taste. The WTP of participants with healthy weight for salty taste changed across cycle phase but the WTP for sweet taste was not affected by cycle phase. Moreover, the cycle effect for the salty snacks ceased in participants with obesity.

Conclusion

The inverse effect of BMI on WTP valuation of snack foods contrasts with the positive effect of BMI on pleasantness ratings for milkshakes by the same women that we previously reported. This indicates that the two measures reflect different aspects of food-related valuative processing in obesity. Furthermore, the WTP data suggest that the selection of salty snacks may differ from that of sweet snacks in the pre-ovulatory phase of the menstrual cycle for individuals of healthy weight. The cycle phase does not seem to affect food valuation of participants with obesity. These findings are relevant to understanding and treating obesity in women.

[A Case of Reactive Hypoglycemia Exacerbated Before Menstruation Improved by the Use of Continuous Glucose Monitoring]

A 40-year-old female patient was referred to our department with a complaint of postprandial hypoglycemia. We performed a 75g oral glucose tolerance test, and the patient was diagnosed as having impaired glucose tolerance with a 1-hour blood glucose of 245 mg/dl and a 2-hour blood glucose of 196 mg/dl. The patient also showed hypoglycemia with a 6-hour blood glucose of 46 mg/dl, and delayed hypersecretion of insulin, which was diagnosed as reactive hypoglycemia. The patient was diagnosed as having reactive hypoglycemia with delayed hypersecretion of insulin. She was given dietary guidance to avoid simple carbohydrates, and voglibose 0.6 mg was started for glucose intolerance and reactive hypoglycemia. The frequency of hypoglycemic symptoms decreased for a while, but gradually increased again. An interview revealed that the frequency of hypoglycemia was high at 2-3 days before menstruation, and Flash Glucose Monitoring (FGM) was applied to check the blood glucose fluctuation before and after menstruation. Her postprandial hyperglycemia worsened with FGM, and reactive hypoglycemia appeared 3 days before menstruation, while postprandial hyperglycemia improved and reactive hypoglycemia disappeared 4 days after menstruation. The frequency of hypoglycemia was reduced by instructing the patient to take voglibose before menses and to eat a supplementary meal after lunch a few days before menses. There have been no reports on the evaluation of reactive hypoglycemia exacerbated before menstruation by FGM. The menstrual cycle should be considered in the diagnosis, evaluation, and treatment of reactive hypoglycemia.

The importance of estradiol for body weight regulation in women

Obesity in women of reproductive age has a number of adverse metabolic effects, including Type II Diabetes (T2D), dyslipidemia, and cardiovascular disease. It is associated with increased menstrual irregularity, ovulatory dysfunction, development of insulin resistance and infertility. In women, estradiol is not only critical for reproductive function, but they also control food intake and energy expenditure. Food intake is known to change during the menstrual cycle in humans. This change in food intake is largely mediated by estradiol, which acts directly upon anorexigenic and orexigenic neurons, largely in the hypothalamus. Estradiol also acts indirectly with peripheral mediators such as glucagon like peptide-1 (GLP-1). Like estradiol, GLP-1 acts on receptors at the hypothalamus. This review describes the physiological and pathophysiological mechanisms governing the actions of estradiol during the menstrual cycle on food intake and energy expenditure and how estradiol acts with other weight-controlling molecules such as GLP-1. GLP-1 analogs have proven to be effective both to manage obesity and T2D in women. This review also highlights the relationship between steroid hormones and women's mental health. It explains how a decline or imbalance in estradiol levels affects insulin sensitivity in the brain. This can cause cerebral insulin resistance, which contributes to the development of conditions such as Parkinson's or Alzheimer's disease. The proper use of both estradiol and GLP-1 analogs can help to manage obesity and preserve an optimal mental health in women by reducing the mechanisms that trigger neurodegenerative disorders.

Effects of menstrual cycle on appetite-regulating hormones and energy intake in response to cycling exercise in physically active women

Although ample evidence supports the notion that an acute bout of endurance exercise performed at or greater than 70% of maximum oxygen uptake suppresses appetite partly through changes in appetite-regulating hormones, no study has directly compared the influence between the phases of the menstrual cycle in women. The present study compared the effects of an acute bout of exercise on orexigenic hormone (acylated ghrelin) and anorexigenic hormones (peptide YY and cholecystokinin) between the early follicular phase (FP) and the mid luteal phase (LP) of the menstrual cycle in physically active women. Ten healthy women (age, 20.6 ± 0.7 years) completed two 3.5-h trials in each menstrual phase. In both trials, participants performed cycling exercises at 70% of heart rate reserve (at a corresponding intensity to 70% of maximum oxygen uptake) for 60 min followed by 90 min of rest. Following 90 min of rest, participants were provided with an ad libitum meal for a fixed duration of 30 min. Blood samples and subjective appetite were collected and assessed before, during, immediately post-, 45 min post-, and 90 min post-exercise. The exercise increased estradiol (327 %) and progesterone (681 %) in the LP more than the FP respectively (P < 0.001, f = 1.33; P < 0.001,f = 1.20). There were no between-trial differences in appetite-regulating hormones, subjective appetite, or energy intake of ad libitum meal. These findings indicate that exercise-induced increases in ovarian hormones in the LP may not influence appetite-regulating hormones in physically active women.

Assessing the influence of fasted and postprandial states on day-to-day variability of appetite and food preferences

INTRODUCTION

Ratings of subjective appetite and food hedonics provide valuable information about energy and macronutrient intake. Ensuring reproducibility of measures of subjective appetite, and food liking and wanting is essential for accurate understanding about their implementation in intervention studies.

METHODS

Nineteen participants participated in two separate 10-h test days consisting of 6 test meals. Subjective appetite was measured in the fasted state and periodically across the test day in a postprandial state. Liking and wanting were measured using the Leeds Food Preferences Questionnaire (LFPQ) immediately before and after breakfast, immediately before the second meal, and at the end of the test day.

RESULTS

Reproducibility of appetite scores was similar to those previously reported in males, however females tended to have consistently higher CVs, wider CRs and wider 95% CIs. Variability in food hedonics was of a similar magnitude to subjective appetite with CVs for fasting explicit liking and wanting between 15.3 and 33.4%, correlations for both implicit and explicit liking and wanting between 0.18 and 0.87 and CRs indicating 95% of between-day changes for any given individual should fall within ±43.4 mm of the mean change. Averages of food hedonics during the test day reduced CVs, improved correlations and reduced CRs. Despite no mean change in preceding energy and nutrient intake, individual changes in prior energy and macronutrient intake appeared to influence individual between-day changes in appetite and food hedonics, and appetite and food hedonics were intricately linked.

CONCLUSIONS

Larger subject numbers may be required for appetite studies with female participants due to greater appetite variability. The LFPQ as a tool for measuring implicit and explicit liking and wanting is sufficiently reproducible and improved by averaging multiple measures across a day.

Effect of resistant wheat starch on subjective appetite and food intake in healthy adults

OBJECTIVE

The aim of this study was to determine the effect of replacing standard wheat flour (SWF) with resistant wheat starch (RWS) on markers of appetite and food intake in healthy adults.

METHODS

A randomized, single-blind, crossover study was conducted with 27 healthy adults (ages 23 ± 2 y with a body mass index of 23.0 ± 3.0 kg/m²). After an overnight fast, muffins that contained only SWF or muffins in which 40% of the SWF was replaced with RWS were consumed as part of the breakfast meal. Appetite questionnaires and plasma samples were collected before the test meal and at 10 time points after meal consumption. An ad libitum meal was provided 240 min after breakfast, and the amount eaten was recorded. Food intake was recorded over the remainder of the day using a diet diary, and appetite was measured hourly using appetite questionnaires. Plasma was assayed to measure biomarkers of satiety and glycemia.

RESULTS

Replacing SWF with RWS had no effect on subjective appetite or energy intake at the lunch meal (P > 0.05). Total daily energy intake (including the breakfast meal) was reduced by 179 kcal when participants consumed the RWS muffins (P = 0.05). Replacing SWF with RWS reduced plasma insulin (P < 0.05) but had no effect on plasma glucose, cholecystokinin, glucagon-like peptide-1, or peptide YY_3-36 concentration (P > 0.05).

CONCLUSIONS

These results indicate that replacing SWF with RWS decreases plasma insulin concentration and reduces energy intake over a 24-h period.

Change in women's eating habits during the menstrual cycle

OBJECTIVES

During the menstrual cycle, the influence of hormonal variations on dietary habits in women has been suggested by several studies. In this context, our work aimed to assess the spontaneous food intake and the anthropometric parameters of women at different periods of their menstrual cycles.

METHODS

This prospective study included 30 healthy women with regular periods (28 to 30 days), aged between 18 and 45. We assessed the spontaneous food intake and the anthropometric measurements (weight and waist circumference) of the participants, during the follicular, peri-ovulatory and luteal phases of their menstrual cycles.

RESULTS

Our results showed a slight but significant increase in body weight during the luteal phase (P=0.022) and the follicular phase (P=0.017) compared with the peri-ovulatory phase, without any significant change in waist circumference. The caloric intake increased during the peri-ovulatory (P<0.001) and the luteal phases (P<0.001), compared with the follicular phase, with a significant increase in carbohydrate (P<0.001), lipid (P=0.008) and protein (P=0.008) intake.

CONCLUSIONS

Our study showed a significant decrease in women's weight during the peri-ovulatory phase, with a significant increase in caloric intake during the luteal phase of the menstrual cycle. Divergent results have been reported by other authors and the physiopathology of these changes is still poorly understood.

Regulation of Leptin mRNA and Protein Expression in Pituitary Somatotropes

Leptin, the ob protein, regulates food intake and satiety and can be found in the anterior pituitary. Leptin antigens and mRNA were studied in the anterior pituitary (AP) cells of male and female rats to learn more about its regulation. Leptin antigens were found in over 40% of cells in diestrous or proestrous female rats and in male rats. Lower percentages of AP cells were seen in the estrous population (21 ± 7%). During peak expression of antigens, co-expression of leptin and growth hormone (GH) was found in 27 ± 4% of AP cells. Affinity cytochemistry studies detected 24 ± 3% of AP cells with leptin proteins and growth hormone releasing hormone (GHRH) receptors. These data suggested that somatotropes were a significant source of leptin. To test regulatory factors, estrous and diestrous AP populations were treated with estrogen (100 pM) and/or GHRH (2 nM) to learn if either would increase leptin expression in GH cells. To rule out the possibility that the immunoreactive leptin was bound to receptors in somatotropes, leptin mRNA was also detected by non-radioactive in situ hybridization in this group of cells. In estrous female rats, 39 ± 0.9% of AP cells expressed leptin mRNA, indicating that the potential for leptin production was greater than predicted from the immunolabeling. Estrogen and GHRH together (but not alone) increased percentages of cells with leptin protein (41 ± 9%) or mRNA (57 ± 5%). Estrogen and GHRH also increased the percentages of AP cells that co-express leptin mRNA and GH antigens from 20 ± 2% of AP cells to 37 ± 5%. Although the significance of leptin in GH cells is not understood, it is clearly increased after stimulation with GHRH and estrogen. Because GH cells also have leptin receptors, this AP leptin may be an autocrine or paracrine regulator of pituitary cell function.

Fluctuations of Hyperglycemia and Insulin Sensitivity Are Linked to Menstrual Cycle Phases in Women With T1D

BACKGROUND

Factors influencing glycemic variability in type 1 diabetes (T1D) may play a significant role in the refinement of closed loop insulin administration. Phase of menstrual cycle is one such factor that has been inadequately investigated. We propose that unique individual patterns can be constructed and used as parameters of closed loop systems.

METHOD

Women with T1D on continuous subcutaneous insulin infusion and continuous glucose monitoring were studied for 3 consecutive menstrual cycles. Ovulation prediction kits and labs were used to confirm phase of menstrual cycle. Glycemic risks were assessed using the low- and high blood glucose indices (LBGI and HBGI). Insulin sensitivity (SI) was estimated using a Kalman filtering method from meal and insulin data. Overall change significance for glycemic risks was assessed by repeated measures ANOVA, with specific phases emphasized using contrasts.

RESULTS

Ovulation was confirmed in 33/36 cycles studied in 12 subjects (age = 33.1 ± 7.0 years, BMI = 25.7 ± 2.9 kg/m(2), A1c = 6.8 ± 0.7%). Risk for hyperglycemia changed significantly during the cycle (P = .023), with HBGI increasing until early luteal phase and returning to initial levels thereafter. LBGI was steady in the follicular phase, decreasing thereafter but not significantly. SI was depressed during the luteal phase when compared to the early follicular phase (P ≤ .05). Total daily insulin, carbohydrates, or calories did not show any significant fluctuations.

CONCLUSIONS

Women with T1D have glycemic variability changes that are specific to the individual and are linked to phase of cycle. An increased risk of hyperglycemia was observed during periovulation and early luteal phases compared to the early follicular phase; these changes appear to be associated with decreased insulin sensitivity during the luteal phase.

Premenstrual dysphoric disorder in medical students residing in hostel and its association with lifestyle factors

CONTEXT

There is scant research on premenstrual syndrome (PMS) and its more severe counterpart, premenstrual dysphoric disorder (PMDD) in Indian females. This study aimed to evaluate symptoms of PMS in medical students and to find the association of sociodemographic variables and lifestyle factors with PMDD.

SUBJECTS AND METHODS

A total of 179 medical students residing in the hostel of an Indian medical college and its affiliated teaching hospital were approached, of which 100 (55.8%) returned the completed questionnaires. Data related to lifestyle factors was collected. Self-screening quiz for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision PMDD and Shortened Premenstrual Assessment Form were used for diagnosis of PMDD and detection of symptomatology, respectively.

RESULTS

PMDD was present in 37% of the respondents. It was found at a higher rate in older and postgraduate students. PMDD was significantly associated with lifestyle factors, namely, sleep, physical activity, total tea/coffee intake, and change in tea/coffee and food intake under stress. The most common physical and psychological symptoms were body ache/joint pain and feeling depressed/blue, respectively.

CONCLUSIONS

PMDD is fairly common in Indian medical students residing in hostel although cultural factors may influence symptom expression. This study suggests that PMDD is associated with lifestyle factors in young, professional, urban women. Modification in lifestyle may thus be an important approach for management of PMS/PMDD. Prospective studies with larger representative samples are needed to validate these findings.

Changes in macronutrient, micronutrient, and food group intakes throughout the menstrual cycle in healthy, premenopausal women

PURPOSE

It is thought that total energy intake in women is increased during the luteal versus follicular phase of the menstrual cycle; however, less is understood regarding changes in diet composition (i.e., macro- and micronutrient intakes) across the cycle. The aim of this study was to investigate changes in macronutrient, micronutrient, and food group intakes across phases of the menstrual cycle among healthy women, and to assess whether these patterns differ by ovulatory status.

METHODS

The BioCycle study (2005-2007) was a prospective cohort study of 259 healthy regularly menstruating women age 18-44 who were followed for up to two menstrual cycles. Dietary intake was measured using 24-h dietary recalls, and food cravings were assessed via questionnaire, up to four times per cycle, corresponding to menses, mid-follicular, expected ovulation, and luteal phases. Linear mixed models adjusting for total energy intake were used to evaluate changes across the cycle.

RESULTS

Total protein (P = 0.03), animal protein (P = 0.05), and percent of caloric intake from protein (P = 0.02) were highest during the mid-luteal phase compared to the peri-ovulatory phase. There were also significant increases in appetite, craving for chocolate, craving for sweets in general, craving for salty flavor, and total craving score during the late luteal phase compared to the menstrual, follicular, and ovulatory phases (P < 0.001).

CONCLUSIONS

Our findings suggest an increased intake of protein, and specifically animal protein, as well as an increase in reported food cravings, during the luteal phase of the menstrual cycle independent of ovulatory status. These results highlight a plausible link between macronutrient intake and menstrual cycle phase.

Sweet/dessert foods are more appealing to adolescents after sleep restriction

STUDY OBJECTIVE

Examine the effect of experimental sleep restriction (SR) on adolescents' subjective hunger and perceived appeal of sweet/dessert foods versus other foods. A secondary goal was to replicate previous findings on the effects of SR on dietary intake.

DESIGN

Randomized cross-over sleep restriction-extension paradigm.

SETTING

Sleep was obtained and monitored at home. Outcome measures were gathered during office visits.

PARTICIPANTS

31 typically-developing adolescents aged 14-17 years.

INTERVENTIONS

The three-week protocol consisted of a baseline week, followed randomly by five consecutive nights of SR (6.5 hours in bed) versus healthy sleep duration (HS; 10 hours in bed), a 2-night wash-out period, and a 5-night cross-over.

MEASUREMENTS

Sleep was monitored via actigraphy. The morning after each experimental condition, teens rated their hunger, underwent a 24-hour diet recall interview, and rated the appeal of a series of pictures of sweet/dessert foods (e.g., ice cream, candy) and non-sweets (meat, eggs, fruits, vegetables).

RESULTS

Teens rated pictures of sweet/dessert foods to be more appealing after SR than after HS (Cohen's d = .41, t = 2.07, p = .045). The sleep manipulation did not affect self-reported hunger or the appeal of non-sweet foods (p >.10). Consistent with our prior work, intake of overall calories was 11% higher and consumption of sweet/dessert servings was 52% greater during SR than HS.

CONCLUSIONS

Adolescent SR appears to increase the subjective appeal of sweet/dessert foods, indicating a potential mechanism by which SR might contribute to weight gain and the risk for obesity and chronic illness.

Allopregnanolone preferentially induces energy-rich food intake in male Wistar rats

Obesity is an increasing problem and identification of the driving forces for overeating of energy‐rich food is important. Previous studies show that the stress and sex steroid allopregnanolone has a hyperphagic effect on both bland food and palatable food. If allopregnanolone induces a preference for more palatable or for more energy‐rich food is not known. The aim of this study was to elucidate the influence of allopregnanolone on food preference. Male Wistar rats were subjected to two different food preference tests: a choice between standard chow and cookies (which have a higher energy content and also are more palatable than chow), and a choice between a low caloric sucrose solution and standard chow (which has a higher energy content and is less palatable than sucrose). Food intake was measured for 1 h after acute subcutaneous injections of allopregnanolone. In the choice between cookies and chow allopregnanolone significantly increased only the intake of cookies. When the standard chow was the item present with the highest caloric load, the chow intake was increased and allopregnanolone had no effect on intake of the 10% sucrose solution. The increased energy intakes induced by the high allopregnanolone dose compared to vehicle were very similar in the two tests, 120% increase for cookies and 150% increase for chow. It appears that in allopregnanolone‐induced hyperphagia, rats choose the food with the highest energy content regardless of its palatability.

We show that allopregnanolone increased the consumption of the more calorie dense food offered in different food preference situations, while palatability was of secondary importance. Thus, it seems as allopregnanolone treatment could favor ingestion of a more energy‐rich diet.

Sex differences in the physiology of eating

Hypothalamic-pituitary-gonadal (HPG) axis function fundamentally affects the physiology of eating. We review sex differences in the physiological and pathophysiological controls of amounts eaten in rats, mice, monkeys, and humans. These controls result from interactions among genetic effects, organizational effects of reproductive hormones (i.e., permanent early developmental effects), and activational effects of these hormones (i.e., effects dependent on hormone levels). Male-female sex differences in the physiology of eating involve both organizational and activational effects of androgens and estrogens. An activational effect of estrogens decreases eating 1) during the periovulatory period of the ovarian cycle in rats, mice, monkeys, and women and 2) tonically between puberty and reproductive senescence or ovariectomy in rats and monkeys, sometimes in mice, and possibly in women. Estrogens acting on estrogen receptor-α (ERα) in the caudal medial nucleus of the solitary tract appear to mediate these effects in rats. Androgens, prolactin, and other reproductive hormones also affect eating in rats. Sex differences in eating are mediated by alterations in orosensory capacity and hedonics, gastric mechanoreception, ghrelin, CCK, glucagon-like peptide-1 (GLP-1), glucagon, insulin, amylin, apolipoprotein A-IV, fatty-acid oxidation, and leptin. The control of eating by central neurochemical signaling via serotonin, MSH, neuropeptide Y, Agouti-related peptide (AgRP), melanin-concentrating hormone, and dopamine is modulated by HPG function. Finally, sex differences in the physiology of eating may contribute to human obesity, anorexia nervosa, and binge eating. The variety and physiological importance of what has been learned so far warrant intensifying basic, translational, and clinical research on sex differences in eating.

Estado nutricional e consumo alimentar de mulheres jovens na fase lútea e folicular do ciclo menstrual

OBJETIVO: Avaliar o estado nutricional e a ingestão alimentar de mulheres adultas sadias durante o ciclo menstrual. MÉTODOS: Quarenta e cinco voluntárias foram acompanhadas durante três meses. A avaliação do estado nutricional foi baseada no índice de massa corporal, porcentagem de gordura e água corporal. Foram aplicados seis registros alimentares para análise da ingestão dos grupos de alimentos, usando como base o guia alimentar da pirâmide. Para a observação do sintoma "desejos alimentares", foram utilizados três "mapas de sintomas diários". RESULTADOS: Os valores médios de índice de massa corporal e de porcentagem de gordura corporal apresentaram-se normais em ambas as fases, entretanto foi observado maior percentual de mulheres com água corporal acima do padrão na fase lútea (77%). O consumo de alimentos do grupo complementar foi maior na fase lútea. Todos os outros grupos de alimentos, com exceção do grupo de carnes, apresentaram consumo inferior às recomendações, em ambas as fases. A intensidade do sintoma "desejos alimentares" foi leve durante o ciclo menstrual, não sendo observada diferença significativa entre as fases. O sintoma "desejos alimentares" associou-se positivamente com o aumento da ingestão do grupo complementar na fase lútea. CONCLUSÃO: O ciclo menstrual influencia o comportamento alimentar e leva à retenção hídrica, na fase lútea, em mulheres adultas sadias.

Response to alcohol in women: role of the menstrual cycle and a family history of alcoholism

The present study determined whether: (1) the response to alcohol varied as a function of menstrual cycle phase and (2) women with a paternal history of alcoholism (FHP) were less sensitive to the effects of alcohol compared to women without a family history of alcoholism (FHN). The behavioral effects of alcohol (0.00, 0.25, and 0.75 g/kg) were evaluated in 21 FHN and 24 FHP women; each dose was tested during both the midfollicular and late luteal phases of the menstrual cycle. Baseline negative mood was increased during the luteal phase compared to the follicular phase (increased Beck Depression scores and decreased Vigor, Arousal, and Friendly scores). Alcohol increased ratings of Drug Liking and Good Drug Effect more in the luteal phase than the follicular phase. FHP women had greater negative mood during the luteal phase and some of these dysphoric effects were increased by alcohol more in FHP women than FHN women. Alcohol impaired performance, with no group or menstrual cycle differences. However, consistent with previous studies, FHP women were less impaired by alcohol than FHN women on the balance task. These data indicate that (1) the differences in response to alcohol across the menstrual cycle are subtle, although alcohol is liked more during the luteal phase; (2) increases in dysphoric mood during the luteal phase are more pronounced in FHP women compared to FHN women, particularly after alcohol; and (3) the differences observed in response to alcohol between FHP and FHN women are less pronounced than previously shown in men.

The effects of oral micronized progesterone on smoked cocaine self-administration in women

There are currently no FDA-approved pharmacotherapies for cocaine abuse. Converging preclinical and clinical evidence indicates that progesterone may have potential as a treatment for cocaine-abusing women, who represent a growing portion of cocaine users. We have previously shown that oral progesterone reduced the positive subjective effects of cocaine in female cocaine users during the follicular phase of the menstrual cycle, when endogenous progesterone levels were low. To extend these findings, the present study assessed the effects of oral progesterone (150 mg BID) administered during the follicular phase on smoked cocaine self-administration in women relative to the normal follicular and luteal phases. Healthy, non-treatment seeking female cocaine smokers (N=10) underwent three 4-day inpatient stays, during: 1) a normal follicular phase; 2) a normal luteal phase; and 3) a follicular phase when oral progesterone was administered. During each stay, participants completed 4 self-administration sessions in which they first smoked a "sample" dose of cocaine (0, 12, 25 or 50 mg) and then had 5 opportunities at 14-minute intervals to self-administer that dose at a cost of $5 per dose. Expected cocaine dose effects on self-administration, subjective effects, and cardiovascular effects were observed. However, there was no effect of oral progesterone administration or menstrual cycle phase on cocaine self-administration. Thus, oral progesterone was not effective in reducing cocaine use in women under the current conditions. However, based on previous literature, further research assessing the role of oral progesterone for the treatment of cocaine dependence in women is warranted.

Food Intake Changes Across the Menstrual Cycle in Taiwanese Women

Background: Studies in Western countries have suggested that there are relationships among sex hormones, the neuropeptide leptin, women’s food intake, and body weight changes across the menstrual cycle. However, data on this question are needed from other cultural groups. Objectives: To compare total food and macronutrient intake and serum estrogen, progesterone, and leptin levels in Taiwanese women of varying body size during three menstrual cycle phases. Method: A cross-sectional survey was conducted using a sample of 39 healthy Taiwanese women (aged 20—40 years) with regular menstrual cycles. Food journals covering 3 days, body weight, height, waist and hip circumferences, and serum samples for estrogen, progesterone, and leptin were collected at three time points during one menstrual cycle. Data were analyzed using the paired t test, mixed-model analysis, and Pearson’s correlations. Results: Regardless of body weight, women consumed more total calories (+160 kcal/day, p < .05) and more grams of protein (+6—8 g/day, p = .01) during the luteal phase and ovulation compared with the follicular phase. A higher percentage of energy was consumed as carbohydrates (CHOs) during the follicular phase (+5% of total energy intake, p < .01). No correlations were noted among serum sex hormone levels, serum leptin levels, food intake, and body weight. Discussion: The findings support the hypothesis that Taiwanese women, as previously reported in women from mixed or Western cultural groups, experience menstrual-related variations in food intake. These changes, however, were not directly linked with serum sex hormone or leptin levels.

Effects of the phases of the menstrual cycle on gastric emptying, glycemia, plasma GLP-1 and insulin, and energy intake in healthy lean women

There is evidence that the menstrual cycle affects appetite, such that energy intake is lower during the follicular compared with the luteal phase. Gastric emptying influences energy intake, glycemia, and plasma glucagon-like peptide-1 (GLP-1), insulin, and cholecystokinin (CCK) release. We hypothesized that 1) gastric emptying of a glucose drink is slower, and glycemia, plasma hormones, hunger, and energy intake are less, during the follicular compared with the luteal phase; 2) the reduction in the latter parameters during the follicular phase are related to slower gastric emptying; and 3) these parameters are reproducible when assessed twice within a particular phase of the menstrual cycle. Nine healthy, lean women were studied on three separate occasions: twice during the follicular phase (days 6-12) and once during the luteal phase (days 18-24). Following consumption of a 300-ml glucose drink (0.17 g/ml), gastric emptying, blood glucose, plasma hormone concentrations, and hunger were measured for 90 min, after which energy intake at a buffet meal was quantified. During the follicular phase, gastric emptying was slower (P < 0.05), and blood glucose (P < 0.01), plasma GLP-1 and insulin (P < 0.05), hunger (P < 0.01), and energy intake (P < 0.05) were lower compared with the luteal phase, with no differences for CCK or between the two follicular phase visits. There were inverse relationships between energy intake, blood glucose, and plasma GLP-1 and insulin concentrations with the amount of glucose drink remaining in the stomach at t = 90 min (r < -0.6, P < 0.05). In conclusion, in healthy women 1) gastric emptying of glucose is slower, and glycemia, plasma GLP-1 and insulin, hunger, and energy intake are less during the follicular compared with the luteal phase; 2) energy intake, glycemia, and plasma GLP-1 and insulin are related to gastric emptying; and 3) these parameters are reproducible when assessed twice during the follicular phase.

[Influence of premenstrual syndrome and oral contraceptive effects on food choice during the follicular and luteal phase of the menstrual cycle]

BACKGROUND AND OBJECTIVE

Food intake and motivation for food varies according to the phase of the menstrual cycle. These changes seem to be more marked in women with premenstrual syndrome (PMS) and may be modified by the use of oral contraceptives (OC). This study examined the effect of menstrual cycle, PMS and OC use on the intake and hedonic rating of sweet and savory snack foods.

MATERIAL AND METHODS

Fifty-five women were recruited and assigned to either a PMS group or a control group. In addition, based on OC use, the women were assigned to an OC-user or non-user group. During the luteal and follicular phases, the participants were asked to consume and rate sweet and savory snacks.

RESULTS

The luteal phase induced greater caloric intake from sweet foods. PMS sufferers did not consume significantly more calories in either phase. There was a significant interaction between phase, flavor, PMS status and OC use. OC users consumed more calories from sweet foods in the follicular phase.

CONCLUSIONS

Food intake is increased in the luteal phase. This effect was modulated by both PMS and OC use. OC use seems to eliminate cyclic fluctuations in caloric intake.

Glycemic instability and spontaneous energy intake: association with knowledge-based work

OBJECTIVE

To further document the impact of knowledge-based work (KBW) on spontaneous energy intake and glucose homeostasis.

METHODS

We used a within-subjects experimental design, in which each participant was engaged in each of the three 45-minute conditions followed by an ad libitum buffet, 1) resting in a sitting position; 2) reading a document and writing a summary; or 3) performing a battery of computerized tests. Fourteen female students (mean age: 22.8 +/- 2.3 years, mean body mass index: 22.4 +/- 2.5 kg/m(2)) were recruited to participate. Plasma glucose, insulin, and cortisol levels at seven time-points, and appetite sensation markers were measured at each experimental condition.

RESULTS

The mean ad libitum energy intake after the reading-writing and the automated test-battery conditions exceeded that measured after rest by 848 kJ and 1057 kJ, respectively (p < .05). No specific dietary preference was detected, as reflected by the comparable percent of energy from each macronutrient in the three conditions. No significant difference in appetite sensation markers was observed among the three conditions. Mean cortisol level over 45 minutes in the two KBW conditions was significantly higher (p < .05) compared with the control condition. Finally, a significant increase in variations in plasma glucose and insulin levels was observed as compared with the control condition (p < .01).

CONCLUSIONS

This study showed that KBW acutely induces an increase in spontaneous energy intake, and promotes an increased fluctuation in plasma glucose and insulin levels. This study contributes to the documentation of a new risk factor for a positive energy balance, with the potential to lead to overweight in the long-term.

Insulin sensitivity, food intake, and cravings with premenstrual syndrome: a pilot study

OBJECTIVE

The objective of this pilot study was to evaluate possible differences in insulin sensitivity, food intake, and cravings between the follicular and luteal phases of the menstrual cycle in women with premenstrual syndrome (PMS).

METHODS

Subjects were screened for PMS using the Penn Daily Symptom Rating (DSR) scale. Each subject had two overnight admissions (once in each cycle phase) to the Hospital of the University of Pennsylvania. They performed 3-day diet histories prior to each hospitalization. After admission, subjects received dinner and a snack, then were fasted until morning, when they underwent a frequently sampled intravenous glucose tolerance test (FSIGT). Insulin sensitivity was determined by Minimal Model analysis. Blinded analysis of diet histories and inpatient food intake was performed by a registered dietitian.

RESULTS

There was no difference found in insulin sensitivity between cycle phases (n = 7). There were also no differences in proportions of macronutrients or total kilocalories by cycle phase, despite a marked difference in food cravings between cycle phase, with increased food cravings noted in the luteal phase (p = 0.002). Total DSR symptom scores decreased from a mean of 186 (+/-29.0) in the luteal phase to 16.6 (+/-14.2) in the follicular phase. Women in this study consumed relatively high proportions of carbohydrates (55%-64%) in both cycle phases measured.

CONCLUSIONS

These findings reinforce the suggestion that although the symptom complaints of PMS are primarily confined to the luteal phase, the neuroendocrine background for this disorder may be consistent across menstrual cycle phases.

Changes in mood, cognitive performance and appetite in the late luteal and follicular phases of the menstrual cycle in women with and without PMDD (premenstrual dysphoric disorder)

Although it's been reported that women with premenstrual dysphoric disorder (PMDD) have increased negative mood, appetite (food cravings and food intake), alcohol intake and cognitive deficits premenstrually, few studies have examined these changes concurrently within the same group of women or compared to women without PMDD. Thus, to date, there is not a clear understanding of the full range of PMDD symptoms. The present study concurrently assessed mood and performance tasks in 29 normally cycling women (14 women who met DSM-IV criteria for PMDD and 15 women without PMDD). Women had a total of ten sessions: two practice sessions, 4 sessions during the follicular phase and 4 sessions during the late luteal phase of the menstrual cycle. Each session, participants completed mood and food-related questionnaires, a motor coordination task, performed various cognitive tasks and ate lunch. There was a significant increase in dysphoric mood during the luteal phase in women with PMDD compared to their follicular phase and compared to Control women. Further, during the luteal phase, women with PMDD showed impaired performance on the Immediate and Delayed Word Recall Task, the Immediate and Delayed Digit Recall Task and the Digit Symbol Substitution Test compared to Control women. Women with PMDD, but not Control women, also showed increased desire for food items high in fat during the luteal phase compared to the follicular phase and correspondingly, women with PMDD consumed more calories during the luteal phase (mostly derived from fat) compared to the follicular phase. In summary, women with PMDD experience dysphoric mood, a greater desire and actual intake of certain foods and show impaired cognitive performance during the luteal phase. An altered serotonergic system in women with PMDD may be the underlying mechanism for the observed symptoms; correspondingly, treatment with specific serotonin reuptake inhibitors (SSRIs) remains the preferred treatment at this time.

Impact of the menstrual cycle on determinants of energy balance: a putative role in weight loss attempts

Women's weight and body composition is significantly influenced by the female sex-steroid hormones. Levels of these hormones fluctuate in a defined manner throughout the menstrual cycle and interact to modulate energy homeostasis. This paper reviews the scientific literature on the relationship between hormonal changes across the menstrual cycle and components of energy balance, with the aim of clarifying whether this influences weight loss in women. In the luteal phase of the menstrual cycle it appears that women's energy intake and energy expenditure are increased and they experience more frequent cravings for foods, particularly those high in carbohydrate and fat, than during the follicular phase. This suggests that the potential of the underlying physiology related to each phase of the menstrual cycle may be worth considering as an element in strategies to optimize weight loss. Studies are needed to assess the weight loss outcome of tailoring dietary recommendations and the degree of energy restriction to each menstrual phase throughout a weight management program, taking these preliminary findings into account.

Pramlintide treatment reduces 24-h caloric intake and meal sizes and improves control of eating in obese subjects: a 6-wk translational research study

Evidence from rodent studies indicates that the beta-cell-derived neurohormone amylin exerts multiple effects on eating behavior, including reductions in meal size, intake of highly palatable foods, and stress-induced sucrose consumption. To assess the effect of amylin agonism on human eating behavior we conducted a randomized, blinded, placebo-controlled, multicenter study investigating the effects of the amylin analog pramlintide on body weight, 24-h caloric intake, portion sizes, "fast food" intake, and perceived control of eating in 88 obese subjects. After a 2-day placebo lead-in, subjects self-administered pramlintide (180 microg) or placebo by subcutaneous injection 15 min before meals for 6 wk without concomitant lifestyle modifications. Compared with placebo, pramlintide treatment elicited significant mean reductions from baseline in body weight on day 44 (-2.1 +/- 0.3 vs. +0.1 +/- 0.4%, P < 0.001), 24-h caloric intake (-990 +/- 94 vs. -243 +/- 126 kcal on day 3, P < 0.0001; -680 +/- 86 vs. -191 +/- 161 kcal on day 43, P < 0.01), portion sizes, and caloric intake at a "fast food challenge" (-385 +/- 61 vs. -109 +/- 88 kcal on day 44, P < 0.05). Pramlintide treatment also improved perceived control of eating, as demonstrated by a 45% placebo-corrected reduction in binge eating scores (P < 0.01). The results of this translational research study confirm in humans various preclinical effects of amylin agonism, demonstrating that pramlintide-mediated weight loss in obese subjects is accompanied by sustained reductions in 24-h food intake, portion sizes, fast food intake, and binge eating tendencies.

Appetite hormones and energy intake in obese men after consumption of fructose, glucose and whey protein beverages

OBJECTIVE

To investigate appetite responses over 4 h to fructose beverages in obese men, relative to glucose and whey protein. Second, to investigate the effect of combining whey and fructose on postprandial appetite hormones.

DESIGN

Randomized, double-blind crossover study of four beverages (1.1 MJ) containing 50 g of whey, fructose, glucose or 25 g whey+25 g fructose. Blood samples and appetite ratings were collected for 4 h then a buffet meal was offered.

SUBJECTS

Twenty-eight obese men (age: 57.0+/-1.6 years, body mass index: 32.5+/-0.6 kg/m(2)).

MEASUREMENTS

Plasma ghrelin (total), glucagon-like peptide-1 (GLP-1 7-36), cholecystokinin-8, glucose, insulin and appetite ratings were assessed at baseline and 30, 45, 60, 90, 120, 180, 240 min after beverages, followed by measurement of ad libitum energy intake.

RESULTS

Fructose produced lower glycaemia and insulinaemia compared to the glucose treatment (P<0.0001); whereas postprandial ghrelin, GLP-1 and cholecystokinin responses were similar after both treatments. Whey protein produced a prolonged (2-4 h) suppression of ghrelin (P=0.001) and elevation of GLP-1 (P=0.002) and cholecystokinin (P=0.003) that were reduced when combined with fructose, while glucose and insulin responses were similar. Energy intake after 4 h was independent of beverage type (glucose 4.7+/-0.2 MJ; fructose 4.9+/-0.3 MJ; whey 4.6+/-0.3 MJ; whey/fructose 4.8+/-0.3 MJ; P>0.05).

CONCLUSION

In obese men, fructose- and glucose-based beverages had similar effects on appetite and associated regulatory hormones, independent of the differing glycaemic and insulinaemic responses. The contrasting profile of plasma ghrelin, GLP-1 and cholecystokinin after whey protein consumption did not impact on ad libitum intake 4 h later and was attenuated when 50% of whey was replaced with fructose.

Low-dose pramlintide reduced food intake and meal duration in healthy, normal-weight subjects

OBJECTIVE

We previously reported that a single preprandial injection (120 microg) of pramlintide, an analog of the beta-cell hormone amylin, reduced ad libitum food intake in obese subjects. To further characterize the meal-related effects of amylin signaling in humans, we studied a lower pramlintide dose (30 microg) in normal-weight subjects.

RESEARCH METHODS AND PROCEDURES

In a randomized, double-blind, placebo-controlled, cross-over study, 15 healthy men (age, 24 +/- 7 years; BMI, 22.2 +/- 1.8 kg/m(2)) underwent a standardized buffet meal test on two occasions. After an overnight fast, subjects received a single subcutaneous injection of pramlintide (30 microg) or placebo, followed immediately by a standardized pre-load meal. After 1 hour, subjects were offered an ad libitum buffet meal, and total caloric intake and meal duration were measured.

RESULTS

Compared with placebo, pramlintide reduced total caloric intake (1411 +/- 94 vs. 1190 +/- 117 kcal; Delta, -221 +/- 101 kcal; -14 +/- 9%; p = 0.05) and meal duration (36 +/- 2 vs. 31 +/- 3 minutes; Delta, -5.1 +/- 1.4 minutes; p < 0.005). Visual analog scale profiles of hunger trended lower and fullness higher during the first hour after pramlintide administration. In response to the buffet, hunger and fullness changed to a similar degree after pramlintide and placebo, despite subjects on pramlintide consuming 14% fewer kilocalories. Visual analog scale nausea ratings remained near baseline, without differences between treatments. Plasma peptide YY, cholecystokinin, and ghrelin concentrations did not differ with treatment, whereas glucagon-like peptide-1 concentrations after meals were lower in response to pramlintide than to placebo.

DISCUSSION

These observations add support to the concept that amylin agonism may have a role in human appetite control.

Changes in nutrient intake during the menstrual cycle of overweight women with premenstrual syndrome

This study presents the nutrient data collected from women who were being screened for premenstrual syndrome (PMS) for entry into an intervention study. Screening was by the Steiner self-rated questionnaire. One hundred and forty-four overweight women completed the screening process and eighty-eight met the criteria for PMS. All women kept 4 d diet diaries pre- and postmenstrually over two menstrual cycles. The mean energy and macronutrient intakes were compared between the pre- and postmenstrual phases. Energy and macronutrient intake was also calculated according to food categories. Goldberg's cut-off limit for the ratio of energy intake to estimated basal metabolic rate was used to exclude data that was incompatible with predicted energy requirements. The diet diaries were also used to determine the mean number of meals or snacks eaten pre- and postmenstrually. Nutrient analysis of the diet diaries of the women with PMS showed a significant increase (P<0.001) in total energy and all macronutrients premenstrually when compared to nutrient intake postmenstrually. Women who did not meet the criteria for PMS showed a significant increase in energy and fat intake (P<0.05) but not in the other macronutrients. When adjusted for energy, data collected from women with PMS showed a premenstrual significant increase in fat, carbohydrate (P<0.05) and simple sugars (P<0.001). There was a significant decrease (P<0.001) in protein premenstrually. Women not meeting the PMS criteria showed no significant difference between pre- and postmenstrual intakes when adjusted for energy. Analysis according to food categories in women with PMS showed a significantly greater intake premenstrually of energy and all macronutrients for cereals, cakes and desserts and high-sugar foods (P<0.001). In women with PMS there was a significantly greater number of ‘episodes of eating’ premenstrually (P<0.001). This study provides further evidence, to support the very limited number of earlier studies, that there is a group of women with PMS who increase their nutrient intake during the premenstrual phase. This could potentially be a contributing factor for some women experiencing difficulties adhering to suggested dietary modification and should be considered when counselling premenopausal women.

Acute effects of knowledge-based work on feeding behavior and energy intake

The aim of this study was to evaluate the impact of knowledge-based work (KBW) on feeding behavior and spontaneous energy intake with the use of a repeated measures/within-subjects design. We used a two-session protocol including an ad libitum buffet preceded by either rest in a sitting position for 45 min or a cognitive task (reading a document and writing a summary of 350 words using a computer) over the same time period. In this regard, 15 healthy Laval University female students (mean age = 24.1+/-2.2 years, mean BMI = 24.0+/-4.3 kg/m2) were recruited to participate in this study. Anthropometric variables, energy expenditure, heart rate, blood pressure, food intake (dietary record), and appetite sensation markers were measured at each testing session, and two questionnaires [Three-Factor Eating Questionnaire (TFEQ) and State-Trait Anxiety Inventory (STAI)] were administered. In addition, a buffet-type meal was used to measure spontaneous energy intake and macronutrient preferences. We found that the mean energy expenditure of the two conditions was about comparable (difference of 13 kJ between the two tasks) whereas the mean ad libitum energy intake after the KBW task exceeded that measured after rest by 959 kJ (p < 0.01). Although a higher absolute energy intake was observed for the three macronutrients after the KBW task (p < 0.05), no specific preference was detected, as reflected by the comparable percent of energy from each macronutrient in the two conditions. No significant difference in appetite sensation markers was observed between the two conditions, although the subjects ate more in the buffet-type meal after the KBW task. Furthermore, the subjects did not compensate by decreasing food intake for the rest of the day, suggesting a net caloric surplus. We also observed negative correlations between cognitive dietary restraint (TFEQ) and spontaneous energy intake in both conditions. In conclusion, our results demonstrate that mental work solicited by KBW has the potential to induce a higher spontaneous energy intake. This also raises the possibility that KBW adds a new component to sedentariness that might further accentuate the positive energy balance that is more likely to occur when one is inactive.

Intranasal cocaine in humans: effects of sex and menstrual cycle

Studies have shown that smoked and intravenous cocaine's effects differ in cocaine-dependent women compared to men and across the menstrual cycle. However, this has not been systematically investigated with intranasal cocaine. Thus, a range of intranasal cocaine doses was examined in cocaine-dependent women across the menstrual cycle. Female cocaine users were admitted to the hospital once during the luteal phase and once during the follicular phase of their menstrual cycle; menstrual cycle phase during admissions was counterbalanced. During each admission, an intranasal cocaine dose-response curve (0.06, 0.34, 0.69 and 1.37 mg/kg) was determined during four laboratory sessions. Cocaine produced similar dose-related increases in ratings of "positive" subjective effects, cardiovascular effects and cocaine plasma levels in women in both menstrual cycle phases. To assess sex differences in the effects of intranasal cocaine, the current data were compared to published data collected in men using an identical procedure. Cocaine produced similar dose-related increases in ratings of positive subjective effects, cardiovascular effects and cocaine plasma levels in men and women. Thus, in contrast to studies examining smoked or intravenous cocaine administration, there were no sex differences or menstrual cycle effects on the subjective or cardiovascular response to intranasal cocaine, suggesting that the influence of sex and menstrual cycle on cocaine's effects vary as a function of route of administration.

Appetite regulatory hormone responses to various dietary proteins differ by body mass index status despite similar reductions in ad libitum energy intake

CONTEXT

Although dietary protein produces higher acute satiety relative to carbohydrate, the influence of protein source and body mass index (BMI) has not been clearly described.

OBJECTIVE

The objective of the study was to assess postprandial responses to different protein sources, compared with glucose, in males with normal and high BMI.

DESIGN

This was a randomized, crossover study of four preloads followed by blood sampling (+15, 30, 45, 60, 90, 120, 180 min) and buffet meal.

SETTING

The study was conducted at an outpatient clinic.

PARTICIPANTS

The study population included 72 men, with a BMI range 20.6-39.9 kg/m(2).

INTERVENTIONS

Interventions consisted of liquid preloads (1.1 MJ, 450 ml) containing 50 g whey, soy, gluten, or glucose.

MAIN OUTCOME MEASURES

Fasting and postprandial plasma glucose, insulin, ghrelin, glucagon-like peptide-1 (GLP-1) and cholecystokinin (n = 38), ad libitum energy intake, and appetite ratings were measured.

RESULTS

Energy intake was 10% lower after all protein preloads, compared with the glucose treatment (P < 0.05), independent of BMI status and protein type. All protein loads prolonged the postprandial suppression of ghrelin (P < 0.01) and elevation of GLP-1 (P < 0.01) and cholecystokinin (P < 0.05). Fasting GLP-1 concentrations [overweight, 17.5 +/- 1.3; lean, 14.7 +/- 0.1 pg/ml (5.2 +/- 0.4 and 4.4 +/- 0.1 pmol/liter, respectively); P < 0.001] and postprandial responses (P = 0.038) were higher in overweight subjects.

CONCLUSIONS

Whey, soy, and gluten similarly tend to reduce ad libitum food intake 3 h later in lean and overweight males relative to glucose. Postprandial ghrelin, GLP-1, insulin, and cholecystokinin may contribute to this higher satiety after protein consumption. GLP-1 concentrations are increased in overweight subjects, which may affect satiety responses in this group.

Exogenous progesterone attenuates the subjective effects of smoked cocaine in women, but not in men

In a previous study, we showed that the positive subjective effects of cocaine were higher during the follicular phase compared to the luteal phase of the menstrual cycle. The purpose of the present study was to determine if exogenously administered progesterone during the follicular phase in females would attenuate the response to cocaine compared to the normal follicular phase, thus making the response to cocaine similar to the luteal phase. To address the role of sex differences, males were also administered exogenous progesterone during one inpatient stay. In all, 11 female and 10 male non-treatment-seeking cocaine smokers participated. Females had three inpatient stays: one during a normal follicular phase, one during a normal luteal phase, and one during a follicular phase when exogenous progesterone was administered. Males had two inpatient stays: one when exogenous progesterone was administered and the other when placebo was administered. During each inpatient admission, there were four smoked cocaine administration sessions: participants were administered six doses of cocaine (0, 6, 12, or 25 mg cocaine base) at 14 min intervals. Smoked cocaine increased heart rate, blood pressure and several subjective effects such as 'good drug effect' and 'drug quality' cluster scores. Administration of progesterone during the follicular phase in women attenuated the positive subjective effects of cocaine, whereas only minimal changes were observed in men. These results indicate that progesterone modulates the response to cocaine in women and suggests that fluctuations in endogenous progesterone levels account for some of the sex differences observed in humans.

Effects of gender and menstrual cycle phase on food-maintained responding under a progressive-ratio schedule in cynomolgus monkeys

Clinical and preclinical data suggest that fluctuations in ovarian steroid hormones across the menstrual/estrous cycle influence spontaneous feeding behavior in females. The effects of gender, menstrual cycle phase, and ovarian hormone fluctuations on food-maintained responding under a progressive-ratio schedule were investigated in four female and three male cynomolgus monkeys. Females were studied across 21 menstrual cycles, and ovulatory cycles were defined by analysis of ovarian steroid hormone levels. Data were analyzed for the early and mid-follicular phase and the mid- and late luteal phase of the menstrual cycle. Progressive-ratio break points for food were significantly higher in males than in females (p < 0.01). However, progressive-ratio break points did not vary consistently as a function of menstrual cycle phase during ovulatory cycles. There were no systematic patterns of progressive-ratio break points in anovulatory menstrual cycles. Only one female monkey reached significantly higher break points during the mid- and late luteal phases in comparison to the mid-follicular phase of the menstrual cycle (p < 0.05). There was also a significant positive correlation between progressive-ratio break points and progesterone levels and a significant negative correlation with estradiol in that monkey. Although fluctuations in ovarian steroid hormones may influence food consumption under some conditions, consistent patterns of food-maintained responding were not detected during ovulatory menstrual cycles in cynomolgus monkeys.

Effect of pramlintide on satiety and food intake in obese subjects and subjects with type 2 diabetes

AIMS/HYPOTHESIS

Long-term trials in insulin-treated subjects with type 2 diabetes have shown that adjunctive treatment with the amylin analogue pramlintide reduces HbA(1)c levels and elicits weight loss. While amylin reduces food intake in rodents, pramlintide's effect on satiety and food intake in humans has not yet been assessed.

METHODS

In this randomised, double-blind, placebo-controlled crossover study, 11 insulin-treated men with type 2 diabetes (age 60+/-9 years, BMI 28.9+/-4.8 kg/m(2)) and 15 non-diabetic obese men (age 41+/-21 years, BMI 34.4+/-4.5 kg/m(2)) underwent two standardised meal tests. After fasting overnight, subjects received single subcutaneous injections of either pramlintide (120 microg) or placebo, followed by a preload meal. After 1 h, subjects ate an ad libitum buffet meal. Energy intake and meal duration were measured, as were hunger ratings (using visual analogue scales), and plasma cholecystokinin, glucagon-like peptide-1 and peptide YY concentrations over time.

RESULTS

Compared with placebo, pramlintide reduced energy intake in both the type 2 diabetes (Delta-202+/-64 kcal, -23+/-8%, p<0.01) and obese (Delta-170+/-68 kcal, -16+/-6%, p<0.02) groups, without affecting meal duration. Hunger and hormonal analyte profiles provided evidence that pramlintide may exert a primary satiogenic effect, independently of other anorexigenic gut peptides.

CONCLUSIONS/INTERPRETATION

The results indicate that enhanced satiety and reduced food intake may explain the weight loss observed in long-term pramlintide trials.