Anne Lluch

Gastrointestinal targets of appetite regulation in humans

The aim of this paper is to describe and discuss relevant aspects of the assessment of physiological functions – and related biomarkers – implicated in the regulation of appetite in humans. A short introduction provides the background and the present state of biomarker research as related to satiety and appetite. The main focus of the paper is on the gastrointestinal tract and its functions and biomarkers related to appetite for which sufficient data are available in human studies. The first section describes how gastric emptying, stomach distension and gut motility influence appetite; the second part describes how selected gastrointestinal peptides are involved in the control of satiety and appetite (ghrelin, cholecystokinin, glucagon‐like peptide, peptide tyrosin‐tyrosin) and can be used as potential biomarkers. For both sections, methodological aspects (adequacy, accuracy and limitation of the methods) are described. The last section focuses on new developments in techniques and methods for the assessment of physiological targets involved in appetite regulation (including brain imaging, interesting new experimental approaches, targets and markers). The conclusion estimates the relevance of selected biomarkers as representative markers of appetite regulation, in view of the current state of the art.

Dietary intakes, eating style and overweight in the Stanislas Family Study

OBJECTIVES: To describe the eating patterns of members of French families and to assess the relationships between dietary intakes, eating style and overweight.DESIGN: Cross-sectional analysis of nutritional and behavioural characteristics.SUBJECTS: 1320 members of 387 families (age 11–65 y) attending the Centre for Preventive Medicine for a routine medical check-up.MEASUREMENTS: Individual body weight and height were measured. Food intake was assessed using a three day dietary record. Eating style was measured using the French validated version of the Dutch Eating Behaviour Questionnaire.RESULTS: In each of the four groups (men, women, boys and girls), dietary restraint was positively correlated with overweight (P≤0.001) and associated with lower energy intakes (P≤0.05–P≤0.001). A negative association between energy intake and overweight was found in girls only (P≤0.001). In all cases, overweight and dietary restraint exaggerated any existing macronutrient imbalance in energy intake (ie higher protein and fat contributions, lower carbohydrate contribution). Emotional eating was positively correlated to body mass index in women only (P≤0.01). External eating was mainly a characteristic of children (P≤0.001).CONCLUSION: As in overweight subjects, clear relationships were found in this sample of general population between dietary intakes and eating style. The population will be followed up for 10 y. In the long term, these results should have implications in the prevention of obesity.

Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta- analyses, of the evidence from human and animal studies

By reducing energy density, low-energy sweeteners (LES) might be expected to reduce energy intake (EI) and body weight (BW). To assess the totality of the evidence testing the null hypothesis that LES exposure (versus sugars or unsweetened alternatives) has no effect on EI or BW, we conducted a systematic review of relevant studies in animals and humans consuming LES with ad libitum access to food energy. In 62 of 90 animal studies exposure to LES did not affect or decreased BW. Of 28 reporting increased BW, 19 compared LES with glucose exposure using a specific ‘learning’ paradigm. Twelve prospective cohort studies in humans reported inconsistent associations between LES use and body mass index (−0.002 kg m−2 per year, 95% confidence interval (CI) −0.009 to 0.005). Meta-analysis of short-term randomized controlled trials (129 comparisons) showed reduced total EI for LES versus sugar-sweetened food or beverage consumption before an ad libitum meal (−94 kcal, 95% CI −122 to −66), with no difference versus water (−2 kcal, 95% CI −30 to 26). This was consistent with EI results from sustained intervention randomized controlled trials (10 comparisons). Meta-analysis of sustained intervention randomized controlled trials (4 weeks to 40 months) showed that consumption of LES versus sugar led to relatively reduced BW (nine comparisons; −1.35 kg, 95% CI –2.28 to −0.42), and a similar relative reduction in BW versus water (three comparisons; −1.24 kg, 95% CI –2.22 to −0.26). Most animal studies did not mimic LES consumption by humans, and reverse causation may influence the results of prospective cohort studies. The preponderance of evidence from all human randomized controlled trials indicates that LES do not increase EI or BW, whether compared with caloric or non-caloric (for example, water) control conditions. Overall, the balance of evidence indicates that use of LES in place of sugar, in children and adults, leads to reduced EI and BW, and possibly also when compared with water.

Satiating effects of protein but not carbohydrate consumed in a between-meal beverage context.

Previous research has suggested that protein is the most satiating macronutrient; however some experiments have found no difference in satiating efficiency of protein and carbohydrate during short intervals after consumption. There is also evidence that the satiating effects of carbohydrate are minimal when in a beverage rather than solid context. To evaluate whether protein-based satiety was evident in a drink context, and clarify further effects of preload time on satiety, the present study compared iso-energetic dairy fruit drink preloads ( approximately 1250 kJ), differing in macronutrient composition and consumed at two time intervals in the morning. Using a counterbalanced within-subjects design, 18 unrestrained lean male volunteers consumed 300 ml of carbohydrate-enriched (CHO), protein-enriched and low-energy control (327 kJ) dairy fruit drinks, 120 min and 30 min before an ad libitum lunch. Significantly less energy was consumed at lunch after the protein (3234 kJ) compared to the control (3468 kJ, p<0.05) and CHO preloads (3588 kJ, p<0.05). However, this was not sufficient to show complete energy compensation. Preload time of consumption did not impact upon any measures. Only satiety ratings at the beginning of lunch varied significantly by preload type, reflecting differences in test meal intake. These findings are consistent with previous research that protein is more satiating than carbohydrate. The roles of sensory and hedonic characteristics are discussed.

Macronutrients and mental performance.

There is currently intense interest in the effects of macronutrients on psychological states, mental performance, and well-being. A strong theoretical perspective has guided work on carbohydrates and their relation to brain serotoninergic function with concomitant effects on performance. The clearest and most reliable effects have been observed for the beneficial action of glucose on cognitive performance, supported by investigations of hypoglycemia, which is associated with general impairment of cognitive performance. The effects of complex carbohydrates are less distinct and change with time of day; e.g., carbohydrate at breakfast tends to improve morning performance. However, these studies are rarely decisive. Far fewer experiments have been performed on protein and fat, and it is difficult to draw any firm conclusions. Macronutrients are seldom given alone, proportions of protein and fat differ greatly between studies, and comparisons are frequently performed with no food at all. Food intake may mitigate the effects of low doses but not of high doses of alcohol on performance. Effects of macronutrients on cognitive performance may be dependent on their effects on glucose metabolism, metabolic activation, or serotonin. Other factors that modify effects include time of day, circadian rhythms, type of task, habitual diet, and vulnerability of the population.

No energy compensation at the meal following exercise in dietary restrained and unrestrained women.

The objective of this investigation was to compare the acute effects of exercise and diet manipulations on energy intake, between dietary restrained and unrestrained females. Comparisons of two studies using an identical 2 x 2 repeated-measures design (level of activity (rest or exercise) and lunch type (high-fat or low-fat)) including thirteen dietary unrestrained and twelve restrained females were performed. Energy expenditure during the rest session was estimated and the energy cost of exercise was measured by indirect calorimetry. Relative energy intake was calculated by subtracting the energy expenditure of the exercise session from the energy intake of the test meal. Post-meal hedonic ratings were completed after lunch. Energy intake and relative energy intake increased during high-fat conditions compared with the low-fat, independently of exercise (P < 0.001). There was a positive relationship between dietary restraint scores and energy intake or relative energy intake in the rest conditions only (r 0.54, P < 0.01). The decrease of relative energy intake between the rest and exercise conditions was higher in restrained than in unrestrained eaters (P < 0.01). These results confirm that a high-fat diet reversed the energy deficit due to exercise. There was no energy compensation in response to an acute bout of exercise during the following meal. In restrained eaters, exercise was more effective in creating an energy deficit than in unrestrained eaters. Exercise may help restrained eaters to maintain control over appetite.

Dose-dependent effects of beverage protein content upon short-term intake.

Protein is considered to be more satiating than carbohydrate, quantified by energy adjustment and subjective appetite. However, the effect of increasing protein content upon short-term energy adjustment in beverage contexts is unclear. This study used a repeated-measures, cross-over design. 28 male volunteers (18-35 years) ate a standard breakfast in the laboratory and 210 min later consumed one of four preloads 30 min prior to an ad libitum pasta meal. Three of the preloads were isocaloric ( approximately 1155 kJ) mixed composition dairy fruit drinks (300 g) of low (13% protein energy/87% carbohydrate energy), medium (25% protein energy/75% carbohydrate energy) and high (50% protein energy/50% carbohydrate energy) protein content. The control drink was a low energy (328 kJ) alternative. Results indicated a dose response effect of preload protein level on intake (g) at the ad libitum meal. Ad libitum intake was: control (637.6g+/-39.7), low (596.9 g+/-40.5), medium (546.9 g+/-34.7), and high protein (533.6g+/-42.3). 100% compensation was not achieved; however total energy intake after the medium and high protein drinks did not differ significantly from control. There were no significant differences in hunger and fullness ratings. Our findings support the view that increasing the protein composition of beverages relative to carbohydrate proportionally affects short-term subsequent intake in controlled conditions.

Perceived thickness and creaminess modulates the short-term satiating effects of high protein drinks

Previous research suggests that increasing beverage protein content enhances subsequent satiety, but whether this effect is entirely attributable to post-ingestive effects of protein or is partly caused by the distinct sensory characteristics imparted by the presence of protein remains unclear. To try and discriminate nutritive from sensory effects of added protein, we contrasted effects of three higher-energy (about 1·2 MJ) and one lower-energy (LE: 0·35 MJ) drink preloads on subsequent appetite and lunch intake. Two higher-energy drinks had 44% of energy from protein, one with the sensory characteristics of a juice drink (HP2, low-sensory protein) and the second a thicker and creamier (HPþ, high-sensory protein) drink. The high-carbohydrate preload (HCþ, high-sensory carbohydrate) was matched for thickness and creaminess to the HPþ drink. Participants (healthy male volunteers, n 26) consumed significantly less at lunch after the HPþ(566 g) and HCþ(572 g) than after HP2 (623 g) and LE (668 g) drinks, although the compensation for drink energy accounted for only 50% of extra energy at best. Appetite ratings indicated that participants felt significantly less hungry and more full immediately before lunch in HPþ and HCþ groups compared with LE, with HP2 being intermediate. The finding that protein generated stronger satiety in the context of a thicker creamier drink (HPþ but not HP2) and that an isoenergetic carbohydrate drink (HCþ), matched in thickness and creaminess to the HPþ drink, generated the same pattern of satiety as HPþ, both suggest an important role for these sensory cues in the development of protein-based satiety.

Individual diet modeling shows how to balance the diet of french adults with or without excessive free sugar Intakes

Dietary changes needed to achieve nutritional adequacy for 33 nutrients were determined for 1719 adults from a representative French national dietary survey. For each individual, an iso-energy nutritionally adequate diet was generated using diet modeling, staying as close as possible to the observed diet. The French food composition table was completed with free sugar (FS) content. Results were analyzed separately for individuals with FS intakes in their observed diets ≤10% or >10% of their energy intake (named below FS-ACCEPTABLE and FS-EXCESS, respectively). The FS-EXCESS group represented 41% of the total population (average energy intake of 14.2% from FS). Compared with FS-ACCEPTABLE individuals, FS-EXCESS individuals had diets of lower nutritional quality and consumed more energy (2192 vs. 2123 kcal/day), particularly during snacking occasions (258 vs. 131 kcal/day) (all p-values < 0.01). In order to meet nutritional targets, for both FS-ACCEPTABLE and FS-EXCESS individuals, the main dietary changes in optimized diets were significant increases in fresh fruits, starchy foods, water, hot beverages and plain yogurts; and significant decreases in mixed dishes/sandwiches, meat/eggs/fish and cheese. For FS-EXCESS individuals only, the optimization process significantly increased vegetables and significantly decreased sugar-sweetened beverages, sweet products and fruit juices. The diets of French adults with excessive intakes of FS are of lower nutritional quality, but can be optimized via specific dietary changes.

Selective effects of acute exercise and breakfast interventions on mood and motivation to eat.

The effects of exercise and breakfast manipulations on mood and motivation to eat were assessed in 11 healthy females who were regular exercisers and habitual breakfast eaters. The study involved a two by two repeated-measures design, with exercise (or no exercise) and a high-energy breakfast (or low-energy breakfast) as the repeated measures. The exercise or no-exercise session (0800 h) was followed by consumption of the low- or high-energy breakfast (0900 h). An ad libitum lunch test meal was provided 4 hours after the beginning of the exercise session (1200 h). Mood and motivation to eat were continuously tracked from 0800 until 1700 h by an electronic appetite ratings system (EARS). In general, morning subjective mood states (e.g., contentment) were significantly lower in the low-energy breakfast condition, but exercise reversed this effect. Exercise also significantly decreased feelings of lethargy, independent of the breakfast condition. Desire-to-eat and fullness ratings were significantly increased in the low-energy breakfast and high-energy breakfast conditions, respectively. Impairments of mood disappeared in the afternoon after consumption of an ad libitum lunch. In these healthy young adults, the condition inducing the largest energy deficit (exercise and low-energy breakfast) was not associated with the lowest mental states.