Cees de Graaf

Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: cluster randomised controlled trial

Abstract Objective To assess the effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents without dementia. Design Cluster randomised trial. Setting Five Dutch nursing homes. Participants 178 residents (mean age 77 years). Two wards in each home were randomised to intervention (95 participants) or control groups (83). Intervention During six months the intervention group took their meals family style and the control group received the usual individual pre-plated service. Main outcome measures Quality of life (perceived safety; autonomy; and sensory, physical, and psychosocial functioning), gross and fine motor function, and body weight. Results The difference in change between the groups was significant for overall quality of life (6.1 units, 95% confidence interval 2.1 to 10.3), fine motor function (1.8 units, 0.6 to 3.0), and body weight (1.5 kg, 0.6 to 2.4). Conclusion Family style mealtimes maintain quality of life, physical performance, and body weight of nursing home residents without dementia. Trial registration Clinical trials NCT00114582

Effect of bite size and oral processing time of a semisolid food on satiation.

BACKGROUND Food texture plays an important role in food intake regulation. In previous studies we showed a clear effect of viscosity on ad libitum food intake and found indications that eating rate, bite size, and oral processing time (OPT) could play a role. OBJECTIVE The objective was to determine the effect of bite size and OPT of a food on satiation, defined as ad libitum food intake. DESIGN Twenty-two healthy subjects participated in all 7 test conditions. Bite sizes were free or fixed to small bite sizes ( approximately 5 g) or large bite sizes ( approximately 15 g). OPT was free (only in combination with free bite size) or fixed to 3 or 9 s. Subjects consumed chocolate custard through a tube, which was connected to a peristaltic pump. Sound signals indicated OPT duration. RESULTS Subjects consumed significantly more when bite sizes were large than when they were small (bite size effect: P < 0.0001) and when OPT was 3 s rather than 9 s (OPT effect: P = 0.008). Under small bite size conditions, mean (+/-SD) ad libitum intakes were 382 +/- 197 g (3-s OPT) and 313 +/- 170 g (9-s OPT). Under large bite size conditions, ad libitum intakes were much higher: 476 +/- 176 g (3-s OPT) and 432 +/- 163 g (9-s OPT). Intakes during the free bite size conditions were 462 +/- 211 g (free OPT), 455 +/- 197 g (3-s OPT), and 443 +/- 202 g (9-s OPT). CONCLUSION This study shows that greater oral sensory exposure to a product, by eating with small bite sizes rather than with large bite sizes and increasing OPT, significantly decreases food intake.

Sweet and sour preferences in young children and adults : role of repeated exposure.

We investigated the influence of repeated exposure to orangeades with added sucrose and different concentrations of citric acid, on the taste preferences of 6- to-11-year-old children and young adults. During an intervention study of 8 days, 59 children (9.2+/-0.9 years) and 46 young adults (22+/-2.0 years) received, each day, either an orangeade with a sweet taste, a sour taste, or no orangeade (control). Before (baseline) and after the intervention, preferences for a series of orangeades and yoghurt, which varied in balance of sweet and sour tastes, were measured by means of a rank-ordering procedure. The variation in balance of sweet and sour taste was established by adding different amounts of citric acid (orangeade: 0.009, 0.013, 0.020, 0.029, 0.043, and 0.065 M added citric acid; yoghurt: 0.027, 0.038, 0.056, 0.081, 0.12, and 0.17 M added citric acid) to a stock orangeade and yoghurt with 0.42 M sucrose. The sweet and sour tasting orangeade that were consumed during the intervention were equally preferred at baseline. After an 8-day exposure to the sweet orangeade, childrens preferences for this orangeade (0.42 M sucrose) significantly increased (p<0.05). A similar trend was observed for the yoghurt with 0.42 M sucrose (p=0.09). An 8-day exposure to the sour orangeade did not have a significant effect on childrens preference for this orangeade. The taste preferences of adults did not change after the intervention. The control group of children and adults did not show any change in preferences for sweet and sour tastes. Future research is needed to investigate whether the changed preferences for sweet taste are stable over time and how these changed taste preferences are related to a change in the consumption of sugar rich foods.

Effects of snacks on energy intake: an evolutionary perspective.

The question addressed in this paper is whether the consumption of snacks contributes to higher energy intake and body weight in humans. Currently available snacks have a higher energy density than most of the foods that were available in Paleolithic diets. Humans have a weak defense against overeating, which is a functional trait from an evolutionary perspective. Various studies found that people do not compensate their energy intake after the consumption of snacks. This is particularly true for energy-containing drinks, which provide calories in liquid form. It is concluded that snack consumption may contribute to a positive energy balance.

Food-related lifestyle and health attitudes of Dutch vegetarians, non-vegetarian consumers of meat substitutes, and meat consumers

The aim was to investigate socio-demographic characteristics, and attitudes to food and health of vegetarians, non-vegetarian consumers of meat substitutes, and meat consumers in The Netherlands. The sample used for this study (participants > or =18 years) was taken from the Dutch National Food Consumption Survey, 1997/1998. Vegetarians (n = 63) and consumers of meat substitutes (n = 39) had similar socio-demographic profiles: higher education levels, higher social economic status, smaller households, and more urbanised residential areas, compared to meat consumers (n = 4313). Attitudes to food were assessed by the food-related lifestyle instrument. We found that vegetarians (n = 32) had more positive attitudes towards importance of product information, speciality shops, health, novelty, ecological products, social event, and social relationships than meat consumers (n = 1638). The health consciousness scale, which was used to assess attitudes to health, supported earlier findings that vegetarians are more occupied by health. Food-related lifestyle and health attitudes of meat substitute consumers (n = 17) were predominantly in-between those from vegetarians and meat consumers. The outcome of this study suggests that in strategies to promote meat substitutes for non-vegetarian consumers, the focus should not only be on health and ecological aspects of foods.

Cognitive development and children's perceptions of fruit and vegetables; a qualitative study

BackgroundMost children do not meet the recommended guidelines for fruit and vegetable intake. Since preference is an important predictor of intake, more knowledge is needed about childrens preferences and about how these preferences develop. As most research about preferences has ignored cognitive development, this study was designed to explore the relation between childrens perceptions and preferences for fruit and vegetables and their cognitive development.MethodsThe study population consisted of eight 4–5-year-old children, eight 7–8-year-old children and twelve 11–12-year-old children, recruited via a primary school in Wageningen, The Netherlands. Qualitative in-depth information was obtained by duo-interviews and focus group discussions. A structured guide with questions and game tasks was applied to address different domains in a consistent way.ResultsThe developmental progress at the abstraction level was seen in childrens reasoning across all domains. Childrens preferences expanded and increased in complexity as they moved to a higher age bracket. The most important determinants for liking and disliking shifted from appearance and texture attributes in 4–5-year-olds towards taste attributes in 11–12-year-olds. Childrens knowledge of basic tastes increased. Their understanding of health improved as they grew older. The emergence of social norms and perspectives of others as the children grew older was also seen in relation to fruit and vegetables. Child-reported parental strategies to stimulate healthy eating appeared to vary with age in line with cognitive development.ConclusionCognitive development is paralleled by changes in the importance given to the attributes that determine whether a child likes or dislikes fruits and vegetables; childrens understanding of and reasoning about health; and parental use of strategies. These developmental differences should be incorporated in programs designed to increase long-term fruit and vegetable intake in children.

Cephalic phase responses and appetite

The current food supply in many parts of the world differs substantially from that which existed during most of human evolution. It is characterized by a high variety of palatable foods with high energy density and low fiber content. Many foods can be eaten very quickly, and there is not always congruency between the sensory properties of the food and the subsequent metabolic consequences of its ingestion, (e.g., as in the consumption of artificially sweetened foods). It is not presently known how the human body copes with this incongruent food environment in terms of short-term satiety responses and long(er)-term regulation of food intake. Cephalic phase responses (CPRs) are innate and learned physiological responses to sensory signals that prepare the gastrointestinal tract for the optimal processing of ingested foods. CPRs could be affected by inconsistencies in the associations between sensory signals and subsequent post-ingestive consequences. Reviewed here are the available data on how CPRs affect the control of food intake.

Functional MRI of human hypothalamic responses following glucose ingestion.

The hypothalamus is intimately involved in the regulation of food intake, integrating multiple neural and hormonal signals. Several hypothalamic nuclei contain glucose-sensitive neurons, which play a crucial role in energy homeostasis. Although a few functional magnetic resonance imaging (fMRI) studies have indicated that glucose consumption has some effect on the neuronal activity levels in the hypothalamus, this matter has not been investigated extensively yet. For instance, dose-dependency of the hypothalamic responses to glucose ingestion has not been addressed. We measured the effects of two different glucose loads on neuronal activity levels in the human hypothalamus using fMRI. After an overnight fast, the hypothalamus of 15 normal weight men was scanned continuously for 37 min. After 7 min, subjects ingested either water or a glucose solution containing 25 or 75 g of glucose. We observed a prolonged decrease of the fMRI signal in the hypothalamus, which started shortly after subjects began drinking the glucose solution and lasted for at least 30 min. Moreover, the observed response was dose-dependent: a larger glucose load resulted in a larger signal decrease. This effect was most pronounced in the upper anterior hypothalamus. In the upper posterior hypothalamus, the signal decrease was similar for both glucose loads. No effect was found in the lower hypothalamus. We suggest a possible relation between the observed hypothalamic response and changes in the blood insulin concentration.

Replacement of meat by meat substitutes. A survey on person- and product-related factors in consumer acceptance

What does it take to increase the consumption of meat substitutes and attract new consumers? We identified main barriers and drivers by a consumer survey (n=553) in the U.K. and the Netherlands. Person-related factors (food neophobia and food choice motives) and product-related attitudes and beliefs towards meat and meat substitutes were compared between non-users (n=324), light/medium-users (n=133) and heavy-users of meat substitutes (n=96). Consumer acceptance was largely determined by the attitudes and beliefs towards meat substitutes and food neophobia. Key barriers for non-users and light/medium-users were the unfamiliarity with meat substitutes and the lower sensory attractiveness compared to meat. In addition, non-users had a higher tendency to avoid new foods. Hence, the less consumers were using meat substitutes, the more they wanted these products to be similar to meat. Although non-users and light/medium-users did recognize the ethical and weight-control aspects of meat substitutes, this was obviously less relevant to them. Actually, only heavy-users had high motivations to choose ethical foods, which explains their choice for meat substitutes. In order to make meat substitutes more attractive to meat consumers, we would not recommend to focus on communication of ethical arguments, but to significantly improve the sensory quality and resemblance to meat.

Eating rate of commonly consumed foods promotes food and energy intake.

We investigated the eating rate of commonly consumed foods and the associations with food intake and macronutrient composition. Ingestion time (s) of 50 g of 45 foods was measured to assess eating rate (g/min), after which ad libitum food intake (g) was measured. Thirteen men and 24 women (aged 23.3 (SD 3.4)y, BMI 21.7 (SD 1.7)kg/m(2)) participated, each testing 7 foods in separate sessions. We observed large differences in eating rate between foods, ranging from 4.2 (SD 3.7) to 631 (SD 507)g/min. Eating rate was positively associated with food intake (β=0.55) and energy intake (β=0.001). Eating rate was inversely associated with energy density (β=-0.00047) and positively with water content (β=0.011). Carbohydrate (β=-0.012), protein (β=-0.021) and fiber content (β=-0.087) were inversely associated with eating rate, whereas fat was not. This study showed that when foods can be ingested rapidly, food and energy intake is high. People may therefore be at risk of overconsumption, when consuming foods with a high eating rate. Considering the current food supply, where many foods have a high eating rate, long-term effects of eating rate on energy balance should be investigated.