Stephanie Budgett

Fatty acid chain length, postprandial satiety and food intake in lean men.

High-fat diets are associated with obesity, and the weak satiety response elicited in response to dietary lipids is likely to play a role. Preliminary evidence from studies of medium (MCT) and long chain triglycerides (LCT) supports greater appetite suppression on high-MCT diets, possibly a consequence of direct portal access, more rapid oxidation and muted lipaemia. No data is as yet available on high-SCT diets which also have direct hepatic access. In this study SCT- (dairy fats), MCT- (coconut oil) and LCT-enriched (beef tallow) test breakfasts (3.3 MJ) containing 52 g lipid (58 en% fat) were investigated in a randomized, cross-over study in 18 lean men. All participants were required to complete the 3 study days in randomised order. Participants rated appetite sensations using visual analogue scales (VAS), and energy intake (EI) was measured by covert weighing of an ad libitum lunch meal 3.5 h postprandially. Blood samples were collected by venous cannulation. There were no detectable differences between breakfasts in perceived pleasantness, visual appearance, smell, taste, aftertaste and palatability (P>0.05). There was no significant effect of fatty acid chain length on ratings of hunger, fullness, satisfaction or current thoughts of food, nor did energy (mean, sem: SCT: 4406, 366 kJ; MCT: 4422, 306 kJ; LCT: 4490, 324 kJ; P>0.05) or macronutrient intake at lunch differ between diets. The maximum difference in EI between diets was less than 2%. Postprandial lipaemia also did not differ significantly. We conclude that there was no evidence that fatty acid chain length has an effect on measures of appetite and food intake when assessed following a single high-fat test meal in lean participants.

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

AIM To determine the effect of low-dose whey protein-enriched water beverages on postprandial satiety and energy intake (EI). METHODS Fifty overweight and mildly obese women were given 500 mL water-based beverages on 4 different occasions in a double blind, cross-over study. The beverages were reasonably matched for colour, flavour, sweetness and contained 0% (water control, 0 g, 8 kJ), 1% (5 g, 93 kJ), 2% (10 g, 178 kJ) and 4% (20 g, 348 kJ) whey protein by weight (ClearProtein8855™). Following a standard evening meal and breakfast, beverages were consumed 120 min before an ad libitum lunch at which EI was measured. Feelings associated with hunger and fullness were also measured using visual analogue scales (VAS). RESULTS 46 participants completed all 4 beverage conditions. There was a significant effect of beverage preload on hunger (beverage×time; P=0.0074), where each of the 1%, 2% and 4% w/w protein beverages decreased hunger compared to the water control (P<0.05). Suppression of hunger was also maintained for longer following the protein beverages (Friedman test, P=0.013). Fullness (beverage×time; P=0.0020) and satisfaction (beverage×time; P=0.0356) were both increased by the 1% and 4% protein beverages (P<0.05). EI at lunch decreased by up to 8 percent (control vs 4% protein, delta=-247 kJ, Tukeys post hoc, P>0.05) when escalating protein doses were added to the water preload (water control, 3028 kJ; 1%, 3080 kJ; 2%, 2924 kJ; 4%, 2781 kJ), only partial compensation for the added energy. CONCLUSIONS These low-dose, whey protein-enriched water beverages significantly altered short term postprandial satiety, however the effect was not sufficient to impact on food intake when assessed 2 h after consumption.

The emulsified lipid Fabuless (Olibra) does not decrease food intake but suppresses appetite when consumed with yoghurt but not alone or with solid foods: A food effect study

The lipid emulsion Fabuless (Olibra) has been shown in some studies to decrease short/medium term energy intake (EI) and prevent weight regain. The purported mechanism is the ileal brake. Whether Fabuless is efficacious under a range of dietary conditions is unknown since studies have administered the emulsion within a fermented, semi-liquid dairy yoghurt, and outcomes have been inconsistent. To determine whether Fabuless suppresses post-ingestive satiety and short-term food intake under a range of dietary conditions and forms we administered the emulsion co-presented with 185 mL water, stirred into a semi-liquid dairy yoghurt, and co-presented with a solid food breakfast muffin. This was a cross-over study in 18 lean men randomised to 6 treatments: (i) lipid emulsion, LE (15 g Fabuless, containing 4.2g lipid, 0.2 MJ)+water, (ii) lipid control, LC (15 g non-emulsified lipid/water, containing 4.2g lipid, 0.2 MJ)+water, (iii) lipid emulsion+yoghurt, LE+Y (1.2 MJ), (iv) lipid control+yoghurt, LC+Y (1.2 MJ), (v) lipid emulsion+muffin, LE+M (1.2 MJ), (vi) lipid control+muffin, LC+M (1.2 MJ), each given as a test breakfast at 8.30 am. Participants rated postprandial appetite sensations using visual analogue scales (VAS), and ad libitum energy intake was measured at a lunch meal 3.5h later. The lipid emulsion increased fullness compared with an energy-matched lipid control but only when administered within the semi-liquid fermented yoghurt (P<0.05). There were no effects on satiety ratings when co-presented with water or with the solid food muffin. Energy and macronutrient intake were not significantly decreased by any of the emulsion treatments. We conclude that effects are small, the format in which lipid emulsions are consumed influences postprandial satiety, and there is no evidence that this emulsion alters eating behaviour at the subsequent meal.

Using a smaller dining plate does not suppress food intake from a buffet lunch meal in overweight, unrestrained women.

The aim of the study was to determine whether plate size affects ad libitum energy intake (EI) at a buffet-style lunch in overweight, yet unrestrained women. Twenty overweight/obese (BMI=25-40 kg/m(2)) women attended two study visits, and were randomly assigned to small (19.5 cm) or large (26.5 cm) diameter plate size at a free choice lunch meal. At 9 am participants were given a small (0.5 MJ) breakfast, followed at 12 noon by the lunch meal from which they ate ad lib until comfortably full. Mean (SEM) EI at lunch was 3975 (239)kJ and 3901 (249) kJ respectively for small and large plate size. There was no detectable difference in EI between the two plate sizes (P>0.05). When in a raised state of hunger and offered a palatable buffet meal, altering the diameter of the dining plate onto which food was self-served did not significantly alter ad lib EI. We conclude there was no evidence that a smaller plate suppressed EI in a group of unrestrained, overweight women encouraged to eat to appetite from a wide choice of items. Whether plate size is a useful cue for portion size, and hence control of EI, in individuals actively restricting intake however remains possible, and requires investigation.

Comparison between transperineal ultrasound and digital detection of levator ani trauma. Can we improve the odds

To investigate the predictive ability of four digital assessment parameters to detect levator ani (LA) muscle defects (avulsion injury) and compare these to transperineal tomographic ultrasound images.

Inference and the introductory statistics course

This article sets out some of the rationale and arguments for making major changes to the teaching and learning of statistical inference in introductory courses at our universities by changing from a norm-based, mathematical approach to more conceptually accessible computer-based approaches. The core problem of the inferential argument with its hypothetical probabilistic reasoning process is examined in some depth. We argue that the revolution in the teaching of inference must begin. We also discuss some perplexing issues, problematic areas and some new insights into language conundrums associated with introducing the logic of inference through randomization methods.

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

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

An automated hand-held elastometer for quantifying the passive stiffness of the levator ani muscle in women.

Design and develop an automated, hand‐held instrument (elastometer) to assess in vivo passive stiffness of the pelvic floor muscle.

Duodenal and ileal glucose infusions differentially alter gastrointestinal peptides, appetite response, and food intake: a tube feeding study

Background: Activation of the ileal brake through the delivery of nutrients into the distal small intestine to promote satiety and suppress food intake provides a new target for weight loss. Evidence is limited, with support from naso-ileal lipid infusion studies.Objective: The objective of the study was to investigate whether glucose infused into the duodenum and ileum differentially alters appetite response, food intake, and secretion of satiety-related gastrointestinal peptides.Design: Fourteen healthy male participants were randomly assigned to a blinded 4-treatment crossover, with each treatment of single-day duration. On the day before the intervention (day 0), a 380-cm multilumen tube (1.75-mm diameter) with independent port access to the duodenum and ileum was inserted, and position was confirmed by X-ray. Subsequently (days 1-4), a standardized breakfast meal was followed midmorning by a 90-min infusion of isotonic glucose (15 g, 235 kJ) or saline to the duodenum or ileum. Appetite ratings were assessed with the use of visual analog scales (VASs), blood samples collected, and ad libitum energy intake (EI) measured at lunch, afternoon snack, and dinner.Results: Thirteen participants completed the 4 infusion days. There was a significant effect of nutrient infused and site (treatment × time, P < 0.05) such that glucose-to-ileum altered VAS-rated fullness, satisfaction, and thoughts of food compared with saline-to-ileum (Tukeys post hoc, P < 0.05); decreased ad libitum EI at lunch compared with glucose-to-duodenum [-22%, -988 ± 379 kJ (mean ± SEM), Tukeys post hoc, P < 0.05]; and increased glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) compared with all other treatments (Tukeys post hoc, P < 0.05).Conclusions: Macronutrient delivery to the proximal and distal small intestine elicits different outcomes. Glucose infusion to the ileum increased GLP-1 and PYY secretion, suppressed aspects of VAS-rated appetite, and decreased ad libitum EI at a subsequent meal. Although glucose to the duodenum also suppressed appetite ratings, eating behavior was not altered. This trial was registered at www.anzctr.org.au as ACTRN12612000429853.

Characterizing levator‐ani muscle stiffness pre‐ and post‐childbirth in European and Polynesian women in New Zealand: a pilot study

The influence of levator‐ani muscles on second‐stage labor is poorly understood. The ability of these muscles to stretch without damage may affect birth outcomes, but little is known about material properties, effects of pregnancy and/or ethnicity on levator‐ani stiffness. There are strong associations between muscle damage and subsequent pelvic floor disorders. This study aimed to quantify levator‐ani muscle stiffness during the third trimester of pregnancy and postpartum in European and Polynesian women. Associations between stiffness, obstetric variables, and the risk of intrapartum levator‐ani injury (avulsion) were investigated.