Feeding frequency and appetite in lean and obese prepubertal children

Abstract

To determine the effect of feeding frequency on appetite in normal weight (NW) and obese (OB) prepubertal children, we carried out a prospective, randomized interventional study of 18 NW and 17 OB children ages 6-10. Children received three or five feedings in random order on separate days. Total calories, carbohydrate, protein, and fat composition on each day were equal. Two hours following the last feeding, children were offered ice cream ad lib. The major outcome variable was kilocalories ice cream consumed. A visual analog scale to assess fullness was also administered before consumption of ice cream. We observed that OB children consumed 73.0 ± 37.4 kcal more after five feedings than after three feedings whereas the NW children consumed 47.1 ± 27.8 kcal less. There was significant interaction between meal pattern and weight group indicating that this change in ice cream consumption differed significantly between groups (P = 0.014 by two-factor analysis). Ice cream intake/kg was less in OB compared to NW subjects (P = 0.012). Fullness ratings before ice cream did not differ by meal pattern or weight group. However, pre-ice cream fullness predicted ice cream intake in NW but not OB children. In summary, OB and NW children differed in appetite response to meal frequency. Our data suggest that: (i) satiety in OB children is related more to proximity of calories (larger supper) than to antecedent distribution of calories and; (ii) NW children may be more prone to restrict intake based on subjective fullness.

Figure 1

Ice cream consumption. (a, b) Total ice cream consumed by normal weight (NW, n = 18) and obese (OB, n = 17) children according to meal pattern (a) and as differential values calculated as kcal consumed after three meals minus that consumed after five meals (b). (c, d) Ice cream consumed at the second serving according to meal pattern (c) and as differential values (d). Data were analyzed by two-factor linear mixed model analysis comparing the effect of meal pattern (three or five meals, repeated measures), weight status (NW or OB), and interaction (weight status × meal pattern). The effect of meal pattern differed according to weight group (b, d). Bonferroni post-tests revealed a significant within group increase in ice cream consumption by OB subjects at the second feeding (c).

Figure 2

Ice cream consumption per kg. (a) Ice cream consumed per kg body weight by normal weight (NW, n = 18) and obese (OB, n = 17) children according to meal pattern. For each child in the OB and NW groups, the differential values were calculated as kcal/kg consumed after three meals minus that consumed after five meals (b). Data were analyzed as in the legend to Figure 1. The effect of meal pattern differed according to weight group (P = 0.012 for interaction). The two-factor analysis also revealed that obese subjects consumed less ice cream per kg body weight than lean (P = 0.031).

Figure 3

Ice cream consumption as a function of subjective fullness. (a, b) Relationships between pre-supper fullness ratings and total ice cream consumed or (c, d) ice cream consumed per kg for normal we ight (NW) and obese (OB) children. Linear regression analysis was performed for data obtained after the three-meal pattern (open circles) and the five-meal pattern (closed circles) or for the combined data.

Figure 4

Insulin and glucose concentrations determined pre-supper (Sup) and pre-ice cream (PIC) in NW and OB children after the meal pattern indicated. *P < 0.001 compared to pre-supper. Data were analyzed by two-factor linear mixed model analysis comparing the effect of meal pattern (three or five meals) and time (Sup or PIC) with repeated measures for both factors. The analysis considers all the insulin and glucose data (assessed pre-meals and pre-ice cream, and presented in detail in Figure 1 of supplementary data online). NW, normal weight; OB, obese.