Requested meals versus scheduled meals

Abstract

Background: Scheduled meals are considered to be equivalent to those requested by the infant (null hypothesis). In adults, we have found high blood glucose before scheduled meals and low blood glucose after recognition of validated initial hunger. Low preprandial blood glucose is associated with a decrease in energy intake and body weight both in adults who are overtly overweight and in those who are of normal weight with insulin resistance (hidden overweight). In this study, we investigated the validity of the null hypothesis between scheduled and requested meals in 2-year-old infants with chronic nonspecific diarrhea.

Methods: We trained a "recognizing request" meal pattern in 70 mother-infant pairs. The trained meal pattern consisted of administering food after a first request that we validated by blood glucose measurement in the hospital laboratory. Using a 7-day food diary, mothers reported preprandial blood glucose measurements for their infants three times a day. We assessed mean preprandial blood glucose, daily energy intake, days with diarrhea, blood parameters, and anthropometry before training and 4 months after training, and compared the results with measurements in 73 randomly selected untrained controls.

Results: In the trained group, there was a decrease in mean blood glucose from 86.9 ± 9.4 mg/dL to 76.4 ± 6.7 mg/dL (P < 0.0001), as well as a decrease in energy intake and days with diarrhea in comparison with control infants who maintained scheduled meals. Only two of 21 infants who had a mean blood glucose lower than 81.2 mg/dL at recruitment showed a statistically significant decrease in mean blood glucose, whereas 36 of 49 infants above this cutoff level showed a statistically significant decrease after training (Chi-square test, P < 0.0001).

Conclusion: Requested meals are associated with low preprandial blood glucose, significantly lower energy intake, and recovery from diarrhea, whereas scheduled meals are associated with high blood glucose, higher energy intake, and persistence of diarrhea. The disparities in blood glucose levels and energy intake disprove the null hypothesis, suggesting the need for a change from scheduled to requested meals early on in food administration, ie, during the neonatal period.

Keywords: blood glucose; chronic diarrhea; energy; homeostasis; meals; overweight.

Figure 1

Difference in mean blood glucose after training versus value from 7-day diary at recruitment for each trained subject. Notes: Column height shows 5-month mean blood glucose minus recruitment value in each trained subject. Significant decreases in red and nonsignificant changes in black. Mean blood glucose reported in sequentially increasing order at recruitment, not in linear correlation with segment length on the x-axis scale. The vertical division indicates the most significant division between subjects who showed no mean blood glucose decrease after training (LBG group, n = 21 subjects) and those who showed significant decrease of mean blood glucose (HBG group, n = 49 subjects; χ² analysis: P = 0.00001). This threshold blood glucose at recruitment (demarcation point) is 81.2 mg/dL (4.5 mmol/L). Abbreviations: HBG, high blood glucose; LBG, low blood glucose.