Interruption of scheduled, automatic feeding and reduction of excess energy intake in toddlers

Abstract

Background: Childhood obesity due to the consumption of excess calories is a severe problem in developed countries. In a previous investigation on toddlers, hospital laboratory measurements showed an association of food-demand behavior with constant lower blood glucose before meals than for scheduled meals. We hypothesize that maternal scheduling of meals for toddlers results in excess energy intake compared to feeding only on demand (previously "on request").

Objective: We tested the cross-sectional null hypothesis of no difference in energy intake between scheduled (automatic) and demanded meals (administered after evaluation) in 24 mother-toddler (21 months old at entry) pairs with chronic, nonspecific diarrhea presenting at a clinic. We tested the same hypothesis in a subset of 14 toddlers by measuring the resting (sleeping) metabolic rate 4 hours after lunch, as well as the total daily energy expenditure (TEE) in 10 toddlers.

Methods: We trained mothers to recognize meal demands (as in the previous investigation) and to provide food in response, but required no blood glucose measurements before meals. Energy intake was assessed by a 10-day food diary, resting metabolic rate (RMR) by respiratory analyses (indirect calorimetry) in 14 toddlers, and TEE by doubly labeled water in 10 toddlers. Their blood parameters, anthropometry, and number of days with diarrhea were assessed before training and 50 days after training.

Results: RMR decreased from 58.6 ± 7.8 to 49.0 ± 9.1 kcal/kg/d (P < 0.001) and TEE decreased from 80.1 ± 6.9 to 67.8 ± 10.0 kcal/kg/d (P < 0.001). Energy intake decreased from 85.7 ± 15.3 to 70.3 ± 15.8 kcal/kg/d (P < 0.001). The height Z-score increased significantly, while weight growth was normal. Toddlers entering the study over the median RMR decreased their RMR significantly more than those below the median RMR (P < 0.01).

Conclusion: Scheduled meal suspension induces meal demand frequency to increase. Demanded meals are associated with significantly lower energy intake, RMR, and TEE than scheduled meals. Feeding on demand may be an effective skill in a strategy for reducing excess energy intake in the long term and in regulating body weight in toddlers and children.

Keywords: balance; blood glucose; chronic diarrhea; energy; homeostasis; hunger; intake; intake habit; meal pattern; meals; overweight.

Figure 1

Resting metabolic rate (RMR) decreases (P < 0.01) in seven infants with low RMR at recruitment in comparison with seven infants with high RMR at recruitment (P < 0.01). Note: White columns show RMR values and black columns show respective decreases after training in the initial demand meal pattern.