Both increases and decreases in energy density lead to sustained changes in preschool children's energy intake over 5 days

Abstract

Background and objective: To investigate preschool children's ability to self-regulate their energy intake, we assessed their response to increases or decreases in dietary energy density (ED) over 5 consecutive days, a period likely long enough for compensatory behavior.

Methods: Using a crossover design, over 3 periods we served the same 5 daily menus to 49 children aged 3-5 y in their childcare centers. During each 5-day period, 3 main dishes and 1 snack per day were systematically varied in ED, from baseline ED to either higher ED (increased by 20%) or lower ED (decreased by 20%). All of the served items were weighed to determine individual intakes.

Results: Modifying the ED of 4 dishes per day had a significant and sustained effect on preschool children's daily energy intake across 5 days. In the baseline condition, children's intakes were similar to daily energy needs (98 ± 2%), but serving higher-ED foods increased energy intake by 84 ± 16 kcal/d (to 105 ± 2% of needs) and serving lower-ED foods decreased energy intake by 72 ± 17 kcal/d (to 89 ± 2% of needs; both P < .0001). The patterns of daily energy intake over the 5 days did not differ across conditions (P = .20), thus there was no evidence that either surfeits or deficits in energy intake led to adjustment over this time period. Furthermore, the response to ED varied, as children with a higher weight status had greater amounts of overconsumption when served higher-ED foods and of underconsumption when served lower-ED foods compared to children with a lower weight status.

Conclusions: These findings counter the suggestion that preschool children's regulatory systems can be relied on to adjust intake in response to energy imbalances. Increasing or decreasing the ED of several foods per day leads to sustained changes in the energy intake of preschool children.

Keywords: Eating behavior; Energy density; Energy intake; Energy regulation; Preschool children.

FIGURE 1

Mean (±SEM) daily intake across time according to the (A) weight and (B) energy consumed by 49 preschool children who over 3 different 5-day periods were served multiple lower-energy density (ED), baseline-ED, and higher-ED foods. Mean daily intakes and trajectories are from mixed models that were adjusted for study week, menu, classroom, and sex. A random coefficients model showed that the pattern of daily intake over 5 days did not differ between conditions for weight (P=0.19) or energy (P=0.94), indicating intake was not adjusted in response to changes in ED. Thus, increases and decreases in energy intake from the baseline-ED condition were sustained over time.

FIGURE 2

Mean cumulative energy intake consumed by 49 preschool children who over 3 different 5-day periods were served lower-energy density (ED), baseline-ED, and higher-ED foods. A mixed linear model demonstrated that ED variations resulted in significantly different cumulative intakes: 5549±290 kcal in the higher-ED, 4976±221 in the baseline-ED condition, and 4549±180 in the lower-ED condition (all P<0.02).