A systematic evaluation of food textures to decrease packing and increase oral intake in children with pediatric feeding disorders

This study examined packing (pocketing or holding accepted food in the mouth) in 3 children who were failing to thrive or had inadequate weight gain due to insufficient caloric intake. The results of an analysis of texture indicated that total grams consumed were higher when lower textured foods were presented than when higher textured foods were presented. The gram intake was related directly to levels of packing. That is, high levels of packing were associated with higher textured foods and low gram intake, and low levels of packing were associated with lower textured foods and high gram intake. All participants gained weight when texture of foods was decreased. Packing remained low during follow-up for 2 participants even when the texture of food was increased gradually over time. These data are discussed in relation to avoidance, response effort, and skill deficit.     

THE EFFECT OF INFORMATIONAL FEEDBACK ON FOOD INTAKE OF ADULT BURN PATIENTS

The effect of informational feedback on the protein and caloric consumption of burn patients was investigated using a multiple-baseline across subjects. The patients were four severely burned adult males who failed to consume sufficient foods to achieve prescribed levels of protein or kilocalories via standard burn unit procedures during recovery. Feedback consisted of informing patients of (a) their prescribed levels of protein and kilocalories, (b) the protein and kilocalorie content of hospital foods and beverages, and (c) their actual intake of protein and kilocalories. Following the provision of feedback, there was an increase in protein and kilocalorie intakes and in the number of days during which prescribed levels for protein and kilocalories were achieved. These results suggest that the informational feedback was effective for improving the oral caloric intake of burn patients.     

Polydipsia induced by intermittent delivery of salted liquid foods

Food-deprived rats given constant access to water were exposed to fixed-time presentations of soybean milk and diluted sweetened condensed cows' milk. In some conditions these liquid foods were adulterated with varying amounts of sodium chloride. Under a fixed-time 30-sec schedule of food delivery, little water was consumed when the food was soybean milk alone, or soybean milk with sodium chloride added in concentrations of .9, 1.8, or 3.6%. However, schedule-induced polydipsia appeared when soybean milk adulterated with 7.2 or 14.4% sodium chloride was delivered under this schedule. When soybean milk containing 7.2% sodium chloride was presented under fixed-time 15-, 30-, 60-, 120-, and 240-sec schedules, schedule-induced drinking increased with the fixed-time value from 15 to 120 seconds, and decreased at 240 seconds. Like soybean milk, diluted sweetened condensed milk delivered under fixed-time schedules of 30, 60, and 120 seconds failed to evoke schedule-induced polydipsia, but did so when adulterated with 7.2% sodium chloride. Drinking induced by salted liquid foods resembled the polydipsia engendered by spaced dry-food presentations in several ways, including temporal relation to food delivery, persistence within and across sections, sensitivity to interfood interval, and magnitude relative to intake evoked by bulk-food presentation.     

Anticipation of future food: suppression and facilitation of saccharin intake depending on the delay and type of future food

A series of studies examined the (Sprague-Dawley) rat's tendency to suppress intake of .15% saccharin when it was followed by a second food after 4-, 16-, or 32-min delays. The second foods examined were 32% sucrose, 64% sucrose, lab chow, a Nutrasweet solution, skim milk, and chocolate milk. Saccharin intake was influenced by both the delay and the specific food available. Subsequent analysis showed that saccharin intake before the 4-min delay was an inverse function of the caloric value of the second food. However, saccharin intake before the 16-min delay was better predicted as an inverse function of the hedonic value of the second food. The results suggest that the caloric and hedonic values of a food may influence food selection across different time courses, and that the effective time horizon for the sequential comparison of foods depends on the specific foods that are compared.     

Snacking while watching TV impairs food recall and promotes food intake on a later TV free test meal

Eating while viewing TV may impair memory of food intake and promote over‐consumption on a later meal. In Experiment 1, females ate a similar amount of snack–food either with or without TV. Later, participants who had snacked with TV ate more food on a TV‐free lunch and were less accurate in recalling their earlier snack–food intake. Experiment 2 explored whether the nature of the TV content might alter these effects. Using a similar design, females watched boring, sad or funny TV, or no‐TV at all. Relative to the no‐TV control, all TV while snacking conditions ate a similarly greater amount on the later TV‐free test lunch. Recall accuracy for the snack phase was also similarly poorer in all TV conditions. These findings suggest that eating with TV per se impacts on later food intake, and a mnemonic‐based explanation seems to be the best account for these findings. Copyright © 2010 John Wiley & Sons, Ltd.     

Hyperphagia in rats with experimental diabetes mellitus: a response to a decreased supply of utilizable fuels

Alloxan-diabetic rats were hyperphagic when fed diets containing little fat, but they ate normal amounts of food when given diets rich in fat. Normal rats increased food intake to the same degree when the caloric density of their diet was decreased by reducing the content of fats or carbohydrates in isocaloric amounts. Diabetic rats did not respond substantially to changes in caloric density of their diet which were produced by altering the content of dietary carbohydrates, but they systematically increased food intake as the amount of fat in their diet was reduced. Diabetic rats ate normal amounts of a high-fat diet despite continued loss of nutrients in urine and persisting impairments in glucose utilization, fat storage, and liver glycogen deposition. These findings suggest that hyperphagia in experimental diabetes mellitus is a compensatory response to a lack of utiliziable fat fuels rather than the result of a metabolic disturbance per se.     

Mere social knowledge impacts children's consumption and categorization of foods

How does social information affect the perception of taste early in life? Does mere knowledge of other people's food preferences impact children's own experience when eating? In Experiment 1, 5‐ and 6‐year‐old children consumed more of a food described as popular with other children than a food that was described as unpopular with other children, even though the two foods were identical. In Experiment 2, children ate more of a food described as popular with children than a food described as popular with adults. Experiment 3 tested whether different perceptual experiences of otherwise identical foods contributed to the mechanisms underlying children's consumption. After sampling both endpoints of a sweet‐to‐sour range (applesauce with 0 mL or 5mL of lemon juice added), children were asked to taste and categorize applesauce samples with varying amounts of lemon juice added. When classifying ambiguous samples that were near the midpoint of the range (2 mL and 3 mL), children were more likely to categorize popular foods as sweet as compared to unpopular foods. Together, these findings provide evidence that social information plays a powerful role in guiding children's consumption and perception of foods. Broader links to the sociality of food selection are discussed.     

INCREASING RURAL HEAD START CHILDREN'S CONSUMPTION OF MIDDLE-CLASS MEALS1

Rural black, economically impoverished Head Start children, whose normal diets were deficient in nutritional requirements, were not consuming the nutritional breakfasts of, to them, unfamiliar foods provided by the county school system. This study investigated a positive simple method to increase the amount of food consumed and thereby ensure proper nutrition. Teachers dispensed sugar-coated cereal and small candies paired with praise contingent on eating behaviors and rewarded children who finished the entire meal with additional treats and praise. Substantial increases were produced in the proportion of meals consumed and in the number of children observed engaged in eating behaviors. These simple traditional behavioral procedures are readily available for any staff working with economically impoverished children as one method of increasing their sampling and consumption of unfamiliar nutritious foods.     

Relations Among Milk and Non-Milk Beverage Consumption, Calcium, and Relative Weight in High-Weight Status Children

Relations among weight, calcium, and milk have received considerable attention, but inconsistencies remain regarding strength and direction of associations. Calcium, milk, other beverages, and weight status associations were examined among children >75th BMI percentile from three studies. Results indicated negative relations between z-BMI and non-whole milk and calcium in one sample, with lower z-BMI and percent body fat among older children drinking any non-whole milk. In one older child sample, z-BMI and percent body fat were higher for whole milk consumers. The only significant relation observed for other beverages was the negative association between juice and percent body fat in younger children. Milk, calcium, and child weight status associations are inconsistent, and appear dependent on milk type and child age.     

How emotions expressed by adults’ faces affect the desire to eat liked and disliked foods in children compared to adults

The aim of this study was to determine whether or not pleasure, neutrality, and disgust expressed by eaters in photographs could affect the desire to eat food products to a greater extent in children than in adults. Children of 5 and 8 years of age, as well as adults, were presented with photographs of liked and disliked foods. These foods were presented either alone or with an eater who expressed three different emotions: pleasure, neutrality, or disgust. Results showed that, compared with food presented alone, food presented with a pleasant face increased the desire to eat disliked foods, particularly in children, and increased the desire to eat liked foods only in the 5‐year‐old children. In contrast, with a disgusted face, the desire to eat the liked foods decreased in all participants, although to a greater extent in children, while it had no effect on the desire to eat the disliked foods. Finally, food presented with a neutral face also increased and decreased the desire to eat disliked and liked foods, respectively, and in each case more for the 5‐year‐olds than for the older participants. In sum, the facial expressions of others influence the desire to eat liked and disliked foods and, to a greater extent, in younger children.     

The Role of External Sources of Information in Children's Evaluative Food Categories

Evaluative food categories are value‐laden assessments, which reflect the healthfulness and palatability of foods (e.g. healthy/unhealthy, yummy/yucky). In a series of three studies, this research examines how 3‐ to 4‐year‐old children (N = 147) form evaluative food categories based on input from external sources of information. The results indicate that children prefer to ask a mom and teacher over a cartoon and child for information about the evaluative status of foods. However, children are cautious to accept information about healthy foods from all of the external sources compared with unhealthy, yummy and yucky foods. The results also indicate that providing information about the positive taste of healthy foods helps to encourage children to select healthy foods to eat. Taken together, these results have potential implications for children's health and nutrition education. Copyright © 2011 John Wiley & Sons, Ltd.     

PLATE A–PLATE B: USE OF SEQUENTIAL PRESENTATION IN THE TREATMENT OF FOOD SELECTIVITY

This study examined the effects of sequential presentation of foods on increasing acceptance of novel foods in a 16‐year‐old boy with autism spectrum disorder residing in a short‐term behavioral stabilization unit. The participant ate only 10 foods and one beverage prior to treatment. The intervention involved presenting a plate containing pea‐sized bites of novel foods (Plate A) and a plate containing spoonful‐sized bites of highly preferred foods (Plate B). After the participant consumed a bite from Plate A, he chose a bite from Plate B and was given a preferred beverage. The intervention, involving sequential presentation and establishing operations without the use of escape extinction, was successful in increasing the number of foods eaten from 10 to 24 while not increasing his maladaptive behaviors. Copyright © 2012 John Wiley & Sons, Ltd.     

Weight gain and withdrawal symptoms after smoking cessation: a preventive intervention using d-fenfluramine

Directly measured food intake in 31 overweight female smokers to test whether (a) calorie and carbohydrate intakes increase after smoking cessation and (b) double-blind d-fenfluramine (30 mg), a serotonin-releasing drug, suppresses weight gain, overeating, and dysphoric mood associated with stopping smoking. Placebo-treated patients grew dysphoric after smoking withdrawal and ate 300 kcal/day more from 2 to 28 days after, showing a 3.5-lb weight gain. Fat and protein intakes did not change, but carbohydrate intake increased (30% to 40%). D-fenfluramine prevented postcessation dysphoria. Although drug-treated patients ate more carbohydrate snacks just after quitting, they returned to baseline by 4 weeks, showing a 1.8-lb weight loss. Agents that enhance brain serotonin-mediated neurotransmission may help prevent weight gain, overeating, and dysphoric mood after smoking withdrawal.     

BEHAVIORAL ASSESSMENT AND TREATMENT OF CHRONIC FOOD REFUSAL IN HANDICAPPED CHILDREN

In this study, we examined the eating behavior of four handicapped children, none of whom exhibited self-feeding skills. All children had a history of food refusal and were nutritionally at risk; one child received all nourishment by way of a gastrostomy tube. Baseline data taken during mealtimes indicated that all children accepted very little food, expelled food frequently, and engaged in a number of disruptive behaviors. Treatments consisted of one or more of the following contingent events: social praise, access to preferred foods, brief periods of toy play, and forced feeding. Results of multiple-baseline and reversal designs showed marked behavioral improvement for each child and increases in the amount of food consumed. Further improvements were noted at follow-up, which ranged from 7 to 30 months posttreatment.     

A comparison of two multicomponent treatment packages for food refusal

Food refusal is a severe feeding problem in which children refuse to eat all or most foods, which can be treated effectively using multicomponent intervention packages. This study compared two multicomponent treatment packages on food and drink consumption, inappropriate mealtime behavior, and total intake in a child with food refusal. Bite and drink consumption was consistently higher; inappropriate mealtime behavior was consistently lower; and total intake was greater when differential reinforcement of alternative behavior and escape extinction treatment were implemented compared to response cost, escape extinction, and differential reinforcement of alternative behavior.     

Conditioned and unconditioned caloric compensation: Evidence for self-regulation of food intake in young children

The purpose of these two experiments was to determine (a) whether young children can be responsive to caloric density cues in regulating their food intake, (b) whether such cues can be associatively conditioned to organoleptic cues in foods, and (c) to obtain evidence regarding which of the many cues available are involved as conditioned stimuli. In Experiment 1 participants were eighteen 3- to 5-year-old children, who were seen for a series of pairs of conditioning trials, followed by extinction test trials. Each trial consisted of a two-part snack: approximately 100 ml of a pudding preload (chocolate or vanilla; high or low caloric density) followed after a delay by ad-lib consumption of snack foods (cookies and crackers). In extinction trials, flavors previously paired with high- or low-caloric density preloads during conditioning were presented in isocaloric intermediate density preloads. Results indicated that 14 of 18 children showed unconditioned caloric compensation on the first pair of conditioning trials; 16 of 18 children showed compensation following the second pair of trials, and 12 of these 16 subjects continued to show this consumption pattern during extinction. Consumption was significantly greater following the low calorie paired flavor than following the high calorie paired flavor during extinction. Experiment 2 (N = 10) replicated these findings, and uncorrelating preload and snack food flavors indicated that flavor cues in the preloads can serve as conditioned stimuli. Children showed both initial responsiveness to caloric density and evidence for associative conditioning of food cues to the physiological consequences of eating. These results provide initial evidence for a mechanism allowing the child to learn to anticipate the caloric consequences of familiar foods and regulate food intake accordingly.     

BEHAVIORAL ASSESSMENT OF FEEDING PROBLEMS OF INDIVIDUALS WITH SEVERE DISABILITIES

As many as 80% of the individuals with severe or profound mental retardation exhibit feeding problems. Although behavioral interventions have been used to treat these problems, no assessment procedure for determining a functional relationship between a person's acceptance of food and the type and texture of that food has been reported. The purpose of this study was to test a behavioral assessment procedure for a feeding problem of limited intake. Five individuals with severe or profound mental retardation were fed 10 to 12 types of foods with one or more textures. Behavioral categories of acceptance, rejection, expulsion, and other negative behavior were recorded. Results indicated that each subject fit into one of four categories of feeding problems: (a) total refusal, (b) type selectivity, (c) texture selectivity, or (d) type and texture selectivity. Thus, although all 5 subjects exhibited limited intake, the food characteristics correlated with the problem were different for each individual. Results suggest that treatments for limited intake may be based on assessments that show the association of food type or texture to a person's rejection or expulsion of food.     

Dietary variety, energy regulation, and obesity

Increased variety in the food supply may contribute to the development and maintenance of obesity. Thirty-nine studies examining dietary variety, energy intake, and body composition are reviewed. Animal and human studies show that food consumption increases when there is more variety in a meal or diet and that greater dietary variety is associated with increased body weight and fat. A hypothesized mechanism for these findings is sensory-specific satiety, a phenomenon demonstrating greater reductions in hedonic ratings or intake of foods consumed compared with foods not consumed. Nineteen studies documenting change in preference, intake, and hedonic ratings of food after a food has been eaten to satiation in animals and humans are reviewed, and the theory of sensory-specific satiety is examined. The review concludes with the relevance of oral habituation theory as a unifying construct for the effects of variety and sensory-specific satiety, clinical implications of dietary variety and sensory-specific satiety on energy regulation, and suggestions for future research.     

Protein deprivation in primates: VI. Food preferences of adult rhesus monkeys maintained on low-protein diets.

Three groups of adult female rhesus monkeys, maintained on low-protein diets (.5 gm, 1 gm, and 2 gm protein per kg body weight, were compared with a control group (4 gm protein per kg body weight) on a food-preference task. Food responsiveness was assessed by presenting 8 small pieces of a certain food, equally spaced about the perimeter of a turntable attached to the home cage, and recording number of pieces taken, number of pieces eaten, and elapsed time for taking all 8 pieces. 21 different foods were used in sequence, 3 each from the following 7 categories: cheese, meat, vegetable, nut, cereal, fruit, and candy. Scores on all 3 measures were highly correlated, and the order of preference was generally the same for all groups. The 2 lowest-protein groups accepted more foods at the lower end of the palatability spectrum than did either the 4-gm or the 2-gm group. There was a tendency for the foods least preferred by the protein-deprived monkeys to be themselves high in protein. Thus, although protein deprivation appears to increase the catholicity of food preference, there is no corresponding increase in the relationship between palatability and protein content.