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PubMed2006

Is dietary intake able to explain differences in body fatness in children and adolescents?

Obesity is the result of an imbalance between energy intake and energy expenditure. Controversial information exists about what are the strongest energy balance aspects influencing body fatness. This article is focused on food consumption facts that could be related to the risk of being obese in children and adolescents. It reviews whether energy intake, macronutrient composition of diet, eating patterns or other dietary intake factors are able to explain differences in body composition when obesity has been already developed or even in subjects at risk to become obese. There is not enough evidence to clarify the importance of diet on overweight children and adolescents, and conclusions derived are somewhat controversial. Cross-sectional and longitudinal studies do not show clear relationships between energy intake or food composition and body fatness. To find relations between dietary factors and childhood obesity perhaps eating patterns or different types of foods must be considered: meal patterns and meal frequency, snacking and beverage consumption, fast food intake, portion sizes, etc. There is no clear association between different aspects of dietary intake and the development of obesity in children and adolescents. Longitudinal and experimental studies are needed in the future.

Adolescent↗
PubMedDate not supplied

Obesity prevention in children: physical activity and nutrition.

The current environmental experience of young children includes few opportunities for physical activity and an overabundance of high calorie foods. Sedentary lifestyles and poor nutrition challenge children who are predisposed to metabolic disorders. Obesity is a logical response to this challenge. To prevent clinically significant obesity and later metabolic disease in predisposed youth, all sectors of society must work together to support strategies to change public opinion and behavior across the life span. Parental education in all medical settings is strongly recommended, especially if the parent(s) are obese, beginning with the first pregnancy visit to the physician. Schools should be primary targets for efforts to educate parents concerning the reduction of TV, computer games, and unhealthy snacks. Schools should be encouraged to adopt vending machine policies that promote healthy drinks and food in appropriate portion sizes and discouraged from providing unhealthy food as rewards for positive behavior or academic accomplishment. Schools should provide daily physical education and frequent periods of unstructured play in young children. Clinical treatment should be both encouraged and financially supported in children who are already overweight. Community wide efforts to increase awareness and promote environments that encourage physical activity and healthy nutrition are needed.

Child↗
PubMed2005

Accuracy of a PDA-based dietary assessment program.

OBJECTIVE: Study objectives were to assess the accuracy of a food record delivered on a personal digital assistant (PDA) and to examine sources of error from the PDA-based food record. METHODS: Thirty-nine adults recruited with a newspaper advertisement were trained to record food intake using DietMatePro, a dietary assessment program delivered on a PDA. After 3 d of use, subjects returned for a follow-up visit in which a 24-h recall was conducted. Subjects also were timed while recording an observed, weighed lunch. Recalled and actual food intakes were compared with estimates recorded by the subjects when using the PDA. Paired sample t tests and Pearson's correlations assessed means and measurements of association between DietMatePro data compared with the 24-h recall data and observed meal data. Bland-Altman plots were used to assess bias in food recording. Sources of error were quantified by using calories as the unit for comparison. RESULTS: There were no significant differences in daily totals for calories and macronutrients between DietMatePro data and comparison measurements. Pearson's correlations of associations between DietMatePro data and the comparison measurement ranged from 0.505 to 0.797 (P < 0.005, n = 28) for the 24-h recall and from 0.419 to 0.786 (P < 0.005, n = 33) for the observed lunch, depending on the nutrient measured. The largest source of absolute error in caloric estimation was attributable to portion size estimation error (49%). CONCLUSIONS: DietMatePro, a PDA-based dietary assessment program, provides a method of assessing energy and macronutrient intakes comparable to the 24-h recall in samples lacking dietary restrictions.

Adult↗
PubMed2004

Energy density, diet composition and palatability: influences on overall food energy intake in humans.

This paper considers the role of energy density (ED), diet composition and palatability in the control of energy intake (EI) in humans through several related considerations: (i) the relationship between ED and diet composition, (ii) the relationship between ED, diet composition and EI, (iii) the relationship between palatability and EI, (iv) the relationship between ED, palatability and EI, (v) the importance of postingestive factors in influencing palatability in the longer term, (vi) the contribution of sensory and nutritional factors to dietary hyperphagia and (vii) the implications these considerations have for people living their normal lives in their natural environment. The main factors influencing ED are the fat and water content of foods. Energy density does elevate EI, especially in short-term studies where it can account for >40% of the variance in EI. In real life, ED accounts for only approximately 7% of the variance in EI. This is because the determinants of EI are multifactorial and also because the short-term effects of ED on EI do not translate into the longer term. We argue that part of the longer term amelioration of short-term effects of ED on EI is due to learned compensation, based on the postingestive consequences of consuming familiar food that differ in ED. More energy-dense foods tend to be more palatable but we learn to consume them in smaller portion sizes. In the longer term, the perceived palatability of a food is strongly influenced by the postingestive consequences of eating it. This effect can override sensory factors alone. This implies that nutrient mimetics, if used continuously, would not be as efficacious as initially supposed and that their ad hoc use may undermine the stability of learned appetites and satieties for foods with different EDs and contribute to the poor weight control capability exhibited by consumers at large.

Diet↗
PubMed2005

The non-regulation of food intake in humans: hope for reversing the epidemic of obesity.

Few doubt that human feeding behavior is part of larger biology regulatory system of energy stores, but the extent to which eating behavior is controlled by these biology systems and how much is due to responses to environmental stimuli is presently under debate. The results of a series of studies are presented which have attempted to determine the responsiveness of human feeding behavior to some of the "classic" biological variables that have conventionally been used to argue the biological basis of eating behavior. When humans are challenged with either overfeeding, underfeeding, or alterations of the caloric density of the diet, they fail to demonstrate precise caloric compensation. When challenged with changes in environmental stimuli, on the other hand, humans appear to be very sensitive to changes in portion size, the number of people with whom they eat, the amount that others eat and the variety of foods available. Other more chronic influences demonstrate that body weight appears to change when people move from one area of the world to another, when they enter the college environment, or when they either marry or break up. It is argued that because humans appear to be more responsive to the external environment than internal biological cues, it should be possible to curb or even reverse the epidemic of obesity by changing aspects of the external environment or human interactions with environmental variables rather than changing their internal environment through pharmacology.

Body Weight↗
PubMed2005

Normative influences on food intake.

Hunger and satiety have conventionally provided the framework for understanding eating and overeating. We argue that hunger and satiety play a relatively small role in everyday eating. The normative control of food intake refers to the fact that our eating is largely governed by the motive to avoid eating excessively. Dieters impose a restrictive intake norm on themselves, but often violate the norm. Personal norms are individualized rules that people develop to help themselves decide how much is appropriate to eat in a given situation. Situational norms are derived from the eating situation itself; examples include portion size and social influence, which exert powerful effects on intake. We discuss the implications of a normative approach to the analysis of eating and overeating.

Diet↗
PubMed2005

Anthropometric indications and nutritional intake of women in the Vaal Triangle, South Africa.

OBJECTIVES: The main purpose of this study was to determine the anthropometric indications and nutritional intake of pregnant and lactating women in the Vaal Triangle (n = 431). DESIGN AND METHODS: A validated quantitative food frequency questionnaire was used in this study. Trained fieldworkers conducted interviews with the help of food models to estimate portion sizes. The anthropometric measurements included weight, height and body mass index (BMI). Blood samples were collected for determining iron status parameters. RESULTS: The 10 items consumed most frequently by pregnant women were, in descending order: fresh milk; tea; coffee; cold drinks; maize meal; fruit juice; bread; magou (non-alcoholic fermented maize drink); rice and sugar. For lactating women, the results were: fresh milk; tea; coffee; maize meal; cold drinks; magou; bread; yoghurt; rice and sugar. Daily intakes (mean +/- SD) for pregnant women were 8425.71 +/- 2279 kJ, 73.18 +/- 23 g protein, 62.29 +/- 23.7 g fat, 292.45 +/- 72.2 g carbohydrate and 9.74 +/- 3.8 mg iron. For lactating women, the intakes were 8511.94 +/- 2047 kJ, 76.24 +/- 25 g protein, 61.95 +/- 22.3 g fat, 294.37 +/- 64.2 g carbohydrate and 10.50 +/- 4.0 mg iron. The results of this study showed that most of the women (98%) resided in towns and 79.3% were unemployed. The majority of the sample population was overweight or obese (BMI> or = 25). CONCLUSIONS: The diets of the subjects consisted primarily of plant-based foods. Animal foods were scarce except for milk. Most of the items consumed were low in iron. IMPLICATIONS: Iron deficiency is partly induced by plant-based diets containing low levels of poorly bio-available iron. An assessment of dietary intake is required to aid in the development of relevant dietary guidelines for the sample population.

Adolescent↗
PubMed2006

Poverty, household food insecurity and nutrition: coping strategies in an informal settlement in the Vaal Triangle, South Africa.

OBJECTIVES: The objective of this study was to determine household food security and coping strategies of an informal settlement in the Vaal Triangle. STUDY DESIGN: A survey study design was used. METHODS: Pre-tested socio-demographic questionnaires were administered to 357 randomly selected caregivers and 149 children aged 9-13 years old. A validated quantified food frequency questionnaire (QFFQ) and 24-h recall were used to measure dietary intake and food consumption patterns and the Cornell hunger scale to determine coping strategies. Data were statistically analysed for means and standard deviations. RESULTS: The results indicated that the majority of caregivers (68.8%) had an income of <R500 (77 US dollars) per month, 70.5% (n=190) indicated a frequent shortage of money and 58.3% spent less than R100 (15 US dollars) per week on food. The coping strategies used were: limiting the variety of foods served (74.7%), limiting portion sizes (80%), skipping of meals (68.4%) and maternal buffering (75.8%). CONCLUSIONS: It can be concluded that this is a poverty-stricken community with household food insecurity where the caregivers changed their food consumption patterns to cope, resulting in compromised nutrition.

Adaptation, Psychological↗
PubMed2004

Novel estimates of the exposure to flavouring substances.

There are thousands of flavouring substances and hundreds of ways of consuming them. It is consequently impossible to carry out detailed analysis of the consumption patterns of each one, so as a result, it is necessary to find more practical and conservative methods for assessing exposure. Two studies have compared the suitability of one method: the maximised survey-derived daily intake (MSDI). In one of these studies, the MSDI-estimated intakes of nine flavouring substances and one spice oleoresin were compared with detailed dietary intakes calculated over a 14-day period using frequency of eating, portion sizes, levels of the flavouring substance and probability of presence in a particularly food item. In a second study, the MSDI-estimated intakes of 12 flavouring substances were compared with intakes calculated using a stochastic model. This model used real levels in over 40,000 flavour formulae used in 31 different categories of food for which the intakes of males in the 16-24 years age group had been surveyed. In both of these studies, the ability of the MSDI to accurately but conservatively estimate upper percentile intakes was demonstrated. This stochastic method offers an opportunity to test whether the MSDI can also be used to estimate the intakes of the volatile constituents that are common to a number of different botanically derived flavouring materials and food ingredients.

Adolescent↗
PubMed2000

In-person vs telephone-administered multiple-pass 24-hour recalls in women: validation with doubly labeled water.

OBJECTIVE: To determine the accuracy of energy intakes estimated with the multiple-pass 24-hour recall method in women by conducting in-person and telephone interviews. Doubly labeled water measurements of total energy expenditure were used for validation. SUBJECTS: Thirty-five weight-stable women (mean age = 30 years, range = 19 to 46 years) participated. DESIGN: Total energy expenditure was measured over a 14-day period using the doubly labeled water method. During this time, 4 multiple-pass 24-hour recalls were obtained from the women (2 in-person, 2 by telephone) who were provided 2-dimensional food models to estimate portion sizes. The Food Intake Analysis System was used to analyze recall data. STATISTICAL ANALYSES: Paired t tests were conducted to examine differences between energy intake estimated from the telephone and in-person interviews. Agreement between the energy intake estimates from the telephone recalls and the in-person recalls was assessed using the technique of Bland and Altman. Paired t tests were used to compare energy intake estimated from the telephone and in-person recalls to total energy expenditure. RESULTS: No significant difference in mean daily energy intake was found between the telephone (2,253 +/- 688 kcal) and in-person (2,173 +/- 656 kcal) interviews (P = .36). However, the mean energy intake from each interview method was significantly lower than total energy expenditure (2,644 +/- 503 kcal) (P = .006 and .001, respectively). APPLICATIONS/CONCLUSIONS: Underreporting of energy intake was widespread in the sample. Although the multiple-pass 24-hour recall method did not generate a group measure of energy intake that was accurate or unbiased, the telephone-administered multiple-pass 24-hour recall was just as effective in estimating energy intake as the recall administered in-person. Dietetics professionals should be aware of the pervasive and serious problem of under-reporting of self-reported food intakes.

Adult↗
PubMed2000

Applying conversation analysis to foster accurate reporting in the diet history interview.

Inaccuracy in reporting dietary intakes is a major problem in managing diet-related disease. There is no single best method of dietary assessment, but the diet history lends itself well to the clinical setting. In many diet histories data are collected orally, so analysis of interviews can provide insights into reporting behaviors. Conversation analysis is a qualitative method that describes the systematic organization of talk between people. Patterns are identified and checked for consistency within and among individual interviews. The aim of this study was to describe consistent ways of reporting diet histories and to identify conversational features of problematic reporting. Diet history interviews from 62 overweight and insulin-resistant adult volunteers (50 women, 12 men) attending an outpatient clinic and 14 healthy volunteers (7 men, 7 women) participating in an energy balance study were audiotaped and transcribed. Conversation analysis identified a remarkably consistent pattern of reporting diet histories and 3 conversational features that indicated problematic reporting: "it depends," denoting variability (least of all at breakfast); "probably," suggesting guesswork (related to portion sizes); and elaborated talk on certain foods, distinguishing sensitive topics (e.g., alcohol, chocolate, butter/margarine, take-out foods) from safe topics. These findings indicate that there are ways in which dietetics practitioners may conduct the diet history interview to foster more accurate reporting.

Adult↗
PubMed2000

A qualitative study of participants' experiences with dietary assessment.

OBJECTIVE: This article reports on the use of focus groups and an experimental participatory activity to investigate factors influencing participants' decisions about what to eat and what to report on food records and food frequency questionnaires. DESIGN: Four focus groups examined participants' experience with diet records and 3 focus groups explored the topic of food portions using a group consensus activity. Twenty-two women participated in the diet record focus groups, and 15 participated in portion estimation groups. SUBJECTS: Focus group participants were equally distributed by age and body mass index values. Each woman completed a 10-day doubly labeled water protocol to measure total energy expenditure, 7 days of diet records (before and during total energy expenditure), and a food frequency questionnaire after the total energy expenditure. ANALYSIS: Transcripts of the focus groups were coded to index categories of responses and to identify themes within and across those responses. Themes discussed in this article are those that were discussed most often and at greatest length by all groups. RESULTS: The diet record focus groups revealed that 2 major factors influenced reporting on diet records: honesty vs social acceptability, and simplifying food intake. The portion estimation focus groups revealed 5 factors that influenced perceptions of portion size: the role of food in the meal, the type of food, personal preferences, product serving sizes, and comparison of personal servings with those of others. APPLICATIONS: The validity and reliability of self-reported food consumption is greatly influenced by the ways people interpret and respond to dietary assessment instruments. These findings indicate that dietetics professionals need to take extra steps to address issues of accurately recording "bad" foods when training patients to complete diet records. Extra probing is needed when dietary records do not include snacks and include simple meals and a large amount of prepared and packaged food because this may indicate that changes in normal dietary patterns were made in order to more easily complete a dietary record.

Adult↗
PubMed2001

Validation for MEDFICTS, a dietary assessment instrument for evaluating adherence to total and saturated fat recommendations of the National Cholesterol Education Program Step 1 and Step 2 diets.

MEDFICTS is a dietary assessment instrument designed to evaluate patient adherence to the National Cholesterol Education Program Step 1 and Step 2 diets. It provides a quick way to record food intake, portion size, and frequency of intake while focusing on foods that are the primary contributors of total fat, saturated fat, and cholesterol in the average American diet (i.e., Meats, Eggs, Dairy, Fried foods, fat In baked goods, Convenience foods, fats added at the Table and Snacks). MEDFICTS was validated in a pilot study using 16 computer-analyzed sets of 4-day food records randomly selected from 7-day food records collected in the Diet Modification Clinic at Baylor College of Medicine, Houston, Tex). MEDFICTS correctly identified the 11 patients consuming a Step 1 diet, the 2 patients consuming the Step 2 diet and the 3 patients consuming an average American diet. Pearson correlation coefficients between MEDFICTS and the 4-day records were significant for percent energy from total fat (r = 0.81, P < .0002), saturated fat (r = 0.79, P < .0003), and cholesterol (r = 0.52, P < .039). Pearson correlation coefficients from 2 follow-up validation studies (3-day diet records [n = 22] through the Mary Imogene Bassett Research Institute, Cooperstown, NY, and a second study at the Diet Modification Clinic [n = 26]) also correlated significantly with percent energy from total fat (r = 0.56, P < .006; r = 0.71, P < .0001), saturated fat (r = 0.60, P < .003; r = 0.71, P < .0001), and approached significance for cholesterol intake (r = 0.54, P < .009; r = 0.39, P < .051) respectively. MEDFICTS is a quick, efficient tool that can be used in cardiovascular health screening, clinical practice, or research for the assessment of adherence to Step 1 or 2 diets. It can be self administered, and when reviewed with a dietitian, can provide an opportunity for nutrition education.

Diet Records↗
PubMed2001

The effects of equal-energy portions of different breads on blood glucose levels, feelings of fullness and subsequent food intake.

OBJECTIVE: This study compared the effects of equal-energy portions of 7 different breads on feelings on fullness and subsequent ad libitum food intake. A satiety index score (SI) was calculated for each of the breads. DESIGN: Within-subject, repeated-measures design. SUBJECTS AND INTERVENTION: Ten healthy subjects participated in the study. Subjects fasted for > or =10 hours overnight and then reported to the research center the next morning, where they first completed baseline satiety ratings, gave a fasting blood sample, and then consumed a test bread. Additional finger prick blood samples and satiety ratings were collected at 15-minute intervals over 120 minutes, after which the subjects' ad libitum intake of food was recorded. A satiety index (SI) score was calculated for each test food by dividing the area under the 120-m satiety response curve (AUC) for the test bread by the satiety AUC for the reference bread (regular white bread) and multiplying by 100%. RESULTS: The mean SI scores for the breads ranged from 100% to 561%, with regular white bread having the lowest SI score. Mean SI scores were negatively correlated with energy intake at a test meal after 120 m (r=-0.88, P<.01, n=7) and total day energy intakes (r=-0.72, P<.05, n=7). The strongest predictor of the breads' SI scores was their portion size and thus energy density. The breads' glycemic responses were not significantly associated with fullness responses. APPLICATIONS: Ingredients and food processing methods are available for the production of palatable, high-satiety versions of processed foods, which may be useful for weight control diets. SI scores would be a useful addition to food labels to indicate which foods are less likely to be overeaten and could be used by dietitians to develop weight control plans to help reduce energy intakes without increased hunger.

Adult↗
PubMed2002

Cognitive research enhances accuracy of food frequency questionnaire reports: results of an experimental validation study.

OBJECTIVE: To test whether changing a food frequency questionnaire (FFQ) on the basis of cognitive theory and testing results in greater accuracy. Accuracy was examined for 4 design issues: a) Grouping: asking about foods in a single vs multiple separate questions; b) different forms of a food: asking consumption frequency of each form of a food (eg, skim, 2%, whole milk) vs a nesting approach--asking frequency of the main food (eg, milk) and proportion of times each form was consumed; c) additions (eg, sugar to coffee): asking independent of the main food vs nested under the main foods; d) units: asking frequency and portion size vs frequency of units (eg, cups of coffee). DESIGN: Participants in two randomly assigned groups completed 30 consecutive daily food reports (DFRs), followed by 1 of 2 FFQs that asked about foods consumed in the past month. One was a new, cognitively-based National Cancer Institute (NCI) Diet History Questionnaire; the other was the 1992 NCI-Block Health Habits and History Questionnaire. SUBJECTS/SETTING: 623 participants, age range 25 to 70 years, from metropolitan Washington, DC. Statistical analyses performed Accuracy was assessed by comparing DFR and FFQ responses using categorical (percent agreement) and continuous (rank order correlation, discrepancy scores) agreement statistics. RESULTS: Grouping: accuracy was greater using separate questions. Different forms of food: accuracy was greater using nesting. Additions: neither approach was consistently superior; accuracy of the addition report was affected by accuracy of the main food report. Units: both approaches were similarly accurate. CONCLUSIONS: Accuracy of FFQ reporting can be improved by restructuring questions based on cognitive theory and testing.

Adult↗
PubMed2002

Tomato consumption increases lycopene isomer concentrations in breast milk and plasma of lactating women.

OBJECTIVE: To compare plasma and milk lycopene concentrations and the changes in lycopene isomer patterns in lactating women before and after a 3-day dietary intervention with fresh or processed tomato products. DESIGN: Randomized prospective trial. SUBJECTS: 24 lactating women, 4 to 12 weeks postpartum, aged 22 to 39 years. INTERVENTION: Subjects initially consumed a low-lycopene diet for 7 days (washout period) and then were randomly assigned to one of 3 dietary groups (n=8 per group) without any other sources of lycopene: control (low-lycopene), fresh tomatoes, or processed tomato sauce. Subjects in each of the tomato groups consumed approximately 50 mg total lycopene over 3 days. OUTCOME MEASURES: Before and after dietary intervention, plasma and breast milk samples were obtained for high-performance liquid chromotography analysis of lycopene and its geometric isomers (all-trans, 5-cis, all other cis, and total lycopene). STATISTICAL ANALYSIS: Descriptive statistics, analysis of variance to test for differences among intervention groups, and Spearman's correlation coefficients to test for blood-milk relationships. RESULTS: Plasma total lycopene and lycopene isomer concentrations increased in the fresh and processed tomato group but not in the low-lycopene control group during the study. Milk total and cis- and trans-lycopene concentrations (unadjusted for fat) increased in the processed tomato group but did not change in the fresh tomato group. In the control group, milk total and trans-lycopene decreased. Milk total lycopene concentrations were not significantly different from baseline in any group when adjusted for fat content of milk. APPLICATIONS: The results of this study indicate that consumption of a "standard size portion" of tomato products increases plasma and milk lycopene concentrations in lactating women and, therefore, could increase the lycopene status of nursing infants. For dietary recommendations during lactation, the results suggest that consumption of tomato sauce increases milk lycopene concentrations more effectively than consumption of fresh tomatoes.

Adult↗
PubMed2002

Fruit and vegetable assessment: performance of 2 new short instruments and a food frequency questionnaire.

OBJECTIVE: To evaluate the ability of 2 new short assessment instruments and a food frequency questionnaire (FFQ) to measure intake of fruit and vegetables. The "All-Day" screener asks frequency and portion size questions about 9 food items. The "By-Meal" screener is similar, except that it asks about 2 of those 9 food items in terms of mealtime. DESIGN: Survey participants completed 4 telephone-administered 24-hour dietary recalls over 1 year, a self-administered FFQ 1 to 2 months later, and 1 of 2 self-administered screeners after an additional 7 months. SUBJECTS/SETTING: Participating were 202 men and 260 women aged 20 to 70 years living throughout the United States. STATISTICAL ANALYSES: Fruit and vegetable intakes measured by each screener and the FFQ were compared with true usual intake based on a measurement error model with 24-hour dietary recalls as the reference instrument. RESULTS: Estimates of median daily servings of fruit and vegetables were as follows: For men: True intake (5.8) vs All-Day screener (5.0), By-Meal screener (5.5), and FFQ (6.6); for women: true intake (4.2) vs All-Day screener (5.0), By-Meal screener (5.4), and FFQ (6.2). Estimated correlations between the test instruments and true intake were as follows: For men: All-Day screener (0.66), By-Meal screener (0.67), FFQ (0.68); for women: All-Day screener (0.51), By-Meal screener (0.53), and FFQ (0.54). APPLICATIONS/CONCLUSIONS: Both screeners might be useful to estimate median intakes of fruit and vegetable servings in US populations, but they might be less useful in accurately ranking individuals. More research is needed before using the screeners in ethnic or low-literacy populations.

Adult↗
PubMed1996

Controlled portions of presweetened cereals present no glycemic penalty in persons with insulin-dependent diabetes mellitus.

OBJECTIVE: To determine metabolic responses to commercially sweetened flaked corn cereal, unsweetened flaked corn cereal, glucose, and sucrose in teenagers and young adults with insulin-dependent diabetes mellitus (IDDM). DESIGN: A crossover design in which each subject consumed test meals in random order on 4 separate days at least 72 hours apart. SETTING: The inpatient setting of the General Clinical Research Center of the Indiana University Medical Center Hospital. SUBJECTS: Sixteen males and eight females, aged 14 to 25 years, with IDDM. INTERVENTIONS: After fasting overnight, each subject underwent challenge tests with 50 g carbohydrate per 1.73 m2 of body surface area from sweetened flaked corn cereal, unsweetened flaked corn cereal, sucrose, and glucose. All subjects were maintained on continuous intravenous infusion of insulin overnight (euglycemic goal = 3.9 to 6.7 mmol/L), with a constant basal insulin dose infused before and throughout a 3-hour postprandial period. MAIN OUTCOME MEASURES: Plasma glucose, free insulin, triglycerides, and free fatty acid levels measured at baseline and 15, 30, 45, 60, 90, 120, 150, and 180 minutes after meals. STATISTICAL ANALYSES PERFORMED: Comparisons among the four meals were made using two-way repeated measures analyses of variance followed by the Newman-Keuls multiple comparison procedure to identify specific differences among meals. The areas under the response curves were compared using one-way repeated measures analysis of covariance, adjusted for baseline values. RESULTS: The response to glucose for the area under the 3-hour blood glucose response curve was significantly greater than the response to sucrose (P = .006 by repeated measures analysis of variance); the areas for the two cereals (not significantly different from one another) were between the glucose and sucrose areas. At 3 hours, glycemia differed significantly among three of the meals: unsweetened flaked corn cereal > sweetened flaked corn cereal > sucrose (P < .001). Glucose at 3 hours was greater than sucrose (P < .001). There were no significant differences for free insulin, triglycerides, or free fatty acids. APPLICATIONS: Equivalent gram amounts of carbohydrate as presweetened breakfast cereals are not detrimental to persons with IDDM compared with unsweetened cereals. Therefore, presweetened cereals can be used in the correct portion sizes and based on the number of carbohydrate or starch servings in a person's diabetic meal plan.

Adolescent↗