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Drinking Water and Weight Management
Abstract
This review summarizes the evidence base for recommending drinking water for weight management. Crossover experiments consistently report that drinking water results in lower total energy intake when consumed instead of caloric beverages, because individuals do not eat less food to compensate for calories in beverages. Crossover experiments also consistently report that drinking water results in greater fat oxidation compared with other beverages, because drinking water does not stimulate insulin. In intervention studies, advice to drink water is associated with reduced weight gain in children and greater weight loss in dieting adults. Although gaps in knowledge remain about specific effects of drinking water on weight loss in children and obesity prevention in adults, there is a strong evidence base for recommending drinking water for weight management
... These two categories refer to plain water intake and plain water intake per kg of weight. In this sense, a review reports that drinking water results in greater rates of fat oxidation because fat oxidation is maximal when blood insulin levels are low (41). The reason for this is that insulin inhibits or decreases the ability of rate limiting enzymes that breakdown triglyceride fats into free fatty acids (41). ...
... In this sense, a review reports that drinking water results in greater rates of fat oxidation because fat oxidation is maximal when blood insulin levels are low (41). The reason for this is that insulin inhibits or decreases the ability of rate limiting enzymes that breakdown triglyceride fats into free fatty acids (41). Since water does not contain calories or carbohydrates like other beverages, it does not trigger an insulin response (41). ...
... The reason for this is that insulin inhibits or decreases the ability of rate limiting enzymes that breakdown triglyceride fats into free fatty acids (41). Since water does not contain calories or carbohydrates like other beverages, it does not trigger an insulin response (41). Moreover, one study in women showed that drinking one liter or more water per day was associated with decreases in triglycerides, total cholesterol and LDL cholesterol over 12 months (42). ...
Introduction:
Beverage consumption and its possible association with current obesity epidemic and metabolic syndrome is under investigation in recent years, however water intake is probably the most underestimated of all beverages and could play an important role.
Objective:
The aim of this study was to examine the association between water intake, body composition and cardiometabolic factors in a sample of Spanish children.
Methods:
A cross-sectional study was conducted in 366 schoolchildren (53.5% girls) aged 9-11 years from the province of Cuenca in Spain. Data of anthropometrics, body composition, cardiometabolic risk factors and ardiorespiratory fi tness variables were collected. Beverage consumption was assessed using two non-consecutive 24 h dietary recalls.
Results:
We found an inverse association between the consumption of water (ml)/kg per weight with BMI, body fat, fat-free mass, waist circumference, insulin levels, HOMA-IR (p < 0.001), and with arterial pressure parameters, systolic (p < 0.010) and diastolic blood pressure (p < 0.028), and mean arterial pressure (p < 0.012), as well as direct associations with HDL cholesterol (p < 0.001). In ANCOVA analyses, children who drank less water (ml)/kg per weight, had higher levels of LDL cholesterol (p < 0.050) and lower levels of HDL cholesterol (p < 0.042), and overweight-obesity subjects drank less water (ml)/kg per weight than normal peers (p < 0.011). Besides, children with lower levels of HDL cholesterol and higher levels of triglycerides and blood pressure had less water intake as a beverage. Finally, children who drank less water from beverages had high levels of LDL cholesterol.
Conclusions:
Higher consumption of water (ml)/kg per weight was negatively associated with BMI, body fat, fat-free mass, waist circumference, insulin levels, HOMA-IR, and positively with HDL cholesterol in children independently of age, sex and cardiorespiratory fi tness. In addition, overweight-obese children drank less water (ml)/kg per weight than normoweight ones. Therefore, water consumption is associated with numerous health benefi ts and its adequate intake could contribute to prevent obesity and metabolic syndrome in childhood.
... These two categories refer to plain water intake and plain water intake per kg of weight. In this sense, a review reports that drinking water results in greater rates of fat oxidation because fat oxidation is maximal when blood insulin levels are low (41). The reason for this is that insulin inhibits or decreases the ability of rate limiting enzymes that breakdown triglyceride fats into free fatty acids (41). ...
... In this sense, a review reports that drinking water results in greater rates of fat oxidation because fat oxidation is maximal when blood insulin levels are low (41). The reason for this is that insulin inhibits or decreases the ability of rate limiting enzymes that breakdown triglyceride fats into free fatty acids (41). Since water does not contain calories or carbohydrates like other beverages, it does not trigger an insulin response (41). ...
... The reason for this is that insulin inhibits or decreases the ability of rate limiting enzymes that breakdown triglyceride fats into free fatty acids (41). Since water does not contain calories or carbohydrates like other beverages, it does not trigger an insulin response (41). Moreover, one study in women showed that drinking one liter or more water per day was associated with decreases in triglycerides, total cholesterol and LDL cholesterol over 12 months (42). ...
Introduction:
Beverage consumption and its possible association with current obesity epidemic and metabolic syndrome is under investigation in recent years, however water intake is probably the most underestimated of all beverages and could play an important role.
Objective:
The aim of this study was to examine the association between water intake, body composition and cardiometabolic factors in a sample of Spanish children.
Methods:
A cross-sectional study was conducted in 366 schoolchildren (53.5% girls) aged 9-11 years from the province of Cuenca in Spain. Data of anthropometrics, body composition, cardiometabolic risk factors and ardiorespiratory fi tness variables were collected. Beverage consumption was assessed using two non-consecutive 24 h dietary recalls.
Results:
We found an inverse association between the consumption of water (ml)/kg per weight with BMI, body fat, fat-free mass, waist circumference, insulin levels, HOMA-IR (p < 0.001), and with arterial pressure parameters, systolic (p < 0.010) and diastolic blood pressure (p < 0.028), and mean arterial pressure (p < 0.012), as well as direct associations with HDL cholesterol (p < 0.001). In ANCOVA analyses, children who drank less water (ml)/kg per weight, had higher levels of LDL cholesterol (p < 0.050) and lower levels of HDL cholesterol (p < 0.042), and overweight-obesity subjects drank less water (ml)/kg per weight than normal peers (p < 0.011). Besides, children with lower levels of HDL cholesterol and higher levels of triglycerides and blood pressure had less water intake as a beverage. Finally, children who drank less water from beverages had high levels of LDL cholesterol.
Conclusions:
Higher consumption of water (ml)/kg per weight was negatively associated with BMI, body fat, fat-free mass, waist circumference, insulin levels, HOMA-IR, and positively with HDL cholesterol in children independently of age, sex and cardiorespiratory fi tness. In addition, overweight-obese children drank less water (ml)/kg per weight than normoweight ones. Therefore, water consumption is associated with numerous health benefi ts and its adequate intake could contribute to prevent obesity and metabolic syndrome in childhood.
... Keeping hydrated is essential for overall health and well-being. Compared with other beverages, evidence has shown that drinking water results in lower total energy intake and greater fat oxidation (Stookey, 2010), potentially a recommended method for body weight management (Boschmann et al., 2003, Stookey, 2010, Akers et al., 2012, Casazza et al., 2015. Meanwhile, water temperature for optimal hydration has been a common debate raging for years. ...
... Keeping hydrated is essential for overall health and well-being. Compared with other beverages, evidence has shown that drinking water results in lower total energy intake and greater fat oxidation (Stookey, 2010), potentially a recommended method for body weight management (Boschmann et al., 2003, Stookey, 2010, Akers et al., 2012, Casazza et al., 2015. Meanwhile, water temperature for optimal hydration has been a common debate raging for years. ...
The diet temperature could potentially affect health outcomes. Our study designed the experiment using a mouse model to explore the effect of the drinking water temperature on physiological states. The results indicated that the administration of drinking water at two different temperatures (4℃ representing the cold water and 45℃ representing the warm water) did not significantly affect the food/water intake and body weight but altered serum metabolomics and fecal microbiome. Compared to the control (23℃), the administration of cold water and warm water were both found to affect the pyrimidine metabolism, as evidenced by the decreasing in serum metabolites of Uridine, Cytidine, Deoxyuridine, Dihydrothymine. Moreover, cold water altered fatty acid biosynthesis while warm water affected the pentose phosphate pathway (PPP) which was involved in carbohydrate metabolism. Regarding the gut microbiome, cold water and warm water both could increase the gut microbiome richness and diversity, reduce the F/B ratio, and promote the population of Bifidobacterium when compare to the control group. Meanwhile, cold water additionally increased the abundances of Alistipes , Acinetobacter , and Pseudochrobactrum while the warm water administration reduced the richness Alcaligenes , Coprococcus , Planctomyces , and Polaribacter . Our findings demonstrated that both cold and warm drinking water temperatures appear to alter pyrimidine metabolism and exhibit potential health benefits by increasing bacteria richness and diversity of gut microbiome, in particular the beneficial bacteria Bifidobacterium . Additionally, cold water administration was relevant to fatty acid metabolism while warm water could affect carbohydrate metabolism.
... Water consumption is effective in body weight loss through two main mechanisms, less energy intake and more fat oxidation [32]. ...
... Drinking water, on the other hand, does not trigger insulin like other beverages, as it does not contain macronutrients like other beverages. Because fat oxidation is maximum when blood insulin levels are low, a lower glycemic response to drinking water is also associated with a higher rate of fat oxidation [32]. ...
Purpose of Review
Water, which is of vital importance, has a critical role in maintaining the normal function of the body, and even mild dehydration can play a role in the development of various diseases. Therefore, it is of great importance to meet the recommended daily water consumption amounts. In addition to the numerous roles of water in metabolism, its effect on energy metabolism should not be overlooked. Water consumption can increase energy expenditure and be an additional tool for weight management. Therefore, the importance of water consumption, which is like a hidden component for treating of obesity, should be emphasized. This review was written to explain the possible mechanisms of water consumption in energy expenditure and body weight management.
Recent Findings
Because water consumption is associated with sympathetic activity, which increases metabolic rate (thermogenesis) and daily energy expenditure, the increase in sympathetic activity caused by water consumption is an important and unrecognized component of daily energy expenditure. In addition to the concept of water-based thermogenesis, water, which is a potential improvement factor in body composition, also plays an auxiliary role in body weight loss with both less energy intake and increased fat oxidation. From this perspective, water consumption may have critical importance in the fight against increasing obesity worldwide.
Summary
Considering its effect on energy metabolism in various ways, it becomes necessary to focus more on the importance of water on human health.
Graphical Abstract
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... The fact that their classical determinants (diet and physical activity) do not sufficiently explain this situation make it necessary to examine other possible factors which could be implicated [4,5]. In this regard, several investigations have suggested that water intake (WI) and water balance (WB) could have important implications for both weight management and body composition [6][7][8][9]. ...
... In recent years, several investigations have shown a positive effect of increasing water consumption in body weight loss and decrease of WC and FBM (%) [7,9,[17][18][19]23,24,48]. Moreover, another study observed that women and obese people display indicators of cellular dehydration and have a higher risk of dehydration [49]. ...
The increasing prevalence of overweight and obesity has become an epidemic public health problem worldwide. In the last years, several investigations have suggested that water intake and retention could have important implications for both weight management and body composition. However, there is a lack of information about this issue globally, and mainly specifically in Spain. Thus, the aim of this study was to analyze the association between hydration status and body composition in a sample of healthy Spanish adults. The study involved 358 subjects, aged 18–39 years. The recently validated “hydration status questionnaire” was used to assess their water intake, elimination, and balance. Anthropometric measurements were performed according to the recommendations of the International Standards for Anthropometric Assessment (ISAK). Body composition variables were acquired by bioelectrical impedance analysis. Differences in anthropometric and body composition variables were assessed through the ANOVA test and considered significant at p < 0.05. Fluid intake was correlated with body water content. Inverse associations between water consumption, normalized by weight, with body weight, body fat mass, and waist circumference were found. Moreover, according to water balance, significant differences in body water content in females were observed. In conclusion, higher fluid intake seems to be related with a healthier body composition. Therefore, the improvement of water intake and water balance could be useful for overweight and obesity prevention, although further studies are needed to confirm the present findings.
... Drinking plain water is an effective way to provide adequate hydration without calories [1,2]. Drinking plain water, tap or bottled, instead of caloric beverages, helps to reduce dietary energy density and may contribute to the management of body weight [3][4][5][6][7][8]. Water from beverages and foods is the key determinant of the energy density of the diet [9]. ...
... The DRIs were established by the IOM mostly to prevent the adverse effects of dehydration, and the IOM report indicates that considerable inter-individual variation exists in terms of necessary amounts of water to be consumed. Beyond issues of hydration, previous studies have shown that plain water consumption was associated with higher quality diets, better health behaviors, and lower risk for chronic disease in youth and adults [7,[14][15][16]. ...
Few studies have examined plain water consumption among US adults. This study evaluated the consumption of plain water (tap and bottled) and total water among US adults by age group (20-50y, 51-70y, and >=71y), gender, income-to-poverty ratio, and race/ethnicity.
Data from up to two non-consecutive 24-hour recalls from the 2005--2006, 2007--2008 and 2009--2010 National Health and Nutrition Examination Survey (NHANES) was used to evaluate usual intake of water and water as a beverage among 15,702 US adults. The contribution of different beverage types (e.g., water as a beverage [tap or bottled], milk [including flavored], 100% fruit juice, soda/soft drinks [regular and diet], fruit drinks, sports/energy drinks, coffee, tea, and alcoholic beverages) to total water and energy intakes was examined. Total water intakes from plain water, beverages, and food were compared to the Adequate Intake (AI) values from the US Dietary Reference Intakes (DRI). Total water volume per 1,000 kcal was also examined.
Water and other beverages contributed 75-84% of dietary water, with 17-25% provided by water in foods, depending on age. Plain water, from tap or bottled sources, contributed 30-37% of total dietary water. Overall, 56% of drinking water volume was from tap water while bottled water provided 44%. Older adults (>=71y) consumed much less bottled water than younger adults. Non-Hispanic whites consumed the most tap water, whereas Mexican-Americans consumed the most bottled water. Plain water consumption (bottled and tap) tended to be associated with higher incomes. On average, younger adults exceeded or came close to satisfying the DRIs for water. Older men and women failed to meet the Institute of Medicine (IOM) AI values, with a shortfall in daily water intakes of 1218 mL and 603 mL respectively. Eighty-three percent of women and 95% of men >=71y failed to meet the IOM AI values for water. However, average water volume per 1,000 kcal was 1.2-1.4 L/1,000 kcal for most population sub-groups, in excess of suggested levels of 1.0 L/1.000 kcal.
Water intakes below IOM-recommended levels may be a cause for concern, especially for older adults.
... Drinking plain water is an effective way to ensure adequate hydration [1,2]. Drinking plain water instead of caloric beverages may also help reduce dietary energy density and help in the management of body weight [3][4][5][6]. Water from beverages and foods -more than any macronutrient -is the key determinant of the energy density of the diet [7]. ...
... The DRIs were established by the IOM mostly to prevent the adverse effects of dehydration. Despite the focus on hydration and de-hydration in many official reports [10,12], some studies have shown that plain water consumption is associated with better diets, better health behaviors, and lower burden for chronic disease [4,13]. Park et al. [14] used data from the 2010 National Youth Physical Activity and Nutrition Study for 11,049 students in grades 9-12 to explore links between plain water consumption, socio-demographic characteristics, dietary habits, and selected health behaviors. ...
Background
Few studies have examined water consumption patterns among US children. Additionally, recent data on total water consumption as it relates to the Dietary Reference Intakes (DRI) are lacking. This study evaluated the consumption of plain water (tap and bottled) and other beverages among US children by age group, gender, income-to-poverty ratio, and race/ethnicity. Comparisons were made to DRI values for water consumption from all sources.
Methods
Data from two non-consecutive 24-hour recalls from 3 cycles of NHANES (2005–2006, 2007–2008 and 2009–2010) were used to assess water and beverage consumption among 4,766 children age 4-13y. Beverages were classified into 9 groups: water (tap and bottled), plain and flavored milk, 100% fruit juice, soda/soft drinks (regular and diet), fruit drinks, sports drinks, coffee, tea, and energy drinks. Total water intakes from plain water, beverages, and food were compared to DRIs for the US. Total water volume per 1,000 kcal was also examined.
Results
Water and other beverages contributed 70-75% of dietary water, with 25-30% provided by moisture in foods, depending on age. Plain water, tap and bottled, contributed 25-30% of total dietary water. In general, tap water represented 60% of drinking water volume whereas bottled water represented 40%. Non-Hispanic white children consumed the most tap water, whereas Mexican-American children consumed the most bottled water. Plain water consumption (bottled and tap) tended to be associated with higher incomes. No group of US children came close to satisfying the DRIs for water. At least 75% of children 4-8y, 87% of girls 9-13y, and 85% of boys 9-13y did not meet DRIs for total water intake. Water volume per 1,000 kcal, another criterion of adequate hydration, was 0.85-0.95 L/1,000 kcal, short of the desirable levels of 1.0-1.5 L/1,000 kcal.
Conclusions
Water intakes at below-recommended levels may be a cause for concern. Data on water and beverage intake for the population and by socio-demographic group provides useful information to target interventions for increasing water intake among children.
... Beverage consumption and the relationship of drink to food consumption is an area seeing increasing researcher attention and with good reasons. First, individuals do not appear to compensate for calories in their total energy intake when those calories are consumed as a beverage (Stookey, 2010). Second, the eating rate for liquids allows rapid ingestion and this is positively related to energy intake (Viskaal-van Dongen, Kok, & de Graaf, 2011). ...
... Third, modern diets tend to involve high intake of sugar-sweetened beverages (Lasater, Pierna, & Popkin, 2011) and at the same time not enough water (Armstrong, 2010;Patel & Hampton, 2011). Importantly, children's intake of sweetened beverages is positively associated with BMI, waist circumference, and poor dietary choices (Collison et al., 2010) while the intake of water is associated with preferable dietary profiles in children (Stahl, Kroke, Bolzenius, & Manz, 2007) and weight management (specifically reduced excess weight gain, Stookey, 2010). ...
... A healthy adult human body consists of an average of 60% water [2]. This percentage is subject to change with age and variation in the body mass index [3][4][5][6]. The shortage of water in the human body causes dehydration, which can range from mild to severe [7,8]. ...
Dehydration is a common problem in the aging population. Medical professionals can detect dehydration using either blood or urine tests. This requires experimental tests in the lab as well as urine and blood samples to be obtained from the patients. This paper proposed 100 GHz millimeter wave radiometry for early detection of dehydration. Reflectance measurements were performed on healthy and dehydrated patients of both genders (120 males and 80 females) in the aging population. Based on the cause of dehydration, the patient groups were divided into three categories: (1) patients dehydrated due to less thirst sensation, (2) patients dehydrated due to illnesses (vomiting and diarrhea), and (3) patients dehydrated due to diabetes. Reflectance measurements were performed on eight locations: (1) the palm, (2) the back of the hand, (3) the fingers, (4) the inner wrist, (5) the outer wrist, (6) the volar side of the arm, (7) the dorsal surface of the arm, and (8) the elbow. Skin dehydrated due to vomiting and diarrhea was found to have lower reflectance at all the measurement locations compared with healthy and other types of dehydrated skin. The elbow region showed the highest difference in reflectance between healthy and dehydrated skin. This indicates that radiometric sensitivity is sufficient to detect dehydration in a few seconds. This will reduce the patient's waiting time and the healthcare professional's intervention time as well as allow early treatment of dehydration, thus avoiding admission to hospitals.
... Several studies in recent years have shown the positive effect of increasing water consumption on reducing waist circumference and body fat mass during weight loss (Dennis et al. 2010;Stookey 2010; .; Muckelbauer et al. 2014;Vij and Joshi 2014;Parretti et al. 2015). ...
The study aims to determine water and beverage consumption status and related factors in daily nutrition of adults living in Turkey. This study was conducted with 6332 adults aged 18–65years across Turkey. Demographics and anthropometric data of subjects, their daily water and beverage consumption habits were explored using the retrospective 24-hour recall method. Water and black tea were the most consumed beverages (1801.38 ± 11.06 mL/day, 455 ± 6.10 mL/day, respectively). Increased BMI was associated with a significantly decreased rate of insuf- ficient fluid intake among the participants. Underweight individuals were found to be consuming less (by 0.558 times) fluid compared to those with normal BMI, while obese individuals appeared to have greater energy intake from daily fluid consumption (by 1.111 times). This study showed a relationship between water and beverage intake and anthropometric measurements, suggesting that further research on personalized water intake strategies is beneficial in weight management.
KEYWORDS
Total fluid intake; beverage consumption; water consumption; body mass index
... Nutrition of children at this age should be characterized not only by an adequate supply of calories and dietary nutritional value [1,2], but also by the correct assortment of consumed products and beverages [3][4][5]. According to the recommendation of the American Academy of Pediatrics (AAP) [6], the amount and quality of beverages consumed by a child is an important discriminant of the diet and an important component in the prevention of diet-related diseases. Results show that water consumption is associated with a higher quality diet, healthier nutritional habits, and lower risks of chronic disease [7]. ...
The aim of the study was to assess the impact of education on improving the assortment of beverages served in nurseries in Poland. This analysis focused on beverages served to children with meals and between meals. We examined: water, tea, juices, soft/fruit drinks, compote, milk, cocoa, and coffee substitute. The study involved 93 nurseries enrolled in the Eating Healthy, Growing Healthy project and was conducted from 2015 to 2017. Nutritional education was carried out by dieticians or nutritionists and included 24 h of lectures given to the staff of nurseries. Training was conducted in a form of workshops that were divided into 12 topics. Additionally, consultations regarding infants and young children nutrition were available to the staff. Typically, education training was completed within 1–2 months in each nursery. The effectiveness of education was verified based on data on beverage supply in 186 ten-day menus, 1860 daily inventory reports before (at baseline), and 3–6 months after staff training (post baseline). Data were analyzed in a total group, and separately for public and non-public nurseries. Statistical analyses for categorical variables were done with Chi2 Pearson test. The differences were considered significant at p < 0.05. After education, a significant increase in the supply of water as a beverage served with meals was observed in all nurseries (68% vs. 87%; p = 0.002), both in public (72% vs. 90%, p = 0.036) and non-public (62% vs. 84%, p = 0.017) ones. Moreover, a decrease in served tea was noted: in all nurseries (71% vs. 44%, p < 0.001) and in public nurseries (77% vs. 42%, p < 0.001). Water was available between meals in almost all nurseries. Nutritional education for staff is an important tool for improving adherence to the nutritional recommendation in the case of core beverage supply in Polish nurseries.
... obesity development [10,11], such as water intake and hydration status, which is defined as the body's fluid level and is determined by water balance (net difference between water input and output) [12]. Its positive role has been documented by several studies conducted in adults [13][14][15][16][17][18] as well as in children [19,20]. In fact, some systematic reviews [14,18,19] conclude that water consumption might have a beneficial effect on weight status as well as a weight reducing effect, although the available evidence for the establishment of causal associations is still scarce. ...
At present, obesity and overweight are major public health concerns. Their classical determinants do not sufficiently explain the current situation and it is urgent to investigate other possible causes. In recent years, it has been suggested that water intake could have important implications for weight management. Thus, the aim of this study was to examine the effect of hydration status on body weight and composition in healthy adolescents from Spain. The study involved 372 subjects, aged 12–18 years. Water intake was assessed through the validated “hydration status questionnaire adolescent young”. Anthropometric measurements were performed according to the recommendations of the International Standards for Anthropometric Assessment (ISAK) and body composition was estimated by bioelectrical impedance analysis. Water intake normalized by body weight was positively correlated with body water content (boys (B): r = 0.316, p = 0.000; girls (G): r = 0.245, p = 0.000) and inversely with body mass index (BMI) (B: r = −0.515, p = 0.000; G: r = −0.385, p =0.000) and fat body mass (B: r = −0.306, p = 0.000; G: r = −0.250, p = 0.001). Moreover, according to BMI, overweight/obese individuals consumed less water than normal weight ones. In conclusion, higher water balance and intake seems to be related with a healthier body composition. In conclusion, higher water balance and intake is associated with a healthier body composition.
... Similarly, a study in USA showed that most children failed to meet water intake recommendations (Drewnowski, Rehm, & Constant, 2013). This is worrying because inadequate water intake is related to adverse health effects such as headache, urolithiasis, and impaired cognition (Goodman et al, 2013), and could also cause one to experience higher burden of chronic disease in the long run (D'Anci, Constant & Rosenberg, 2006;Stookey, 2010). Furthermore, in the context of this study, increasing water consumption may also help limit excess weight gain among children and adolescents (Muckelbauer et al., 2009;Daniels & Popkin 2010). ...
Background: Inculcating healthy life style such as the habit of consuming balanced diet and performing physical activity among children could prevent them from becoming overweight or obese and thus avoid the risk of chronic diseases related with obesity. Such efforts are challenging yet crucial. This study assessed the immediate effect on children's knowledge, attitude and practices regarding healthy diet and physical activity following an awareness programme. Materials and Methods: A half-day childhood obesity awareness programme was conducted to encourage the practise of healthy diet and physical activity, and persuade against unhealthy food consumption and sedentary life style. The programme was carried out among 30 children aged 8-11year old in an international school in Putrajaya who were overweight or obese. A pre-and post-test design was carried out to evaluate their knowledge, attitude, and practice toward healthy diet and physical activity using pretested questionnaire. Comparison of pre-and post-test' scores were carried out using paired t test. Result: Over half of the respondents were female (63.3%) and obese (70.0%). The mean(sd) knowledge and attitude scores for healthy diet were 2.00(0.91) and 2.33(0.84). The mean knowledge score for physical activity was better i.e., 3.10(1.32) but the attitude scores was very low 0.87(1.07). After the programme, although not statistically significant there were slight increases in all scores, except 'intend to practise' physical activity after the programme. Conclusion: The knowledge, attitude and practices regarding healthy diet and physical exercise among these children were low. A series of improved and validated programmes are recommended for greater impact.
... Similarly, a study in USA showed that most children failed to meet water intake recommendations (Drewnowski, Rehm, & Constant, 2013). This is worrying because inadequate water intake is related to adverse health effects such as headache, urolithiasis, and impaired cognition (Goodman et al, 2013), and could also cause one to experience higher burden of chronic disease in the long run (D'Anci, Constant & Rosenberg, 2006;Stookey, 2010). Furthermore, in the context of this study, increasing water consumption may also help limit excess weight gain among children and adolescents (Muckelbauer et al., 2009;Daniels & Popkin 2010). ...
Background: Inculcating healthy life style such as the habit of consuming balanced diet and performing physical activity among children could prevent them from becoming overweight or obese and thus avoid the risk of chronic diseases related with obesity. Such efforts are challenging yet crucial. This study assessed the immediate effect on children's knowledge, attitude and practices regarding healthy diet and physical activity following an awareness programme. Materials and Methods: A half-day childhood obesity awareness programme was conducted to encourage the practise of healthy diet and physical activity, and persuade against unhealthy food consumption and sedentary life style. The programme was carried out among 30 children aged 8-11year old in an international school in Putrajaya who were overweight or obese. A pre-and post-test design was carried out to evaluate their knowledge, attitude, and practice toward healthy diet and physical activity using pretested questionnaire. Comparison of pre-and post-test' scores were carried out using paired t test. Result: Over half of the respondents were female (63.3%) and obese (70.0%). The mean(sd) knowledge and attitude scores for healthy diet were 2.00(0.91) and 2.33(0.84). The mean knowledge score for physical activity was better i.e., 3.10(1.32) but the attitude scores was very low 0.87(1.07). After the programme, although not statistically significant there were slight increases in all scores, except 'intend to practise' physical activity after the programme. Conclusion: The knowledge, attitude and practices regarding healthy diet and physical exercise among these children were low. A series of improved and validated programmes are recommended for greater impact.
... Drinking water has been linked to associated better diets, superior health behaviors and reduced risk of chronic disease. (4,5) Two sources fulfill the human body's need for water: food and fluids. (3) The EFSA has determined that approximately 20-30% of humans' total water intake is in their foods, while fluids of all kinds account for 70-80% of it. ...
This study was aimed to determine the daily water and fluid consumption of health professionals. Methods: The sample included 313 subjects (female: 222, male: 91) between 22 and 49 years of age. The questionnaire solicited demographic information from the participants and asked about their fluid consumption and its frequency. The principal variable was gender. To analyze the data statistically, tables of means, standard deviations (X±SD) and percentage (%) values were used. When identifying the fluid intake of healthcare staff, the independent t test was used to account for gender. Results: The fluid consumption of the participants was examined, and the average was 2,262.6±845.2 mL. The mean consumption of water was 1,404.0±719.8 mL. Other significant fluid intake included black tea at 314.4±147.9 mL, instant coffee at 160.5±52.2 mL, milk/ayran/kefir at 157.7±134.8 mL, soft drinks at 61.6±104.7 mL and fruit juice at 72.5±103.9 mL. It was also found that the gender differences in total fluid and soft drink consumption were statistically significant (p<.05), while the consumption of other drinks did not vary significantly by gender (p>.05). Conclusion: To precisely determine water and fluid intake, studies should be planned and conducted with large samples using standardized assessment tools.
... Drinking plain water instead of caloric beverages helps to reduce dietary energy density, and may contribute to the regulation of body weight [1,9,14]. Some studies have also suggested that consumption of plain water is associated with better diets and better health behaviors in youth [15]. Based on the 2010 National Youth Physical Activity and Nutrition Study, Park et al. showed that low water intake was associated with poor diet quality and physical inactivity amongst US adolescents [16]. ...
This study evaluates total water intake (TWI) from plain water, beverages and foods among Lebanese children and compares TWI to dietary reference intakes (DRIs). In a national cross-sectional survey, data on demographic, socioeconomic, anthropometric, and physical activity characteristics were obtained from 4 to 13-year-old children (n = 752). Food and beverage consumption patterns were assessed using a validated food-frequency questionnaire. TWI was estimated at 1651 mL/day, with beverages contributing 72% of the TWI compared to 28% from foods. Beverages with the highest contribution to TWI included plain water, fruit juice and soda. A significantly higher proportion of 9-13-year-old children failed to meet the DRIs compared to 4-8 years old (92%-98% vs. 74%). Gender differentials were observed with a significantly higher proportion of boys meeting the DRIs compared to girls. The water to energy ratio ranged between 0.84 and 0.87, which fell short of meeting the desirable recommendations. In addition, children from higher socioeconomic status had higher intakes of water from milk and bottled water, coupled with lower water intakes from sodas. The study findings show an alarming high proportion of Lebanese children failing to meet TWI recommendations, and call for culture-specific interventions to instill healthy fluid consumption patterns early in life.
... Drinking plain water, such as tap or bottled water, delivers adequate hydration without adding calories [17]. Plain water intake has been linked to reduced energy consumption and improved body weight management [18][19][20][21]. Potential mechanisms include, but may not be limited to, plain water intake in substitution for caloric beverage consumption [22], and satiety from plain water consumption in coping with feelings of hunger and desire to eat [23]. ...
Background:
Drinking plain water, such as tap or bottled water, provides hydration and satiety without adding calories. We examined plain water and sugar-sweetened beverage (SSB) consumption in relation to energy and nutrient intake at full-service restaurants.
Methods:
Data came from the 2005-2012 National Health and Nutrition Examination Survey, comprising a nationally-representative sample of 2900 adults who reported full-service restaurant consumption in 24-h dietary recalls. Linear regressions were performed to examine the differences in daily energy and nutrient intake at full-service restaurants by plain water and SSB consumption status, adjusting for individual characteristics and sampling design.
Results:
Over 18% of U.S. adults had full-service restaurant consumption on any given day. Among full-service restaurant consumers, 16.7% consumed SSBs, 2.6% consumed plain water but no SSBs, and the remaining 80.7% consumed neither beverage at the restaurant. Compared to onsite SSB consumption, plain water but no SSB consumption was associated with reduced daily total energy intake at full-service restaurants by 443.4 kcal, added sugar intake by 58.2 g, saturated fat intake by 4.4 g, and sodium intake by 616.8 mg, respectively.
Conclusion:
Replacing SSBs with plain water consumption could be an effective strategy to balance energy/nutrient intake and prevent overconsumption at full-service restaurant setting.
... The goal of the review was to generate hypotheses about intervention conditions, not to estimate unbiased effects of drinking water. Additional studies were identified by searching the reference list of review articles [19,[41][42][43][45][46][47], as well as the references cited by each identified article. ...
Drinking water has heterogeneous effects on energy intake (EI), energy expenditure (EE), fat oxidation (FO) and weight change in randomized controlled trials (RCTs) involving adults and/or children. The aim of this qualitative review of RCTs was to identify conditions associated with negative, null and beneficial effects of drinking water on EI, EE, FO and weight, to generate hypotheses about ways to optimize drinking water interventions for weight management. RCT conditions that are associated with negative or null effects of drinking water on EI, EE and/or FO in the short term are associated with negative or null effects on weight over the longer term. RCT conditions that are associated with lower EI, increased EE and/or increased FO in the short term are associated with less weight gain or greater weight loss over time. Drinking water instead of caloric beverages decreases EI when food intake is ad libitum. Drinking water increases EE in metabolically-inflexible, obese individuals. Drinking water increases FO when blood carbohydrate and/or insulin concentrations are not elevated and when it is consumed instead of caloric beverages or in volumes that alter hydration status. Further research is needed to confirm the observed associations and to determine if/what specific conditions optimize drinking water interventions for weight management.
... Several studies suggest there is an association between higher dairy intake and greater weight loss [33][34][35]38], however some studies are inconclusive [35,40] and others have found that high intakes of dairy to lead to weight gain [41,42]. Studies have also shown that increasing water consumption during weight loss interventions can lead to greater weight loss [43,44]. Therefore, it may be effective to focus on these particular food groups during weight loss interventions to facilitate greater weight loss. ...
Background:
Better diet quality has been associated with less weight gain over time. However, few studies have examined the role of diet quality during weight loss. This study aimed to compare changes in diet quality in overweight/obese adults during a weight loss intervention, and determine whether an association between diet quality score and weight loss exists.
Methods:
Overweight or obese (BMI 25-40 kg/m2) adults, aged 18-60 years, were recruited from the Hunter Region of NSW, Australia and randomized to one of three groups: a standard online weight loss program (n = 94); an enhanced version of this online program that provided additional personalized feedback and reminders (n = 98); or a wait-list control group (n = 97). Diet quality was calculated using the Australian Recommended Food Score (ARFS) with dietary data from the Australian Eating Survey (AES) Food Frequency Questionnaire at baseline and 12-weeks.
Results:
The basic and enhanced groups lost significantly more weight than the control group after 12 weeks (basic -2.2 ± 3.4 kg, enhanced -3.0 ± 4.0 kg, control 0.4 ± 2.4 kg, P < 0.001) with no difference between the basic and enhanced groups. The mean change in ARFS in the enhanced group (2.2 ± 5.7) was significantly higher (P = 0.03) than the control group. There were no significant differences in change in ARFS between the enhanced and basic, or basic and control groups. The ARFS and the fruit, meat, wholegrain, dairy and water sub-scale scores at 12 weeks were significantly associated with greater weight loss (P < 0.05).
Conclusions:
Diet quality improved significantly in the enhanced group compared to controls following 12-weeks intervention. Furthermore, higher diet quality was associated with greater weight loss.
Trial registration:
ACTRN12610000197033.
... Conversely, water consumption with meals compared with caloric beverages lowers meal energy intake, 27,28 insulin levels, and consequently increases fat oxidation in children, factors that are all protective against weight gain. 5 Higher BMI with skipping breakfast is likely mediated by dietary quality and appetite control. 9 One novel item-measuring parents' confidence that they could influence their child's soft drink intake-was included because it speaks to the monitoring and gatekeeping role of parents in children's consumption patterns. ...
The aims of this study were to generate composite measures quantifying a household's obesogenic potential and to examine the relationship of the composite variables with older children's eating, physical activity (PA), and small screen recreation.
Data were from surveys with 1685 child-parent pairs in which the child was in grade 6, 8, or 10 (mean age: 14 years). Composite measures of the obesogenic household environment were generated from 11 measures using nonlinear principal components analysis. Associations between the composite measures and the children's healthy and unhealthy food intake, PA, and screen time were tested (adjusting for demographic characteristics).
Two scales were generated: (1) obesogenic control, which clustered together factors that mitigate risk; and (2) obesogenic risk. Higher scores on the control scale were associated with higher adolescent intake of healthy foods, lower intake of unhealthy foods, higher PA, and less screen time. Higher scores on the risk scale were associated with lower adolescent intake of healthy foods, higher intake of unhealthy foods, lower PA, and more screen time. There were significant 2-way interactions between the scales for soft drink consumption and PA.
Household obesogenic potential may be quantified as 2 factors reflecting cumulative risk and control practices. These factors have both additive associations with obesogenic behaviors and, in some cases, modify each other, suggesting that a healthy home environment requires attention to both. Health promotion messages could incorporate these 2 different but interacting factors that parents can use to modify the obesogenic potential of their household.
Objective:
The present study examined plain water consumption in relation to energy intake and diet quality among US adults.
Methods:
A nationally representative sample of 18 311 adults aged ≥18 years, from the National Health and Nutrition Examination Survey 2005-2012, was analysed. The first-difference estimator approach addressed confounding bias from time-invariant unobservables (e.g. eating habits, taste preferences) by using within-individual variations in diet and plain water consumption between two nonconsecutive 24-h dietary recalls.
Results:
One percentage point increase in the proportion of daily plain water in total dietary water consumption was associated with a reduction in mean (95% confidence interval) daily total energy intake of 8.58 (7.87-9.29) kcal, energy intake from sugar-sweetened beverages of 1.43 (1.27-1.59) kcal, energy intake from discretionary foods of 0.88 (0.44-1.32) kcal, total fat intake of 0.21 (0.17-0.25) g, saturated fat intake of 0.07 (0.06-0.09) g, sugar intake of 0.74 (0.67-0.82) g, sodium intake of 9.80 (8.20-11.39) mg and cholesterol intake of 0.88 (0.64-1.13) g. The effects of plain water intake on diet were similar across race/ethnicity, education attainment, income level and body weight status, whereas they were larger among males and young/middle-aged adults than among females and older adults, respectively. Daily overall diet quality measured by the Healthy Eating Index-2010 was not found to be associated with the proportion of daily plain water in total dietary water consumption.
Conclusions:
Promoting plain water intake could be a useful public health strategy for reducing energy and targeted nutrient consumption in US adults, which warrants confirmation in future controlled interventions.
Water is essential for life. There wouldn't be the proper functioning of body processes without it. An inadequate water intake relative to recommendation contributes to the decline in physical capacity and adversely effects on cognitive function and mood. On the other hand, an adequate water intake helps maintain the balance between total energy intake and daily energy expenditure and determines the correct rate of fat oxidation. This might be useful and commonly used in weight reduction and thus might favorably affect on body composition in overweight and obese people by increasing the total body water and lean muscle mass and might contribute to a decrease in body fat. Research results indicate clearly that drinking water instead of caloric beverages might be an effective way to reduce daily total energy consumption and in this way might may contribute to the reduction of weight, body circumferences and body fat.
The dramatic increase in the prevalence of childhood overweight and its resultant comorbidities are associated with significant health and financial burdens, warranting strong and comprehensive prevention efforts. This statement proposes strategies for early identification of excessive weight gain by using body mass index, for dietary and physical activity interventions during health supervision encounters, and for advocacy and research.
The prevalence of obesity has increased substantially in the past several decades, and clinicians, policy makers, and others seek tools to abate this epidemic. One tantalizingly simple solution is to identify a single class of foods for which the elimination or radical reduction would meaningfully decrease the energy intake/expenditure ratio and obesity prevalence. Nutritively sweetened beverages (NSBs) (eg, sugar-sweetened beverages, soft drinks) seem to have become a leading contender, and the surrounding dialogue has become contentious, evoking scientific, clinical, and sociopolitical questions.
Sugar-sweetened soft drinks (SSD) are a special target of many obesity-prevention strategies, yet critical reviews tend to be more cautious regarding the aetiological role of SSD in promoting excess body weight. Since ongoing evaluation of this issue is important, the present systematic review re-examined the evidence from epidemiological studies and interventions, up to July 2008. Database searches of Medline, Cochrane reviews, Google scholar and a hand search of cross-references identified forty-four original studies (twenty-three cross-sectional, seventeen prospective and four intervention) in adults and children, as well as six reviews. These were critically examined for methodology, results and interpretation. Approximately half the cross-sectional and prospective studies found a statistically significant association between SSD consumption and BMI, weight, adiposity or weight gain in at least one subgroup. The totality of evidence is dominated by American studies where SSD consumption tends to be higher and formulations different. Most studies suggest that the effect of SSD is small except in susceptible individuals or at high levels of intake. Methodological weaknesses mean that many studies cannot detect whether soft drinks or other aspects of diet and lifestyle have contributed to excess body weight. Progress in reaching a definitive conclusion on the role of SSD in obesity is hampered by the paucity of good-quality interventions which reliably monitor diet and lifestyle and adequately report effect sizes. Of the three long-term (>6 months) interventions, one reported a decrease in obesity prevalence but no change in mean BMI and two found a significant impact only among children already overweight at baseline. Of the six reviews, two concluded that the evidence was strong, one that an association was probable, while three described it as inconclusive, equivocal or near zero. Reasons for some discrepancies are presented.
During the nutrition transition in Chile, dietary changes were marked by increased consumption of high-energy, nutrient-poor products, including sugar-sweetened beverages (SSBs). Obesity is now the primary nutritional problem in posttransitional Chile.
We conducted a randomized controlled trial to examine the effects on body composition of delivering milk beverages to the homes of overweight and obese children to displace SSBs.
We randomly assigned 98 children aged 8-10 y who regularly consumed SSBs to intervention and control groups. During a 16-wk intervention, children were instructed to drink 3 servings/d (approximately 200 g per serving) of the milk delivered to their homes and to not consume SSBs. Body composition was measured by dual-energy X-ray absorptiometry. Data were analyzed by multiple regression analysis according to the intention-to-treat principle.
For the intervention group, milk consumption increased by a mean (+/- SEM) of 452.5 +/- 37.7 g/d (P < 0.0001), and consumption of SSBs decreased by -711.0 +/- 33.7 g/d (P < 0.0001). For the control group, milk consumption did not change, and consumption of SSBs increased by 71.9 +/- 33.6 g/d (P = 0.04). Changes in percentage body fat, the primary endpoint, did not differ between groups. Nevertheless, the mean (+/- SE) accretion of lean body mass was greater (P = 0.04) in the intervention (0.92 +/- 0.10 kg) than in the control (0.62 +/- 0.11 kg) group. The increase in height was also greater (P = 0.01) in the intervention group (2.50 +/- 0.21 cm) than in the control group (1.77 +/- 0.20 cm) for boys but not for girls.
Replacing habitual consumption of SSBs with milk may have beneficial effects on lean body mass and growth in children, despite no changes in percentage body fat. This trial was registered at clinicaltrials.gov as NCT00149695.
We computed the respective amounts of exogenous glucose (G) and fructose (F), which are oxidized during exercise when ingested simultaneously, with the use of 13C labeling. Six subjects exercised for 2 h at 60.7 +/- 2.9% of maximal O2 uptake on a cycle ergometer while ingesting 50 or 100 g of G or F or a mixture of 50 g each of G and F in 500 ml of water. The amount of exogenous G oxidized increased from 37.8 +/- 2.2 to 58.3 +/- 8.1 g when the total amount ingested increased from 50 to 100 g. The amount of F oxidized was significantly lower (32.2 +/- 1.2 and 45.8 +/- 2.6 g for the 50 and 100 g ingested, respectively). When 50 g each of G and F were simultaneously ingested in the same drink, the amounts oxidized (39.5 +/- 4.8 and 34.1 +/- 1.5 g, respectively) were similar to those observed when 50 g of G or F were ingested separately. The cumulative amount of exogenous hexoses oxidized (73.6 +/- 6.6 g) was 21% larger than when 100 g of G were ingested. This finding could be due to the fact that the routes for absorption and metabolism of exogenous G and F are at least partly different, resulting in less competition for oxidation when a mixture of these two hexoses is ingested than when an isocaloric amount of G is ingested. From a practical point of view, these data may provide experimental support for using mixtures of carbohydrates in the energy supplements for endurance athletes.
The pattern of fruit juice consumption has changed over time. Fifty years ago, orange juice was the major juice produced and it was consumed primarily to prevent scurvy. Now, apple juice is the juice of choice for the under 5 age group. While fruit juice is a healthy, low-fat, nutritious beverage, there have been some health concerns regarding juice consumption. Nursing bottle caries have long been recognized as a consequence of feeding juice in bottles, using the bottle as a pacifier, and prolonged bottle feeding. Non-specific chronic diarrhea or "toddler's" diarrhea has been associated with juice consumption, especially juices high in sorbitol and those with a high fructose to glucose ratio. This relates to carbohydrate malabsorption, which varies by the type, concentration, and mixture of sugars present in different fruit juices. Fruit juice consumption by preschoolers has recently increased from 3.2 to about 5.5 fl oz/day. Consumption of fruit juice helps fulfill the recommendation to eat more fruits and vegetables, with fruit juice accounting for 50% of all fruit servings consumed by children, aged 2 through 18 years, and 1/3 of all fruits and vegetables consumed by preschoolers. Concomitant with the increase in fruit juice consumption has been a decline in milk intake. This is concerning as milk is the major source of calcium in the diet, and at present, only 50% of children, aged 1 through 5 years, meet the RDA for calcium. Studies of newborn infants and preschool-aged children have demonstrated a preference for sweet-tasting foods and beverages. Thus, it is not surprising that some children, if given the opportunity, might consume more fruit juice than is considered optimal. Eleven percent of healthy preschoolers consumed > or = 12 fl oz/day of fruit juice, which is considered excessive. Excess fruit juice consumption has been reported as a contributing factor in some children with nonorganic failure to thrive and in some children with decreased stature. In other children, excessive fruit juice consumption has been associated with an increased caloric intake and obesity. This paper reviews the role of fruit juice in the diets of infants and children and outlines areas for future research. Recommendations regarding fruit juice consumption based on current data are also given.
To compare the effects of aspartame-sweetened and sucrose-sweetened soft drinks on food intake and appetite ratings of female restrained eaters.
Fourteen female students, shown to have eating restraint.
Subjects were given four drinks (330 ml) of aspartame-sweetened lemonade, sucrose-sweetened lemonade and carbonated mineral water on three separate days. Seven of the subjects were informed of the drink type they were consuming on each occasion.
Appetite ratings were recorded and energy and macronutrient intakes were measured during the study day and day after leaving the department.
During the first study day energy intake was lower whilst drinking the sucrose-sweetened lemonade compared with the aspartame-sweetened lemonade, although neither differed significantly from energy intakes during the day the drank water. When the calories from the sucrose-sweetened lemonade were included (1381 kJ, 330 Kcal) energy intake did not differ between treatments. The following day energy intake was significantly higher after the aspartame-sweetened lemonade compared with both sucrose-sweetened lemonade and the water due to an increase in the amount of carbohydrate consumed and resulted in a higher total energy intake over the two days studied. Knowledge of the drink types had no effect on energy intake or macronutrient intake. Appetite ratings did not differ between drinks and were not affected by knowledge of the drink types.
These results suggest that in females with eating restraint, substituting sucrose-sweetened drinks for diet drinks does not reduce total energy intake and may even result in a higher intake during the subsequent day.
The purpose of this study was to determine whether presweetened breakfast cereals with various fiber contents and a moderate glycemic index optimize glucose availability and improve endurance exercise performance. Six recreationally active women ate 75 g of available carbohydrate in the form of breakfast cereals: sweetened whole-grain rolled oats (SRO, 7 g of dietary fiber) or sweetened whole-oat flour (SOF, 3 g of dietary fiber) and 300 ml of water or water alone (Con). The meals were provided 45 min before semirecumbent cycle ergometer exercise to exhaustion at 60% of peak O2 consumption (VO2peak). Diet and physical activity were controlled by having the subjects reside in the General Clinical Research Center for 2 days before each trial. Blood samples were drawn from an antecubital vein for glucose, free fatty acid (FFA), glycerol, insulin, epinephrine, and norepinephrine determination. Breath samples were obtained at 15-min intervals after meal ingestion and at 30-min intervals during exercise. Muscle glycogen concentration was determined from biopsies taken from the vastus lateralis muscle before the meal and immediately after exercise. Plasma FFA concentrations were lower (P < 0.05) during the SRO and SOF trials for the first 60 and 90 min of exercise, respectively, than during the Con trial. Respiratory exchange ratios were higher (P < 0.05) at 90 and 120 min of exercise for the SRO and SOF trials, respectively, than for the Con trial. At exhaustion, glucose, insulin, FFA, glycerol, epinephrine, and norepinephrine concentrations, respiratory exchange ratio, and muscle glycogen use in the vastus lateralis muscle were similar for all trials. Exercise time to exhaustion was 16% longer (P < 0.05) during the SRO than during the Con trial: 266.5 +/- 13 and 225.1 +/- 8 min, respectively. There was no difference in exercise time for the SOF (250.8 +/- 12) and Con trials. We conclude that eating a meal with a high dietary fiber content and moderate glycemic index 45 min before prolonged moderately intense exercise significantly enhances exercise capacity.
This study was intended to compare exogenous [(13)C]glucose (Glu(exo)) oxidation in boys with insulin-dependent diabetes mellitus (IDDM) and healthy boys of similar age, weight, and maximal O(2) uptake. In a control trial with water intake (CT) and in a (13)C-enriched glucose trial (GT), subjects cycled for 60 min (58.8 +/- 0.9% maximal O(2) uptake) while the utilization of total glucose, total fat, and Glu(exo) was assessed. In CT, total glucose was 84.7 +/- 9.2 vs. 91.3 +/- 6.6 g/60 min (not significantly different) and total fat was 13.3 +/- 2.2 vs. 11.1 +/- 1.7 g/60 min (not significantly different) in IDDM vs. healthy boys, respectively. In GT, Glu(exo) was 10.4 +/- 1.7 vs. 14.8 +/- 1.1 g/60 min, corresponding to 9.0 +/- 1.0 vs. 12.4 +/- 0.5% of the total energy supply in IDDM and healthy boys, respectively (P < 0.05). Endogenous glucose was spared in both groups by 12.6 +/- 3.5% (P < 0.05). Blood glucose and plasma insulin concentrations were two- to threefold higher in IDDM vs. healthy boys in both trials. In conclusion, Glu(exo) is impaired in exercising boys with IDDM, even when plasma insulin levels are elevated.
We measured substrate utilization during exercise performed with water (W), exogenous glucose (G), and exogenous fructose plus glucose (FG) ingestion in boys age 10-14 yr. Subjects (n = 12) cycled for 90 min at 55% maximal O(2) uptake while ingesting either W (25 ml/kg), 6% G (1.5 g/kg), or 3% F plus 3% G (1.5 g/kg). Fat oxidation increased during exercise in all trials but was higher in the W (0.28 +/- 0.023 g/min) than in the G (0.24 +/- 0.023 g/min) and FG (0.25 +/- 0.029 g/min) trials (P = 0.04). Conversely, total carbohydrate (CHO) oxidation decreased in all trials and was lower in the W (0.63 +/- 0.05 g/min) than in the G (0.78 +/- 0.051 g/min) and FG (0.74 +/- 0.056 g/min) trials (P = 0.009). Exogenous CHO oxidation, as determined by expired (13)CO(2), reached a maximum of 0.36 +/- 0.032 and 0.31 +/- 0.030 g/min at 90 min in G and FG, respectively (P = 0.04). Plasma insulin levels decrease during exercise in all trials but were twofold higher in G than in W and FG (P < 0.001). Plasma glucose levels decreased transiently after the onset of exercise in all trials and then returned to preexercise values in the W and FG (approximately 4.5 mmol/l) trials but were elevated by approximately 1.0 mmol/l in the G trial (P < 0.001). Plasma lactate concentrations decreased after the onset of exercise in all trials but were lower by approximately 0.5 mmol/l in W than in G and FG (P = 0.02). Thus, in boys exercising at a moderate intensity, the oxidation rate of G plus F is slightly less than G alone, but both spare endogenous CHO and fat to a similar extent. In addition, compared with flavored W, the ingestion of G alone and of G plus F delays exhaustion at 90% peak power by approximately 25 and 40%, respectively, after 90 min of moderate-intensity exercise.
Foods with a low glycemic index are increasingly being acknowledged as beneficial in relation to the insulin resistance syndrome. Certain organic acids can lower the glycemic index of bread products. However, the possible effect of acids in fermented milk products on the glycemic index and on insulinemic characteristics has not been addressed. The metabolic effects of fermented milk or pickled products used as additives to mixed meals have also not been addressed.
One objective was to characterize the glycemic and insulinemic responses after intake of regular or fermented milk products (study 1). In addition, the acute metabolic effect of fermented milk (yogurt) and pickled cucumber as supplements to a traditional breakfast based on a high-glycemic index bread was evaluated (study 2).
Ten healthy volunteers were served different breakfast meals after an overnight fast. Capillary blood samples were collected before and during 2 (study 1) or 3 (study 2) h after the meal. White-wheat bread was used as a reference meal in both studies.
The lactic acid in the fermented milk products did not lower the glycemic and insulinemic indexes. Despite low glycemic indexes of 15-30, all of the milk products produced high insulinemic indexes of 90-98, which were not significantly different from the insulinemic index of the reference bread. Addition of fermented milk (yogurt) and pickled cucumber to a breakfast with a high-glycemic index bread significantly lowered postprandial glycemia and insulinemia compared with the reference meal. In contrast, addition of regular milk and fresh cucumber had no favorable effect on the metabolic responses.
Milk products appear insulinotropic as judged from 3-fold to 6-fold higher insulinemic indexes than expected from the corresponding glycemic indexes. The presence of organic acids may counteract the insulinotropic effect of milk in mixed meals.
To determine whether eating a breakfast cereal with a moderate glycemic index could alter substrate utilization and improve exercise duration.
Six active women (age, 24 +/- 2 yr; weight, 62.2 +/- 2.6 kg; VO(2peak), 46.6 +/- 3.8 mL x kg(-1) x min(-1)) ate 75 g of available carbohydrate in the form of regular whole grain rolled oats (RO) mixed with 300 mL of water or water alone (CON). The trials were performed in random order and the meal or water was ingested 45 min before performing cycling exercise to exhaustion (60% of VO(2peak)). Blood samples were drawn for glucose, glucose kinetics, free fatty acids (FFA), glycerol, insulin, epinephrine (EPI), and norepinephrine (NE) determination. A muscle biopsy was obtained from the vastus lateralis muscle before the trial and immediately after exercise for glycogen determination. Glucose kinetics (Ra) were determined using a [6,6-(2)H] glucose tracer.
Compared with CON, plasma FFA and glycerol levels were suppressed (P < 0.05) during the first 120 min of exercise for the RO trial. Respiratory exchange ratios (RER) were also higher (P < 0.05) for the first 120 min of exercise for the RO trial. At exhaustion, glucose, insulin, FFA, glycerol, EPI, NE, RER, and muscle glycogen were not different between trials. Glucose Ra was greater (P < 0.05) during the RO trial compared with CON (2.36 +/- 0.22 and 1.92 +/- 0.27 mg x kg(-1) x min(-1), respectively). Exercise duration was 5% longer during RO, but the mean times were not significantly different (253.6 +/- 6 and 242.0 +/- 15 min, respectively).
Increased hepatic glucose output before fatigue provides some evidence of glucose sparing after the breakfast cereal trial. However, exercise duration was not significantly altered, possibly because of the sustained suppression of lipid metabolism and increased carbohydrate utilization throughout much of the exercise period.
The objective was to evaluate the impact of milk added to a high-glycaemic index (GI) white bread meal vs a low-GI spaghetti meal, respectively, on postprandial glucose and insulin responses in healthy subjects.
The volunteers were served the bread or spaghetti meals with either milk (200 or 400 ml, respectively) or water (400 ml) following an overnight fast. Capillary blood samples were collected before and during 3 h after the meals.
The study was performed at the Department of Applied Nutrition and Food Chemistry, Lund University, Sweden.
Ten healthy volunteers, seven men and three women, aged 22-30 y, with normal body mass indices, were recruited.
There was no difference in postprandial glucose area under curve (AUC) with and without added milk in the case of the high-GI bread meals. As could be expected, glucose AUC after the bread meal+water was higher than after the spaghetti meal+water. Milk added at 200 or 400 ml to the spaghetti meal did not affect glucose AUC. However, a significantly higher insulin AUC was seen with the bread meal with 400 ml milk (+65%) and the spaghetti meal with 200 ml or 400 ml milk (+300%), respectively, compared with corresponding test meal with water
The addition of milk to a low-GI spaghetti meal may significantly increase the postprandial insulinaemia. Even an ordinary amount of milk (200 ml) increased the insulin AUC to a low-GI spaghetti meal to the same level as seen with white bread. The mechanism for the insulinotrophic effect of milk is not known, and the potential long-term metabolic consequences need to be elucidated.
Swedish Dairy Association.
Reliable tables of glycemic index (GI) compiled from the scientific literature are instrumental in improving the quality of research examining the relation between GI, glycemic load, and health. The GI has proven to be a more useful nutritional concept than is the chemical classification of carbohydrate (as simple or complex, as sugars or starches, or as available or unavailable), permitting new insights into the relation between the physiologic effects of carbohydrate-rich foods and health. Several prospective observational studies have shown that the chronic consumption of a diet with a high glycemic load (GI x dietary carbohydrate content) is independently associated with an increased risk of developing type 2 diabetes, cardiovascular disease, and certain cancers. This revised table contains almost 3 times the number of foods listed in the original table (first published in this Journal in 1995) and contains nearly 1300 data entries derived from published and unpublished verified sources, representing > 750 different types of foods tested with the use of standard methods. The revised table also lists the glycemic load associated with the consumption of specified serving sizes of different foods.
The purpose of the present study was to investigate whether combined ingestion of two carbohydrates (CHO) that are absorbed by different intestinal transport mechanisms would lead to exogenous CHO oxidation rates of >1.0 g/min. Nine trained male cyclists (maximal O(2) consumption: 64 +/- 2 ml x kg body wt(-1) x min(-1)) performed four exercise trials, which were randomly assigned and separated by at least 1 wk. Each trial consisted of 150 min of cycling at 50% of maximal power output (60 +/- 1% maximal O(2) consumption), while subjects received a solution providing either 1.8 g/min of glucose (Glu), 1.2 g/min of glucose + 0.6 g/min of sucrose (Glu+Suc), 1.2 g/min of glucose + 0.6 g/min of maltose (Glu+Mal), or water. Peak exogenous CHO oxidation rates were significantly higher (P < 0.05) in the Glu+Suc trial (1.25 +/- 0.07 g/min) compared with the Glu and Glu+Mal trials (1.06 +/- 0.08 and 1.06 +/- 0.06 g/min, respectively). No difference was found in (peak) exogenous CHO oxidation rates between Glu and Glu+Mal. These results demonstrate that, when a mixture of glucose and sucrose is ingested at high rates (1.8 g/min) during cycling exercise, exogenous CHO oxidation rates reach peak values of approximately 1.25 g/min.
The purpose of the present study was to examine whether combined ingestion of a large amount of fructose and glucose during cycling exercise would lead to exogenous carbohydrate oxidation rates >1 g/min. Eight trained cyclists (maximal O(2) consumption: 62 +/- 3 ml x kg(-1) x min(-1)) performed four exercise trials in random order. Each trial consisted of 120 min of cycling at 50% maximum power output (63 +/- 2% maximal O(2) consumption), while subjects received a solution providing either 1.2 g/min of glucose (Med-Glu), 1.8 g/min of glucose (High-Glu), 0.6 g/min of fructose + 1.2 g/min of glucose (Fruc+Glu), or water. The ingested fructose was labeled with [U-(13)C]fructose, and the ingested glucose was labeled with [U-(14)C]glucose. Peak exogenous carbohydrate oxidation rates were approximately 55% higher (P < 0.001) in Fruc+Glu (1.26 +/- 0.07 g/min) compared with Med-Glu and High-Glu (0.80 +/- 0.04 and 0.83 +/- 0.05 g/min, respectively). Furthermore, the average exogenous carbohydrate oxidation rates over the 60- to 120-min exercise period were higher (P < 0.001) in Fruc+Glu compared with Med-Glu and High-Glu (1.16 +/- 0.06, 0.75 +/- 0.04, and 0.75 +/- 0.04 g/min, respectively). There was a trend toward a lower endogenous carbohydrate oxidation in Fruc+Glu compared with the other two carbohydrate trials, but this failed to reach statistical significance (P = 0.075). The present results demonstrate that, when fructose and glucose are ingested simultaneously at high rates during cycling exercise, exogenous carbohydrate oxidation rates can reach peak values of approximately 1.3 g/min.
To investigate the influence of ingestion of beverages with sucrose or with intense sweeteners on food intake (FI) and on hunger ratings in before and after a month of daily consumption of beverages.
Experimental study.
Department of Physiology, University Hospital, Dijon, France.
In all, 12 men and 12 women, aged 20-25 y.
Four beverages contained either sucrose (E+:100 g/l, 1672 kJ) or intense sweeteners (E-: null energy content) and were flavoured with either orange (O) or raspberry (R). FI was measured in the lab during two 2-consecutive-day periods, carried out on 2 successive weeks (session 1). The subjects drank 2 l of either E+ or E- beverages on the first day of both weekly periods, according to a balanced randomised design. E+ was paired with O for 50% of subjects and with R for the other 50%. Subjects were then habituated over a 4-week period to both beverages, consuming 1 l of E+ beverage on odd days and 1 l of E- drink on even days. After this period, the measurements of session 1 were repeated (session 2, weeks 7-8). Finally, FI was measured for two more 2-day periods (weeks 9-10) after the association between flavour and energy content was reversed (session 3).
The E- drinks were less palatable than the E+ drinks. Besides, we observed that FI was not reduced in response to a liquid extra caloric load and there was no change in hunger ratings after the beverages in any of the sessions.
Ingestion of caloric beverages induced a positive energy balance and the continuous exposure phase to these beverages over 1 month did not improve FI adaptation in response to the extra energy provided by the beverages.
To determine if a school based educational programme aimed at reducing consumption of carbonated drinks can prevent excessive weight gain in children.
Cluster randomised controlled trial.
Six primary schools in southwest England.
644 children aged 7-11 years.
Focused educational programme on nutrition over one school year.
Drink consumption and number of overweight and obese children.
Consumption of carbonated drinks over three days decreased by 0.6 glasses (average glass size 250 ml) in the intervention group but increased by 0.2 glasses in the control group (mean difference 0.7, 95% confidence interval 0.1 to 1.3). At 12 months the percentage of overweight and obese children increased in the control group by 7.5%, compared with a decrease in the intervention group of 0.2% (mean difference 7.7%, 2.2% to 13.1%).
A targeted, school based education programme produced a modest reduction in the number of carbonated drinks consumed, which was associated with a reduction in the number of overweight and obese children.
Background: Rates of overweight and obesity have increased. Consumption of sugar-sweetened beverages (SBs) may play a role.
Objective: The purpose of this meta-analysis was to determine whether the results of original research with the use of longitudinal and randomized controlled trials (RCTs) support the hypothesis that SB consumption is associated with weight gain among children and adolescents.
Design: The MEDLINE database was used to retrieve all original studies of SBs and weight gain involving children and adolescents. Twelve (10 longitudinal and 2 RCT) studies were reviewed. Eight of the longitudinal studies and both RCT studies were incorporated into a quantitative meta-analysis. Forest plots and overall estimates and CIs for the association of the difference (Δ) in SB consumption with Δbody mass index (BMI; in kg/m²) were produced. Funnel plots were examined as a diagnostic test for publication bias. Databases of unpublished scientific studies were searched. Sensitivity tests were conducted to examine the robustness of the meta-analysis results.
Results: The overall estimate of the association was a 0.004 (95% CI: −0.006, 0.014) change in BMI during the time period defined by the study for each serving per day change in SB consumption with the fixed-effects model and 0.017 (95% CI: −0.009, 0.044) with the random-effects model. The funnel plot is consistent with publication bias against studies that do not report statistically significant findings. The sensitivity tests suggest that the results are robust to alternative assumptions and new studies.
Conclusion: The quantitative meta-analysis and qualitative review found that the association between SB consumption and BMI was near zero, based on the current body of scientific evidence.
This study determined if the suppression of lipolysis after preexercise carbohydrate ingestion reduces fat oxidation during exercise. Six healthy, active men cycled 60 min at 44 ± 2% peak oxygen consumption, exactly 1 h after ingesting 0.8 g/kg of glucose (Glc) or fructose (Fru) or after an overnight fast (Fast). The mean plasma insulin concentration during the 50 min before exercise was different among Fast, Fru, and Glc (8 ± 1, 17 ± 1, and 38 ± 5 μU/ml, respectively; P< 0.05). After 25 min of exercise, whole body lipolysis was 6.9 ± 0.2, 4.3 ± 0.3, and 3.2 ± 0.5 μmol ⋅ kg-1⋅ min-1and fat oxidation was 6.1 ± 0.2, 4.2 ± 0.5, and 3.1 ± 0.3 μmol ⋅ kg-1⋅ min-1during Fast, Fru, and Glc, respectively (all P < 0.05). During Fast, fat oxidation was less than lipolysis ( P < 0.05), whereas fat oxidation approximately equaled lipolysis during Fru and Glc. In an additional trial, the same subjects ingested glucose (0.8 g/kg) 1 h before exercise and lipolysis was simultaneously increased by infusing Intralipid and heparin throughout the resting and exercise periods (Glc+Lipid). This elevation of lipolysis during Glc+Lipid increased fat oxidation 30% above Glc (4.0 ± 0.4 vs. 3.1 ± 0.3 μmol ⋅ kg-1⋅ min-1; P < 0.05), confirming that lipolysis limited fat oxidation. In summary, small elevations in plasma insulin before exercise suppressed lipolysis during exercise to the point at which it equaled and appeared to limit fat oxidation.
It is the position of the American Dietetic Association that children ages 2 to 11 years should achieve optimal physical and cognitive development, attain a healthy weight, enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity. The health status of American children has generally improved during the past 3 decades. However, the number of children who are overweight has more than doubled among 2- to 5-year-old children and more than tripled among 6- to 11-year-old children, which has major health consequences. This increase in childhood overweight has broadened the focus of dietary guidance to address children's overconsumption of energy-dense, nutrient-poor foods and beverages and physical activity patterns. Health promotion will help reduce diet-related risks of chronic degenerative diseases, such as cardiovascular disease, type 2 diabetes, cancer, obesity, and osteoporosis. This position reviews what US children are eating and explores trends in food and nutrient intakes as well as the impact of school meals on children's diets. Dietary recommendations and guidelines and the benefits of physical activity are also discussed. The roles of parents and caregivers in influencing the development of healthful eating behaviors are highlighted. Specific recommendations and sources of nutrition messages to improve the nutritional well-being of children are provided for food and nutrition professionals
Obesitas bij kinderen heeft epidemische vormen aangenomen.2 De belangrijkste oorzaken voor excessieve gewichtstoename bij
kinderen zijn genetisch, endocrien bepaald en kan ontstaan onafhankelijk van andere ziekten.3 Nu is veronderstelling dat de
consumptie van zoete koolzuurhoudende dranken bijdraagt aan overgewicht bij kinderen. Uit onderzoek is gebleken dat kinderen
die regelmatig koolzuurhoudende zoete frisdrank drinken gemiddeld 10 procent hogere energie-inname hebben vergeleken met kinderen
die deze frisdrank niet consumeren.4 In Engeland drinkt meer dan 70 procent van de adolescenten frequent koolzuurhoudende
frisdrank.
Exercise is known to cause physiological changes that could affect the impact of nutrients on appetite control. This study was designed to assess the effect of drinks containing either sucrose or high-intensity sweeteners on food intake following exercise. Using a repeated-measures design, three drink conditions were employed: plain water (W), a low-energy drink sweetened with artificial sweeteners aspartame and acesulfame-K (L), and a high-energy, sucrose-sweetened drink (H). Following a period of challenging exercise (70% VO2 max for 50 min), subjects consumed freely from a particular drink before being offered a test meal at which energy and nutrient intakes were measured. The degree of pleasantness (palatability) of the drinks was also measured before and after exercise. At the test meal, energy intake following the artificially sweetened (L) drink was significantly greater than after water and the sucrose (H) drinks (p < 0.05). Compared with the artificially sweetened (L) drink, the high-energy (H) drink suppressed intake by approximately the energy contained in the drink itself. However, there was no difference between the water (W) and the sucrose (H) drink on test meal energy intake. When the net effects were compared (i.e., drink + test meal energy intake), total energy intake was significantly lower after the water (W) drink compared with the two sweet (L and H) drinks. The exercise period brought about changes in the perceived pleasantness of the water, but had no effect on either of the sweet drinks. The remarkably precise energy compensation demonstrated after the higher energy sucrose drink suggests that exercise may prime the system to respond sensitively to nutritional manipulations. The results may also have implications for the effect on short-term appetite control of different types of drinks used to quench thirst during and after exercise.
We sought to document increases in caloric contributions from sugar-sweetened beverages and 100% fruit juice among US youth during 1988-2004.
We analyzed 24-hour dietary recalls from children and adolescents (aged 2-19) in 2 nationally representative population surveys: National Health and Nutrition Examination Survey III (1988-1994, N = 9882) and National Health and Nutrition Examination Survey 1999-2004 (N = 10 962). We estimated trends in caloric contribution, type, and location of sugar-sweetened beverages and 100% fruit juice consumed.
Per-capita daily caloric contribution from sugar-sweetened beverages and 100% fruit juice increased from 242 kcal/day (1 kcal = 4.2 kJ) in 1988-1994 to 270 kcal/day in 1999-2004; sugar-sweetened beverage intake increased from 204 to 224 kcal/day and 100% fruit juice increased from 38 to 48 kcal/day. The largest increases occurred among children aged 6 to 11 years ( approximately 20% increase). There was no change in per-capita consumption among white adolescents but significant increases among black and Mexican American youths. On average, respondents aged 2 to 5, 6 to 11, and 12 to 19 years who had sugar-sweetened beverages on the surveyed day in 1999-2004 consumed 176, 229, and 356 kcal/day, respectively. Soda contributed approximately 67% of all sugar-sweetened beverage calories among the adolescents, whereas fruit drinks provided more than half of the sugar-sweetened beverage calories consumed by preschool-aged children. Fruit juice drinkers consumed, on average, 148 (ages 2-5), 136 (ages 6-11), and 184 (ages 12-19) kcal/day. On a typical weekday, 55% to 70% of all sugar-sweetened beverage calories were consumed in the home environment, and 7% to 15% occurred in schools.
Children and adolescents today derive 10% to 15% of total calories from sugar-sweetened beverages and 100% fruit juice. Our analysis indicates increasing consumption in all ages. Schools are a limited source for sugar-sweetened beverages, suggesting that initiatives to restrict sugar-sweetened beverage sales in schools may have an only marginal impact on overall consumption. Pediatricians' awareness of these trends is critical for helping children and parents target suboptimal dietary patterns that may contribute to excess calories and obesity.
Water consumption acutely reduces meal energy intake (EI) among middle-aged and older adults. Our objectives were to determine if premeal water consumption facilitates weight loss among overweight/obese middle-aged and older adults, and to determine if the ability of premeal water consumption to reduce meal EI is sustained after a 12-week period of increased water consumption. Adults (n = 48; 55-75 years, BMI 25-40 kg/m(2)) were assigned to one of two groups: (i) hypocaloric diet + 500 ml water prior to each daily meal (water group), or (ii) hypocaloric diet alone (nonwater group). At baseline and week 12, each participant underwent two ad libitum test meals: (i) no preload (NP), and (ii) 500 ml water preload (WP). Meal EI was assessed at each test meal and body weight was assessed weekly for 12 weeks. Weight loss was ~2 kg greater in the water group than in the nonwater group, and the water group (beta = -0.87, P < 0.001) showed a 44% greater decline in weight over the 12 weeks than the nonwater group (beta = -0.60, P < 0.001). Test meal EI was lower in the WP than NP condition at baseline, but not at week 12 (baseline: WP 498 +/- 25 kcal, NP 541 +/- 27 kcal, P = 0.009; 12-week: WP 480 +/- 25 kcal, NP 506 +/- 25 kcal, P = 0.069). Thus, when combined with a hypocaloric diet, consuming 500 ml water prior to each main meal leads to greater weight loss than a hypocaloric diet alone in middle-aged and older adults. This may be due in part to an acute reduction in meal EI following water ingestion.
To estimate the net caloric impact from replacing sugar-sweetened beverages (SSBs) with alternatives in children and adolescents in naturalistic settings.
Secondary analysis based on nationally representative cross-sectional study.
Fixed-effect regression analysis of 2 nonconsecutive 24-hour dietary recalls from the 2003-2004 National Health and Nutrition Examination Survey data.
Children and adolescents 2 to 19 years of age (N = 3098).
Within-person beverage consumption between 2 surveyed days.
The association between changes in the consumption of SSBs and other beverages and changes in total energy intake (TEI) of the same individual.
Each additional serving (8 oz) of SSB corresponded to a net increase of 106 kcal/d (P < .001; 95% confidence interval [CI], 91 to 121 kcal/d), holding other beverages constant. Increases were also seen (all P < .001) for each additional serving of whole milk (169 kcal/d; 95% CI, 143 to 195 kcal/d), reduced-fat milk (145 kcal/d; 95% CI, 118 to 171 kcal/d), and 100% juice (123 kcal/d; 95% CI, 90 to 157 kcal/d). No net increases in TEI were seen for water (8 kcal/d; P = .27; 95% CI, -6 to 22 kcal/d) or diet drinks (47 kcal/d; P = .20; 95% CI, -23 to 117 kcal/d). Substituting SSBs with water was associated with a significant decrease in TEI, controlling for intake of other beverages, total beverage and nonbeverages, and fast-food and weekend effects. Each 1% of beverage replacement was associated with 6.6-kcal lower TEI, a reduction not negated by compensatory increases in other food or beverages. We estimate that replacing all SSBs with water could result in an average reduction of 235 kcal/d.
Replacing SSB intake with water is associated with reductions in total calories for all groups studied.
The study tested whether a combined environmental and educational intervention solely promoting water consumption was effective in preventing overweight among children in elementary school.
The participants in this randomized, controlled cluster trial were second- and third-graders from 32 elementary schools in socially deprived areas of 2 German cities. Water fountains were installed and teachers presented 4 prepared classroom lessons in the intervention group schools (N = 17) to promote water consumption. Control group schools (N = 15) did not receive any intervention. The prevalence of overweight (defined according to the International Obesity Task Force criteria), BMI SD scores, and beverage consumption (in glasses per day; 1 glass was defined as 200 mL) self-reported in 24-hour recall questionnaires, were determined before (baseline) and after the intervention. In addition, the water flow of the fountains was measured during the intervention period of 1 school year (August 2006 to June 2007).
Data on 2950 children (intervention group: N = 1641; control group: N = 1309; age, mean +/- SD: 8.3 +/- 0.7 years) were analyzed. After the intervention, the risk of overweight was reduced by 31% in the intervention group, compared with the control group, with adjustment for baseline prevalence of overweight and clustering according to school. Changes in BMI SD scores did not differ between the intervention group and the control group. Water consumption after the intervention was 1.1 glasses per day greater in the intervention group. No intervention effect on juice and soft drink consumption was found. Daily water flow of the fountains indicated lasting use during the entire intervention period, but to varying extent.
Our environmental and educational, school-based intervention proved to be effective in the prevention of overweight among children in elementary school, even in a population from socially deprived areas.
To investigate the influence of pre-exercise carbohydrate ingestion on fat and carbohydrate oxidation during prolonged arm cranking exercise in persons with spinal cord injury.
Six male paraplegic subjects (PS, Ll-Th3, 46.3+/-6.6 years) and seven able-bodied subjects (AB, 43.1+/-4.6 years) were volunteered to participate in the present study.
The subjects were required to consume a glucose solution (1 g kg(-1) body mass and 500 ml plain water; glucose experiment) or only plain water (water experiment) before the prolonged exercise. Then the subjects performed for 1-h arm cranking exercise at a moderate workload.
In the water experiment, the carbohydrate oxidation slightly decreased and the fat oxidation increased continuously in AB. In contrast, the carbohydrate and fat oxidation of PS was constant during the exercise in the water experiment. In the glucose experiment, the fat oxidation did not rise and the carbohydrate oxidation was constant until the end of the exercise in PS and AB. PS oxidized more fat than AB in the glucose experiment (P<0.05), but no significant difference was found between PS and AB in the water experiment.
Using a wheelchair in daily life regularly was regarded as an exercise training that disciplined PS indirectly and is considered to cause PS to have more percentage of type I fiber than AB in the anterior deltoid muscle. Thus, the distribution of muscle fiber type in anterior deltoid muscle might be one of the factors that impacted the fat oxidation of PS in glucose experiment.
Data from short-term experiments suggest that drinking water may promote weight loss by lowering total energy intake and/or altering metabolism. The long-term effects of drinking water on change in body weight and composition are unknown, however.
This study tested for associations between absolute and relative increases in drinking water and weight loss over 12 months.
Secondary analyses were conducted on data from the Stanford A TO Z weight loss intervention on 173 premenopausal overweight women (aged 25-50 years) who reported <1 l/day drinking water at baseline. Diet, physical activity, body weight, percent body fat (dual-energy X-ray absorptiometry), and waist circumference were assessed at baseline, 2, 6, and 12 months. At each time point, mean daily intakes of drinking water, noncaloric, unsweetened caloric (e.g., 100% fruit juice, milk) and sweetened caloric beverages, and food energy and nutrients were estimated using three unannounced 24-h diet recalls. Beverage intake was expressed in absolute (g) and relative terms (% of beverages). Mixed models were used to test for effects of absolute and relative increases in drinking water on changes in weight and body composition, controlling for baseline status, diet group, and changes in other beverage intake, the amount and composition of foods consumed and physical activity.
Absolute and relative increases in drinking water were associated with significant loss of body weight and fat over time, independent of covariates.
The results suggest that drinking water may promote weight loss in overweight dieting women.
The purpose of this study was to reassess the metabolic availability of oral glucose during prolonged exercise in man, using 13C-labeling and a computation procedure (J Appl Physiol 69:1047-1052, 1990) that correctly takes into account changes in isotopic composition of CO2 arising from oxidation of endogenous substrates (Rendo). These changes are due to glucose ingestion associated with exercise. Each of the seven subjects completed three 2-hour periods of exercise at 67% maximum oxygen consumption (VO2max) on an ergocycle, with ingestion of water (1,000 mL) or 60 g (in 1,000 mL water) of 13C-labeled glucose at two levels of enrichment (13C/12C = 1.11482% and 1.13303%). As expected, Rendo significantly increased from rest to exercise with water ingestion (1.09888% +/- .00196% to 1.09970% +/- .00175%) and with glucose ingestion (1.10002% +/- .00159%) due to changes in the respective contributions of endogenous carbohydrates and fat to energy requirements as assessed by the respiratory exchange ratio (RER). When changes in Rendo were taken into account, the estimated amount of exogenous glucose oxidized was 38.8 +/- 10.3 g. Much higher values were found when Rendo at rest or during exercise with water ingestion were used in the computation (42.3 +/- 10.3 to 65.1 +/- 20.5 g) according to the commonly used method. Examination of data in the literature indicates that the reported oxidation rate of exogenous glucose (g/min) is significantly related to oxygen consumption (VO2) (L/min; r = .592) and that exogenous glucose contributes approximately 14% to 17% to the energy requirement.(ABSTRACT TRUNCATED AT 250 WORDS)
Dietary self-selection was examined in 40 preschool children who were offered high-energy chocolate-flavored or plain milk with a lunchtime meal. Children aged 20-56 months were served various nutritious menus for lunch twice a week, for 8 weeks, and the chocolate milk was offered with half of the meals. The children consumed large quantities of the high-energy chocolate milk when it was offered, without decreasing their intake of other food items in the meal. Thus, significantly more energy was consumed during each of the different meals in which chocolate milk was served. These results open the possibility that, by offering palatable, high-energy drinks to preschool children at a mealtime, one might be able to increase children's caloric intake without compromising the rest of the diet at that meal. The effect of this increased caloric consumption on intake during subsequent meals, as well as the effect of repetition of the test meals, remains to be tested.
This study examined the effects of aspartame, saccharin, and sucrose on hunger and food intake. Twenty normal adults consumed a standard breakfast followed 3 h later by 200 mL of either water or a sweetened drink. One hour later, subjects' ad libitum consumption of a standardized lunch was measured. Subjects recorded self-assessments of hunger-related indices every half hour on visual analogue scales (VAS). ANOVA with repeated measures showed a significant effect of drink type on VAS scores 15 and 45 min after drinks were consumed but not for other times or for lunch consumption. Hunger-related ratings after drink consumption were generally highest for water, lower for noncaloric sweeteners (NCSs), and lowest for sugar. Pairwise comparisons of means showed that only the ratings for sugar and water were significantly different. The results show that, under the conditions of this study, NCSs do not increase hunger or food intake.
To determine how long a meal will affect the metabolic response to exercise, nine endurance-trained and nine untrained subjects cycled for 30 min at 70% of peak O2 consumption (VO2 peak) 2, 4, 6, 8, and 12 h after eating 2 g carbohydrate/kg body wt. In addition, each subject completed 30 min of cycling 4 h after the meal at an intensity that elicited a respiratory exchange ratio (RER) of 0.94-0.95. During exercise after 2 and 4 h of fasting, carbohydrate oxidation was elevated 13-15% compared with the response to exercise after an 8- and 12-h fast (P less than 0.01). The increase in blood glycerol concentration during exercise (30 to 0 min) was linearly related to the length of fasting (r = 0.99; P less than 0.01). In all subjects, plasma glucose concentration declined 17-21% during exercise after 2 h of fasting (P less than 0.01). Plasma glucose concentration also declined (15-25%) during exercise in the trained subjects after 4 and 6 h of fasting (P less than 0.05) but did not change in the untrained subjects. However, the decline in plasma glucose concentration was similar (14%) in the two groups when the exercise intensity was increased in the trained subjects (i.e., 78 +/- 1% VO2 peak) and decreased in the untrained subjects (i.e., 65 +/- 3% VO2 peak) to elicit a similar RER.(ABSTRACT TRUNCATED AT 250 WORDS)
In two experiments, 2-5-year-old children's responsiveness to caloric density cues was examined. In a preloading protocol, consumption of fixed volumes of drinks (205 ml in Experiment 1; 150 ml in Experiment 2), sweetened with sucrose, aspartame, aspartame plus low glucose maltodextrin, or a water control, was followed by ad lib consumption from among a variety of foods. Caloric drinks had about 90 kcal in Experiment 1, 65 kcal in Experiment 2. The delay interval between the preload and the ad lib consumption was 0, 30 or 60 minutes. In Experiment 1, 24 4- and 5-year-old children participated in only one delay interval, while in Experiment 2, all 20 2- and 3-year-old children were seen in all conditions. Results revealed evidence of caloric compensation, but no evidence of preload x time delay interaction. In both experiments, aspartame also produced a significant suppression of intake relative to water, primarily due to the pattern at 30 min following the preload. Across conditions, the suppression following aspartame was usually significantly less than that produced by the caloric sweet drinks, providing evidence for postingestive effects. In Experiment 1, suppression of intake was related to the children's preferences for the foods, not to macronutrient content; consumption of nonpreferred foods was most suppressed. Consumption of sweetened drinks as long as 1 hour prior to eating suppressed food intake, and this common feeding practice may also reduce dietary variety.
Twenty-one two and half- to five-year-old children and 26 25- to 35-year-old adults participated in an experiment designed to provide evidence for two behavioral mechanisms involved in self regulation of food intake: caloric compensation and sensory specific satiety. All participants were seen in two lunch sessions that differed in the caloric density of the preload presented. To obtain evidence on sensory specific satiety, preference data were obtained immediately before and after, and 20 min after preload consumption. Subjects then ate an ad libitum lunch and consumption was recorded. Both children's and adults' preferences for the food eaten declined relative to foods not eaten, providing the first evidence of sensory specific satiety in children. The patterns of preference did not differ with the caloric density of the food eaten. Children showed much clearer evidence for caloric compensation than did the adults.
In Sweden, milk and milk products are important sources of daily energy intake but the role of milk with preschool lunch meals has been debated frequently and water is often alternatively given today. We studied the effects of milk or water on lunch energy intake. Water or milk alternatively was served in a controlled, within-subject design on 12 occasions to 36 children aged 4-6 years, and energy intake was analysed at an individual level in three typical preschool lunches with a varying degree of preference among the children. When milk was given with the meals, a mean additional energy intake of 17% (p<0.0001) was found. The pattern was similar among boys and girls and irrespective of the lunch dish served. However, for the least preferred dish (fish with potatoes) milk helped to increase the energy intake by 26%. Physical activity measured as MET units (energy expenditure/body weight), atmosphere at the table as registered by a three-graded scale, and meal duration did not differ with meals or milk/water. Milk with preschool lunch meals seems to be a significant source of energy to achieve nutritional goals for this group of children.
To examine the influence of the oro-sensory properties of different beverages on spontaneous intake of drinks, and the consequence of the volume of fluid ingested on subsequent food intake, 24 subjects (12 men, 12 women), slightly dehydrated, had access ad libitum, during four different experimental sessions in a cross-over design, to one of four commercial beverages without any other drink. The four beverages differed in flavour and caloric content: mineral water; the same mineral water flavoured with orange and unsweetened; the same mineral water flavoured with orange and sweetened with 100 g/l sucrose; or equally sweetened with 50 mg/l aspartame. Ad libitum: lunch was served 15 min after the subjects had access to the beverages and dinner was served when they spontaneously requested it, about 6 h after the end of lunch. The nature of the beverage exerted a small but significant effect on the cumulative fluid intake of the subjects. They consumed slightly more of the two sweetened beverages than the mineral water, and slightly less of the orange-flavoured beverage. However, energy intake and macronutrient selection during lunch and dinner on the experimental days and on the following day did not differ significantly between the different conditions. This resulted in a significantly higher total energy intake when the imposed beverage contained sucrose. Moreover, in such experimental conditions, with only one type of beverage to drink, the flavour of this beverage had little influence on the amount of fluid consumed, and the volume consumed did not influence subsequent food intake. As a consequence, the energy provided by the sucrose-sweetened beverage was not taken in account in the overall energy balance by the subjects, at least in the short term.
To examine the eating behavior of preschool children offered chocolate-flavored or plain milk at lunch, food consumption by 135 children, aged 18-66 months, was measured. Four different menus were served six times during a 12-week period, each menu being presented twice with each of three test beverages, plain milk (18.1 kcal/oz), sucrose-sweetened chocolate milk (29.4 kcal/oz), or aspartame-sweetened chocolate milk (18.6 kcal/oz). The type of milk beverage served had no significant effect on the consumption of other food items offered at that meal. Subjects did drink significantly more chocolate milk than plain milk during all meals and consequently consumed significantly more energy during those meals in which sucrose-sweetened chocolate milk was served. A macronutrient analysis of lunch-time food intake for each menu revealed significant differences in protein, fat, and carbohydrate content among the four menus. Older children consumed significantly more milk and more energy per lunch-time meal than did younger preschoolers, but no other consistent age-related differences were observed. No significant gender differences were detected in any of the statistical analyses conducted. These findings suggest that young children do not reduce the intake of other food items at a meal to compensate for the increased energy intake that results from excessive sucrose-sweetened milk consumption. Aspartame-sweetened milk increases milk intake in small children without providing them with the additional calories of sucrose-sweetened milk.
We investigated the effect of carbohydrate (CHO) ingestion before and during exercise and in combination on glucose kinetics, metabolism and performance in seven trained men, who cycled for 120 min (SS) at approximately 63% of peak power output, followed by a 7 kJ/kg body wt time trial (TT). On four separate occasions, subjects received either a placebo beverage before and during SS (PP); placebo 30 min before and 2 g/kg body wt of CHO in a 6.4% CHO solution throughout SS (PC); 2 g/kg body wt of CHO in a 25.7% CHO beverage 30 min before and placebo throughout SS (CP); or 2 g/kg body wt of CHO in a 25.7% CHO beverage 30 min before and 2 g/kg of CHO in a 6.4% CHO solution throughout SS (CC). Ingestion of CC and CP markedly (>8 mM) increased plasma glucose concentration ([glucose]) compared with PP and PC (5 mM). However, plasma [glucose] fell rapidly at the onset of SS so that after 80 min it was similar (6 mM) between all treatments. After this time, plasma [glucose] declined in both PP and CP (P < 0.05) but was well maintained in both CC and PC. Ingestion of CC and CP increased rates of glucose appearance (R(a)) and disappearance (R(d)) compared with PP and PC at the onset of, and early during, SS (P < 0.05). However, late in SS, both glucose R(a) and R(d) were higher in CC and PC compared with other trials (P < 0.05). Although calculated rates of glucose oxidation were different when comparing the four trials (P < 0.05), total CHO oxidation and total fat oxidation were similar. Despite this, TT was improved in CC and PC compared with PP (P < 0.05). We conclude that 1) preexercise ingestion of CHO improves performance only when CHO ingestion is maintained throughout exercise, and 2) ingestion of CHO during 120 min of cycling improves subsequent TT performance.
Children exhibit individual differences in their ability to self-regulate energy intake. Feeding strategies that focus on external signals, like the time of day or amount of food left on a plate, tend to diminish children's ability to respond to internal cues of hunger and fullness.
We investigated whether children could be taught to focus on internal cues of hunger and satiety, and consequently improve their self-regulation of energy intake. We explored whether parents' eating behaviors and adiposity were related to their children's self-regulation skills and adiposity.
In a pretest and posttest design, preschoolers participated in single-meal protocols to assess their individual ability to self-regulate food intake. During a 6-week intervention period, children took part in individual and group activities designed to help them recognize internal cues. Parents completed questionnaires regarding adult dietary restraint and disinhibition.
At baseline, we found a large individual variability in children's regulation: some children overate, some regulated accurately, and others underate. At baseline, children's eating related to their adiposity and to mothers' disinhibition: heavier children and children whose mothers' reported difficulty controlling food intake showed less evidence of self-regulation. Both overeaters and undereaters responded to the intervention, improving their ability to self-regulate, and children's eating was no longer significantly related to mother's eating.
Children's disregulated energy intake is related to mothers' weight status and mothers' perceived control over eating. Cues can be provided that help children to focus on internal signals and improve their ability to self-regulate energy intake.
The influence of glucose ingestion on substrate utilization during prolonged exercise in children and adolescents is currently unknown. In the present study we determined the effect of intermittent exogenous glucose (GLUexo) ingestion on substrate utilization during prolonged exercise, in adolescent boys ages 13 17 years. Healthy untrained volunteers performed four 30-min exercise bouts on a cycle ergometer, separated by 5-min rest periods (approximately equal to 60% maximum O2 consumption), on two occasions spaced 1-4 weeks apart. Two trials were performed, a control trial (CT), in which subjects ingested water intermittently during the exercise, and a glucose trial (GT), in which subjects ingested a 13C-enriched GLUexo drink (approximately egual to glucose kg body mass(-1)), also intermittently during the exercise. Total free fatty acids (FATtotal), glucose (GLUtotal) and carbohydrate (CHOtotal) oxidation was determined from indirect calorimetry, while GLUexo oxidation was calculated from the 13C/12C ratio in expired air after 5-10 min and 25-30 min of exercise in each bout. Heart rate and rating of perceived exertion (RPE) were determined at the same time intervals. The oxidation of CHOtotal was 169.1 (12.9) g x 120 min(-1) and 203.1 (15.9) g x 120 min(-1) (P < 0.01) and that of FATtotal was 31.0 (4.2) g x 120 min(-1) and 17.1 (2.5) g x 120 min(-1) (P < 0.01) in CT and GT, respectively. GLUexo oxidation in GT was 57.8 (4.3) g x 120 min(-1), or 34.2 (2.2)% of that ingested. Endogenous glucose oxidation was 169.1 (12.9) g x 120 min(-1) and 145.3 (11.9) g x 120 min(-1) (P < 0.01) in CT and GT, respectively. Insulin and glucose concentrations were higher in GT than in CT by 226% and 37%, respectively (both P < 0.05). Free fatty acids and glycerol concentrations were lower in GT than in CT, by 27% and 79%, respectively (both P < 0.05). Heart rate was similar between trials, but RPE was lower in GT vs CT at both 115 and 135 min. Thus, under these experimental conditions, GLUexo intake spares endogenous carbohydrate and fat by 16% and 45%, respectively, contributes to approximately 25% of the total energy demand of exercise, and lowers the RPE.
To study the effects of excessive sweetened drink consumption on daily energy balance and nutrient intake in a longitudinal study of children.
Daily dietary intakes of 30 children aged 6 to 13 years old were collected over 4 to 8 weeks. Weights and heights of children were measured at the beginning and end of the study in 21 children. Data were analyzed by analysis of variance (ANOVA) (PROC MIXED in SAS) and multiple regression.
Excessive sweetened drink consumption (>12 oz/day) displaced milk from children's diets (122-147 g/day less milk drank, P <.0001) because caregivers served less milk and the children consumed smaller amounts of milk. The consequences were lower daily protein, calcium, magnesium, phosphorus, and vitamin A intakes. Because children failed to reduce consumption of solid foods to compensate for the caloric contribution of sweetened drinks, higher daily energy intakes were observed. Consequently, the greater the sweetened drink consumption the greater the weight gain (1.12 +/- 0.7 kg) compared with children who consumed <12 oz per day (0.32-0.48 +/- 0.4 kg).
Excessive sweetened drink consumption is associated with the displacement of milk from children's diets, higher daily energy intake, and greater weight gain.
Studies that have investigated oxidation of a single carbohydrate (CHO) during exercise have reported oxidation rates of up to 1 g x min(-1). Recent studies from our laboratory have shown that a mixture of glucose and sucrose or glucose and fructose ingested at a high rate (1.8 g x min(-1)) leads to peak oxidation rates of approximately 1.3 g x min(-1) and results in approximately 20 to 55% higher exogenous CHO oxidation rates compared with the ingestion of an isocaloric amount of glucose.
The purpose of the present study was to examine whether a mixture of glucose, sucrose and fructose ingested at a high rate would result in even higher exogenous CHO oxidation rates (>1.3 g x min(-1)).
Eight trained male cyclists (VO2max: 64 +/- 1 mL x kg(-1) BM x min(-1)) cycled on three different occasions for 150 min at 62 +/- 1% VO2max and consumed either water (WAT) or a CHO solution providing 2.4 g x min(-1) of glucose (GLU) or 1.2 g x min(-1) of glucose + 0.6 g x min(-1) of fructose + 0.6 g x min(-1) of sucrose (MIX).
High peak exogenous CHO oxidation rates were found in the MIX trial (1.70 +/- 0.07 g x min(-1)), which were approximately 44% higher (P < 0.01) compared with the GLU trial (1.18 +/- 0.04 g x min(-1)). Endogenous CHO oxidation was lower (P < 0.05) in MIX compared with GLU (0.76 +/- 0.12 and 1.05 +/- 0.06 g x min(-1), respectively).
When glucose, fructose and sucrose are ingested simultaneously at high rates (2.4 g x min(-1)) during cycling exercise, exogenous CHO oxidation rates can reach peak values of approximately 1.7 g x min(-1) and estimated endogenous CHO oxidation is reduced compared with the ingestion of an isocaloric amount of glucose.
The percentage of overweight children in the United States and other countries has now reached epidemic proportions. Both physical activity and food intake contribute to the energy equation, but research increasingly points to physical inactivity as the primary culprit in weight gain. Singling out and restricting specific foods and beverages are unlikely to be effective in reducing the prevalence of overweight children. Nutrition educators need to emphasize overall lifestyle, including physical activity, as well as caloric intake, in childhood overweight intervention efforts. Long-lasting solutions to the obesity epidemic must be comprehensive and must include all of the key stakeholders: children, parents, schools, health professionals, businesses, and community leaders and organizations. Nutrition educators can play a key role in developing wide-ranging and diverse coalitions, including food and beverage companies, designed to affect social change aimed at achieving healthy weight for children.
Beverages are frequently consumed with meals, but their influence on meal energy intake is not understood. We hypothesized that differences in the energy, nutrient content, and sensory properties of beverages consumed with a meal would affect intake. Forty-four women ate lunch in the laboratory once a week for 6 weeks. Lunch was consumed ad libitum, and was served with one of five beverages that were consumed in full, or no beverage. The beverages were 360 g of water, diet cola, regular cola, orange juice, and 1% milk. Results showed an effect of beverage type on meal intake (p<0.0001). Energy intake did not differ among the non-caloric and no-beverage conditions. Similarly, energy intake from lunch (including beverage) did not differ among the caloric beverage conditions. When a caloric beverage (156 kcal; 653 kJ) was consumed with the meal, energy intake was 104+/-16 kcal (435+/-67 kJ) greater than when a non-caloric beverage or no beverage was consumed. Subjects' ratings of fullness after lunch did not differ among the beverage conditions, but were lower for the no-beverage condition. These results show that when caloric beverages are consumed with a meal they add to energy intake from food, without significantly affecting satiety ratings.
The first purpose of the study was to examine whether combined ingestion of glucose and sucrose at an intake rate of 1.2 g/min would lead to higher oxidation rates compared with the ingestion of an isocaloric amount of glucose or sucrose alone. The second aim of the study was to investigate whether a mixture of glucose and sucrose when ingested at a high rate (2.4 g/min) would result in exogenous CHO oxidation rates higher than 1.2 to 1.3 g/min. Eight trained cyclists (maximal oxygen consumption: 64 +/- 2 mL . kg -1 . min -1 , mean +/- SE) performed 5 exercise trials in random order. Each trial consisted of 120 minutes of cycling at 50% maximum power output (63% +/- 2% maximal oxygen consumption), whereas subjects received a solution providing either 1.2 g/min of glucose (GLU), 1.2 g/min of sucrose (SUC), 0.6 g/min of glucose + 0.6 g/min of sucrose (M-GLU+SUC), 1.2 g/min of glucose + 1.2 g/min of sucrose (H-GLU+SUC), or water (WAT). Peak exogenous CHO oxidation rates in the H-GLU+SUC trial (1.20 +/- 0.07 g/min) were significantly higher ( P < .01) compared with the GLU, M-GLU+SUC, and SUC trials (0.77 +/- 0.04, 0.90 +/- 0.07, 0.98 +/- 0.04 g/min, respectively). Furthermore, peak exogenous CHO rates in M-GLU+SUC and SUC trials were significantly higher ( P < .05) compared with the GLU trial. In conclusion, combined ingestion of moderate amounts of glucose and sucrose (144 g) during cycling exercise resulted in approximately 21% higher exogenous CHO oxidation rates compared with the ingestion of an isocaloric amount of glucose. Furthermore, when a mixture of glucose and sucrose was ingested at high rates (2.4 g/min), exogenous CHO oxidation rates reached peak values of approximately 1.20 g/min.