Influence of Fruit and Vegetable Intake on Satiety and Energy Intake: A Review

Abstract

Fruit and vegetable are the natural foods that contained various nutrients vital for good health and help in weight loss by suppressing an individual’s appetite. Therefore, this review aimed to investigate the acute effect of fruit and vegetable intake on satiety and energy intake. We included randomized controlled trial or experimental designs measuring fruit and/or vegetable intake on satiety using subjective appetite rating and appetite related hormone and energy intake among healthy adults, published in English-language. The use of extract, powder form or concentrated fruit and/or vegetable and animal study were excluded. Twelve studies were identified from Pubmed, Science Direct and Cochrane from the year 1995 to August 2017, consists of six studies on fruit and six studies on vegetable. This review discussed the preload of fruit and vegetable in promoting satiety and reducing the energy intake. Manipulating energy density rather than portion size was effective in reducing total energy intake and promotes satiety. Fruit and vegetable in solid form had a greater satiety effect and significantly reduce energy intake compared to liquid or pureed form. The variation in time interval between fruit and/or vegetable intake and the test meal may also account a significant effect on satiety up to 2 h and diminished 3 h onward. The satiety effect of fruit and vegetable would be beneficial in body weight management. © Penerbit Universiti Kebangsaan Malaysia. All rights reserved.

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Sains Malaysiana 47(10)(2018): 2381–2390
http://dx.doi.org/10.17576/jsm-2018-4710-14
Inuence of Fruit and Vegetable Intake on Satiety and Energy Intake: A Review
(Pengaruh Pengambilan Buah-buahan dan Sayur-Sayuran ke atas Tahap Kekenyangan
dan Pengambilan Tenaga: Suatu Ulasan)
BIBI NABIHAH ABDUL HAKIM, HANIS MASTURA YAHYA*, SUZANA SHAHAR & ZAHARA ABDUL MANAF
ABSTRACT
Fruit and vegetable are the natural foods that contained various nutrients vital for good health and help in weight loss
by suppressing an individual’s appetite. Therefore, this review aimed to investigate the acute effect of fruit and vegetable
intake on satiety and energy intake. We included randomized controlled trial or experimental designs measuring fruit
and/or vegetable intake on satiety using subjective appetite rating and appetite related hormone and energy intake among
healthy adults, published in English-language. The use of extract, powder form or concentrated fruit and/or vegetable
and animal study were excluded. Twelve studies were identied from Pubmed, Science Direct and Cochrane from the
year 1995 to August 2017, consists of six studies on fruit and six studies on vegetable. This review discussed the preload
of fruit and vegetable in promoting satiety and reducing the energy intake. Manipulating energy density rather than
portion size was effective in reducing total energy intake and promotes satiety. Fruit and vegetable in solid form had a
greater satiety effect and signicantly reduce energy intake compared to liquid or pureed form. The variation in time
interval between fruit and/or vegetable intake and the test meal may also account a signicant effect on satiety up to 2
h and diminished 3 h onward. The satiety effect of fruit and vegetable would be benecial in body weight management.
Keyword: Adult; energy intake; fruit; satiety; vegetable
ABSTRAK
Buah dan sayuran merupakan makanan semula jadi yang mengandungi pelbagai nutrien penting untuk kesihatan
dan membantu dalam penurunan berat badan dengan menahan selera individu. Oleh itu, ulasan ini dijalankan bagi
mengenal pasti kesan akut pengambilan buah dan sayuran terhadap tahap kekenyangan dan pengambilan tenaga.
Kajian dipilih adalah berdasarkan kajian percubaan rawak terkawal atau kajian berunsur uji kaji yang mengukur
pengambilan buah dan/atau sayuran ke atas tahap kekenyangan menggunakan skala kekenyangan subjektif dan hormon
berkaitan selera serta pengambilan tenaga dalam kalangan individu dewasa yang sihat. Penggunaan ekstrak, serbuk
atau pati buah dan/atau sayuran serta kajian ke atas haiwan dikecualikan. Dua belas kajian telah dikenal pasti hasil
daripada pencarian di pangkalan data Pubmed, Science Direct dan Cochrane dari tahun 1995 hingga Ogos 2017. Enam
kajian berdasarkan pengambilan buah dan enam kajian berdasarkan pengambilan sayuran. Tinjauan menunjukkan
pengambilan buah dan sayuran lebih mengenyangkan dan mengurangkan pengambilan tenaga. Manipulasi ketumpatan
tenaga berbanding saiz catuan makanan lebih berkesan dalam mengurangkan jumlah pengambilan tenaga dan lebih
mengenyangkan. Buah dan sayuran dalam bentuk pepejal mempunyai kesan kekenyangan yang lebih tinggi dan
mengurangkan jumlah pengambilan tenaga berbanding dalam bentuk cecair atau puri. Variasi selang masa antara
pengambilan buah dan/sayuran dengan memberi kesan yang besar terhadap tahap kekenyangan dan ia bertahan
sehingga 2 jam dan hilang selepas 3 jam. Kesan kekenyangan pengambilan buah dan sayuran mempunyai potensi
dalam pengurusan berat badan.
Kata kunci: Buah; dewasa; kekenyangan; pengambilan tenaga; sayuran
INTRODUCTION
Living in an obesogenic environment through consumption
of high energy density food and decrease in performing
physical activities can impede a person’s health and lead to
overweight and obesity. The increasing rate of overweight
and obesity worldwide are alarming as it does not only
affect social health and wellbeing (Dixon et al. 2012; Xian
et al. 2016), but also impact the environment and economic
growth (Yach et al. 2006). Higher level of body adiposity
among adult was linked to lower consumption of fruit and
vegetable (Yu et al. 2018). Dietary strategies by sustaining
satiety could be a comprehensive approach for body weight
management as it may increase the compliance of individual
to practise healthy eating (Daud et al. 2014; Weickert et al.
2008). It aids in reducing food intake whilst diminishing
the sensation of hunger (Hetherington et al. 2013).
Currently, food with high satiety index score has
received more attention (Brum et al. 2016). Satiety index

2382
score refers to an area under the satiety response curve
(AUC) for the test food in comparison to white bread as
a standard and multiply by 100 (Holt et al. 1995). Fruits
and vegetables rich in nutrients were categorized higher
on satiety index (Fardet 2016). Foods with the higher
value of satiety index will prolong satiety. The earlier idea
was conceptualized by Blundell et al. (1987) in which
sensation of satiety are more than just the metabolic effect
of nutrients in the gastrointestinal tract. Several researches
have suggested the idea on the effect of cognitive and
sensory cues based on food’s sight and smell as well as
oro-sensory experience of food in the oral cavity such
as taste and texture on satiety (Halford & Harrold 2012;
McCrickerd & Forde 2016; Van Kleef et al. 2012).
Satiety level may vary in each individual and is
affected by multiple factors including age, gender, body
mass index and physical activity. Ageing resulted the
individuals to experience less hunger (Chapman et al. 2012;
Hays & Robert 2006). It was found that female subjects
reported higher satiety and fullness rating as compared
to men. However, one study reported the opposite result
where female subjects in menstruation period tend to have
a higher postprandial hunger rating than during ovulation
period (Greary 2000). This is due to the difference in
concentration of sex hormones such as estradiol. Higher
level of estradiol increase the satiating power initiated by
the endogenous cholecystokinin (Gregersen et al. 2011).
Individuals with sedentary lifestyle also tend to have
a higher rating of hunger compared to hard/moderate
exercisers (Gregersen et al. 2011).
Multiple peptides synthesized by gastrointestinal tract
may also affect appetite regulation. These include ghrelin
as orexigenic peptide and anorexigenic peptides include
peptide YY, pancreatic polypeptide, glucagon-like-peptide
1, oxyntomodulin and cholecystokinin (Perry & Wang
2012). Ghrelin showed positive correlation with hunger
(Kojima & Kangawa 2008) whilst other anorexigenic
hormones may suppress hunger and make individuals feel
full (Holst 2007; Neary & Batterham 2009).
A study by Rolls et al. (2010) has reported that lling
up with fruit or vegetable before meal or with meal may
reduce energy intake. One possible reason is due to the
ber content that makes individual to feel full longer. In
addition, fruit and vegetable are low in energy density
which causes the individuals to feel full on fewer calories
and may stay full longer as compared to other foods
consumed in the same amount. It was reported by de
Oliveira et al. (2008) that fruits can reduce energy intake
and body weight as compared to other food regardless of
the same energy content. Systematic review by Kaiser et al.
(2014) found no signicant effect of increasing fruit and/or
vegetable intake in isolation of other interventions for more
than 8 weeks on body weight whilst a small reduction in
body weight was found in a recent review among those who
consumed more fruit and vegetable without any dietary
advice and modication (Mytton et al. 2014). This variation
of results was due to the absence of specic guideline in
promoting the increment of fruit and vegetable intake in
each study. Therefore, this article has reviewed the effect
of fruit and vegetable intake on satiety by controlling food
intake and appetite based on the specic study design. It
can be an indispensably helpful guideline for body weight
management as well as practices of healthy eating.
MATERIALS AND METHODS
Relevant studies were identied through PubMed, Science
Direct and Cochrane database published from January 1995
to August 2017. The articles published prior to 1995 were
excluded as methodology of research on satiety has been
improved in recent years. The keywords used were ‘Fruit’
or ‘Vegetable’ AND ‘Satiety’ or ‘Satiation’ or ‘Fullness’
or ‘Appetite’ or ‘Energy Intake’ or ‘Satiety Hormone’
or ‘CCK’ or ‘Ghrelin’ or ‘Leptin’ or ‘Insulin’ or ‘PYY’ or
‘GLP-1’ or ‘GIP’ or ‘Orexin’ and limited to human, adult,
clinical trial, randomized control trial and those published
in English language only. The studies were narrowed down
to only those using whole fruit and/or vegetable without
any added food components such as carbohydrate, fat
and protein. Intervention based solely on powder, extract
or concentrated fruit and vegetable were also excluded.
Eligible studies reported the subjective appetite rating or
energy intake and hormone related to appetite and satiety
was included. Any studies involving animals and children
or subjects with genetic conditions that may affect their
dietary intake and those with chronic diseases such as
diabetes, cardiovascular disease and chronic kidney disease
were excluded. Intervention that sought to manipulate
any dietary components and to promote weight loss was
also excluded as it may overshadow the effect of fruit and
vegetable on satiety.
RESULTS
From a total of 1671 publications only twelves studies met
all the selection criteria and were included in the present
review. Six out of 12 studies examine the effect of fruit on
satiety whilst another 6 studies examine satiety effect of
vegetable. The summary tables are shown in Tables 1 and 2
for satiety effect of fruit and vegetable, respectively. All of
the studies measured both the effect of fruit and vegetable
on subjective appetite rating and energy intake except for
a study on fruit intake only to measure the effect of fruit
on satiety hormone. Only two studies of fruit intake and
one study vegetable reported on satiety hormone. Majority
of subjects were overweight and obese adults aged 18
to 65 years old. Only one study on fruit and a study on
vegetable involved subjects with normal BMI. Most of the
studies include both male and female subjects, except for
four studies were among female subjects and a study on
male subjects.

2383
TABLE 1. Effect of fruit intake on satiety
Author,
Year
Sample population Study design Intervention Results
Satiety Energy intake Satiety hormone
Flood-Obbagy &
Rolls (2009)
N= 58
18-45 years old
18.0-40.0 kg/m
2
Crossover repeated
measure
Preload of apple or apple puree
or apple juice or apple juice with
added ber or no preload
Apple> apple puree> both
apple juice>
no preload
Apple< apple puree <
both apple juice<
no preload
-
Farajian et al.
(2010)
N=30
18-50 years old
18.5-24.9 kg/m
2
Randomized within-
subject crossover
Preload of dried prune or white
bread
Dried prune > white bread No signicant difference -
Wien et al. (2013) N=30
25-65 years old
20.0-25.0 kg/m
2
Randomized single
-blind crossover
Meal with inclusive avocado or
added avocado or with no avocado
Inclusive avocado> added
avocado>
no avocado
No signicant difference Insulin level was higher in control and added
avocado tests meal compared to inclusive
avocado
No signicant difference was found for glucose
Houchins et al.
(2013)
N=34
18-38 years old
18.5-40.0 kg/m
2
Randomized crossover,
two arm study
Preload of fruit or no preload,
and preload of fruits juice and no
preload
No signicant difference Preload of solid fruit <
fruit beverage
-
James et al. (2015) N=15 women
18-25 years old
26.6 + 2.6 kg/m
2
Crossover repeated
measure
Snack on berries or confectionary
with the same energy content 60
min before dinner
No signicant difference Snack on berries <
confectionary
-
Kaliora et al.
(2017)
N=10
20-60 years old
18.5-24.9 kg/m
2
Randomized crossover Breakfast meal with either 74 g of
raisins or 50 g of glucose diluted in
a glass of water
- - Low level of ghrelin after raisin consumption
compared to glucose solution at 120 and at 180
min post ingestion
GIP levels lower in raisin trial compared to
glucose trials at 60 and 120 min
No signicant differences were found for
glucose, insulin, apelin, obestatin and GLP-1 in
both trials

2384
TABLE 2. Effect of vegetable intake on satiety
Author,
Year
Sample population Study design Intervention Results
Satiety Energy intake Satiety hormone
Rolls et al.
(2004)
N=50 women
19-45 years old
18.5-39.9 kg/m
2
Within-subject cross
over
Preload of 150 g salad with energy density
(0.33, 0.67 or 1.33 kcal/g) or preload 300 g
salad with energy density (0.33, 0.67 or 1.33
kcal/g) or no salad
Large portion of salad > small
portion of salad
High portion size of salad < less
portion size of salad
No signicant different was found
for the energy density
-
Rolls et al.
(2010)
Addition:
N= 53
Substitution:
N= 48
20-45 years old
18.0-40.0 kg/m
2
Cross over repeated
measure, two arm
study
Addition of vegetable in meal
Alteration of energy density of meal by
substitution of vegetables
No signicant diference
No signicant difference
No signicant difference
Substitution of vegetables by 180 to
270 g reduce energy intake
-
Chang et al.
(2010)
N= 30 women
20-40 years old
18.0-30.0 kg/m
2
Cross over repeated
measure
Consumption of parboiled vegetable rice or
parboiled normal rice with side dishes
Parboiled vegetable rice >
parboiled normal rice
No difference after 3 hour of
test meal
Parboiled vegetable rice < Parboiled
normal rice
Energy intake was low after 4 hours
in parboiled vegetable rice than
parboiled normal rice
-
Blatt et al.
(2011)
N=48
20-45 years old
18.0-40.0 kg/m
2
Cross over repeated
measure
Substitution of vegetable reduce energy
density for each meal (Breakfast, Lunch and
Dinner) by 100%, 85% and 75% of energy
density
No signicant difference
except during breakfast, 75%
condition > 100%
Total energy intake in 75% condition
< 85% < 100%
-
Roe et al.
(2012)
N=55 women
20-45 years old
18.0-40.0 kg/m
2
Cross over repeated
measure
Preload ad libitum salad or preload of xed
amount of salad or ad libitum salad with
meal or xed salad with meal or no salad
Preload of salad and salad
with meal > no salad
Fixed salad and ad libitum salad with
meal < No salad
Fixed salad < ad libitum salad
-
Zhu et al.
(2013)
N= 20 male
18-50 years old
20.0-29.9 kg/m
2
Randomized cross
over repeated
measure
Liquid-solid meal (LS) (Chicken broth with
whole piece of vegetables or Liquid Meal
(LM) (Chicken broth with small piece of
vegetable) 3 hour before lunch (test meal)
Liquid meal > liquid-solid
meal
No signicant difference No signicant difference on
ghrelin
Hormone CCK was higher at 90
minutes and 120 minutes in LM
compared to LS
Insulin level was higher in LM
than LS at 30 and 45 min

2385
EFFECT OF FRUIT AND VEGETABLE ON SUBJECTIVE
APPETITE RATING
Subjective appetite rating scale by using Visual Analogue
Scales (VA S ) is one of the most common methods used
in measuring satiety. It provides a greater insight for
interpretation of eating behaviour and allows measurement
of eating motivation (Drapeau et al. 2005; Flint et al. 2000).
A variety of studies have examined the satiety effect of fruit
consumption either the fruit was served before meal, with
meal or as a snack prior to main meal. In this review, three
out of six studies reported a signicantly higher score of
satiety among those subjects consume fruit as compared to
those without fruit. Consuming fruit before meal facilitate
in suppressing appetite which in turn cause individual to
feel full longer than those who having a meal without fruit
(Flood-Obbaggy & Rolls 2009) (Table 1). Farajian et al.
(2010) studied 30 subjects in a crossover design where the
subjects were provided a preload of either dried prune or
white bread matched with energy content prior to lunch
test meal. Subjects who had a preload of prunes reported a
signicant less hunger and feel full more than white bread
at all time points. A study by Wien et al. (2013) examined
the effect of avocado on satiety. Avocado was either
added in a lunch test meal (AA) or inclusively added in a
test meal by reducing energy content (AI) to match with
the control which is without avocado (C). No signicant
difference was found among 3 interventions on hunger and
satiety rating. However, additional avocado (AA) scored
higher satisfaction and scored less desire to eat compared
to those without avocado (p<0.05). This indicated that
adding avocado may inuence post-ingestive satiety over
a subsequent 3 and 5 h period. Inclusive avocado (AI) with
match energy content with control group also showed a
tendency of higher score of satisfaction as compared to
control group (p=0.07).
In contrast, two studies (Houchins et al. 2013; James
et al. 2015) did not nd such an effect. No signicant
difference was found between preload of fruit either in
solid or beverage form and control (no fruit) on satiety.
Nevertheless, a higher satiety rating was reported among
those consume preload of whole fruit compared to preload
fruit beverage (Houchins et al. 2013). James et al. (2015)
found no difference in satiety for both trials (preload of
160 g mix berries or confectionary (19.4 g of sweets)
match with energy content). Nevertheless, it was noted
that preload of mix berries was more palatable than
confectionary. Foods with high palatability was associated
with the fast return of hunger and desire to eat (Srubbs et
al. 1996).
Table 2 summarizes six studies based on the effect
of vegetable consumption on satiety. All studies have
manipulated several parameters including energy density,
physical form of vegetable or either vegetable were
served before meal or were served inclusively with the
meal. Out of six studies, two studies examine the effect of
vegetable intake before the meal and other studies involved
vegetable intake with meal. A study involving 55 women
examined the effect of the consumption of ad libitum or
xed amount of salad before meal, ad libitum or xed
amount of salad with meal or meal with no salad (Roe et
al. 2012). Subjects scored less hunger and more satiety
for a xed or ad libitum salad compared to without salad
(p<0.001). However, no signicant effect of timing of salad
either consume before meal or with meal was identied.
Whilst, the subjects reported to feel less hunger and more
satiety when consume xed salad than consume salad in ad
libitum. Rolls et al. (2010) also found a signicant effect
of vegetable consumption on satiety whereby consuming
large portion of salad (300 g) was more satiety than small
portion of salad (150 g) and no salad, respectively.
Out of four studies involved consumption of vegetable
with the meal, only one study showed no significant
difference between meals served with vegetable and
without vegetable on satiety (de Oliveira et al. 2008).
Another study found that energy density of food was
manipulated by adding vegetable in different portions
(Blatt et al. 2011). Nevertheless, this study reported the
same result whereby substitution with vegetable in three
main meals did not affect satiety except during breakfast.
Subject reported to feel more satiety after taking more
puree vegetable with 75% energy density of meal compared
to 100% of energy density (Blatt et al. 2011). Small particle
size of vegetable (liquid meal) was also found to be more
satiety compared to large particle size (liquid-solid meal)
(Zhu et al. 2013). It opposed the initial hypothesis of
this study where liquid-solid meal would be more satiety
compared to liquid meal as it requires mastication and will
take more longer to eat. The slower eating rate resulting
in higher satiety (Kokkinos et al. 2010). However, Zhu et
al. (2013) did not measure the time taken by the subject to
complete their meal that will contribute to the difference in
feeling satiety among subjects. Furthermore, the addition
of vegetable in parboiled rice resulted in more satiety than
parboiled rice without vegetable (Chang et al. 2010).
It was reported that subject characteristics such as
age and gender were not signicantly associated with
energy intake (Blatt et al. 2011; Flood-Obbagy & Rolls
2009; Rolls et al. 2010). However, other studies (Farajian
et al. 2010; Houchins et al. 2013) did not report the mean
difference of satiety and energy intake between male and
female subjects.
EFFECT OF FRUIT AND VEGETABLE ON ENERGY INTAKE
Assessment of the amount of energy intake at a subsequent
eating event or known as subsequent energy intake also
being used to measure satiety (Blatt et al. 2011; de Graaf et
al. 1992; Geliebter et al. 1988). Studies have examined the
inuence of fruit or vegetable intake on satiety. The study
design of each study in this review are similar whereby
fruit and vegetable were given either before meal or with
meal. In this review, three out six studies on fruit showed
less energy intake after consumed fruit as compared to
without fruit (Flood-Obbagy & Rolls 2009; James et al.
2015) and less energy intake when consume whole fruit
than fruit beverage (Houchins et al. 2013). No signicant

2386
difference of energy intake was found in two studies
(Farajian et al. 2010; Wien et al. 2013). Energy intake
after the consumption of dried prune has no difference
with trials of white bread (Farajian et al. 2010). Wien et al.
(2013) also reported the same nding where subjects who
consumed added avocado or inclusively added avocado in
meal showed no signicant difference in subsequent energy
intake as compared to without avocado.
In this review, satiety rating for vegetable intake either
with meal of before meal cannot be used to predict the
subsequent energy intake since both studies (Blatt et al.
2011; Rolls et al. 2010) showed no signicant difference in
satiety rating while the meal intake reduced signicantly.
Preload of xed amount of vegetable reduced meal intake
more than ad libitum intake of vegetable. This is due to
the differences in the amount of salad consumed in xed
amount and ad libitum group. It was found that intake of
salad for ad libitum were less compared to xed salad
either before or with meal (Rolls et al. 2014). Besides,
there was a less energy intake when consuming a preload
of large portion of salad (300 g) compared too small portion
of salad (150 g) but no signicant difference was found
when energy density was manipulated (Rolls et al. 2010).
Out of four studies that includes vegetable intake in test
meal, a study that included vegetable in the parboiled rice
signicantly reduced the subsequent energy intake (Chang
et al. 2010). As energy density was reduced, the lower the
energy intake consumed by an individual. A study has
been conducted in manipulating energy density for three
main meals; breakfast (carrot bread), lunch (macaroni and
cheese) and dinner (chicken and rice casserole). Subjects
were provided with 100% energy density (standard meal),
85% energy density of the standard and 75% energy
density of the standard. Energy density was manipulated
by increased the amount of pureed vegetable in each meal
to 3 or 4.5 time than the standard meal. It was reported that
subjects consumed less 202 ± 60 calories in 85% energy
density and less 357 ± 47 calories in 75% energy density
as compared to standard meal (100% energy density
condition) which was 3117 ± 132 kcal (Blatt et al. 2011).
Rolls et al. (2010) reported a signicant reduction in meal
energy intake (83 ± 14 kcal or equivalent to 14 ± 3%) as
energy density of meal was reduced from 0.8 to 0.4 kcal/g
and portion size of vegetable was increased from 180 to
270 g. No signicant difference was found as the portion
was further increased from 270 to 360 g. Besides, preload
of difference particle size of vegetable in soup also had no
signicant difference on subsequent energy intake (Zhu
et al. 2013).
EFFECT OF FRUIT AND VEGETABLE ON APPETITE HORMONE
There was limited study on the effect of fruit and
vegetable intake on appetite related hormone. Only two
studies examine on the effect of fruit intake on appetite
hormone. A signicant rise of insulin level was found
among those consume inclusive avocado or added
avocado, 37% and 22%, respectively, (p<0.05) 30 min
after the lunch test meal (Wien et al. 2013). However,
after three hours, the level of insulin was lower among
subjects consumed inclusive avocado as compared to
control and added avocado, respectively. No signicant
difference was found for glucose concentration for three
trials. In a recent study, Kaliora et al. (2017) reported a
signicant low level of ghrelin after the consumption of
raisin as compared to glucose solution at 120 and 180
min post ingestion. Gastric Inhibitory Polypeptide (GIP)
level was also lower in raisin trials compared to glucose
trials at 60 and 120 min. GIP level may peak as there is an
active absorption of glucose (Fujita et al. 2009; Wachters-
Hagedoorn et al. 2006). In this study, the raisin trials
showed a delay of GIP response indicate that there was a
delayed of glucose absorption as compared to consuming
glucose concentration. One possible explanation was due
to the ber content which leads to a slower digestion
and absorption by delaying gastric emptying or shorten
bowel transit time. However, no signicant difference
was found for glucose, insulin, apelin, obestatin and
GLP-1 in both trials.
Only one study involve vegetable had reported
the effect of vegetable intake on satiety hormone. It
was found that, there was no signicant difference on
ghrelin after consuming whole piece of vegetable in
a broth, liquid solid meal (LS) or liquid version of the
same ingredients, liquid meal (LM) in the meal (Zhu et
al. 2013). However, CCK level was higher as subjects
consumed LM than LS at 90 and 120 min postprandial.
The potential cause was due to the size of particle where
the smaller the size of particle of vegetable the larger the
surface area intact with small intestine and causing more
CCK hormone to be released.
EFFECT OF ENERGY DENSITY AND PORTION SIZE ON
SATIETY AND ENERGY INTAKE
Energy displacement by alteration of energy density of
food was suggested as the best method to decrease or
maintain body weight (Ello-Martin et al. 2007). Lower
energy density foods provide less energy per gram of food,
therefore eating more will not contribute too much calorie
intake compared with the intake of high energy density
foods (Monsivais & Drewnowski 2007). Most fruit and
vegetable are low in energy density due to the high amount
of water content that increases the volume and weight of
the food itself (Flood-Obbagy & Rolls 2009). Many studies
used the strategy of adding portion size of fruit or vegetable
in meal in order to increase volume of foods and reduce the
energy (Bell et al. 2001, 1998; Rolls et al. 1999). Study by
Wien et al. (2013) reported that addition of either avocado
in meal or substitution of avocado in meal by reducing the
amount of salad dressing and cookies (avocado inclusive)
have increased the satiety and reduce the desire to eat over
3 and 5 h in overweight and moderately obese adults,
respectively. Furthermore, addition of avocado reduce
meal energy intake during lunch as compared to control
(without avocado). However, there is no mean difference

2387
between three lunch test meal on subsequent ad libitum
dinner meal due to long duration between lunch and dinner
meal which was 5 h time interval.
In this review, three out of six studies used vegetables
inclusively with main meal thus manipulated the energy
density of the main meal. As energy density of test meal
decrease by addition of vegetable and reduction of meal
size of other food components, the energy intake decreases
(Blatt et al. 2011). In two arm study, Rolls et al. (2009)
found no signicant difference in total meal and energy
intake as vegetable was added in meal whereas total energy
intake was reduced signicantly as the portion size was
increased to match with the reduction in energy density.
Addition of vegetable by increase portion size of vegetable
from 180 to 360 g did not signicantly affect total energy
intake. This result in line with substitution study in which
the reduction of energy density of food by reducing
portion size of meat and grain and increase portion size
of vegetable did not affect overall meal energy intake.
However, the study found a signicant reduction of meal
energy intake as portion size of vegetable was increased
from 180 to 270 g. In addition, Chang et al. (2010) found
the intake of parboiled vegetable rice resulted in more
satiety as compared to parboiled rice and thus reduce total
energy intake. This is due to the parboiled vegetable rice
had larger volumes than parboiled rice when both were
compared by weight. However, there was no signicant
difference in amount of side dishes taken by subjects in
both interventions. As the energy density was changed,
the percentage of macronutrients also differs and might
affect satiety (Clegg & Shafat 2010; Wikarek et al. 2014).
However, none of the studies from this review reported any
signicant effect of other macronutrients on satiety. For
example, parboiled vegetable rice contains less protein (2.1
g) and carbohydrate (18.9 g) per 0.86 kcal/g as compared
to a match volume of normal parboiled rice with 2.7 g of
protein and 31.4 g of carbohydrate per 1.42 kcal/g (Chang
et al. 2010). Rolls et al. (2004) also found, there was a
signicant effect of energy density rather than variation
in fat content (14% to 67%) on satiety.
PHYSICAL FORM OF FRUIT AND VEGETABLE ON SATIETY
Many studies also manipulated the physical form of fruit
in order to optimize the satiety effect (Almiron-Roig et
al. 2003; Mattes 2006). Previous studies showed that
consuming solid form of fruit resulted in more satiety
than in liquid form (Pan et al. 2011). Based on Flood-
Obbagy and Rolls (2009), preload of whole apple led to
more satiety as compared to applesauce, apple juice, apple
juice with ber and no preload. Fiber might be one of the
factor that affect the satiety level of an individual (Slavin
2005). However, another study found no effect of ber on
satiety (Flood-Obbaggy & Rolls 2009). The other possible
explanation might be due to the number of mastication.
Increase mastication of food would initiate cephalic-phase
response by affecting digestion and metabolism thus affect
food intake (Li et al. 2011).
In contrast, Zhu et al. (2013) found an opposite
result whereby vegetable in liquid form resulted in more
satiety than in solid form. However, this study has some
limitation as how much mastication effort was required to
induce satiety was not reported. Besides, this study did not
show the gastric transit time. Previous study by Kong and
Singh (2008) proved that foods with larger particle size
can slower the rate of gastric emptying. Of all, none of the
studies included in this review measures the masticatory
effort on satiety. The time interval between test meal and
subsequent meal intake which is longer (three hours) may
reduce its effect on satiety. Satiety hormone such as CCK
also found to be higher among subjects who consumed
liquid meal compared to solid meal, suggested that the
smaller particle size of test meal increase the surface area
intact with duodenum where the CCK will be released
(Ledebeor et al. 1999; Maljaar et al. 2012). However,
there was no signicant difference of ghrelin concentration
between both interventions either in liquid or solid form.
DISCUSSION
Preload or added fruit and vegetable were likely to show
a signicant increase on satiety and reduction of energy
intake. Most of the studies only measured satiety and food
intake during the meal without taking into account the
food intake for the whole day, thus limiting the data on
the long term effect of fruit and vegetable consumption on
the subsequent energy intake and satiety. Apart from using
visual analogue scale (VA S ), there are several approaches
to assess satiety including labelled magnitude scale (LMS)
(Zalifah et al. 2008) and computer-based approach (Farah
et al. 2012).
Fruits and vegetables are very nutritious and packed
with vitamin and minerals that can be eaten throughout
the day. Nonetheless, some general guidelines should
be highlighted to fully benet our health and optimized
the potential role of fruit and vegetable in managing
body weight (Harden et al. 2009). Even though fruit and
vegetable help to ll the stomach with less calorie, the
emphasis on portion size and how they are prepared should
be considered. Whole fruit is much better compared to juice
since most of the natural ber is removed during process
and extra calorie from added sugar will increase the total
calories. Besides, more chewing effort needed for the
whole fruit, thus induce satiation through cephalic-phase
respond. A small serving of dried fruit can be a choice for
a healthy snack and alternative for high energy dense foods
if consume in a small serving size. If taken too much, dried
fruit that have high sugar content will increase the total
calorie, promote weight gain and even cause a sharp rise
on blood sugar (Alinia et al. 2009; Khairuddin et al. 2017).
The timing of fruit intake might also make a signicant
difference on satiety. To date, no study has been designed
to nd out the effectiveness of fruit intake either before
or after meal on appetite control as well as blood glucose
control especially among those with impaired glucose. This

2388
would be benecial for the patient in controlling their blood
glucose control when including fruit as part of their diet.
The study design of each study was heterogeneous
in terms of study population, size and duration between
preload and test meal. A wide gap of age among subjects
would affect the overall results (Harden et al. 2009).
However, studies showed that socio demographic factors
did not have strong impact on the satiety rating and
subsequent energy intake. Manipulation of portion size and
energy density of fruit and vegetable would be an effective
strategy in promoting satiety as well as reducing overall
energy intake (de Oliveira et al. 2008). Time interval
between preload and test meal may also affect satiety
(Luhovvy et al. 2007; Veldhorst et al. 2009). However,
as the energy density was manipulated, the effect of time
interval fades out. Preload of fruit and vegetable in between
15 min to 1 h has effectively increased satiety and reduced
subsequent meal intake, however, there was no effect on
satiety found after an interval of 3 h onwards.
The time delay of preload of protein, maltodextrin or
water (30, 60 and 120 min) had no effect on subsequent
meal intake (Chungchunlam et al. 2012). Nevertheless,
the time interval between preload and test meal might
also be affected by variation of macronutrients. It was
found that the ingestion of carbohydrate and protein may
supress hunger within 60 min whilst proteins showed more
suppressive effect where it can last longer. Meanwhile, fat
was reported to be the least suppressive effect compared
to protein and carbohydrate, respectively (Fischer et al.
2004). The physical form of food also may affect the effect
of time interval on satiety and subsequent meal intake. The
amount of vegetable and the threshold of masticatory effort
are still unclear and need to be further investigated.
There is a need in emphasizing a concise and systematic
study design to formulate effective strategies in controlling
appetite and body weight management by manipulating
the consumption of fruit and/or vegetable in individuals’
diet. A concise study design should be conducted such as
controlling the type of fruit and vegetable consumed since
some of the previous studies failed to get the signicant
result as the food items used during intervention did not
match between groups (Houchins et al. 2013). In addition,
further study should be done precisely with specific
preparation of fruit and vegetable in term of cooking
method and either it is served with skin or not, since the
ber content might differ and can make a signicant change
in overall result.
CONCLUSION
This review has proven that consumption of fruit and/or
vegetable either before meal or with meal may promote
satiety and are beneficial in reducing energy intake.
There are three studies on fruit intake and four studies
on vegetable intake which reported a signicant effect on
satiety. Meanwhile, three studies on fruit intake and ve
studies on vegetable intake found a signicant reduction
of subsequent energy intake. Measurement of appetite
hormone may aid in measuring the satiety level of an
individual precisely. Factors such as ber content, physical
form, particle size, timing and energy density of fruits and
vegetables, time interval between fruit and/or vegetable
intake and test meal may inuence the satiety response.
It can be as part of strategies for weight management in
controlling appetite and food intake by manipulating these
factors.
ACKNOWLEDGEMENTS
We would like to thank the Universiti Kebangsaan
Malaysia for the nancial assistance given for the project
(grant number: GUP-2014- 088).
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Bib i N a bih ah Ab d ul Ha ki m, Su za na S ha har &
Zahara Abdul Manaf
Centre for Healthy Aging and Wellness and Dietetics Programme
Faculty of Health Sciences
Universiti Kebangsaan Malaysia
50300 Kuala Lumpur, Federal Territory
Malaysia
Hanis Mastura Yahya*
Centre for Healthy Aging and Wellness and Nutritional Science
Programme
Faculty of Health Sciences
Universiti Kebangsaan Malaysia
50300 Kuala Lumpur, Federal Territory
Malaysia
*Corresponding author; email: hanis.yahya@ukm.edu.my
Received: 29 January 2018
Accepted: 5 June 2018