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Original Research Communications |
1 From the Nutrition Department, The Pennsylvania State University, University Park.
2 Supported by NIH grant DK-50156.
3 Address reprint requests to BJ Rolls, Nutrition Department, 226 Henderson Building, The Pennsylvania State University, University Park, PA 16802-6501. E-mail: bjr4{at}psu.edu.
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONSUBJECTS AND METHODSRESULTSDISCUSSIONREFERENCES |
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Objective: This study examined the effects of water, both served with a food and incorporated into a food, on satiety.
Design: In a within-subjects design, 24 lean women consumed breakfast, lunch, and dinner in our laboratory 1 d/wk for 4 wk. Subjects received 1 of 3 isoenergetic (1128 kJ) preloads 17 min before lunch on 3 d and no preload on 1 d. The preloads consisted of 1) chicken rice casserole, 2) chicken rice casserole served with a glass of water (356 g), and 3) chicken rice soup. The soup contained the same ingredients (type and amount) as the casserole that was served with water.
Results: Decreasing the energy density of and increasing the volume of the preload by adding water to it significantly increased fullness and reduced hunger and subsequent energy intake at lunch. The equivalent amount of water served as a beverage with a food did not affect satiety. Energy intake at lunch was 1209 ± 125 kJ after the soup compared with 1657 ± 148 and 1639 ± 148 kJ after the casserole with and without water, respectively. Subjects did not compensate at dinner for this reduction in lunch intake.
Conclusion: Consuming foods with a high water content more effectively reduced subsequent energy intake than did drinking water with food.
Key Words: Energy density • energy intake • lean women • food intake • obesity • satiety • water
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONSUBJECTS AND METHODSRESULTSDISCUSSIONREFERENCES |
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Few studies, however, have investigated how water served as a beverage affects hunger and food intake. In one study, investigators examined whether water consumption affected subjective sensations of satiety. They found that water served with a meal decreased feelings of hunger during the meal, but that this effect was not maintained after the meal (7). In other investigations, water was used as a control for the effects of variations in the energy content of drinks (8, 9). Results from these studies indicated that drinking water either before or with a meal had no significant effect on energy intake.
The present study was the first to systematically examine the effects of both water served as a beverage and incorporated into a food on subsequent intakes. We hypothesized that incorporating water into a food, but not drinking water as a beverage with food, would reduce energy intakes.
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SUBJECTS AND METHODS |
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TOPABSTRACTINTRODUCTIONSUBJECTS AND METHODSRESULTSDISCUSSIONREFERENCES |
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1 wk.
Subjects
We recruited 29 women through advertisements in local and university newspapers and posters. Potential subjects were initially screened through a telephone interview to determine whether they were between 20 and 45 y of age, ate 3 meals/d, did not smoke, did not have any food allergies or restrictions, were not athletes in training, were not pregnant or lactating, were not dieting to gain or lose weight, and were not taking any medications or dietary supplements known to affect appetite. Potential subjects completed the following questionnaires in our laboratory: the short form of the Eating Attitudes Test (EAT-26; possible score: 0–78), which detects symptoms of an eating disorder (10); the Eating Inventory (11), which measures dietary restraint (possible score: 0–21), perceived hunger (possible score: 0–14), and disinhibition (possible score: 0–16); the Beck Depression Inventory (12; possible score: 0–63) and the Zung Self-Rating Questionnaire (13; possible score: 20–80), both of which detect depression; a detailed demographic inquiry; and a family weight history. Weight and height measurements were also taken at this time. Subjects were included in the study if their body mass index (in kg/m2) was between 20 and 25. Subjects were excluded if they scored 40 on the Zung Self-Rating Questionnaire, 10 on the Beck Depression Inventory, or 20 on the EAT-26, or if they had lost or gained >10% of their body weight in the previous 6 mo. Finally, subjects were asked whether they disliked any of the food items to be offered in the experiment and were excluded if they disliked the preloads (chicken rice casserole or chicken rice soup) or the main food items to be served at breakfast (bagels), lunch (ham sandwich), and dinner (vegetable lasagna or chicken breast). All aspects of the study were approved by the Institutional Review Board of The Pennsylvania State University.
Procedures
On the day before each test day, subjects were asked to keep their activity level and evening meal as similar as possible and to refrain from eating or drinking (except water) after 2200. Subjects were also asked to refrain from drinking alcohol on the day before and throughout each test day and to complete food and activity diaries the evening before each test session. The diaries were reviewed by the experimenters to ensure compliance. Subjects also reported the days of their menstrual period so that we could ensure that menstrual cycle phase was evenly distributed across conditions.
On each test day, subjects reported to the laboratory 4 h before the start of the lunch meal to consume breakfast. At this time, food and activity diaries were collected, subjects were weighed without shoes, and subjects completed a brief questionnaire assessing whether they felt well, had taken medications, or consumed alcohol in the previous 24 h. The experimenters reviewed the diaries and questionnaires and rescheduled subjects if their evening meal intakes or activity levels deviated markedly from those in the first session or if they were ill or had taken medications known to affect appetite or food intake.
At the start of the lunch session, subjects were served 1 of 3 preloads or were informed that no preload would be served that day. On the days that the preloads were served, subjects were instructed to consume the preload over a 12-min period. Preset timers were given to assist subjects in pacing their consumption of the preload. Subjects were permitted to read magazines before lunch, but not while consuming the preload. Magazines were screened to exclude any articles pertaining to food, weight loss, or body image. Lunch was served 5 min after completion of the preload or 17 min after the subjects had arrived at the laboratory in the no-preload condition. Subjects returned to the laboratory for dinner 4.5 h after the start of lunch. After completion of both breakfast and lunch, subjects were given bottled water (592 g) to drink ad libitum until they returned for their next meal. Subjects were instructed not to consume any foods or beverages other than the bottled water and to return the bottle and any remaining water at the next meal. Subjects were instructed that they were to refrain from drinking water during the hour before lunch. To ensure that subjects followed the experimental protocol, they completed brief questionnaires before lunch and dinner that assessed whether they felt well, had taken any medications, or ate or drank any foods or beverages between meals. During all meals, subjects were tested alone in private cubicles.
Preloads
Three isoenergetic (1128 kJ) preloads were served: 1) chicken rice casserole, 2) chicken rice casserole served with a glass of water (356 g), and 3) chicken rice soup (Table 1
). To investigate whether decreasing the energy density of a food by adding water to it affects satiety, we compared energy intakes after subjects consumed the casserole without water and the soup. These preloads differed not only in energy density and water content but also in volume, appearance, and form. To test the effects of drinking water as a beverage on intake, intakes after consumption of the casserole with and without water were compared. To examine whether drinking water with a food affects intake differently than does consumption of an equal volume of water incorporated into a food, we compared intakes after consumption of the casserole with water and the soup. The casserole and soup meals contained identical ingredients, but varied in appearance and form. The water content was held constant by accounting for water losses associated with baking the casserole. Specifically, we added an amount of water equivalent to baking losses (66 g) to the glass of water served with the casserole. There were no cooking losses associated with cooking the soup because it was heated in a sealed plastic bag. Thus, the casserole served with water and the soup each weighed 619 g; however, one preload was served with water as a beverage and the other preload had an equivalent amount of water incorporated into the food.
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During all meals, subjects were instructed to eat as much or as little of any food item as they wished and to ask for more if desired. All food items were weighed before and after consumption to obtain the amount consumed to the nearest tenth of a gram. Energy and macronutrient intakes were calculated by using information from the manufacturers and from Bowes & Church's Food Values of Portions Commonly Used (14).
Visual analogue scales
Subjects rated their hunger, thirst, nausea, fullness, and prospective consumption (how much food they thought they could eat) on visual analogue scales. For example, hunger was rated on a 100-mm line preceded by the question "How hungry are you right now?" and anchored on the left by "not at all hungry" and on the right by "extremely hungry." Other anchors consisted of the phrases "not at all" and "extremely" combined with the adjectives "thirsty," "nauseated," and "full." Ratings were completed before and after breakfast, lunch, and dinner and before and after the preload (or at equivalent times in the no-preload condition). Subjects completed rating booklets hourly outside the laboratory for 4 h after lunch. At the time each preload was served, subjects rated the pleasantness of taste, pleasantness of appearance, fat content, salt content, and prospective consumption of the preload on 100-mm visual analogue scales.
Debriefing
Subjects completed a debriefing questionnaire at the end of the study. Specifically they were asked the purpose of the study, if they noticed any differences between test days, and if there were any factors that affected their responses.
Statistical analyses
Data were analyzed by using SAS-PC for WINDOWS (version 6.11; SAS Institute, Inc, Cary, NC). Analyses of food intake and visual-analogue-scale ratings were conducted by using the PROC MIXED procedure. The residuals for energy intake at lunch were examined for the presence of outliers and for normality and equality of variance by using a univariate procedure. The influence of each observation on the regression function was examined by using DFFITS (an approximation of the number of SDs that a fitted value changes when a particular observation is removed from the data set). Observations with P < 0.001 for the studentized residual and |DFFITS| >2 were considered to be significant outliers. Subjects were excluded from the analyses if they consumed <1255 kJ for lunch in the control condition.
To test the effects of the preloads on intake, compensation scores, and visual-analogue-scale ratings, the control condition was excluded from the analyses and Tukey's honestly significant difference test was used for post hoc comparisons of the significant effects. To compare the results of the 3 preload conditions with that of the control condition, all 4 conditions were included in the analyses and the general linear model procedure was used with Dunnett's post hoc test to examine differences between means. Baseline measures of disinhibition, cognitive restraint, and hunger were tested as covariates. Results were considered significant at P < 0.05. Chi-square analysis was used to determine whether menstrual phase was evenly distributed across conditions.
Food intake
Energy and gram intakes (with and without beverages) and the percentage of energy from macronutrients were analyzed for lunch and for lunch plus dinner, with and without the preload. The percentage of energy from macronutrients was analyzed by using an equivalent multivariate analysis of variance procedure. Energy compensation at lunch was calculated by dividing the energy intake at lunch in each of the preload conditions by the energy intake at lunch in the control condition [ie, (preload + lunch energy intake)/control lunch energy intake] and multiplying by 100. Energy compensation at dinner was calculated by dividing energy intake at lunch and dinner in each of the preload conditions by the energy intake at lunch and dinner in the control condition [ie, (preload + lunch + dinner energy intake)/control lunch + dinner energy intake)] and multiplying by 100. For these calculations, values <100% indicate overcompensation (undereating); values >100% indicate undercompensation (overeating). To examine whether compensation scores differed from 100% (ie, control) the general linear models procedure was used with Dunnett's post hoc test, as described above.
Visual-analogue-scale ratings
Subjective ratings of hunger, fullness, thirst, nausea, and prospective consumption made before consumption of the preload were analyzed to ensure that systematic differences did not exist between test days. In addition, ratings were analyzed at each time point to determine whether consumption of the preloads differentially affected hunger, fullness, etc. Ratings of taste, appearance, prospective consumption, and salt and fat contents of the preloads were analyzed to determine whether the preloads differed in sensory properties.
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RESULTS |
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TOPABSTRACTINTRODUCTIONSUBJECTS AND METHODSRESULTSDISCUSSIONREFERENCES |
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Subjects
Twenty-nine women were selected for participation; however, 5 subjects were dropped from the study: 1 did not meet the minimum requirements for energy intake at lunch in the control condition (1255 kJ), 2 could not eat all of the soup, 1 reported in the discharge questionnaire that she felt nauseated after consuming the soup and the casseroles, and 1 failed to report to the laboratory for her last 2 sessions. The final sample consisted of 24 lean women aged 20–37 y (
± SEM: 24 ± 1.0 y). On average, subjects weighed 60.5 ± 1.4 kg, were 1.6 ± 0.01 m tall, and had a body mass index of 22.6 ± 0.4. Mean scores for the 3 factors of the Eating Inventory were 7.4 ± 0.9, 3.0 ± 0.4, and 3.2 ± 0.5 for restraint, disinhibition, and hunger, respectively. The 2 tests used to assess depression, the Zung Self-Rating Questionnaire and the Beck Depression Inventory, indicated low mean scores: 28.7 ± 1.1 and 2.4 ± 0.5, respectively. In addition, the EAT-26 indicated no signs of an eating disorder (mean score: 4.8 ± 0.9). Chi-square analysis revealed that menstrual cycle phase was evenly distributed across conditions.
Energy intake
Mean energy intakes at each meal are presented in Table 2. Breakfast intakes were similar across conditions. As would be expected, subjects consumed significantly more energy at lunch in the control condition than in the 3 preload conditions. When the amount of energy from the preloads (1128 kJ) was added to that from lunch intake, subjects consumed significantly less energy (16%) when they consumed the soup than when they consumed the casserole with water or the casserole. Drinking water with the casserole did not significantly affect intake compared with the casserole served without water. Thus, incorporating water into the casserole reduced energy intake, but drinking the equivalent amount of water did not (Figure 1).
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). There was a trend, however, for energy intake to be lower after consumption of the soup than after the 2 casserole conditions (P < 0.08). Energy intakes at dinner were similar across conditions. Thus, subjects did not adjust their energy intake at dinner to compensate for the reduction in lunch intake after consumption of the soup.
Energy compensation
Energy compensation at lunch was significantly lower after consumption of the soup than after consumption of the casserole or the casserole with water; however, energy compensation was similar during the 2 casserole conditions (Figure 1). Energy compensation scores at dinner did not differ significantly across conditions (112%, 112%, and 106% for the casserole, casserole with water, and soup, respectively). Energy compensation scores at lunch and dinner were not significantly different from 100% for any condition.
Weight of food consumed and macronutrient intake
Amounts of food and water consumed at each meal are presented in Table 2. Subjects consumed significantly more food (g) at lunch in the control condition than in the 3 preload conditions. Subjects consumed significantly less food at lunch after the soup than after the casserole or the casserole with water. This effect was due to a reduction in intake of all foods, rather than a reduction in one type of food. Subjects consumed similar amounts of food at lunch after both casserole conditions, but drank significantly more water at lunch when the casserole was served without water. Across all conditions, subjects consumed similar amounts of food and water at dinner. Excluding the preload, when lunch and dinner intakes were combined, the amount of food consumed was still significantly lower after the soup (724 g) than after the casserole with water. The amount of food consumed at lunch and dinner was similar after the casserole with water (805 g) and the casserole without water (800 g). There were no significant differences across conditions in the percentages of energy derived from macronutrients. When intakes from the preload, lunch, and dinner were combined, subjects consumed, on average, 33% fat, 49% carbohydrate, and 18% protein.
Visual-analogue-scale ratings
Subjective sensations
Subjective ratings of hunger, fullness, thirst, nausea, and prospective consumption reported before the preload was served were similar across all conditions (Table 3). Hunger and prospective consumption ratings were lower and the fullness rating was higher after all 3 preloads compared with the control condition. After consumption of the soup, fullness was higher and prospective consumption was lower compared with the 2 casserole conditions. Fullness ratings measured before lunch (ie, 5 min after consumption of the preload) were still significantly higher after consumption of the soup. The soup and the casserole with water decreased hunger significantly more than did the casserole without water. Hunger and prospective consumption ratings measured immediately before lunch were significantly lower after the soup than after the casserole without water. Nausea ratings were similar across conditions and at all time points.
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Preload ratings
Ratings of taste and appearance of the preloads did not differ significantly between conditions (Table 4). Prospective consumption ratings indicated that subjects thought they could eat more of the casseroles (with and without water) than of the soup. This finding was not surprising because the soup appeared to be larger in size than the casseroles. The soup was rated significantly lower in salt and fat contents than was the casserole without water. Ratings of the preloads were not found to be significant covariates in the analysis of lunch intake.
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONSUBJECTS AND METHODSRESULTSDISCUSSIONREFERENCES |
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Another study conducted in our laboratory showed that the energy density and the volume of food consumed can affect satiety (6). Specifically, the addition of water to milk-based preloads affected intake such that as the volume increased, less energy was consumed at lunch 15 min later. In that study, the preloads were all liquids, whereas in the present study the addition of water changed the form of the food from a solid to a liquid.
Only a limited number of studies have considered how the form of food affects satiety and results from these studies are inconsistent. Comparisons of apples (15) or oranges and grapes (16) served either as whole fruit or as juice showed that the whole fruit was consistently rated as more satiating. The fruit, however, varied not only in form but also in fiber content. In another study (17), a formulated preload was consumed either as a drink or as each of 2 types of solid food. The form of the food affected appetite ratings such that the solid preloads were more satisfying than was the liquid, but there were no significant differences in subsequent energy intake. In another study in which identical ingredients were served either as solids or liquids, solid food suppressed subsequent intake more so than did liquid (18).
Other studies have shown that soup effectively suppressed subsequent intake compared with solid foods. For example, a preload of tomato soup decreased intakes at lunch significantly more than did isoenergetic preloads of cheese and crackers (with or without juice) or melon (19, 20). In those studies, many properties of the preloads varied, such as macronutrient content, energy density, volume, temperature, and type of food; therefore, it was not possible to determine which factors influenced satiety. In a recent study, vegetables served with water were compared with the same ingredients prepared as either a chunky or blended soup (21). As in the present study, the soup was more satiating than was a solid food served with water. The chunky soup was particularly effective in decreasing subsequent food intake. The authors speculated that the chunky soup may have remained in the stomach longer than the other preloads, thus prolonging gastric distension and satiety.
The results of the present study may be attributable to differences in the gastric handling of the preloads. Because of its larger volume, the soup may have caused greater gastric distension than did the casserole. However, when the preloads varied in volume (ie, casserole with or without water), intake was similar, which does not support this possibility. In addition, despite the fact that the soup and the casserole served with water provided identical ingredients, the soup suppressed subsequent intake significantly more so than did the casserole. It is possible that the effect of the soup on subsequent intake may have been due to differences in the dispersion of nutrients in the gut or in gastric emptying. Studies have shown that the proportions of solids and liquids and the particle size of food in the stomach can affect the distribution of nutrients in the stomach and the gastric emptying rate (21, 22). In the present study, any differences were likely to be subtle and small because the rate of gastric emptying of solid and liquid meals or nutritive liquid meals has been found to be relatively constant (22, 23).
Beliefs about the satiating capacity of preloads may have contributed to the different effects of the preloads on intake. The amount of food that is considered appropriate for the satisfaction of hunger (24, 25) or that represents a culturally acceptable portion (26) may influence beliefs about the satiating capacity of foods. We speculate that, in the present study, the portion of soup, which was served in an oversized cup, appeared large compared with the casserole, which was served in a small bowl. It is unlikely that serving a glass of water with the casserole would change this perception. Visual cues may have led participants to associate the soup with a high degree of satiety and, thus, to reduce subsequent intake.
The orosensory cues related to ingesting the preloads also differed. For example, chewing, a factor believed to enhance satiety (1), varied between conditions. In this experiment, however, the casseroles required the most chewing yet they influenced satiety less than did the soup, which required the least chewing. One way that chewing could affect satiety would be by prolonging the time needed to consume food (27, 28). In the present study, however, preloads were consumed over a fixed period of time to ensure that the length of time eating did not influence the results. Palatability is another orosensory cue that can affect intake (29), but subjects' ratings of the pleasantness of taste of the preloads did not differ significantly between conditions.
Another difference between the foods that could have affected satiety was the temperature of the preloads. The serving temperature of the soup was 67°C, whereas the casserole without water was 79°C. Mixing room-temperature water (20–22°C) with the casserole produced a soup temperature of 
45°C. It is unlikely that these differences in temperature affected intake. In a previous study, larger differences in the temperature of a soup preload (60–62°C compared with 1°C) had no significant effect on food intake (30). In the present study, there was no systematic relation between preload temperature and lunch intake.
Although it has been suggested that consuming water with meals is an effective strategy for decreasing food intake, few data are available to either support or refute this claim. In one study, women were served breakfast with or without 2 glasses of water (7). Results showed that consumption of the water decreased hunger and increased satiety during breakfast, but this effect did not extend beyond the meal. Food intake was not measured. In another study, water (237 and 474 mL) consumed with lunch or 30 or 60 min before lunch did not significantly affect energy intake compared with the control condition, in which no water was served (8). In the present study, drinking water with the casserole did not affect satiety or food intake. Thus, simply drinking a large quantity of water at a meal was not an effective means of decreasing energy intake. Data regarding the effects of drinking large quantities of water over periods of time longer than the time required to consume a single meal are not available.
The results imply that water has a greater effect on satiety when it is consumed as part of a food rather than when consumed with a food. Part of the reason for this finding could be that water in food, which increases the weight or volume of the food and changes the dispersion of nutrients consumed, probably activates mechanisms involved with hunger. On the other hand, water consumed with a food would be processed by thirst mechanisms, which are distinct from those for hunger (31). In this study, thirst ratings before lunch differed but were not related to the amount of food eaten. It is not yet understood what properties of nutrient-containing liquids critically affect the degree to which they are processed as foods or drinks by the body.
In summary, decreasing the energy density of food by adding water to it significantly increased fullness and decreased hunger and subsequent energy intake. An equivalent amount of water served as a beverage with the food did not significantly influence food intake. Thus, consumption of foods with a high water content more effectively decreased subsequent energy intake than did drinking water with food.
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REFERENCES |
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B. J. Rolls The Role of Energy Density in the Overconsumption of Fat J. Nutr., February 1, 2000; 130(2): 268 - 268. [Abstract] [Full Text]
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