You are on page 1of 9

See

discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/13480851

Stubbs RJ, Johnstone AM, O'Reilly LM, Barton


K, Reid C. The effect of covertly manipulating
the energy density of mixed diets on...

Article in International Journal of Obesity October 1998


DOI: 10.1038/sj.ijo.0800715 Source: PubMed

CITATIONS READS

121 176

5 authors, including:

James Stubbs Alexandra M Johnstone


University of Derby University of Aberdeen
225 PUBLICATIONS 3,772 CITATIONS 141 PUBLICATIONS 3,793 CITATIONS

SEE PROFILE SEE PROFILE

Karen L Barton
Abertay University
42 PUBLICATIONS 444 CITATIONS

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

NoHoW - EVIDENCE-BASED ICT TOOLS FOR WEIGHT LOSS MAINTENANCE View project

All in-text references underlined in blue are linked to publications on ResearchGate, Available from: Karen L Barton
letting you access and read them immediately. Retrieved on: 17 November 2016
International Journal of Obesity (1998) 22, 980987
1998 Stockton Press All rights reserved 03070565/98 $12.00
http://www.stockton-press.co.uk/ijo

The effect of covertly manipulating the energy


density of mixed diets on ad libitum food intake
in `pseudo free-living' humans

RJ Stubbs1, AM Johnstone1, LM O'Reilly1, K Barton and C Reid2


1
The Rowett Research Institute and 2Biomathematics and Statistics Scotland, The Rowett Research Institute, Bucksburn, Aberdeen, UK

OBJECTIVE: This study examined the effects of covert alterations in the energy density (ED) of mixed, medium fat
(MF) diets on ad libitum food and energy intake (EI), subjective hunger and body weight in humans.
DESIGN: Randomised cross-over design. Subjects were each studied three times (factorial design), during 14 d,
throughout which they had ad libitum access to one of three covertly-manipulated MF diets.
SUBJECTS: Six healthy men, mean age (s.e.m.) 30.0 y (12.76 y), mean weight 71.67 kg (19.80 kg); mean
height 1.79 m (0.22 m), body mass index (BMI) 22.36 (2.60) kg/m2, were studied. The fat, carbohydrate (CHO) and
protein in each diet (as a proportion of the total energy) and energy density (ED) were, low-ED (LED), 38:49:13%;
373 kJ/100 g; medium-ED (MED), 40:47:13%; 549 kJ/100 g; high-ED (HED), 39:48:13%; 737 kJ/100 g. Subjects could alter
the amount but not the composition of foods eaten. They were resident in (but not conned to) a metabolic suite
throughout the study.
RESULTS: Solid food intake decreased as ED increased, giving mean values of 2.84, 2.51 and 2.31 kg/d, respectively.
This was insufcient to defend energy balance, since energy intake increased with increasing ED (F (2,10) 16.08;
P < 0.001) giving mean intakes of 10.12, 12.80 and 16.17 MJ/d, respectively. Rated pleasantness of food (measured on
visual analogue scales) was not signicantly different between diets nor was subjective hunger different between the
LED, MED and HED diets, respectively. Diet signicantly affected body weight (F (2,10) 4.62; P 0.038), producing
changes of 71.20, 0.02 and 0.95 kg, respectively, by day 14.
CONCLUSION: Dietary ED can inuence EI and body weight, since changes in amount eaten alone are insufcient to
defend energy balance, when subjects feed on unfamiliar diets and diet selection is precluded. Comparison with our
previous studies suggest that there was compensation in solid food intake when ED was altered using mixed diets (as
in this study) compared to previous studies which primarily used fat or CHO to alter dietary ED.

Keywords: carbohydrate; fat; energy; macronutrients; food intake; appetite; energy density; humans

Introduction This may not be the case since two recent studies
found that the increased consumption of modied low
fat (LF) foods decreases fat but not energy intake (EI),
Increased fat intake is considered to be a major factor
in free-living consumers.7,8 These results suggest that
in Western society, predisposing individuals to gain
while dietary fat intake may be a risk factor for weight
weight. Indeed, government reports now suggest that
gain, substantial weight loss is unlikely to be achieved
in order to limit weight gain, people should speci-
simply by increasing the consumption of LF food
cally attempt to reduce dietary fat intake (for example,
products.
see Ref. 1). The evidence that fat somehow bypasses
The majority of studies that compare the effects of
appetite control and that changes in fat intake are a
high fat (HF) and LF diets on appetite and indices of
major factor underlying secular trends in body weight
energy balance, confound diet composition with ED,
appears to be compelling.2 6
since dietary fat content and ED tend to co-vary.
The food industry has responded to dietary recom-
These studies have not therefore assessed whether
mendations regarding fat, by producing a large
the excess EI induced by consumption of HF diets is
number of food products which are `low' or `lower-
a macronutrient-specic effect. Two studies have
fat' foods. These foods are not always foods which are
compared the effects of isoenergetically-dense HF
low in energy density (ED) or in the case of some
and LF diets on EI. When the ED of HF and LF
`lower fat' foods, low in absolute fat content. Despite
diets was very similar, the effect of fat in promoting
this fact, some consumers appear to have developed
excess EI was not apparent.9,10 These ndings have
the perception that in order to lose weight, a person
led to the suggestion that the effects of fat in promot-
simply needs to reduce their total dietary fat intake.
ing excess EI is simply a non-nutrient specic effect
of dietary ED.11 However, many experts would agree
Correspondence: RJ Stubbs, The Rowett Research Institute, that the effects of diet composition on feeding beha-
Greenburn Road, Bucksburn, Aberdeen, AB21 9SB, UK.
Received 22 August 1997; revised 12 March 1998; accepted viour cannot be simply reduced to a question of
22 May 1998 whether dietary fat or ED promotes excess EI.
Energy density of mixed diets and energy intake
RJ Stubbs et al
981
Other studies which have compared the effects of mass index (BMI) 22.36 (2.60) kg=m2) were recruited
isoenergetic (1.0 1.5 MJ) macronutrient loads on by advertisement. They were normal weight, non-
subjective hunger, have found protein to be the most smoking, non-trained, healthy men, who were not
satiating macronutrient.12 14 Differences between iso- taking any medication. Subjects were resident in, but
energetically-dense HF and high carbohydrate (HC) not conned to, the metabolic suite, since they could
diets are detectable, but tend to be more subtle than come and go as they pleased. They also had ad libitum
when fat contributes disproportionately to dietary ED access to a diet that was of a xed composition per run
(for example, see Ref. 15). A consideration of the and so were not strictly free-living in the true sense of
literature suggests, that under ecological conditions, the phrase.
there is a hierarchy in the satiating efciencies of the
macronutrients protein (most satiating), carbohydrate
(CHO) and fat (least satiating).16 This hierarchy may
be over-ridden by changes in dietary ED, since we Study design
have recently shown that subjects can spontaneously Each subject was studied three times in 16 d during
overeat on high-CHO (HC) diets which are high in treatments which began with 2 d equilibration on a
ED.17 A much more complex picture of the way diet designed to standardise energy and macronutrient
human subjects respond to different controlled (and intakes at 1.6  basal metabolic rate (BMR), as
often covert) manipulations of the nutrient content described previously.17 The ED of these meals were,
and=or ED of the diet is thus beginning to emerge. on average 600 kJ=100 g. During the subsequent 14 d,
Walls and Koopmans18 have found that in rodents, the subjects had continuous ad libitum access to one
compensatory responses were greater when rats were of three covertly manipulated diets, which were low
given intravenous infusions of mixed nutrients, than (LED), medium (MED) or high-energy density (HED)
when either fats or glucose were given alone. Com- (Table 1). The proportion of energy derived from
pensatory responses were greater for glucose than fat. protein, CHO and fat was the same on each diet.
This effect has been found in humans.19 Campbell et Each dish was made in three versions, corresponding
al20 observed marked (albeit incomplete) compensa- to the LED, MED and HED regimes. The ED of each
tory responses for covert alterations in the ED of food type increased on going from the LED to HED
mixed, liquid diets in lean but not obese subjects. version of the same food. The order of diets was
These observations, together with the above discus- randomised in a counterbalanced design across sub-
sion, suggest that subjects may compensate to a jects. The energy and macronutrient composition of
greater extent for variations in the ED of mixed each time of the diet, the diet recipes, three-day
diets than when the ED of the diet is altered primarily rotating menu and instructions for preparation of the
using fat or CHO. foods, can be obtained by contacting the authors. The
This study therefore examined subjects' responses means of anthropometric measurement, food prepara-
to variations in the ED (but not the composition) of tion, presentation and food intake measurements have
mixed diets, under the same experimental conditions been described in detail previously.17
that we have used to examine responses to ED Subjects completed subjective hunger, appetite and
manipulations of the diet by primarily using fat,5,6 palatability ratings 15 min after each meal as
CHO17 or isoenergetically dense HF and HC diets.10 described by Hill and Blundell.21 There was a mini-
mum period of one week between treatments, during
which subjects had access to free food. The subjects
entirely determined their own daily activity regimes.
Materials and methods We did not therefore ensure that physical activity was
strictly controlled across treatments, although subjects
reported that they did not change their normal routines
Subjects during the course of the study. The study was
Six healthy men (mean (s.e.m.) age 30.00 (12.76) y; approved by the Grampian Health Board and Univer-
weight 71.67 (19.80) kg; height 1.79 (0.22) m; body sity of Aberdeen Joint Ethical Committee.

Table 1 Average composition of dietary treatments expressed as water, dry matter, energy and nutrient composition for the high
(HED), medium (MED) and low-energy density (LED) diets

Water Dry matter Energy Protein Fat CHO Sugar Starch NSP % % %
(g) (g) (MJ) (MJ) (MJ) (MJ) (g) (g) (g) Protein CHO Fat

HED 583 417 7.38 0.98 2.89 3.51 110 100 5 13 48 39


(s.e.m.) (26) (26) (0.14) (0.01) (0.12) (0.02) (14) (14) (1) (0) (1) (1)
MED 671 329 5.49 0.72 2.19 2.57 88 63 6 13 47 40
(s.e.m.) (27) (27) (0.05) (0.01) (0.03) (0.02) (11) (11) (1) (0) (0) (0)
LED 762 238 3.56 0.48 1.38 1.70 57 40 6 13 48 39
(s.e.m.) (23) (23) (0.03) (0.01) (0.02) (0.01) (7) (7) (1) (0) (0) (0)

CHO carbohydrate; NSP non-starch polysaccharides.


Energy density of mixed diets and energy intake
RJ Stubbs et al
982
Statistical analysis Results
ANOVA was conducted on the intakes of energy, fat,
CHO and protein for the individual 24 h results from
each subject, using the Genstat 5 statistical program Food, energy and nutrient intakes
(Genstat 5 Rothampstead Experimental Station, Har- Table 2 summarises the mean intakes of weight,
penden, UK). The analysis treated subject, run and energy, fat, CHO, protein, sugar and starches, and
week (week 1 or 2 of each run) as blocking factors, gives the standard errors of the difference between the
and diet and week as factors. Menu days were means (s.e.d.), F ratios and probability values, asso-
included as a covariate. Post-hoc Scheffe tests were ciated with the main effects for dietary manipulation.
conducted to assess signicant differences between There were no signicant differences in the weight of
specic mean values. The analysis of the visual food and non-caloric drinks (summed) consumed
analogue ratings was complicated by the large between diets (Figure 1). There was no signicant
number of missing observations for some subjects. increase or decrease in the rate of food and drink
Therefore it was necessary to check that there were no intake over the 14 d of the study (Figure 1). When the
systematic differences in the times of non-response wet weight of food without non-caloric drinks was
between diets, as this may bias the results. A logistic examined, there was a signicant compensatory
regression was performed with binary response, obser- decrease in food intake as dietary ED increased,
vation or missing value. Terms for subject, diet, time which was insufcient to defend energy balance,
and the interactions between subject and diet, and since the effect of dietary ED on EI was highly
subject and time, were included in the model. The signicant (Table 2). Menu-day effects were also
interactions between time and diet, and subject, time signicant and will not be discussed further. Since
and diet were then added to the model. After nding the composition of the diets was constant, macro-
no evidence for systematic differences in response, nutrient intakes (Figure 2) paralleled EI.
average ratings were calculated for each day and these Figure 3 shows that subjects lost weight over the
were analysed by ANOVA, with diet as factor and 14 d on the LED diet, weight did not signicantly
subject as blocking factor. change on the MED diet and increased on the HED
Hunger ratings were analysed by ANOVA with diet, giving cumulative weight changes of 71.20 kg,
subject, run, week and weekday as blocking factors 0.02 kg and 0.91 kg on the LED, MED and HED diets,
and diet, week and weekday as factors. Pleasantness respectively, [F (2,10) 4.62; P 0.038] by the
and satisfaction were analysed by ANOVA with morning of day 15.
subject, run, week and meal as blocking factors
and diet, week and meal as factors. Menu day
was included as a covariate. Change in body Subjective hunger, appetite and perceived pleasantness
weight was analysed by ANOVA, with subject, of the diets
run and week as blocking factors and day, week Subjects differed from one another in their expression
and diet as factors. of subjective hunger (F (5,8) 294; P < 0.001). Mean
Table 2 Average daily food, energy and nutrient intakes (s.e.m.) for the low energy density (LED), medium energy
density (MED) and high energy density (HED) dietary treatments, for the six subjects. Variance ratios, standard
errors of the difference between the means (s.e.d.) and statistical probability for the main treatment effects has also
been summarised

LED MED HED Variance ratio Probability s.e.d.

Food and drink (g) 4075 3410 3663 1.77 0.219 356.3
s.e.m. (215) (166) (199)
Water (g) 3513 2718 2819 3.93 0.055 308.8
s.e.m. (194) (140) (173)
Solid food (g) 2839a 2506 2304 3.93 < 0.01 192.3
s.e.m. (637) (550) (540)
Energy (MJ) 10.19a,c 12.80 16.17 13.23 < 0.002 1165.2
s.e.m. (0.41) (0.59) (0.60)
Protein (MJ) 1.35a,c 1.68 2.11 13.63 < 0.001 145.9
s.e.m. (0.05) (0.08) (0.08)
Fat (MJ) 3.80a,b 5.03 6.23 13.46 < 0.001 466.8
s.e.m. (0.15) (0.23) (0.23)
CHO (MJ) 4.97a,c 6.00 7.64 7.64 < 0.002 546.4
s.e.m. (0.20) (0.28) (0.28)
Sugar (g) 135a,b 173 192 8.15 0.008 14.74
s.e.m. (5) (8) (8)
Starch (g) 154a,c 167 265 20.34 < 0.001 19.06
s.e.m. (8) (10) (12)
NSP (g) 20a,b 13 14 14.85 0.001 1.546
s.e.m. (1) (1) (1)
a
Indicates a signicant difference between LED and HED diets; b indicates a signicant difference between LED and
MED diets; cindicates a signicant difference between MED and HED diets; CHO carbohydrate; NSP non-starch
polysaccharides.
Energy density of mixed diets and energy intake
RJ Stubbs et al
983

Figure 1 Mean (s.e.m.) daily intake of food and energy for the
six subjects on the three dietary treatments. ANOVA conrmed
the treatment effect was signicant at P < 0.002.

daily hunger was 26 mm, 24 mm and 24 mm on the


LED, MED and HED diets, respectively. Results for
`fullness', `urge to eat', `desire to eat' and `thoughts
of food', exhibited similar non-signicant trends.
There was a signicant diet effect for prospective Figure 2 Mean (s.e.m.) daily protein, carbohydrate (CHO) and
consumption (F (2,8); 6.41; P 0.02). Mean values fat intakes for the six subjects on the three dietary treatments.
ANOVA conrmed the treatment effect was signicant at
were 36 mm, 37 mm and 31 mm on the LED, MED P < 0.001.
and HED diets, respectively. Clearly this effect was
accounted for by a contrast between the HED diet and
the other two diets. There were no signicant differ-
ences in rated pleasantness of the food between days
or diets (F (2,8) 1.18; P 0.380). The mean values for
pleasantness were 80 mm, 84 mm and 84 mm for the
LED, MED and HED diets, respectively.

Discussion

The effect of increasing the ED of mixed diets on food


Figure 3 Mean (s.e.m.) change in body weight, relative to day 1
and EI (set to zero), for ve of the six subjects on the three dietary
Covertly increasing the ED of mixed diets, led to a treatments. ANOVA conrmed the treatment effect was signi-
graded increase in the EI of these subjects. The MED cant at P 0.038.
diet was chosen to have an average ED of approxi-
mately 550 kJ=100 g, because subjects have been
shown to eat to approximate energy balance on similar balance on the MED diet. The LED (373 kJ=100 g)
diets, of this composition, in our laboratory. Indeed, in and HED (737 kJ=100 g) diets were chosen to be
the present study, it appears from the body weight approximately 36% less or more in ED than the
data, that subjects were in approximate energy MED diet, respectively. At rst sight, it appeared
Energy density of mixed diets and energy intake
RJ Stubbs et al
984
less of a diet in a xed composition and ED. Further-
more, dietary manipulations are often covert, the order
of runs is randomised and the diets are formulated to
appear as similar as possible in taste, texture and
appearance. As in most studies of feeding behaviour,
there were limitations to the design of this experiment.
The study design (and hence conclusions arising from
it) was subject to the following constraints. The food
items are not common, familiar or `real' foods.
Furthermore the ED of the diets range from 356
738 kJ=100 g, which in absolute terms is a narrow
range relative to foods available in the free-living
Figure 4 Mean (s.e.m.) daily food intake in response to changes environment. It is likely that subjects would learn to
in the energy density (ED) of the diet using mixed nutrients compensate more rapidly for changes in the ED and
(present study), primarily fat6 and primarily carbohydrate
(CHO).21 There were six men in each experiment, which lasted composition of manipulated diets, if the manipulations
14 d per dietary treatment. Signicance levels are indicated for were overtly paired to appropriate learning cues.
treatments effects within each study. NS not statistically Ideally, the results of overt and covert manipulations
signicant.
should be compared. This study was conducted in a
very small number of subjects and these results should
that the subjects in the present study were consuming perhaps be replicated before attempting to extrapolate
an amount of food and drink that was similar on each them to other groups or the general population. This
diet. We have previously expressed EI on MED and design precludes learning about the physiological
HED diets, in relation to that on the LED diet, to consequences of ingesting manipulated foods and
assess whether subjects ate in direct proportion to the the ability of subjects to respond to those manipula-
ED of the diets. Indeed, this was the case when the ED tions, is blunted by these constraints of the experi-
of diets was previously increased covertly primarily mental design. The result of this is to articially raise
using fat.5,6 In our previous study, where the ED of the causal effect of dietary ED on EI. In other words,
the diet was manipulated primarily using CHO, sub- if a diet is manipulated in a way that subjects respond
jects showed an incipient but non-signicant tendency weakly, signicant differences in energy (but not
to eat more food on the LED diet17 (Figure 4). EI was food) intake will occur. Subjects fail to compensate
thus largely in proportion to the ED of the diet.17 In to any great degree under these experimental condi-
the present study, expressing the average ED of each tions and EI tends to reect the initial dietary manip-
diet relative to the LED diet, gave ratios of 1.00, 1.47 ulation. Thus, face-value interpretations of
and 1.98. Expressing EI on each diet, relative to the quantitative-response studies, such as these, may
LED diet, gave ratios of 1.00, 1.26 and 1.60, respec- tend to overestimate the `regulatory' signicance of
tively, indicating that the difference in EI between passive overconsumption, as the ED of diets is
diets was less than it would have been had subjects not increased, and underestimate the importance of
compensated to some degree by altering food intake. active changes in food intake or subjective hunger.
The wet weight of solid food also decreased as the ED This argument is supported by studies conducted
of the diet increased giving values of 2.84, 2.51 and under more ecological conditions7,8 and studies
2.31 kg=d on the LED, MED and HED diets, respec- using diets more similar to those encountered in
tively. Thus subjects consumed 12% and 19% less in everyday life,22 25 in which subjects tend to compen-
solid food, on the MED and HED diets, in comparison sate more accurately for alterations in dietary ED.
to the LED diet. Clearly this degree of caloric com- These arguments also imply that it is important to
pensation was insufcient to defend energy balance. It design experiments which examine both quantitative
is important to question how quantitatively signicant (amount eaten) and qualitative (selection of food type,
these effects actually are. In order to appreciate this, composition and ED) responses to dietary manipula-
the nature of the experimental design must be taken tions.
into account.

Comparison of a series of quantitative studies


Limitations of the current experimental design examining variations in the ED of the diet primarily
In studies where subjects have access to a range of using fat, CHO or mixed nutrients
familiar foods, after ingesting macronutrient-manipu- If the above arguments are accepted, interesting dif-
lated foods,7,8,22 25 caloric compensation is far more ferences in group responses occurred in a series of
complete than when they can alter the amount but not studies which manipulated dietary ED primarily using
type, composition or ED of the foods eaten. Studies, fat5,6 or CHO,17 under the same experimental condi-
such as the present study, tend to be relatively tions. When the ED of the diet was altered primarily
insensitive, in that they only allow the subject to using fat, subjects did not compensate at all for
respond to a dietary manipulation by eating more or alterations in dietary ED.5,6 Neither were there
Energy density of mixed diets and energy intake
RJ Stubbs et al
985
signicant differences in subjective hunger between Forbes et al26 made estimates of the energy cost of
the diets.5 When ED was altered, primarily using weight gain in adults. Using empirical data from their
CHO, there was no compensation for the ED of the own laboratory and a number of rigorous studies from
diets, but subjects were signicantly (and anecdotally) the literature, they have estimated the relationship
more hungry on the LED diet, compared to the HED between total excess energy ingested and total
diet.17 In the present study, there were no signicant weight gain. From this they estimate the energy cost
differences in subjective hunger between the diets, but of weight gain in non-obese subjects to be 33.7 MJ=kg
there was a signicant diet effect for prospective weight gain. Subtracting the energy content of weight
consumption. Subjects also showed a highly signi- change from the energy cost of weight gain gives an
cant (albeit quantitatively small) compensation of estimate of the cost of synthesis and maintenance of
food and EI on going from the LED to the HED tissue deposition, 33.7 7 26.2 7.5 MJ=kg.
diet. Thus, subjects responded more effectively to The energy cost of weight loss is likely to be less
changes in the ED of the mixed nutrient manipulations than that for weight gain. This is because the energy
(by active changes in food intake) than the primarily cost of tissue mobilisation is far less than the energy
CHO-based manipulations (detectable changes in cost of tissue synthesis, and is likely to be cancelled
hunger),17 which in turn showed a greater response out by the decrease in the energy required to main-
than the primarily fat-based manipulations.5,6 These tain the tissues that have been lost. We have
patterns are illustrated in Figure 4. These comparisons assumed this to be so and have therefore used the
are consistent with infusion studies in rodents18 and energy content of weight change (26.2 MJ=kg), esti-
humans,19 which have found greater caloric compen- mated above as an estimate of the energy cost of
sation in response to mixed infusions than glucose- weight loss for this group of subjects. This is
infusions, which in turn produced greater caloric necessarily an approximation, and in early life the
compensation than lipid infusions. These ndings in energy cost of weight gain and loss may be inu-
turn, are consistent with the notion that dietary macro- enced by a number of factors, including body com-
nutrients exert hierarchical effects on satiety (protein position and physical activity of the subjects.26,27
having the greatest effect and fat the least).16 Using these values and the changes in body weight
gives an estimated change in energy balance
of 71.2  26.2 731.4 MJ, 0.02  33.7 0.7 MJ
Body weight changes and 0.95  33.7 32.0 MJ on the LED, MED and
By day 14 of each dietary treatment, mean body HED diets, respectively. Assuming that subjects were
weights had changed by 71.20, 0.02 and 0.95 kg on in zero energy balance on the MED diet, the differ-
the LED, MED and HED diets, respectively. Change ences in EI would have cumulated to produce energy
in body weight can be used to estimate change in balances of 736.4 and 47.2 MJ for the LED and
energy balance, using estimates of the energy cost of HED diets, respectively. Thus the estimated change
weight gain and weight loss. The energy content of in energy balance from increase in weight was 15 MJ
adipose tissue and lean body mass can be combined lower, and from decrease in weight 5 MJ lower, than
with the estimated ratio of fat (61%) to lean tissue the estimates using differences in EI, assuming zero
(39%) contributing to body weight changes in a group energy balance on the MED diet.
of men with the physical characteristics of these Body weight uctuated, on a day-to-day basis, by
subjects, to estimate the approximate energy content an average 220 g=d (range 20670 g) on the MED
of weight change.26,27 It should be noted that the diet. Using an average of the energy cost of weight
above ratio of fat to lean tissue corresponds to a gain (33.7 MJ=kg) and loss (26.2 MJ=kg), gives an
ratio of 75% adipose tissue to 25% lean body mass, approximate mean energy cost of weight change of
since adipose tissue comprises 80% lipid and 20% 30.0 MJ=kg. This would give an average daily uncer-
lean tissue. The adipose tissue of Reference Man tainty of  (0.22  30.0) 6.6 MJ (range 0.6
comprises 80% fat, 15% water and 5% protein 20.1). The above discrepancy is therefore at the
as wet tissue.28 The gross energy of fat of extreme end of the error-range, arising from an
39.9 MJ=kg and of protein is 23.6 MJ=kg. The accu- assumed energy cost of weight change of
rate estimate of the energy content of adipose tissue 30.0 MJ=kg. These differences between energy bal-
should therefore be (0.8  39.9) (0.15  0) ance estimated from change in body weight and
(0.05  23.6) 33.1 MJ=kg. The gross energy of change in EI are also within the errors arising from
average meat protein is 23.6 MJ=kg. The estimated dietary intake measurements and the assumptions
protein content of lean tissue is 20% wet weight, used in calculating the energy cost of weight gain
giving an estimated energy content of lean tissue and loss. Subjects may have been more physically
amounting to 23.6 MJ=kg  0.2 4.72 MJ=kg. The active or less compliant on the HED diet. However,
estimated energy content of body weight change can if subjects were non-compliant on this diet, it would
therefore be calculated as (0.75  33.1) (0.25  not have been due to their eating foods not on the
4.72) 26.2 MJ=kg, assuming that 39% of tissue menu, since if that were the case they should have
gain is lean tissue and 61% is fat (or 25% lean body gained more and not less weight than expected. It is
mass and 75% adipose tissue). unlikely that subjects pretended to eat more food,
Energy density of mixed diets and energy intake
RJ Stubbs et al
986
since they were feeding ad libitum and could eat as foods they subsequently select. Food and nutrient
much or as little as they wanted and could simply selection may well be an important component of
leave the food in their fridge. caloric compensation.

ED, uid and food intake


In the present study, uid intake estimates were not as Acknowledgements
precise as the food intake estimates, since subjects This work was supported by funding from the Scottish
would occasionally drink water from other sources Ofce Department of Agriculture, Environment and
the most common being the kettle, for tea and coffee. Fisheries. We are grateful to Scientic Hospital Sup-
However, it was of interest to note that subjects plies Ltd, Liverpool, UK, for the donation of the
tended to drink more of the drinks provided as the MaxiJoule.
ED and hence dry matter of the diets increased.
Furthermore, failing to differentiate between uid
and food intake in the present study would have led References
to the erroneous conclusion that the subjects did not 1 Department of Health. The health of the nation: A strategy for
compensate at all for the increase in dietary ED. The health in England. HMSO: London, 1992.
exact relationship between uid and food intake in 2 Lissner L, Heitmann BL. Dietary fat and obesity: evidence
human feeding behaviour is unclear. It is also unclear from epidemiology. Eur J Clin Nutr 1995; 49: 79 90.
3 Thomas CD, Peters JC, Reed GW, Abumrad NN, Sun M, Hill
how uids may interact with the food matrix under- JO. Nutrient balance and energy expenditure during ad libitum
going digestion in the gut (Mela, personal commu- feeding of high-fat and high-carbohydrate diets in humans. Am
nication). It may be hypothesised that when uids and J Clin Nutr 1992; 55: 934 942.
food matter interact to form a complex in the gut, that 4 Kendall A, Levitsky DA, Strupp BJ, Lissner L. Weight-loss
this may enhance short-term satiety. When solid food on a low fat diet: consequence of the impression of the control
of food intake in humans. Am J Clin Nutr 1991; 53:
matter and uids interact less in the gut, it is likely 1124 1129.
that uid intake will exert less inuence over solid 5 Stubbs RJ, Harbron CG, Murgatroyd PR, Prentice AM. Covert
food intake. manipulation of dietary fat and energy density: effect on
substrate ux and food intake in men feeding ad libitum. Am
J Clin Nutr 1995; 62: 316 330.
6 Stubbs RJ, Ritz P, Coward WA, Prentice AM. Covert manip-
ulation of the ratio of dietary fat to energy density: effect on
Conclusions food intake and energy balance in free-living men feeding ad
libitum. Am J Clin Nutr 1995; 62: 330 338.
7 Gatenby SJ, Aaron G, Morton G, Mela DJ. Nutritional
This study concludes a series of studies where we implications of reduced-fat food use by free-living consumers.
have examined the effects of covertly altering the ED Appetite 1995; 25: 241 252.
of the diet, primarily in the form of fat,5,6 or CHO,17 8 Aaron JI, Gatenby SJ, Jack V, Mela DJ. Effect of reduced fat
and in this study using mixed diets of xed composi- and reduced sugar food use on diet and weight control status of
tion. These studies suggest that under the precise, but free-living consumers (abstract). Proc Nutr Soc 1996; 55:
215A.
behaviourally insensitive, experimental conditions of 9 Van Stratum P, Lussenburg RN, van Wezel LA, Vergroesen
quantitative feeding studies, where subjects can only AJ, Cremer HD. The effect of dietary carbohydrate:fat ratio on
alter the amount, but not the composition of covertly energy intake by adult women. Am J Clin Nutr 1978; 31:
manipulated foods eaten, changes in dietary ED as fat, 206 212.
as CHO and as mixed diets, can exert profound effects 10 Stubbs RJ, Harbron CG, Prentice AM. The effect of covertly
manipulating the dietary fat to carbohydrate ratio of isoener-
on EI and body weight. The evidence from more getically dense diets on ad libitum food intake in free-living
ecological studies7,8,22 25 suggests that in real-life, humans. Int J Obes 1996; 20: 651 660.
where subjects can alter the amount, type, composi- 11 Prentice AM, Poppitt SD. Importance of energy density and
tion and ED of foods they ingest, compensatory macronutrients in the regulation of energy intake. Int J Obes
responses to changes in diet composition and=or ED 1996; 20: S18 S23.
12 Stubbs RJ, Van Wyk MCW, Johnstone AM, Harbron C.
are likely to be more accurate, though often incom- Breakfasts high in protein, fat or carbohydrate: effect on
plete. Comparing the results of this study to our within-day appetite and energy balance. Eur J Clin Nutr
previous work, suggests that subjects may respond 1996; 50: 409 417.
to a greater extent to covert manipulations of the ED 13 Johnstone AM, Harbron CG, Stubbs RJ. Macronutrients,
of mixed diets than changes in the ED of CHO-rich appetite and day-to-day food intake in humans. Eur J Clin
Nutr 1996; 50: 418 430.
diets, which produce greater responses than manipula- 14 Johnstone AM, Stubbs RJ, Reid C. Macronutrient composition
tions of the ED of the diet by increasing its fat content. of weight-reducing diets: effects on compliance and weight
The signicance of these effects under ecological loss [Abstract]. Int J Obes 1997; 21 (Suppl 2): S212.
conditions has yet to be determined. It is recom- 15 Rolls BJ, Kim-Harris S, Fischmann MW, Foltin RW, Moran
mended where possible, that quantitative studies TH, Stoner SA. Satiety after preloads with different amounts
of fat and carbohydrate: implications for obesity. Am J Clin
such as the present study be compared to studies Nutr 1994; 60: 476 487.
where subjects can respond to prior dietary manipula- 16 Stubbs RJ. Macronutrient effects on appetite. Int J Obes 1995;
tion by altering both the amount and composition of 19 (Suppl 5): S11 S19.
Energy density of mixed diets and energy intake
RJ Stubbs et al
987
17 Stubbs RJ, Harbron C, Johnstone AM. The effect of covertly 23 Foltin RW, Rolls BJ, Moran TH, Kelly TH, McNelis AL,
manipulating the energy density of high-carbohydrate diets on Fischman MW. Caloric, but not macronutrient, compensation
ad libitum food intake in `pseudo free-living' humans. Int J by humans for required eating occasions with meals and
Obes (this volume). snacks varying in fat and carbohydrate. Am J Clin Nutr
18 Walls EK, Koopmans HS. Differential effects of intravenous 1992; 55: 331 342.
glucose, amino acids and lipid on daily food intake in rats. Am 24 Caputo FA, Mattes RD. Human dietary responses to covert
J Physiol 1992; 262: R225 R234. manipulations of energy, fat and carbohydrate in a midday
19 Gil K, Skeie B, Kvetan V, Askanazi J, Friedman MI. Par- meal. Am J Clin Nutr 1992; 56: 36 43.
enteral nutrition and oral intake: Effect of glucose and fat 25 Mattes RD, Pierce CB, Friedman MI. Daily caloric intake of
infusion. J Parenter Ent Nutr 1991; 15: 426 432. normal weight adults: responses to changes in dietary energy
20 Campbell RG, Hashim SA, Van Itallie TB. Studies of food density of a luncheon meal. Am J Clin Nutr 1988; 48:
intake regulation in man. Responses to variations in nutritive 214 219.
density in lean and obese subjects. New Engl J Med 1971; 285: 26 Forbes GB, Brown MR, Welle SL, Lipinski BA. Deliberate
1402 1407. overfeeding in women and men: energy cost and composition
21 Hill AJ, Blundell JE. Nutrients and behaviour: research of the weight gain. Br J Nutr 1986; 56: 1 9.
strategies for the investigation of taste characteristics food 27 Forbes GB. Do obese individuals gain weight more easily
preferences, hunger sensations and eating patterns in man. than nonobese individuals? Am J Clin Nutr 1990; 52:
J Psychol Res 1982; 17: 203 212. 224 227.
22 Foltin RW, Fischman MW, Moran TH, Rolls BJ, Kelly TH. 28 Snyder WS, Cook MJ, Nasset ES, Karkhausen LR, Parry
Caloric compensation for lunches varying in fat and carbohy- Howells G, Tipton IH. Report of the Task Group on Reference
drate contents by humans in a residential laboratory. Am J Clin Man. International commission on radiological protection
Nutr 1990; 52: 969 980. No. 23. Pergamon Press: Oxford, 1974.