Double trouble: Portion size and energy density combine to increase preschool children's lunch intake

Abstract

Background Both portion size and energy density (ED) have substantial effects on intake; however, their combined effects on preschool children’s intake have not been examined when multiple foods are varied at a meal. Objective We tested the effects on intake of varying the portion size and ED of lunches served to children in their usual eating environment. Design In a crossover design, lunch was served in 3 childcare centers once a week for 6 weeks to 120 children aged 3 to 5 y. Across the 6 meals, all items were served at 3 levels of portion size (100%, 150%, or 200%) and 2 levels of ED (100% or 142%). The lunch menu had either lowerED or higher-ED versions of chicken, macaroni and cheese, vegetables, applesauce, ketchup, and milk. Children’s ratings of the foods indicated that the lower-ED and higher-ED meals were similarly well liked. Results The weight of food and milk consumed at meals was increased by serving larger portions (P<0.0001) but was unaffected by varying the ED (P=0.22). Meal energy intake, however, was independently affected by portion size and ED (both P<0.0001). Doubling the portions increased energy intake by 24% and increasing meal ED by 42% increased energy intake by 40%. These effects combined to increase intake by 175±12 kcal or 79% at the higherED meal with the largest portions compared to the lower-ED meal with the smallest portions. The foods contributing the most to this increase were chicken, macaroni and cheese, and applesauce. The effects of meal portion size and ED on intake were not influenced by child age or body size, but were significantly affected by parental ratings of child eating behavior. Conclusion Strategically moderating the portion size and ED of foods typically consumed by children could substantially reduce their energy intake without affecting acceptability.

Reduction of Portion Size and Eating Rate Is Associated with BMI-SDS Reduction in Overweight and Obese Children and Adolescents: Results on Eating and Nutrition Behaviour from the Observational KgAS Study

“…in fast food restaurants or at home) and package sizes have increased, and research increasingly focused on this topic [12,13] . As fast food restaurants serve large portions of energy-dense foods and exposure to a large portion size induces a higher eating rate and bite size, the contribution to energy intake is multiplied [12][13][14][15][16] .…”

Does milk matter: Is children’s intake affected by the type or amount of milk served at a meal?

“…A power analysis was conducted to determine the number of children needed for the study, based on previous research in a similar population with similar foods (Kling et al, 2016; Leahy, et al, 2008c; Spill et al, 2011). A 7.5% (15 kcal) difference in meal energy intake as a result of varying the properties of one item (milk) was considered the minimum difference to be detected.…”

“…oz.]). The foods in the meal were frequently served by the participating childcare centers and were well-accepted by preschool children in previous studies (Kling et al, 2016; Leahy, Birch, & Rolls, 2008b; Leahy, et al, 2008c; Spill et al, 2011). The participating childcare centers usually serve lower-ED, 1% fat milk.…”

“…Previous controlled studies have focused on chocolate milk because of its increased energy and sugar content; results showed that serving higher-ED chocolate milk substantially increased both milk intake and total energy intake at a meal compared to lower-ED unflavored milk (Wilson, 1991, 1994, 2000). Chocolate milk, however, is highly palatable and is not typically served in childcare centers; whereas, unflavored milk is offered on a daily basis and is available in lower-ED and higher-ED versions that are similar in palatability (Kling, Roe, Keller, & Rolls, 2016). In a previous study, we found that increasing the ED and portion size of all items in a meal (including unflavored milk) increased the amount of energy consumed from both food and milk (Kling et al, 2016).…”

“…Chocolate milk, however, is highly palatable and is not typically served in childcare centers; whereas, unflavored milk is offered on a daily basis and is available in lower-ED and higher-ED versions that are similar in palatability (Kling, Roe, Keller, & Rolls, 2016). In a previous study, we found that increasing the ED and portion size of all items in a meal (including unflavored milk) increased the amount of energy consumed from both food and milk (Kling et al, 2016). Varying the ED and portion size of just the milk at a meal, however, has not been studied and thus the effects on meal energy intake are not known.…”