Children's Energy Intake Generally Increases in Response to the Energy Density of Meals but Varies with the Amounts and Types of Foods Served

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Background: Food energy density (ED; kcal/g) is positively related to energy intake in numerous studies. A recent secondary analysis proposed that when the ED of consumed food is above a breakpoint, adults sense calories and adjust meal size to minimize overconsumption. Objectives: We conducted a secondary analysis of measured intakes in preschool children to assess how meal energy intake was related to meal ED as well as to meal portions, eating occasions, and menus. Methods: We analyzed weighed intakes from 6355 meals served to 94 children aged 3 to 5 y in 2 randomized crossover trials. We provided children with all their daily food and milk for multiple periods of 5 consecutive days in their usual childcare setting. We used linear mixed models with repeated measures to analyze the effects on energy intake of meal ED and meal weight, either as served or as consumed. Results: Energy intake at meals was related to the ED and portions of served food and also to the ED and weight of consumed food (all P < 0.0001). Energy intake was also significantly affected by the eating occasion and the foods served on the menus. Children selectively ate higher-ED items, which were served in smaller amounts than lower-ED options. Meal energy intake was curvilinear across consumed ED; it initially increased (slope: 113 ± 2 kcal/ED unit) but decreased at higher-ED meals (deceleration: −11 ± 1 kcal/ED unit2) without evidence of a clear breakpoint. This trajectory may be attributable to the relatively limited portions of higher-ED foods that were served. Conclusions: Children's energy intake generally increased with greater ED; at higher-ED meals, however, energy intake decreased in a curvilinear manner without a clear breakpoint. This reduction in intake at higher ED could be explained by meal-related factors such as the portions served rather than by sensitivity to meal energy content. This study was registered at as NCT03010501 and NCT03242863.

Original languageEnglish (US)
Pages (from-to)185-195
Number of pages11
JournalAmerican Journal of Clinical Nutrition
Issue number1
StatePublished - Jan 2024

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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