Food intake regulation in children. Fat and sugar substitutes and intake.

A series of experiments exploring children's responsiveness to manipulations of energy density and macronutrient content of foods have been reviewed to assess the nutritional impact of macronutrient substitutes on children's intake. In these experiments, the focus is on the extent to which the energy content of foods was a salient factor influencing children's food intake, and macronutrient substitutes were used as tools to investigate this issue. Therefore, although several different macronutrient substitutes have been used in this research, we do not have a parametric set of experiments systematically assessing the impact of a variety of macronutrient substitutes. Given this, what can we conclude from the existing data? When the energy density and macronutrient content of foods is altered through the use of macronutrient substitutes that reduce the energy content of foods, children tend to adjust for the missing energy, although this adjustment may be partial and incomplete. This suggests the possibility that when macronutrient substitutes are used to reduce the energy content of foods, children's energy intake may be reduced. This adjustment, however, will most likely be less than a "calorie for calorie" reduction. In addition, even among young children, there are individual differences in the extent to which children adjust their intake in response to macronutrient and energy manipulations. The data are more extensive and particularly clear for cases in which CHO manipulations are used to alter energy density, but there is evidence for adjustments in energy intake in response to alterations of the fat content of the diet. The compensation for energy is not macronutrient specific; that is, when the fat content of food is reduced to reduce energy density of foods, children do not selectively consume fat in subsequent meals. This means that manipulations of macronutrient content of foods that reduce foods' energy content may not result in alterations of energy intake, but because these adjustments in energy intake are not macronutrient specific, changes in the overall macronutrient composition of children's diets can be obtained. There does not appear to be anything unique or special about the effects of macronutrient substitutes on children's intake; their effects are similar to those produced by other manipulations of macronutrient and energy content accomplished without macronutrient substitutes (e.g., augmenting foods with fat or carbohydrate to produce macronutrient differences). The research also indicates that under conditions that minimize adult attempts to control how much and what children eat, children can adjust their food and energy intake in response to the alterations of macronutrient and energy content of foods. Whether or not young children adjust food intake to compensate for energy-density changes depends upon their opportunity to control their own food intake as opposed to having their intake controlled by others. Young children's ability to adjust intake in response to alterations in the energy density of foods can be readily disrupted by the imposition of controlling child-feeding practices that attempt to regulate what and how much children eat. We believe that early experiences, including child-feeding practices imposed by parents, are major factors contributing to the etiology of individual differences and gender differences in the behavioral controls of food intake that can occur in response to the energy content of foods. The extent to which children respond to energy density of the diet has major implications for the effects of fat and sugar substitutes on children's intake. If children who are responsive to energy density consume substantial amounts of foods containing macronutrient substitutes, they should show some adjustments in intake to compensate for reduced energy, so that the impact of macronutrient substitutes on energy intake may be relatively small. However, changes in macronutrient com