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Reducing the energy density of multiple meals decreases the energy intake of preschool-age children
Open accessAbstract
Background The energy density (ED) of an entrée affects children's energy intake at a meal consumed ad libitum. However, the effects in children of changing the ED of meals over multiple days are unknown.Objective We aimed to test the effect of reducing the ED of multiple meals on the ad libitum energy intake of preschool-age children over 2 d.Design In this crossover study, 3- to 5-y-old children (n = 10 boys, 16 girls) were served manipulated breakfasts, lunches, and afternoon snacks 2 d/wk for 2 wk. Foods and beverages served at these meals during 1 wk were lower in ED than were those served during the other week. ED reductions were achieved by decreasing fat and sugar and by increasing fruit and vegetables. Dinner and an evening snack were sent home with children, but these meals did not vary in ED. The same 2-d menu was served in both conditions.Results Children consumed a consistent weight of foods and beverages over 2 d in both conditions, and therefore their energy consumption declined by 389 +/- 72 kcal (14%) in the lower-ED condition, a significant decrease (P < 0.0001). Differences in energy intake were significant at breakfast on day 1, and they accumulated at manipulated meals over 2 d (P < 0.01). Intake of the nonmanipulated meals was similar between conditions.Conclusions Children's energy intake is influenced by the ED of foods and beverages served over multiple days. These results strengthen the evidence that reducing the ED of the diet is an effective strategy for moderating children's energy intake.
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“it follows that substituting less energy-dense foods for more energy-dense foods should decrease total energy intake [43,44].”
From Healthier side dishes at restaurants: an analysis of children's perspectives, menu content, and energy impacts (2014) · cites this paper as [44]
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“experimental research on energy density suggests that children consume a consistent weight of food”
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Self-citationDoes Eating Vegetables at Start of Meal Prevent Childhood Overweight in Japan? A-CHILD Study
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“In several multiple-meal studies of both adults and children, reducing the energy density ofmultiplemeals over 2 days resulted in decreased cumulative energy intake (34, 35), suggesting that reducing the energy density of multiple meals leads to persistent and habitual decreases in energy intake from meals.”
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Nicklas, T. A., O’Neil, C. E., Stuff, J. E., Hughes, S. O., & Liu, Y. (2011) · Childhood Obesity · doi:10.1089/chi.2011.0114 · Cited by 13
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Impacts of energy density and portion size on satiation and satiety
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“Similar weight-based intake across different energy densities has also been shown in studies with children (Fisher et al., 2007; Leahy et al., 2008b; Bouhlal, Issanchou, & Nicklaus, 2011).”
BackgroundResultDietary energy density is associated with body mass index‐for‐age in Mexican adolescents
Arango‐Angarita, A., Shamah‐Levy, T., & Rodríguez‐Ramírez, S. (2018) · Maternal and Child Nutrition · doi:10.1111/mcn.12664 · Cited by 11
Chan, J. W. S., Conroy, P., Phongsavan, P., Raubenheimer, D., & Allman-Farinelli, M. A. (2025) · Obesity Reviews · doi:10.1111/obr.13897 · Cited by 12
“85,86,112,137 One study reported increased energy intake which was higher than recommendations.”
Estay, K., Kurzer, A., & Guinard, J. (2021) · Foods · doi:10.3390/foods10030519 · Cited by 11
Energy Density of New Food Products Targeted to Children
Azzopardi, D. J., Lacy, K. E., & Woods, J. (2020) · Nutrients · doi:10.3390/nu12082242 · Cited by 10
“The Big Three” properties of food that drive intake
Rolls, B. J., Cunningham, P. M., & Zuraikat, F. M. (2025) · Physiology & Behavior · doi:10.1016/j.physbeh.2025.114994 · Cited by 8
Self-citationSystems map of interventions to improve dietary intake of pre-school aged children: A scoping review
Chan, J. W. S., Conroy, P., Phongsavan, P., Raubenheimer, D., & Allman-Farinelli, M. A. (2023) · Preventive Medicine · doi:10.1016/j.ypmed.2023.107727 · Cited by 8
Satiating Effects of Rye Foods
Isaksson, H. (2014) · Elsevier eBooks · doi:10.1016/b978-1-891127-81-6.50011-0 · Cited by 8
“A low energy density has the potential to decrease food intake, because, as discussed in the previous section, food intake is determined by amount of food to a larger extent than by energy content (Leahy et al., 2008; Bell et al., 1998).”
BackgroundConsumption of obesogenic foods in non‐Hispanic black mother–infant dyads
Kay, M. C., Wasser, H., Adair, L. S., Thompson, A. L., Siega‐Riz, A. M., Suchindran, C., & Bentley, M. E. (2017) · Maternal and Child Nutrition · doi:10.1111/mcn.12482 · Cited by 8
Schwartz, C., Madrelle, J., Brignot, H., Delarue, J., Cuvelier, G., Nicklaus, S., Féron, G., & Tournier, C. (2018) · Appetite · doi:10.1016/j.appet.2018.08.007 · Cited by 8
Influencers of children's vegetable liking—A look from a social and cultural perspective
Estay, K., Lestringant, P., Pan, S., Zhong, F., Capitaine, C., Agosin, E. E., & Guinard, J. (2019) · Journal of Sensory Studies · doi:10.1111/joss.12534 · Cited by 8
Reductions in Dietary Energy Density to Moderate Children’s Energy Intake
Rolls, B. J., & Leahy, K. E. (2010) · Elsevier eBooks · doi:10.1016/b978-0-12-374387-9.00044-1 · Cited by 8
Self-citationCreativity needs some serendipity: Reflections on a career in ingestive behavior
Rolls, B. J. (2016) · Physiology & Behavior · doi:10.1016/j.physbeh.2016.02.009 · Cited by 7
“reduced, the children ate significantly less (78).”
Self-citationEffects of learning and food form on energy intake and appetitive responses
Jones, J. B., & Mattes, R. D. (2014) · Physiology & Behavior · doi:10.1016/j.physbeh.2014.06.016 · Cited by 6
Energy and nutritional value of the meals in kindergartens in Nis (Serbia).
Lazarević, K., Stojanović, D. B., & Bogdanović, D. C. (2014) · PubMed · Cited by 6
Rolls, B. J., Roe, L. S., & Keller, K. (2023) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2023.10.019 · Cited by 5
Self-citationFunctional foods, satiation and satiety
Tremblay, A., & Arguin, H. (2013) · Elsevier eBooks · doi:10.1533/9780857098719.3.202 · Cited by 5
Available energy from soft drinks: more than the sum of its parts
Merchant, A. T., Tripathi, A., & Pervaiz, F. (2010) · Public Health Nutrition · doi:10.1017/s136898001000128x · Cited by 5
“This is consistent with the results of a crossover trial with ad libitum food consumption in which daily energy intake declined by 1629kJ (389kcal) in the group with less SSB((6)).”
BackgroundResultEffects of Healthy Eating Promotion on Food Preference of Head Start Preschoolers
He, M., Sosa, E. T., Cordova, A., Wilmoth, S., Bustos, D., Perez, A., & Yin, Z. (2015) · Journal of Research in Obesity · doi:10.5171/2015.830827 · Cited by 5
“(Leahy et al. 2008) Studies also show that serving small entrée portions increase fruits and vegetables intake and decrease total energy intake in preschoolers.”
BackgroundA School-Based Fruit and Vegetable Snacking Pilot Intervention for Lower Mississippi Delta Children
Tussing-Humphreys, L. M., Thomson, J. L., McCabe‐Sellers, B., Strickland, E., Lovera, D., & Bogle, M. L. (2012) · ICAN Infant Child & Adolescent Nutrition · doi:10.1177/1941406412455690 · Cited by 5
ASSESSMENT OF THE NUTRITIONAL STATUS FOR PRESCHOOL CHILDREN IN JORDAN
Al-Rewashdeh, A. (2009) · Egyptian Journal of Agricultural Sciences /Egyptian Journal of Agricultural Sciences · doi:10.21608/ejarc.2009.215927 · Cited by 5
“However, boys consumed more energy and macro and micro nutrients than girls and may resulted in their higher body measurements (Agrabar-Murugker, 2005; Leahy et al., 2008 and Briefel et al., 2009).”
BackgroundThe Influence of Portion Size on Eating and Drinking
Zuraikat, F. M., Smethers, A. D., & Rolls, B. J. (2020) · Springer eBooks · doi:10.1007/978-3-030-14504-0_129 · Cited by 4
“This response emerges early in life as shown in studies in preschool children (Leahy et al. 2008a, b; Rolls and Leahy 2010; Kling et al. 2016; Smethers et al. 2019b) and persists even when the energy density of the diet is varied over multiple days (Rolls et al. 2006b; Leahy et al. 2008c; Smethers…”
BackgroundSelf-citationDietary Energy Density from Infancy to 5 Years: Results from NHANES 2009–2018
Fultz, A. K., Burns, K. F., Davey, A., Trabulsi, J., & Robson, S. M. (2022) · Journal of Nutrition · doi:10.1093/jn/nxac133 · Cited by 4
MacLean, S., Bolton, K. A., Dickie, S., Woods, J., & Lacy, K. E. (2025) · Nutrients · doi:10.3390/nu17142293 · Cited by 4
“Manipulating dietary energy density (DED) can be achieved by incorporating more fruits and vegetables into meals and/or reducing the fat content of foods, which results in reduced DED [20,22].”
The Influence of the Food Environment on Food Intake and Weight Regulation in Children
Kral, T. V. E. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-811716-3.00008-7 · Cited by 3
Anaokulu Menülerinin Değerlendirilmesi: Çankaya Örneği
KARAAĞAOĞLU, Y. M. V. (2017) · Ankara sağlık bilimleri dergisi · doi:10.1501/asbd_0000000064 · Cited by 3
Bottle and sippy cup use is associated with diet and energy intake in toddlers
Avraham, S. B., Hyden, C. J., Fletcher, J., & Bonuck, K. A. (2014) · Maternal and Child Nutrition · doi:10.1111/mcn.12114 · Cited by 2
“Studies in children (2 to 6 years old) found consistency in the weight of food consumed despite varying energy density both in a single meal (Leahy et al. 2008a,b) and when tested over the course of a day (Leahy et al. 2008c), thus resulting in a decrease in total energy intake © 2014 John Wiley &…”
BackgroundFox, K., Herrera, Y. M., Abreu, A. M., & Vadiveloo, M. K. (2023) · Journal of Nutrition · doi:10.1016/j.tjnut.2023.12.028 · Cited by 2
Metadata
- Authors
- Leahy, K. E., Birch, L. L., & Rolls, B. J.
- Affiliations
- Pennsylvania State University (US)
- Corresponding author
- Rolls, Barbara J
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2008-12
- Volume
- 88
- Issue
- 6
- Pages
- 1459-1468
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2113876353
- Cited by
- 124
- References
- 25
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 2 · 2023: 7 · 2022: 6 · 2021: 4 · 2020: 6 · 2019: 5 · 2018: 12 · 2017: 5 · 2016: 3 · 2015: 8 · 2014: 10 · 2013: 8 · 2012: 10
- FWCI
- 9.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- energy density, energy intake, preschool children, ad libitum feeding, dietary fat reduction, sugar reduction, fruit and vegetable intake, breakfast, lunch, snacks, childhood obesity prevention
- MeSH terms
- Energy Intake, Child Nutritional Physiological Phenomena, Child, Preschool, Dietary Fats, Eating, Female, Fruit, Humans, Male, Menu Planning, Nutritive Value, Obesity, Vegetables, Cross-Over Studies, Dietary Sucrose, Overweight
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