Pregnant Women Consume a Similar Proportion of Highly vs Minimally Processed Foods in the Absence of Hunger, Leading to Large Differences in Energy Intake

Abstract

Background: The eating in the absence of hunger (EAH) experimental paradigm measures intake of highly palatable, highly processed foods when sated. However, no studies have examined EAH in pregnant women.

Objective: The objectives were to investigate whether EAH in pregnant women differs by level of food processing and to examine relationships of EAH with hedonic hunger, addictive-like eating, and impulsivity.

Design: EAH was assessed in a counterbalanced crossover feeding substudy in which participants completed two free-access eating occasions following a standardized meal during their second pregnancy trimester. Hedonic hunger (Power of Food Scale), addictive-like eating (modified Yale Food Addiction Scale), and impulsivity (Barratt Impulsiveness Scale-15) were assessed by self-report during early pregnancy.

Participants and setting: Data were collected from March 2015 through September 2016 from a subsample of participants (n = 46) enrolled at ≤12 weeks gestation in an observational, prospective cohort study (the Pregnancy Eating Attributes Study) in North Carolina.

Intervention: Participants were presented with highly processed and minimally processed foods in two separate assessments.

Main outcome measures: Energy intake (EAH-kcal) and percent consumed (EAH-%) (calculated as 100 × [amount consumed (g) / amount served (g)]) was measured overall and separately for sweet and savory foods.

Statistical analyses performed: Linear mixed models estimated the effect of condition on EAH. Hedonic hunger, addictive-like eating, impulsivity and their interaction were examined separately.

Results: EAH-% was similar across conditions (16.3% ± 1.1% highly processed vs 17.9% ± 1.2% minimally processed; P = 0.76), resulting in 338.5 ± 34.2 kcal greater energy intake in the highly processed vs minimally processed condition (P < 0.001). Hedonic hunger was not significantly associated with EAH; reward-related eating was positively associated with EAH-kcal and EAH-% of savory foods, and Barratt Impulsivity was positively associated with EAH-kcal and EAH-% overall, and with EAH-% of sweet foods (P < 0.05). There was little evidence of an interaction of Barratt Impulsivity with hedonic hunger or reward-related eating.

Conclusions: EAH in pregnant women occurs for both highly processed and minimally processed foods and correlates positively with self-reported addictive-like eating, but not hedonic hunger. Impulsivity did not modify associations of addictive-like eating with EAH in this sample.

Trial registration: ClinicalTrials.gov NCT02217462.

Keywords: Appetite; Crossover study; Eating in the absence of hunger; Pregnancy; Reward-related eating.

Conflict of interest statement

Conflict of Interest Disclosure: The authors declare that they have no competing interests.

Copyright © 2021 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1.

Participant flow diagram of 46 pregnant women in North Carolina participating in an Eating in the Absence of Hunger crossover substudy (March 2015 – September 2016) of the Pregnancy Eating Attributes Study.

Figure 2.

Energy and percent consumed by 46 pregnant women when presented with highly processed (HP) and minimally processed (MP) snack foods during an Eating in the Absence of Hunger crossover substudy (North Carolina, March 2015 – September 2016) of the Pregnancy Eating Attributes Study. Sweet foods included cookies, brownies, and peanut butter cups in the highly processed (HP) condition, and grapes, apples, and clementines in the minimally processed (MP) condition. Savory foods included potato chips, nacho chips, and cheese popcorn in the HP condition, and grape tomatoes, dry roasted unsalted peanuts, and baby carrots in the MP condition. Overall intake reflects intake of all sweet and savory foods in each respective condition (p-values are presented for the effect of condition on EAH intake). Values were estimated from linear mixed models controlling for time, the interaction of condition with time, and intake at the standardized meal (n=46). Mean ± SE EAH overall was 461.3 ± 24.5 kcal (16.3 ± 1.1 %) for HP, 122 ± 25.0 kcal (17.9 ± 1.2 %) for MP; mean ± SE EAH for sweet was 309.7 ± 21.0 (14.7 ± 1.6 %) for HP, 71.3 ± 21.5 kcal (25.4 ± 1.7 %) for MP; mean ± SE EAH for savory was 151.6 ± 51.4 kcal (21.9 ± 1.9 %) for HP, 51.4 ± 12.3 kcal (13.3 ± 1.9 %) for MP.