***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Slow eating has been associated with enhanced satiation , but also with increased water intake . Therefore , the role of water ingestion in regard to eating rate needs to be discerned . This study examined the influence of eating rate on appetite regulation and energy intake when water intake is controlled . Methods In a r and omized design , slow and fast eating rates were compared on two occasions , in 30 women ( 22.7±1.2y ; BMI = 22.4±0.4kg/m2 ) who consumed an ad libitum mixed-macronutrient lunch with water ( 300 mL ) . Satiation was examined as the main outcome by measuring energy intake during meals . At design ated times , subjects rated hunger , satiety , desire-to-eat , thirst , and meal palatability on visual analogue scales . Paired t-tests were used to compare hypothesis-driven outcomes . Appetite ratings were compared across time points and conditions by repeated measures analysis of variance ( ANOVA ) using a within-subject model . Results Energy intake and appetite ratings did not differ between conditions at meal completion . However , subjects rated less hunger and tended to rate lower desire-to-eat and greater satiety at 1 hour following the slow condition . Conclusions Results tend to support a role of slow eating on decreased hunger and higher inter-meal satiety when water intake is controlled . However , the lack of significant differences in energy intake under these conditions indicates that water intake may account for the effects of eating rate on appetite regulation BACKGROUND Television viewing is associated with childhood obesity . Eating during viewing and eating highly advertised foods are 2 of the hypothesized mechanisms through which television is thought to affect children 's weight . OBJECTIVES Our objectives were to describe the amounts and types of foods that children consume while watching television  , compare those types with the types consumed at other times of the day , and examine the associations between children 's body mass index ( BMI )  and the amounts and types of foods consumed during television viewing . DESIGN Data were collected from 2 sample s. The first sample consisted of ethnically diverse third- grade children , and the second consisted predominantly of Latino fifth- grade children . Three nonconsecutive 24-h dietary recalls were collected from each child . For each eating episode reported , children were asked whether they had been watching television . Height and weight were measured by using st and ard methods and were used to calculate BMI . RESULTS On weekdays and weekend days , 17 - 18 % and approximately 26 % of total daily energy , respectively , were consumed during television viewing in the 2 sample s. Although the fat content of the foods consumed during television viewing did not differ significantly from that of the foods consumed with the television off , less soda , fast food , fruit , and vegetables were consumed with the television on . The amount of food consumed during television viewing was not associated with children 's BMI , but in the third- grade sample , the fat content of foods consumed during television viewing was associated with BMI . CONCLUSIONS A significant proportion of children 's daily energy intake is consumed during television viewing , and the consumption of high-fat foods on weekends may be associated with BMI in younger children BACKGROUND Gastric distension reduces food intake , and antral , rather than proximal , gastric distension may be the dominant mechanism in the induction of appetite-related sensations . Healthy aging is associated with reduced appetite . OBJECTIVE We examined the effects of different energy preloads on appetite , plasma cholecystokinin , antral area , and subsequent energy intake in healthy older and young subjects . DESIGN On 3 separate days , 12 young and 12 older subjects consumed 400 mL of a drink containing either 0 kcal ( water ) , 250 kcal , or 750 kcal 70 min before a buffet-style meal . RESULTS Hunger was less in the older than in the young subjects ( P < 0.001 ) . Both nutrient preloads reduced hunger and increased fullness more than did water ( P < 0.02 ) , and older subjects were more full than were the young ( P < 0.05 ) . Antral area was greater after the nutrient preloads than after water ( P = 0.001 ) and greater in the older than in the young subjects ( P = 0.005 ) . In both groups , food intake was suppressed in an energy-dependent manner ( P = 0.008 ) . Plasma cholecystokinin was greater in the older than in the young subjects ( P = 0.003 ) . Immediately before the meal , hunger ( r = -0.59 ) and energy intake ( r = -0.90 ) were inversely related and fullness ( r = 0.66 ) was directly related to antral area ( all : P < 0.001 ) . Antral area , but not plasma cholecystokinin , was a predictor of subsequent energy intake . CONCLUSION In healthy young and older subjects , the suppression of subsequent energy intake by a liquid preload is nutrient dependent and comparable , and both satiation and satiety are related to antral area and ( presumably ) antral distension BACKGROUND Ad libitum , low-carbohydrate diets decrease caloric intake and cause weight loss . It is unclear whether these effects are due to the reduced carbohydrate content of such diets or to their associated increase in protein intake . OBJECTIVE We tested the hypothesis that increasing the protein content while maintaining the carbohydrate content of the diet lowers body weight by decreasing appetite and spontaneous caloric intake . DESIGN Appetite , caloric intake , body weight , and fat mass were measured in 19 subjects placed sequentially on the following diets : a weight-maintaining diet ( 15 % protein , 35 % fat , and 50 % carbohydrate ) for 2 wk , an isocaloric diet ( 30 % protein , 20 % fat , and 50 % carbohydrate ) for 2 wk , and an ad libitum diet ( 30 % protein , 20 % fat , and 50 % carbohydrate ) for 12 wk .  Blood was sample d frequently at the end of each diet phase to measure the area under the plasma concentration versus time curve ( AUC ) for insulin , leptin , and ghrelin . RESULTS Satiety was markedly increased with the isocaloric high-protein diet despite an unchanged leptin AUC . Mean ( + /-SE ) spontaneous energy intake decreased by 441 + /- 63 kcal/d , body weight decreased by 4.9 + /- 0.5 kg , and fat mass decreased by 3.7 + /- 0.4 kg with the ad libitum , high-protein diet , despite a significantly decreased leptin AUC and increased ghrelin AUC . CONCLUSIONS An increase in dietary protein from 15 % to 30 % of energy at a constant carbohydrate intake produces a sustained decrease in ad libitum caloric intake that may be mediated by increased central nervous system leptin sensitivity and results in significant weight loss . This anorexic effect of protein may contribute to the weight loss produced by low-carbohydrate diets BACKGROUND Whether large portion sizes affect children 's eating behavior has rarely been studied . OBJECTIVES Our objectives were 1 ) to determine the effects of repeated exposure to a large portion of an entrée on preschool-aged children 's awareness of portion size , self-selected portion size , and food intake and 2 ) to evaluate associations of children 's responsiveness to portion size with weight status and overeating . DESIGN Energy intake , bite size , and comments about portion size were evaluated among 30 children at 2 series of lunches in which either an age-appropriate portion or a large portion of an entrée was served . On separate occasions , the children 's self-served portions , weight , height , and tendency to overeat were assessed . RESULTS Doubling an age-appropriate portion of an entrée increased entrée and total energy intakes at lunch by 25 % and 15 % , respectively . Changes were attributable to increases in the average size of the children 's bites of the entrée without compensatory decreases in the intake of other foods served at the meal . These increases were seen even though observational data indicated that the children were largely unaware of changes in portion size . Greater responsiveness to portion size was associated with higher levels of overeating . The children consumed 25 % less of the entrée when allowed to serve themselves than when served a large entrée portion . CONCLUSIONS Large entrée portions may constitute an " obesigenic " environmental influence for preschool-aged children by producing excessive intake at meals . Children with satiety deficits may be most susceptible to large portions . Allowing children to select their own portion size may circumvent the effects of exposure to large portions on children 's eating OBJECTIVE : To establish factors that affect food choices among adolescents living in rural areas and to identify their food choices . DESIGN : A r and om sample of adolescents living in a Greek rural area ( n = 382 ) aged 12–18 years were individually interviewed . Food consumption  was assessed by a semi-quantitative food-frequency question naire and adherence to the Mediterranean diet was evaluated using the KIDMED question naire . Information was collected regarding self-perceived body size , dieting , dietary knowledge , parental control , meal and snack frequency , eating out of home , eating takeaways and precooked meals , eating from the school canteen . RESULTS : Body image concerns , dieting , education about food , parental control , maternal education level and eating with family and peers are factors that were found to affect food choices in this group of Greek adolescents . The adherence to the Mediterranean diet  was low ( KIDMED index was 4.5±2.7 ) . Regular family meals at home were frequent in this group and 99 % of the adolescents ate lunch daily at home . Eating out with peers and eating from the school canteen was related with higher consumption of ‘ junk type of food ’ . Girls and younger adolescents and those whose mothers had a higher education level seem to make healthier choices . CONCLUSIONS : Factors such as personal issues , family and peer pressure significantly affect food choices among adolescents living in a Greek rural area and highlight the importance of implementing multilevel strategies to promote healthy eating among adolescents This study estimated the levels and differentials in nutritional status and dietary intake and relevant knowledge of adolescent girls in rural Bangladesh using data from the Baseline Survey 2004 of the National Nutrition Programme . A stratified two-stage r and om cluster-sampling was used for selecting 4,993 unmarried adolescent girls aged 13–18 years in 708 rural clusters . Female interviewers visited girls at home to record their education , occupation , dietary knowledge , seven-day food-frequency , intake of iron and folic acid , morbidity , weight , and height . They inquired mothers about age of their daughters and possessions of durable assets to divide households into asset quintiles . Results revealed that 26 % of the girls were thin , with body mass index ( BMI ) -for-age < 15th percentile ) , 0.3 % obese ( BMI -for-age > 95th percentile ) , and 32 % stunted ( height-for-age ≤2SD ) . Risks of being thin and stunted were higher if girls had general morbidity in the last fortnight and foul-smelling vaginal discharge than their peers . Consumptions of non-staple good- quality food items in the last week were less frequent and correlated well positively with the household asset quintile . Girls of the highest asset quintile ate fish/meat 2.1 ( 55 % ) days more and egg/milk two ( 91 % ) days more than the girls in the lowest asset quintile . The overall dietary knowledge was low . More than half could not name the main food sources of energy and protein , and 36 % were not aware of the importance of taking extra nutrients during adolescence for growth spurt . The use of iron supplement  was 21 % in nutrition-intervention areas compared to 8 % in non-intervention areas . Factors associated with the increased use of iron supplements were related to awareness of the girls about extra nutrients and their access to mass media and education . Community-based adolescent-friendly health and nutrition education and services and economic development may improve the overall health and nutritional knowledge and status of adolescents OBJECTIVE The aim of this study was to determine the prevalence of overweight in adolescents in a southern Brazilian city , and ascertain gender differences and association with socio-economic and demographic conditions , family factors and individual behaviours . METHODS Cross-sectional population -based study with r and om cluster sampling of households , including 722 adolescents ( 10 - 19 years ) , from a city in southern Brazil .  Body mass index ( BMI ) was calculated based on the National Center for Health and Statistics reference curve , defining overweight as BMI 85th percentile . RESULTS Prevalence of overweight was 17 % in girls and 19 % in boys . In multivariate Poisson regression , chronic illness in parent(s ) and household of up to four people were associated with overweight in boys , whereas low fibre intake , more hours spent watching television and regular exercise were associated with overweight in girls . CONCLUSION The prevalence of overweight  in Brazilian adolescents is high , with gender differences in associated factors . Health workers in schools and public health services should be aware of these differences in order to improve preventive and therapeutic strategies in this age group Background Physical exercise can modify subsequent energy intake and appetite and may thus be of particular interest in terms of obesity treatment . However , it is still unclear whether an intensive bout of exercise can affect the energy consumption of obese children and adolescents . Objective To compare the impact of high vs. moderate intensity exercis 
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However , a number of review s confirm that many factors namely physical activity level , socio-economic status , diet , individual and social factors do contribute to either a higher or a lower EI of adolescents .