This study compared the longer-term effects of a very low-carbohydrate, high-fat diet with a high-carbohydrate, low-fat diet on cognitive performance in individuals with type 2 diabetes (T2D). In total, 115 obese adults with T2D (sixty-six males, BMI: 34·6 (sd 4·3) kg/m2, age: 58 (sd 7) years, HbA1c: 7·3 (sd 1·1) %, diabetes duration: 8 (sd 6) years) were randomised to consume either an energy-restricted, very low-carbohydrate, low-saturated-fat (LC) diet or an energy-matched high unrefined carbohydrate, low-fat (HC) diet with supervised aerobic/resistance exercise (60 min, 3 d/week) for 52 weeks. Body weight, HbA1c and cognitive performance assessing perceptual speed, reasoning speed, reasoning ability, working memory, verbal fluency, processing speed, short-term memory, inhibition and memory scanning speed were assessed before and after intervention. No differences in the changes in cognitive test performance scores between the diet groups were observed for any of the cognitive function outcomes assessed (P≥0·24 time×diet). Percentage reduction in body weight correlated with improvements with perceptual speed performance. In obese adults with T2D, both LC and HC weight-loss diets combined with exercise training had similar effects on cognitive performance. This suggests that an LC diet integrated within a lifestyle modification programme can be used as a strategy for weight and diabetes management without the concern of negatively affecting cognitive function.

Although the effects of dietary fat and carbohydrate on satiety are well documented, little is known about the impact of these macronutrients on food hedonics. We examined the effects of ad libitum and isoenergetic meals varying in fat and carbohydrate on satiety, energy intake and food hedonics. In all, sixty-five overweight and obese individuals (BMI=30·9 (sd 3·8) kg/m2) completed two separate test meal days in a randomised order in which they consumed high-fat/low-carbohydrate (HFLC) or low-fat/high-carbohydrate (LFHC) foods. Satiety was measured using subjective appetite ratings to calculate the satiety quotient. Satiation was assessed by intake at ad libitum meals. Hedonic measures of explicit liking (subjective ratings) and implicit wanting (speed of forced choice) for an array of HFLC and LFHC foods were also tested before and after isoenergetic HFLC and LFHC meals. The satiety quotient was greater after ad libitum and isoenergetic meals during the LFHC condition compared with the HFLC condition (P=0·006 and P=0·001, respectively), whereas ad libitum energy intake was lower in the LFHC condition (P<0·001). Importantly, the LFHC meal also reduced explicit liking (P<0·001) and implicit wanting (P=0·011) for HFLC foods compared with the isoenergetic HFLC meal, which failed to suppress the hedonic appeal of subsequent HFLC foods. Therefore, when coupled with increased satiety and lower energy intake, the greater suppression of hedonic appeal for high-fat food seen with LFHC foods provides a further mechanism for why these foods promote better short-term appetite control than HFLC foods.

Human milk proteins provide term and preterm infants with both nutrition and protection. The objective of the present study was to examine longitudinal changes in the protein composition of term and preterm milk during the first 2 months of lactation, focusing on protein phosphorylation and glycosylation. Using gel electrophoresis, the relative concentration and glycosylation status of lactoferrin, secretory Ig A, β-casein, α-lactalbumin, serum albumin, bile salt-stimulated lipase, xanthine oxidoreductase, tenascin and macrophage mannose receptor 1 were measured in milk collected on days 7, 10, 14, 18, 21, 28 and 60 postpartum from preterm mothers (28–32 weeks gestation, n 17). The phosphorylation status of β-casein was also investigated. To determine if these variables differ in term and preterm milk, samples from term mothers (38–41 weeks gestation, n 8) collected on days 7, 14 and 30 of lactation were also analysed. The concentration of the abundant milk proteins decreased during lactation in term and preterm milk (P <0·05). No difference in protein glycosylation was observed, except for the glycoproteins serum albumin and tenascin. The phosphorylation of β-casein varied significantly between term and preterm milk. Further investigation is required to determine whether these modifications affect protein function and are clinically important to preterm infants.

The effect of energy density (ED) on energy intake (EI) has been assessed in short-term and long-term experiments. In the short term, it was found that ED affects EI directly in situations when the subjects cannot estimate the ED of the food; then subjects mainly monitor the weight of the food ingested. In the long term, the effects of ED on EI are modulated. Average daily EI appears to be related to ED of the food and drinks when ED is determined by specific macronutrients, but not when ED is only determined by the weight of water. Thus, the short-term effect ED has on EI cannot be extrapolated to the long term, because a possible dominating effect of the weight of water determining ED undoes the relationship of ED with EI. Moreover, in the long-term portion sizes are used to compensate for correctly estimated ED, resulting in less variation in EI than ED alone would imply. Finally, dietary restraint compensates for the effect of a relatively high ED on daily EI, whereas dietary unrestraint compensates for the effect of relatively low ED on daily EI. We conclude that the short-term effect of ED on EI is modulated by the effect of water on ED, and compensated for by the effect of dietary restraint and adapted portion sizes.

The relationship between energy density (ED) of food and drink consumption ad libitum and energy intake (EI) was analysed. EI was taken as average daily EI over the long term, and as EI during a single meal. Moreover, the distribution of EI over three ED categories was analysed. Average daily EI was related to ED of the food and drinks when ED was strongly influenced by specific macronutrients. When ED was strongly influenced by the weight of water, it was not related to EI. During a meal subjects monitored mainly weight, and to a lesser extent, the energy content of the food ingested. Therefore, covertly manipulated ED of a meal affected EI directly. The impact of ED on EI was modulated by dietary behaviours such as restraint. Overt manipulation of ED for 6 months showed that EI was adjusted to a decreased but not to an increased ED in dietary-unrestrained subjects, and that EI was adjusted to an increased but not to a decreased ED in dietary-restrained subjects. Knowledge of ED was shown to lead to an inverse relationship between portion sizes and ED during a meal. Average daily EI consisted of a distribution of EI over the three different categories of ED, so that obese women ate more of foods with a high ED and less of foods with a low ED compared with normal weight women (and nutritional guidelines). In conclusion, ED affected daily EI by means of macronutrient specific effects. EI from a meal with an unknown ED can become inversely related to EI through learning or conditioning. Therefore, the effect of ED on EI during a single meal observation cannot be extrapolated directly to the 24 h effect on EI. With regard to the treatment of obesity, a conscious decreased consumption of foods high in ED and an increase in consumption of low-ED food is necessary to decrease and subsequently maintain body weight, particularly in subjects with a sedentary lifestyle.