|
1
|
de Rijk MG, Boesveldt S, Feskens EJ, de Vries JH. The Effect of Meal Frequency and Glycemic Index During the Night Shift on Alertness, Hunger, and Gastrointestinal Complaints in Female Health Care Workers-A Two-Armed Randomized Crossover Trial. J Nutr 2024; 154:3803-3814. [PMID: 39343301 DOI: 10.1016/j.tjnut.2024.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 09/19/2024] [Accepted: 09/23/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Nutrition strategies for night-shift workers could optimize alertness and minimize hunger and reduce gastrointestinal complaints, enhancing safety and well-being. OBJECTIVES This study aimed to investigate the effects of 1 or 3 small meals, with either low or high glycemic index (GI), compared with no meal, on alertness, hunger, and gastrointestinal complaints during the night shift. METHODS Fifty-one female health care workers, aged 18 to 61 y, participated in a 2-armed randomized crossover design. In 1 study arm, participants received 1 yogurt meal during the night shift, AND in the other, they received 3. Each study arm involved 3 intervention periods during night shifts, with participants consuming yogurt with low GI (1LGI or 3LGI) OR high GI (1HGI or 3HGI) carbohydrates, or no meal (0NGI). Objective alertness was assessed using a validated brief psychomotor vigilance task (PVT-B), subjective alertness with the Samn-Perelli scale, and hunger and gastrointestinal complaints through questionnaires. RESULTS Participants in the 1LGI (β: -4.6; 95% CI: 0.0, 9.3) and 3LGI (β: -3.4; 95% CI: 0.0, 6.8) conditions had fewer lapses during the PVT-B than those in the 3HGI condition. No differences were found between meal conditions for median and reciprocal reaction time or subjective alertness. All 4 conditions reported less hunger (β: from -0.6 to -1.2) compared with no meal. The 3LGI condition resulted in more rumbling intestines than the 3HGI (β: 1.1; 95% CI: 0.4, 1.7) and 0NGI (β: 0.74; 95% CI: 0.11, 1.37) conditions. CONCLUSIONS Our study suggests that consuming 3 small low GI meals during the night shift helps maintain alertness and reduces lapses compared with 3 high GI meals. It also minimizes hunger but may cause mild gastrointestinal complaints. This trial was registered at International Clinical Trial Registry (https://trialsearch.who.int/Trial2.aspx?TrialID%3dNL-OMON25574).
Collapse
Affiliation(s)
- Mariëlle G de Rijk
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Edith Jm Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands.
| | - Jeanne Hm de Vries
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| |
Collapse
|
|
2
|
Possible effects of short rest after lunch on hemodynamics in the afternoon. Eur J Appl Physiol 2021; 122:523-530. [PMID: 34846579 DOI: 10.1007/s00421-021-04852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Drowsiness is often experienced in the afternoon after lunch. Decreases in blood flow to the brain secondary to increases in blood flow to the digestive organs after food intake could represent an underlying cause. As various beneficial effects of short rests on mental activities have been reported, the present study investigated hemodynamics using Doppler sonography of the common carotid artery (CCA) and superior mesenteric artery (SMA) after lunch, comparing resting and non-resting cases. METHODS Subjects comprised 24 healthy young adults (10 men, 14 women; mean age 22 ± 1 years). Sonography was performed to measure blood flow before and after lunch on each day, with and without a 15-min lying rest with eyes closed after lunch in each subject. RESULTS The timing of the peak velocity-time integral in the SMA in resting cases was delayed to 1.5 h after lunch compared to 0.5 h in non-resting cases. Although end-diastolic velocity in the CCA decreased after lunch, this decrease was suppressed in resting cases compared to non-resting cases even 4.5 h after lunch (median 96%, interquartile range [IQR] 83-102% vs. median 87%, IQR 77-92%; P = 0.037). Mean velocity (MV) in the CCA maintained unchanged after lunch in resting cases (P = 0.318), whereas non-resting cases showed decreased MV after lunch (P < 0.001). CONCLUSION These findings suggest that a short lying rest with eyes closed suppresses increases in blood flow to the digestive organ and maintains blood flow to the brain after lunch. These hemodynamic changes might help explain the benefits of afternoon rests.
Collapse
|
|
3
|
de Rijk MG, van Eekelen APJ, Kaldenberg E, Boesveldt S, Te Woerd W, Holwerda T, Lansink CJM, Feskens EJM, de Vries JHM. The association between eating frequency with alertness and gastrointestinal complaints in nurses during the night shift. J Sleep Res 2021; 30:e13306. [PMID: 33622018 PMCID: PMC8518800 DOI: 10.1111/jsr.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/14/2020] [Accepted: 01/20/2021] [Indexed: 12/05/2022]
Abstract
We investigated the association of the number of eating occasions and energy intake with alertness and gastrointestinal (GI) complaints in nurses during their night shift. During this observational study we collected data on anthropometrics and demographics, eating frequency, energy intake, alertness and GI complaints in 118 healthy female nurses, aged 20 to 61 years. Nurses completed an alertness test (psychomotor vigilance task) during the night shift and a 24‐hr dietary recall and a questionnaire about GI complaints after the night shift. This was repeated three times, always on the first night shift in a night shift series. The number of eating occasions during the night shift was negatively associated with reaction times (β = −4.81 ms, 95% confidence interval [CI] −9.14 to −0.48; p = .030), and number of lapses (β = −0.04, 95% CI −0.07 to −0.00; p = .030). However, the number of eating occasions was not associated with subjective alertness and GI complaints. Energy intake during the night shift was not associated with objective or subjective alertness or with GI complaints. These associations were independent of caffeine intake, age, body mass index and dependence among the repeated measurements. The present study showed that eating frequency was positively associated with objectively measured alertness levels in female nurses during the night shift. The results need to be confirmed in an intervention study, where also timing, size and composition of the meal will be taken into account. In practice, optimising nutritional guidelines on these aspects could lead to faster responses, less (medical) errors, and a better wellbeing of night shift workers.
Collapse
Affiliation(s)
- Mariëlle G de Rijk
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | | | | | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | | | | | | | - Edith J M Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Jeanne H M de Vries
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| |
Collapse
|
|
4
|
Abstract
AbstractThis study investigated metabolic, endocrine, appetite and mood responses to a maximal eating occasion in fourteen men (mean: age 28 (sd5) years, body mass 77·2 (sd6·6) kg and BMI 24·2 (sd2·2) kg/m2) who completed two trials in a randomised crossover design. On each occasion, participants ate a homogenous mixed-macronutrient meal (pizza). On one occasion, they ate until ‘comfortably full’ (ad libitum) and on the other, until they ‘could not eat another bite’ (maximal). Mean energy intake was double in the maximal (13 024 (95 % CI 10 964, 15 084) kJ; 3113 (95 % CI 2620, 3605) kcal) compared with thead libitumtrial (6627 (95 % CI 5708, 7547) kJ; 1584 (95 % CI 1364, 1804) kcal). Serum insulin incremental AUC (iAUC) increased approximately 1·5-fold in the maximal compared withad libitumtrial (mean:ad libitum43·8 (95 % CI 28·3, 59·3) nmol/l × 240 min and maximal 67·7 (95 % CI 47·0, 88·5) nmol/l × 240 min,P< 0·01), but glucose iAUC did not differ between trials (ad libitum94·3 (95 % CI 30·3, 158·2) mmol/l × 240 min and maximal 126·5 (95 % CI 76·9, 176·0) mmol/l × 240 min,P= 0·19). TAG iAUC was approximately 1·5-fold greater in the maximalv.ad libitumtrial (ad libitum98·6 (95 % CI 69·9, 127·2) mmol/l × 240 min and maximal 146·4 (95 % CI 88·6, 204·1) mmol/l × 240 min,P< 0·01). Total glucagon-like peptide-1, glucose-dependent insulinotropic peptide and peptide tyrosine–tyrosine iAUC were greater in the maximal compared withad libitumtrial (P< 0·05). Total ghrelin concentrations decreased to a similar extent, but AUC was slightly lower in the maximalv.ad libitumtrial (P= 0·02). There were marked differences on appetite and mood between trials, most notably maximal eating caused a prolonged increase in lethargy. Healthy men have the capacity to eat twice the energy content required to achieve comfortable fullness at a single meal. Postprandial glycaemia is well regulated following initial overeating, with elevated postprandial insulinaemia probably contributing.
Collapse
|
|
5
|
Sawicki P, Muda R, Goral K, Skrzypek M, Wiśniewska K, Bieniak M, Ginszt M. Increasing blood glucose level via breakfast meals is not connected with changes in delay discounting. Physiol Behav 2019; 210:112619. [DOI: 10.1016/j.physbeh.2019.112619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/23/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
|
|
6
|
Effects of almond consumption on the post-lunch dip and long-term cognitive function in energy-restricted overweight and obese adults. Br J Nutr 2017; 117:395-402. [PMID: 28183366 DOI: 10.1017/s0007114516004463] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The post-lunch dip in cognition is a well-established phenomenon of decreased alertness, memory and vigilance after lunch consumption. Lunch composition reportedly influences the post-lunch dip. Moreover, dieting is associated with cognitive function impairments. The negative effects of dieting have been reversed with nut-supplemented diets. The aims of this study were to (1) evaluate the acute effect of an almond-enriched high-fat lunch or high-carbohydrate lunch on the post-lunch decline in cognitive function, and (2) evaluate the effects of chronic almond consumption as part of an energy-restricted diet on the memory and attention domains of cognitive function. In total, eighty-six overweight and obese adults were randomised to consume either an almond-enriched diet (AED) or a nut-free control diet (NFD) over a 12-week weight loss intervention. Participants were also randomised to receive either an almond-enriched high-fat lunch (A-HFL) (>55 % energy from fat, almonds contributing 70-75 % energy) or a high-carbohydrate lunch (HCL) (>85 % energy from carbohydrates) at the beginning and end of the weight loss intervention. Memory and attention performance indices decreased after lunch consumption (P<0·001). The A-HFL group ameliorated the decline in memory scores by 57·7 % compared with the HCL group (P=0·004). Both lunch groups had similar declines in attention. Moreover, memory and attention performance indices increased after the 12-week intervention period (P<0·05) with no difference between the AED and NFD groups. In conclusion, almond consumption at a midday meal can reduce the post-lunch dip in memory. However, long-term almond consumption may not further improve cognitive function outcomes in a weight loss intervention.
Collapse
|
|
7
|
Appetite and energy balancing. Physiol Behav 2016; 164:465-471. [DOI: 10.1016/j.physbeh.2016.03.038] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/23/2016] [Accepted: 03/26/2016] [Indexed: 12/31/2022]
|
|
8
|
Lunch at school and children's cognitive functioning in the early afternoon: results from the Cognition Intervention Study Dortmund Continued (CoCo). Br J Nutr 2016; 116:1298-1305. [PMID: 27608921 DOI: 10.1017/s0007114516002932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Studies about effects of school lunch on children's cognition are rare; two previous studies (CogniDo, CogniDo PLUS) generally found no negative effects of lunch on children's cognitive performance at the end of lunch break (i.e. 45 min after finishing lunch), but suggested potential beneficial effects for single parameters. Therefore, the present study investigated the hypothesis of potential positive effects of school lunch on cognitive performance at early afternoon (90 min after finishing lunch). A randomised, cross-over intervention trial was conducted at a comprehensive school with fifth and sixth grade students. Participants were randomised into two groups: On day 1, group 1 did not eat lunch, whereas group 2 received lunch ad libitum. On day 2 (1 week later), group 2 did not eat lunch and group 1 received lunch ad libitum. The cognitive parameters task switching, working memory updating and alertness were tested using a computerised test battery 90 min after finishing the meal. Of the 204 recruited children, fifty were excluded because of deviations from the study protocol or absence on one of the 2 test days, which resulted in 154 participants. Data showed no significant effects of lunch on task switching, working memory updating and alertness (P values between 0·07 and 0·79). The present study suggests that school lunch does not seem to have beneficial effects on children's cognitive functions regarding the conducted tests at early afternoon. Together with our previous studies, we conclude that school lunch in general has no negative effects on cognitive performance in children. However, beneficial effects seem to be restricted to a relatively short time period after eating lunch.
Collapse
|
|
9
|
Hetherington MM, Macdiarmid JI. Effects of Snack Intake on Appetite, Affect and Attention. Nutr Neurosci 2016; 2:93-102. [DOI: 10.1080/1028415x.1999.11747267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
|
10
|
Thomas JM, Higgs S, Dourish CT. Test-retest reliability and effects of repeated testing and satiety on performance of an Emotional Test Battery. J Clin Exp Neuropsychol 2015; 38:416-33. [PMID: 26702993 PMCID: PMC4784484 DOI: 10.1080/13803395.2015.1121969] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The P1vital® Oxford Emotional Test Battery (ETB) comprises five computerized tasks designed to assess cognition and emotional processing in human participants. It has been used in between-subjects experimental designs; however, it is unclear whether the battery can be used in crossover designs. This is of particular importance given the increasing use of ETB tasks for repeated assessment of depressed patients in clinical trials and clinical practice. In addition, although satiety state has been reported to affect performance on some cognitive and emotional tasks, it is not known whether it can influence performance on the ETB. Two studies explored these issues. In Experiment 1, 30 healthy women were tested on the ETB on 4 separate occasions (each a week apart) in a within-subjects design. In Experiment 2, another 30 healthy women were randomized to either a satiated or a hungry condition, where they were given an ad libitum lunch of cheese sandwiches, before (satiated) or after (hungry) they were asked to complete the ETB. Experiment 1 demonstrated good test–retest reliability for the ETB. One of the tasks was free from practice effects, whilst performance on the other four tasks stabilized after the first two sessions. In Experiment 2, eating to satiety only affected performance on a single ETB task. These results suggest that the ETB can be used in crossover designs after two initial training sessions. Further, as a robust satiety manipulation had only a limited effect on a single ETB task, it is unlikely that appetitive state will confound ETB performance.
Collapse
Affiliation(s)
| | - Suzanne Higgs
- a School of Psychology, University of Birmingham , Birmingham , UK
| | | |
Collapse
|
|
11
|
Müller K, Libuda L, Terschlüsen AM, Kersting M. A Review of the Effects of Lunch: On Adults’ Short-term Cognitive Functioning. CAN J DIET PRACT RES 2013; 74:181-8. [DOI: 10.3148/74.4.2013.181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Because of widespread irregular lunch consumption by both children and adults, information on the effects of lunch on short-term cognitive functioning is relevant to public health. In September 2012, a MEDLINE search was conducted for studies in which the effects of lunch on cognitive performance were examined. Eleven experimental studies published from 1981 to 1996 were found and evaluated; all involved adults. In three studies, the effects of lunch and lunch skipping were compared; the remaining studies involved a determination of the effects of lunch size and lunch composition. Results of studies in which lunch was compared with no lunch indicate that lunch leads to potential impairment of some aspects of cognitive functioning in the early afternoon. Lunch size may influence cognitive functioning, with impairment more likely to occur after a large lunch than a small lunch. Furthermore, in comparison with low-fat lunches, high-fat lunches seem to result in slower but more accurate responses to some cognitive tasks. However, these suggestions must be viewed with caution, as they are based on only a few studies and are not thoroughly supported by high-quality evidence. In addition, results obtained with adults are not applicable to children. Thus, the potential effects of lunch need further examination in children and adults.
Collapse
Affiliation(s)
- Katrin Müller
- Research Institute of Child Nutrition (FKE), Dortmund, Germany
| | - Lars Libuda
- Research Institute of Child Nutrition (FKE), Dortmund, Germany
| | | | | |
Collapse
|
|
12
|
Edwards JS, Hartwell HJ, Brown L. The relationship between emotions, food consumption and meal acceptability when eating out of the home. Food Qual Prefer 2013. [DOI: 10.1016/j.foodqual.2013.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
|
13
|
Effects of lunch on children's short-term cognitive functioning: a randomized crossover study. Eur J Clin Nutr 2013; 67:185-9. [PMID: 23385968 DOI: 10.1038/ejcn.2012.209] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Considering the large number of children worldwide attending all-day schools, information on the effects of lunch on short-term cognitive performance is of public health relevance. However, only adult studies investigated this issue yet. Therefore, this study examined the impact of skipping lunch vs having lunch on children's cognitive functioning in the early afternoon. SUBJECTS/METHODS Participants in this randomized crossover study with two groups were healthy 6th grade students of an all-day school in Gelsenkirchen, Germany. Group 1 skipped lunch on study day 1 and received an ad libitum lunch 1 week later on study day 2. The order for group 2 was vice versa. In the afternoon tonic alertness, visuospatial memory and selective attention were determined using a computerized test battery of the Vienna Test System. For continuous and discrete interval-scaled variables, treatment effect was estimated using the two sample t-test or the Wilcoxon rank-sum test, for discrete ordinal-scaled variables using generalized linear models. RESULTS Data on 105 children (48% male; 12.6 ± 0.6 years) were analyzed. Except for tonic alertness there were no significant differences in cognitive functioning between the skipping lunch day and the having lunch day. The higher number of omission errors on the skipping lunch day lost significance when adjusting for multiple testing. CONCLUSIONS In the first study on this topic lunch did not have relevant effects on children's cognitive functioning in the early afternoon. Future research needs to be done to figure out potential methodical and physiological explanations.
Collapse
|
|
14
|
Leigh Gibson E, Green MW. Nutritional influences on cognitive function: mechanisms of susceptibility. Nutr Res Rev 2009; 15:169-206. [DOI: 10.1079/nrr200131] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
|
15
|
Hewlett P, Smith A, Lucas E. Grazing, cognitive performance and mood. Appetite 2009; 52:245-8. [DOI: 10.1016/j.appet.2008.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 09/06/2008] [Accepted: 09/11/2008] [Indexed: 11/28/2022]
|
|
16
|
Dietary Modification of Brain Function: Effects on Neuroendocrine and Psychological Determinants of Mental Health‐ and Stress‐Related Disorders. Adv Clin Chem 2008; 45:99-138. [DOI: 10.1016/s0065-2423(07)00005-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
|
17
|
Mahoney CR, Taylor HA, Kanarek RB. Effect of an afternoon confectionery snack on cognitive processes critical to learning. Physiol Behav 2007; 90:344-52. [PMID: 17081573 DOI: 10.1016/j.physbeh.2006.09.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Revised: 09/21/2006] [Accepted: 09/21/2006] [Indexed: 01/27/2023]
Abstract
Two experiments examined how an afternoon confectionery snack affects a variety of cognitive processes critical to learning. For Experiment 1, thirty-eight male undergraduates completed a dual learning task where the primary task involved learning either a map or stories and the secondary task required monitoring a radio broadcast for a specific word category. Results showed that for map learning, participants who consumed the confectionery snack performed better on the primary task. They correctly placed more country names and left fewer blanks on a map during long-term recall. However, on the secondary attention task, participants who consumed the confectionery snack had a lower hit rate. The confectionary snack did not affect story memory performance. In Experiment 2, 38 boys, aged 9-11 years, participated in a similar, age appropriate task. Results showed that boys who had consumed the confectionery snack correctly placed more names and left fewer blanks on a map in both short-term and long-term recall. In contrast with Experiment 1, performance on the secondary task was better after confectionary consumption. However, when tested on a separate vigilance attention task, children who consumed the placebo performed better. Overall results indicate that a confectionery snack, ingested in the afternoon, generally improves spatial memory, but has a mixed effect on attention performance.
Collapse
|
|
18
|
Pallotta N, Pezzotti P, Corazziari E. Relationship between antral distension and postprandial symptoms in functional dyspepsia. World J Gastroenterol 2006; 12:6982-91. [PMID: 17109520 PMCID: PMC4087342 DOI: 10.3748/wjg.v12.i43.6982] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate in patients with functional dyspepsia (FD) after an every-day meal whether (1) gastrointestinal (GI) and extra-GI symptoms had any relation with the degree of antral volume, (2) the onset of postprandial symptoms was associated with, and may predict, delayed gastric emptying.
METHODS: In 94 symptomatic FD patients, antral volume variations and gastric emptying were assessed with ultrasonography after a 1050 kcal meal. Symptoms were evaluated with a standardized questionnaire. The association of GI and extra-GI symptoms with antral volumes and gastric emptying were estimated with logistic regression analysis.
RESULTS: Forty percent of patients did not report any symptoms after a meal. Compared to the healthy controls, the antrum was more distended in patients throughout the entire observation period and 37 (39.4%) patients had delayed gastric emptying. Only postprandial drowsiness was associated with antral volume variations (AOR = 1.42; P < 0.001) and with delayed gastric emptying (AOR = 3.59; P < 0.03).
CONCLUSION: In FD patients, GI symptoms are neither associated with antral distension nor with gastric emptying. Drowsiness is associated with antral distension and delayed gastric emptying. The onset of drowsiness is preceded by an increment of antral distension and the duration of the symptom appears to be related to the persistence of antral distension.
Collapse
Affiliation(s)
- Nadia Pallotta
- Department Scienze Cliniche, Università degli Studi di Roma La Sapienza, Rome, Italy
| | | | | |
Collapse
|
|
19
|
Abstract
Research indicates that the ability to perform a task can be affected by the composition of the meal preceding the task. This study investigated the effect of shift workers’ consumption of a medium-fat, medium-carbohydrate meal on alertness scores. Six subjects (four men, two women) aged 19 to 44 recorded food intake, sleep, and quality of sleep for two weeks, and measured their body temperature and performed cognitive tests during two night shifts at baseline and in test periods. The Stanford Sleepiness Scale (SSS) was used to quantify sleepiness, and a Paced Auditory Serial Addition Test (PASAT) was used to measure cognitive performance. In comparison with the score at baseline, when subjects had a low-fat, high-carbohydrate dietary intake (1,335 kcal/5,588 kJ, 56% carbohydrate, 28% fat), the 1.6-second PASAT score improved significantly (p=0.042) during night shifts when subjects consumed a test meal (987 kcal/4,131 kJ, 46% carbohydrate, 42% fat). No statistically significant difference in SSS was found between baseline and test periods. The reduced body temperature between 2400 hours and 0530 hours was similar for both baseline and test periods. Meal composition and size during night shifts may affect cognitive performance.
Collapse
|
|
20
|
Ziegler PJ, Jonnalagadda SS, Nelson JA, Lawrence C, Baciak B. Contribution of meals and snacks to nutrient intake of male and female elite figure skaters during peak competitive season. J Am Coll Nutr 2002; 21:114-9. [PMID: 11999538 DOI: 10.1080/07315724.2002.10719203] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the contribution of breakfast, lunch, dinner and snack to the macronutrient and micronutrient intake of elite male and female figure skaters during their competitive season. SUBJECTS Male (n = 46) and female (n = 48) figure skaters who participated in the 1999 U.S. National Figure Skating Championships completed the study. METHODS Each athlete completed three-day food records, during the athlete's competitive season. Food records were analyzed using Nutritionist V software. Macronutrient and micronutrient contributions from meals were assessed. RESULTS Lunch and dinner meals were the main contributors to the total calorie intake of these skaters (27% and 32%, respectively). Likewise, lunch and dinner were the main contributors to the total protein (27% and 41%), carbohydrate (26% and 29%), fat (30% and 32%), saturated fat (29% and 32%) and polyunsaturated fat (31% and 32%) intakes. Dinner was the main source of the monounsaturated fat (34%), cholesterol (40%) and dietary fiber (34%). Breakfast was the main source of dietary folate (36%), whereas iron and calcium intakes were mainly contributed by breakfast and dinner (29% and 32%, 27% and 29%, respectively). CONCLUSION These elite figure skaters appear to be starting their day with low energy reserves and therefore need to be educated about the benefits of consuming breakfast. These athletes also need to be educated about consuming adequate calories throughout the day in order to meet the energy needs of their activity. It is thus important to monitor eating patterns throughout the day to ensure adequate energy intake to sustain the physical and mental aspects of the athletes' training and performance.
Collapse
|
|
21
|
Rogers PJ, Kainth A, Smit HJ. A drink of water can improve or impair mental performance depending on small differences in thirst. Appetite 2001; 36:57-8. [PMID: 11161346 DOI: 10.1006/appe.2000.0374] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- P J Rogers
- Department of Experimental Psychology, University of Bristol, 8 Woodland Road, Bristol, BS8 1TN, UK.
| | | | | |
Collapse
|
|
22
|
Finnigan F, Hammersley R, Millar K. Effects of meal composition on blood alcohol level, psychomotor performance and subjective state after ingestion of alcohol. Appetite 1998; 31:361-75. [PMID: 9920688 DOI: 10.1006/appe.1998.0168] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Moderating effects of meal composition on psychomotor performance impairment and feelings after alcohol were examined in a between-subjects design. Fifty-one male volunteers fasted or received either a high carbohydrate (85% energy) or a high protein (94% energy) meal. Alcohol was administered at a dose to achieve a blood alcohol level (BAL) of 60 mg/100 ml, as a placebo. Subjects performed a dual task of primary tracking and secondary reaction time and a five-choice reaction time task. Feelings were also assessed by rating. The high carbohydrate meal reduced BAL at peak and 2 h after drinking, but a high protein meal had no significant effect. Although performance was impaired by alcohol, neither meal significantly reduced impairment and there was no effect of meal type on performance in the placebo condition. However, alcohol increased rated intoxication and the high carbohydrate meal reduced this effect. Subjects who had consumed high protein meals had more negative affect 2 h after alcohol than did subjects who had consumed high carbohydrate meals or fasted. It is concluded that there is only a weak relationship between BAL and performance impairment and food has only limited effects on impairment, although it reduces BAL.
Collapse
Affiliation(s)
- F Finnigan
- Department of Psychology, Glasgow Caledonian University, Cowcaddens, UK
| | | | | |
Collapse
|
|
23
|
Wells AS, Read NW, Macdonald IA. Effects of carbohydrate and lipid on resting energy expenditure, heart rate, sleepiness, and mood. Physiol Behav 1998; 63:621-8. [PMID: 9523907 DOI: 10.1016/s0031-9384(97)00517-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The effects of gastric infusions of fat and carbohydrate on physiological and psychological measures were compared using a within subject design in 9 healthy subjects (6 males). Each subject received isovolaemic rapid gastric infusions of sucrose solution (100% energy carbohydrate), lipid emulsion (100% energy fat, 20% Intralipid), and a non-nutrient control (0.9% saline) in a randomised order. Nutrient infusions were isoenergetic, containing one-third of an individual subject's estimated daily energy requirements (mean, 3227 kJ; range, 2479-3971 kJ). Measures of heart rate (HR), energy expenditure (EE), mood, and sleepiness were collected before the infusions and every 0.5 h for 3.5 h. Mean postingestive HR, EE, and satiation were significantly greater after the nutrient infusions than after the control. Sucrose induced a rapid increase in HR and EE, whereas lipid had a lesser and more delayed effect. Thirty minutes after the gastric infusions, HR and EE were significantly higher after the sucrose than after the lipid and saline. Hedonic tone was greater and tension lower after the saline and sucrose infusions than after the lipid infusion. From 3 to 3.5 h after ingestion, subjects felt significantly more sleepy after the lipid infusion than they did at these times after the saline infusion, and significantly more dreamy after the lipid infusion than they did after the sucrose infusion. In conclusion, the presence of lipid and sucrose in the intestine induces significant and differing physiological and psychological effects, which are independent of cognitive and orosensory influences.
Collapse
Affiliation(s)
- A S Wells
- Centre for Human Nutrition, University of Sheffield, Northern General Hospital, United Kingdom
| | | | | |
Collapse
|
|
24
|
Wells AS, Read NW, Idzikowski C, Jones J. Effects of meals on objective and subjective measures of daytime sleepiness. J Appl Physiol (1985) 1998; 84:507-15. [PMID: 9475860 DOI: 10.1152/jappl.1998.84.2.507] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Effects of recent food ingestion on daytime sleepiness were assessed in 16 subjects (8 men and 8 women) who were each studied on two occasions, 28 days apart. On each occasion, subjects ate a high-fat low-carbohydrate (CHO) (fat/CHO energy ratio 54:41) meal and an isoenergetic low-fat high-CHO meal (fat/CHO energy ratio 7:88) 4 h apart in a counterbalanced order. Sleepiness was measured at 2-hr intervals by using the Multiple Sleep Latency Test and the Akerstedt electroencephalograph sleepiness test. To control for circadian factors, one group (4 men, 4 women) ate the meals 2 h later than did the other group of subjects. There were no differences in sleepiness according to the composition of the meal. Sleepiness in the Multiple Sleep Latency Test was significantly greater 1.5 h after the meals were eaten than before (F 11.37; df 1,15; P = 0.004). Sleepiness was also enhanced in the Akerstedt sleepiness test 3 h 20 min after the meals. The results suggest that the meals induced an enhancement in sleepiness that was not solely due to circadian rhythms.
Collapse
Affiliation(s)
- A S Wells
- Centre for Human Nutrition, University of Sheffield, Northern General Hospital, United Kingdom.
| | | | | | | |
Collapse
|
|
25
|
Wells AS, Read NW, Fried M, Borovicka J, D'Amato M. Effects of a specific CCK-A antagonist, Loxiglumide, on postprandial mood and sleepiness. J Psychopharmacol 1997; 11:241-6. [PMID: 9305416 DOI: 10.1177/026988119701100307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Previous studies have demonstrated that feelings of sleepiness increase after ingestion of a fat-rich meal. The aim of the study was to test the hypothesis that postprandial sleepiness is mediated by cholecystokinin (CCK) acting on CCK-A receptors. A double-blind crossover study was conducted. Twelve male volunteers ate a high-fat morning meal [54% energy fat, 41% energy carbohydrate (CHO)]. On one day they received an i.v. infusion of Loxiglumide, a CCK-A receptor antagonist (30 mg/kg/h for 10 min then 10 mg/kg/h for 3 h 10 min). On another day the protocol was repeated except a saline placebo infusion was given at similar rates as the Loxiglumide, starting 20 min before the meal. Subjects' mood and sleepiness were monitored throughout using questionnaires and performance tasks. The results indicate that ratings of vigour were significantly lower during the Loxiglumide infusion than during the saline infusion, [F(1,10) = 6.65; p = 0.027]. Subjects who were infused with Loxiglumide on their first test day felt significantly (p < 0.05) more fatigued, sleepy and tense and less vigorous, less efficient and had lower energetic arousal during the Loxiglumide infusion than during the saline infusion. In conclusion, the results suggest that the postprandial decline in feelings of alertness after a fat-rich meal is not mediated solely by CCK acting through CCK-A receptors.
Collapse
Affiliation(s)
- A S Wells
- Centre for Human Nutrition, University of Sheffield, Northern General Hospital, UK.
| | | | | | | | | |
Collapse
|
|
26
|
Abstract
This report reviews studies addressing the issue of the effect that carbohydrates have on affective behavior. The review begins with an overview of the physiologic and psychological mechanisms that have been proposed to explain a carbohydrate-induced behavioral effect. Attention is then devoted to studies that have investigated the mood-altering effect of carbohydrates on normal individuals, depressed individuals, obese individuals, and individuals with seasonal affective disorder and premenstrual syndrome. Throughout the report it is apparent that carbohydrate consumption is relevant for individuals experiencing symptoms of emotional distress, particularly symptoms indicative of depression, and that the individuals with depressive symptoms show a preference for sweet simple carbohydrates. Enduring questions permeating the diet-behavior field are delineated and future research directions are suggested.
Collapse
Affiliation(s)
- L Christensen
- Department of Psychology, University of South Alabama, Mobile 36688, USA
| |
Collapse
|
|
27
|
Wells AS, Read NW, Uvnas-Moberg K, Alster P. Influences of fat and carbohydrate on postprandial sleepiness, mood, and hormones. Physiol Behav 1997; 61:679-86. [PMID: 9145937 DOI: 10.1016/s0031-9384(96)00519-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Paired studies were conducted in 18 healthy volunteers (9 men, 9 women) to investigate whether differences in mood and daytime sleepiness induced by high-fat-low-carbohydrate (CHO) and low-fat-high-CHO morning meals were associated with specific hormonal responses. Plasma insulin concentrations were significantly higher after low-fat-high-CHO meals, and cholecystokinin (CCK) concentrations were significantly higher after high-fat-low-CHO meals. Subjects tended to feel more sleepy and less awake 2-3 h after the high-fat-low-CHO meal, and ratings of fatigue were significantly greater 3 h after the high-fat-low-CHO meal than after the low-fat-high-CHO meal. The results of the present study are consistent with the hypothesis that there is an association between the lassitude experienced after a meal and the release of CCK.
Collapse
Affiliation(s)
- A S Wells
- Centre for Human Nutrition, University of Sheffield, England
| | | | | | | |
Collapse
|
|
28
|
Kanarek R. Psychological effects of snacks and altered meal frequency. Br J Nutr 1997; 77 Suppl 1:S105-18; discussion 118-20. [PMID: 9155498 DOI: 10.1079/bjn19970108] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Over the past two decades, substantial research has been conducted to investigate the idea that alterations in short-term nutritional intake play a role in influencing cognitive behaviour and mood. A portion of this research has examined specifically the effect of meal intake on the performance of mental tasks and subjective feelings of mood. Results of this research indicate that a number of variables including the timing and nutritional composition of the meal, nutritional status, habitual patterns of feeding behaviour, beliefs about food, and the nature of the mental tasks, can influence the effects of meals on cognitive behaviour. For example, studies have demonstrated that breakfast intake generally is associated with an improvement in cognitive performance later in the morning, while lunch intake is associated with an impairment in mid-afternoon performance on mental tasks and more negative reports of mood. Intake of nutrients late in the afternoon appears to have a positive effect on subsequent performance on tasks involving sustained attention or memory. Although research has provided insights into the role of meal intake on cognitive behaviour and mood, there are a number of factors which remain to be studied. These include the interaction of age, gender, activity level, meal composition, personality factors, stress with the effects of meals on cognitive behaviour. Additionally, more work is needed on the time-course of short-term nutrient effects, and the effects of chronic changes in meal intake on behaviour.
Collapse
Affiliation(s)
- R Kanarek
- Tufts University, Department of Psychology, Medford, MA 01255, USA
| |
Collapse
|
|
29
|
Abstract
Paired studies testing the effects of lower energy high-fat, low-CHO meals (3181 kJ, fat:CHO energy ratio 54:41) and higher energy low-fat, high-CHO meals (3599 kJ, fat:CHO energy ratio 7:88) were conducted in 18 healthy males. The meals were eaten at 1030 h by group A (nine subjects) and 1230 h by group B (nine subjects). Subjective lassitude increased following ingestion of all four meals, but there was little change in performance. In addition, group A, but not group B, felt significantly less vigorous, imaginative, and antagonistic, and significantly more dreamy, feeble, and fatigued after the lower energy high-fat, low-CHO meal than after the higher energy low-fat, high-CHO meal. These results suggest that in the morning, fat exerts a greater depression on alertness and mood than carbohydrate irrespective of a reduction in energy content, but this effect varies according to the time at which food is eaten, and is less evident at lunch time.
Collapse
Affiliation(s)
- A S Wells
- Centre for Human Nutrition, University of Sheffield, Northern General Hospital, Sheffield, UK
| | | |
Collapse
|
|
30
|
Foltin RW, Haney M, Comer SD, Fischman MW. Effect of fenfluramine on food intake, mood, and performance of humans living in a residential laboratory. Physiol Behav 1996; 59:295-305. [PMID: 8838609 DOI: 10.1016/0031-9384(95)02098-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Five male and four female normal weight research volunteers, participating in 13-day residential studies, received oral fenfluramine (20, 40 mg) or placebo at 09:30 and 17:00. Food intake, performance, and subjective ratings were measured throughout the day. Carbohydrate intake was manipulated by providing lunch meals high (males: 120 g; females: 80 g) or low (males: 25 g; females: 16 g) in carbohydrate on 8 days; on the remaining days subjects self-selected lunch. Total caloric intake (approximately 2800 Kcal) did not differ among the low- and high-carbohydrate, and self-selected lunch conditions when subjects received placebo, indicating caloric compensation. Total carbohydrate intake was significantly less, however, when subjects consumed the low-carbohydrate lunch compared to the other lunch conditions. Fenfluramine significantly decreased total caloric intake (approximately 500 kcal) by decreasing meal size, not number, only when subjects consumed the low-carbohydrate lunch. Fenfluramine was only an effective anorectic drug when subjects consumed a lunch with fewer calories and a lower carbohydrate:protein ratio than self-selected baseline. Also, fenfluramine improved performance on a range of computer tasks and increased ratings of "Alert," "Friendly," and "Talkative," while decreasing ratings of "Tired" and "Irritable."
Collapse
Affiliation(s)
- R W Foltin
- Division on Substance Abuse, New York State Psychiatric Institute, NY 10032, USA
| | | | | | | |
Collapse
|
|
31
|
Lloyd HM, Green MW, Rogers PJ. Mood and cognitive performance effects of isocaloric lunches differing in fat and carbohydrate content. Physiol Behav 1994; 56:51-7. [PMID: 8084907 DOI: 10.1016/0031-9384(94)90260-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Eighteen subjects consumed low-fat/high-carbohydrate (LFHC) (29% fat, 54% carbohydrate, 15% protein), medium-fat/medium-carbohydrate (MFMC) (45% fat, 42% carbohydrate, 12% protein), and high-fat/low-carbohydrate (HFLC) (62% fat, 24% carbohydrate, 13% protein) isocaloric lunches in random order on 3 separate days. The MFMC lunch was similar in energy and macronutrient composition to the habitual lunchtime intake of the subjects. A battery of cognitive performance tasks together with mood and appetite ratings were carried out before and during the 3 h after lunch. Results showed longer reaction times following the LFHC and HFLC lunches compared to the MFMC lunch, which produced an improvement in performance on this task. In addition, subjects rated themselves as more drowsy, uncertain and muddled, and less cheerful after the LFHC and HFLC lunches compared to the MFMC lunch, and as less tense after the LFHC meal. These findings indicate that the macronutrient content of lunch can have significant acute effects on subsequent mood and performance. In particular, higher than usual proportions of fat or carbohydrate produced a relative impairment of cognitive efficiency.
Collapse
Affiliation(s)
- H M Lloyd
- Consumer Sciences Department, Institute of Food Research, Reading, UK
| | | | | |
Collapse
|
|
32
|
Smith A, Kendrick A, Maben A, Salmon J. Effects of fat content, weight, and acceptability of the meal on postlunch changes in mood, performance, and cardiovascular function. Physiol Behav 1994; 55:417-22. [PMID: 8190755 DOI: 10.1016/0031-9384(94)90094-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study examined the effects of fat content and meal size on postlunch changes in mood, performance, and cardiovascular function. Forty-six subjects (20 males, 26 females) were tested before and after lunch. Subjects were assigned to one of the following lunch conditions: a) low fat (23 g), large meal (860 g); b) low fat (18 g), small meal (600 g); c) high fat (84 g), large meal (840 g); d) high fat (79 g), small meal (530 g). The results showed only small effects of fat composition and meal size, with no cardiovascular effects being observed and no evidence of fat content or the weight of the meal influencing performance of logical reasoning or cognitive vigilance tasks. A few effects of meal type were significant in the mood data, but given the large number of analyses conducted, these could represent chance effects. Results from two selective attention tasks showed that subjects given the high-fat meals responded more slowly but more accurately, which differs from the effects of carbohydrate, protein, and calorie content reported in earlier papers. Weight of the meal influenced the degree of distraction from near and far distractors and also the accuracy of responses to central and peripheral targets. However, both the effects of fat and meal size were modified by task parameters, and further research is required before firm conclusions can be drawn about the functional importance of the influences of nutrient content and meal size on performance. The high-fat and large meals were rated as more acceptable than the low-fat and small meals.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- A Smith
- Health Psychology Research Unit, School of Psychology, University of Wales College of Cardiff
| | | | | | | |
Collapse
|
|
33
|
Smith A, Maben A. Effects of sleep deprivation, lunch, and personality on performance, mood, and cardiovascular function. Physiol Behav 1993; 54:967-72. [PMID: 8248391 DOI: 10.1016/0031-9384(93)90310-c] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The present study examined the effects of sleep deprivation on performance, mood, and cardiovascular functioning in the late morning and early afternoon. The results showed that the sleep-deprived subjects felt less alert and detected fewer targets in a cognitive vigilance task. Selective impairments due to sleep deprivation were also observed in a logical reasoning task. There was little evidence to suggest that consumption of lunch altered these effects of sleep deprivation. However, individual differences in the effects of sleep deprivation were apparent, with trait anxiety being related to the changes in subjective alertness produced by sleep deprivation, and sleep-deprived extraverts showing greater performance impairments than the sleep-deprived introverts.
Collapse
Affiliation(s)
- A Smith
- Health Psychology Research Unit, School of Psychology, University of Wales College of Cardiff
| | | |
Collapse
|
|
34
|
Abstracts of Communications. Proc Nutr Soc 1993. [DOI: 10.1079/pns19930092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
|
35
|
Abstracts of Communications. Proc Nutr Soc 1993. [DOI: 10.1079/pns19930060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|