Nutrition

Reseamh,Vol.20,No.4,~~.479-489.2000
Copyright 0 2000 Elsevier Science Inc.
Printed in the USA. Allrights reserved
0271.5317/CO/$-see front matter

PII: SO271-5317(00)00140-8

EFFECT OF STARCH INTAKE ON SATIATION AND

SATIETY IN PRESCHOOL CHILDREN

Marcela Alvifia, M.Sc., H6ctor Araya, Gloria Vera, M.Sc., Nelly Pak.
Center for Human Nutrition, Faculty of Medicine, University of Chile

ABSTRACT

The aim of the study was to evaluate the effect of diierent food starch levels on satiation
and satiety in preschool children. The study was carried out in 25 preschool children,
aged 24 to 48 months, with a normal nutritional status. Three rice formulas were given
to the children at lunch. Three starch levels were assayed: low, medium and high (4, 8
and 12 % of starch, respectively). Nutrient and energy densities of the formulas were
Similar. Satiation was determined at lunch by measuring the subjects intake of prepared
dishes, which were offered in high volumes. If children asked for more an additional
amount was served. Satiety was determined using the food and energy intakes at tea
time in those children who consumed siiar amounts of meals with different starch
levels at lunch. The result demonstrated that children consumed signi6cantly less of the
high-starch food preparation at lunch. Also, an inverse and significant relationship was
observed between the formula starch level and the food and energy intakes at the
subsequent meal time. From these results, it can be concluded that preschool children
show the highest satiating rate and satiety when they consume foods with a higher starch
level. The tidings of this work are a contribution to a better understanding of the effect
of nutritional factors on food and energy intakes in preschool children. From an applied
point of view, these fmdings could be valuable tools in the food management of under or
ovemourished preschool children.
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KEY WORDS: Food starch, Satiation, Satiety, Preschool children.

INTRODUCTION

The study of nutritional and textural variable effects on preschool childrens food and energy intake is
essential to establish food recommendations aimed at reducing undernutrition or overnutrition risks.
Preschool children represent a specia.l age group in regards to food intake since they have less gastric

: Partially financed by FONDECYT Project 1320/91

Corresponding author: MSc.Marcela Alvifia, Center Human Nutrition, Faculty of
Medicine, University of Chile. Independencia 1027, Santiago, Chile. Phone (56-
02) 678 6242, FAX (56-02) 735 5581, E-mail: malvina@machi.med.uchile.cl

479
480 M. ALVlfiA et al.

capacity, are starting to participate in family consumption patterns and are consolidating their food habits
(l-3).

The diets of low socioeconomic status populations consist primarily of basic foods (cereals, tubers and
leguminous plants) containing high percentages of starch. When these foods are cooked, the starch
absorbs great amounts of water, forming gels that make preparations highly viscous, but provide low
energy densities. These diets so called bulky diets have been pointed out as an etiological factor of
undernutrition (4-7). On the other hand, in developing countries, nutritional deficit problems coexist
with increasing overweight and obesity prevalence in preschool age children. This ovemutrition problem
takes place in every socioeconomic level. High priority should be assigned to investigating this situation
since obesity needs to be prevented in early childhood in order to reduce obesity risks in adults and the
chronic pathologies related to this disease.

Nutritional solutions proposed to increase energy intake in children involve raising a food preparations
solid concentration without a significant increase in its consistency. This effect can be achieved by raising
fat concentration (4, 8), or by hydrolyzing part of the starches, applying a technological process such as
extrusion (9, IO) or treatment by the dextrinizing enzymes alpha amylase or malt flour (1 1- 14).

Conversely, existing data show that preschool children consume less food and energy during meal times
when their food has a greater consistency, which is closely related to its starch content and energy
density (15, 16). However, neither consistency nor energy density seems to lower immediate
consumption when starch of a soup preparation has been hydrolyzed (14). This gives rise to the
hypothesis that starch may be responsible for reduced intake observed in preschool children.

Although certain evidence has been obtained in terms of the immediate satiety effect of starches, the
situation is not as clear when establishing its short-term effects. Most studies evaluating the effect of
complex,carbohydrates on food and energy intake in subsequent meals have been conducted with adults
and their results are contradictory (17-20).

According to literature, the methodology to evaluate satiation consists of an ad lib&urn offering of a meal
preparation and the measurement of the quantity that subjects can eat. On the other hand, there are two
methodologies to evaluate satiety. One uses the pre-load method, in which individuals are asked to eat a
6xed volume of a preparation. After a short span of time, 20 to 60 minutes, they are offered ad libitum
foods and their intake or hunger level is determined by a score scale. The other consists of determining
the effect of food intake during a meal time on the intake of the following meal 3 or 4 hours later.

In the existing literature there are few controlled studies that have been conducted to evaluate the effects
of the intake of starchy food on immediate intake, reflecting satiation, or on the following meal intake,
reflecting satiety. This situation, and its Wure applications in the reduction of undernutrition and
ovemutrition, support the need to study the role of starch as a determining factor in the food and energy
intakes of preschool-aged children.

MATERIAL. AND METHODS

Immediateintake(satiation).Immediate food and energy intakes were studied in 25 healthy preschool

children (10 females and 15 males). The subjects ranged in age from 24 to 48 months with an average of
 STARCH INTAKE ON SATIATION 481

36.38 f 6.45 months. The average height and weight were 93.71 f 5.51 cm and 15.100 * 1.850 kg,
respectively. All subjects had a normal nutritional status according to their Body Mass Index (BMI)
(15.85 f 0.78). Children of lower-middle socioeconomic level were randomly selected from those
attending a day care center, where they received breakfast, lunch and an afternoon snack Monday
through Friday. For the purposes of the study the children were given a specially prepared lunch. The
children were not aware of the purposes of the study, and to them the study intervention days were
completely normal. Nothing out of the ordinary was said to the children when they were given the soup.
The only words spoken were what are normally said to encourage the children to eat when they are
served their daily meals. The investigators were given instructions not to intervene in the eating hall
during lunch, and the preschools normal personnel were in charge of supervising the children while they
ate as they do on any given day. The parents were given detailed information about the activities and the
objectives of the study and gave their informed consent for their child to participate in the study.

Three soup-puree preparations with different starch levels were tested: low (4%) medium (8%) and high
(12%). Their characteristics are shown in Table 1. AU preparations were formulated with 15% rice, the
differences in starch levels resulted from whether the rice used was extruded or not and in the addition of
a dextrinizing agent (malt flour), which allowed manipulation of the starch concentration. Meat,
vegetables, spices, water and oil were added to aI soups, which then were homogenized. These
ingredients were added in equal quantities to achieve similar nutritional and organoleptic characteristics
between the three soups.

TABLE 1
Food and chemical composition of the assayed soups

Starch Level Soups

Low Medium

Basic ingredients 15% extruded rice 15% extruded rice 15% rice
Malt flour (g/100) 0.3 0 0
Starch concentration (g/lOOg) 4.2 8.5 11.6
Apparent viscosity (cps) 1470 4940 13180
Proximal composition (g/l OOg)
Moisture 77.3 76.8 79.1
Protein 2.6 3.1 2.4
Fat 6.3 5.6 53
Carbohydrate 13.3 13.7 12.6
Ash 0.8 0.9 0.8

Energy Density (kcaUg) 1.2 1.2 1.1

Each childs soup intake was determined at lunch time, during three non consecutive days. The soups
were offered to each child one time in a randomized order, served at 40C and accompanied by 100 g of
a jelly dessert with a caloric density of 1 k&g.

The childrens habitual consumption capacity was determined previous to the study by offering the
482 M. ALVlfiA et al.

subjects a high starch meal (such as spaghetti or a potato based dish) and measuring the quantities that
they ingested. The soup portion size was established at 20% more than the volume that the children
habitually consume, or 3 18 g. The children were offered more soup than their normal consumption
capacity in order to assure that their soup consumption was not limited by its availability. Those children
that consumed the entire initial portion we given an additional 150 g of soup ifthey wanted.

Food intake was determined for each child at each eating occasion by weighing the food both before and
after the meal.

Subsequent intake (satiety). ARer each food intake control conducted during lunch, the subsequent food
and energy intake were determined at tea time, maintaining a three hour time interval in between and
taking precautions that nothing was eaten during that period.

Food service at tea time consisted in flavored milk with sugar and bread with margarine. Those foods
were provided in larger amounts than those usually provided by the day care center, to assure that
children ate as much as they could. Furthermore, repetitions were available for those children requesting
them.

Chemical composition. Proximal analysis of the foods offered at lunch and tea time was carried out
according to AOAC (21).

Starch determination. In the unextruded rice formula, starch concentration was evaluated by determining
D-glucose and dextrines under 14 Carbons released from starch (22). As for soups formulated with
extruded rice flour, its relation established starch concentration to viscosity.

Viscosity. Apparent viscosity of soups with different starch levels was determined by means of a
Brookfield model RVT rotational viscosimeter, usiig the N6 spindle at a 50 rpm flow speed and a 40C
sample temperature.

Food Intake. Food intake was determined by calculating the difference in weights between the amount of
food served to and left by each child. The children were stimulated, albeit not forced, to eat.

Statistical analysis. The statistical analysis of immediate and subsequent intakes were carried out by
repeated-measures analysis of variance (ANOVA) followed by contrasts to identity differences between
treatments. The level of significance was pcO.05.

RESULTS

Immediate intake. The volume and energy intakes achieved using the difberent starch level soups are
illustrated in Table 2. An inverse and signiftcant effect was found between the starch concentration and
the amount consumed. Preschool children were able to eat 313 g when most of the starch in the soup
was hydrolyzed, and they reduced their consumption to 220 g when they consumed the high starch
preparation. Energy intake fluctuated from 375 to 239 kcal, respectively. A comparison of intake values
corresponding to the extreme starch concentration formulas (high versus low) shows a food and energy
intake reduction of approximately 90 g and 135 kcal when the soups starch level was raised from 4% to
12%. The children consumed the full amount of jelly offered in all lunch modalities, increasing volume
 STARCH INTAKE ON SATIATION 483

and energy intake by 100 g and 100 kcal, respectively.

The total starch intake achieved through the soup consumption, described in Table 2, were 13.5 f 0.01,
24.5 f 2.02 and 29.7 f 4.73 g for the low, medium and high starch formulas, respectively. All these
diBerences were statisticahy significant.

Subsequent intake. Subsequent food and energy intake values are shown in Figure 1 and 2, respectively.
Tea time food and energy intake decreased as starch increased in the soups supplied at lunch. However,
the analysis of its components (milk and bread) shows that only the reduction of milk intake was
statistically sign&ant.

TABLE 2
Immediate food and energy intakes of soups with di&rent starch level

Starch Level Soups Consumption

Food @ Energy (kcal)

LOW 313.0 f 33.9 375.6 f 40.7

Medium 282.8 f 40Bb 330.9 f 47.7b
High 222.2 f 42.9 239.9 f 46.4
Means f standard deviation
Means with difhxent superscripts were statistically dif%rent ( p<O.OOl)

Tea-Time
(I)
1
. .._ . . . . . . . . .~ . . . . . . . .T ..
300

Bread

FIG 1. Subsequent food intake determined at tea time after preschool children had
wnsumed at lunch rice-based soups with different starch wncentrations. Means f
standard deviation. Means with diierent superscripts were statistically diierent
Q.60.05)
484 M. ALVlfiA et al.

It is noteworthy that the effect of high starch on food and energy consumption was more evident when
both meal-times are considered together than separately (Figure 3). Results show that preschool children,
despite haying eaten 90 g less when offered the high starch formula during lunch, were not able to
compensate the food and energy deficit in the next meal time. On the contrary, they again consumed a
signilicantly smaller amount at the subsequent mealtime, increasing the food gap to a total of 130 g, with
a difference of 163 kcal.

Broad
(kc.,,
.._...........
*O T Tl

FIG 2. Subsequent energy intake determined at tea time after preschool children had
consumed at lunch ricebased soups with diierent starch concentrations. Means f
standard deviation. Means with d&rent superscripts were statistically different
(p<O.OS)

Low Low

Medium Medium

High

I I I
0200400600aoo 0 200 400 600 I

(8) ww

? L?uaoh ? ?
Tea-Time

FIG 3. Food and energy intakes determined at lunch and tea time. Preschool children
had consumed at lunch rice-based soups with different starch concentrations. At tea
time they consumed ad lib&urn common foods for these meal time.
 STARCH INTAKE ON SATIATION 485

DISCUSSION

The study of the dietary factors at&cting food intake is essential to cont?ont problems originating from a
positive or negative energy balance. This paper studied how the concentration of complex carbohydrates
can affect preschool childrens food and energy intakes. The satiating effect of starch was not only
observed immediately, it also at&ted intake during the next meal.

Most studies centering on the effect of starch intake on short term satiety have been conducted with
adults. Their purpose has been to determine the relative capacity of carbohydrates, in relation to that of
proteins and fat, to produce satiety, and their results have been controversial (23-29). Studies comparing
satiety efficiency of simple vs. complex carbohydrates have found that complex ones play a more
significant role (16, 29). Their results also had similar findings: preschool children consumed
signitIca.ntly less of the high starch soup as compared to the soup with practically all its carbohydrates in
the form of low molecular weight dextrines or sugars. Although in other study was within a design
where other nutritional variables interacted, our work group demonstrated that preschool children fed a
soup of leguminous-cereals consumed signiticantly more of a formula prepared with the highest quantity
of dextrinizing agent (14).

There is a direct relation between starch concentration and viscosity, ranging between 1500 and 13000
cps approximately; the former corresponding to liquid soup and the latter to creamy soup. In this study,
children consumed signiIicantly less of the creamy soup, which in turn had the highest starch level. The
direct relation between the starch concentration and soup consistency does not allow us to overlook the
possibility that the children consumed less simply because they did not like the soups creamy
consistency. Early studies (5, 30) have indicated that consistency is a textural factor that limits
consumption. However, Araya et al. (3 l), demonstrated in preschool children that different viscosity
level soups were consumed in similar quantities, when difference in their viscosities were moderate.

Most studies evaluating the effect of starch on satiety have been conducted on adults and are not
conclusive. Blundell et al. (23) demonstrated that a carbohydrate supplement at breakfast suppressed
appetite at 90 minutes but did not at&ct the meal provided 270 minutes later. Likewise, Rodin (18) and
de Graafet al. (19) failed to demonstrate the satiety effect of short term carbohydrates. However, other
studies show the contrary (32-34). According to evidence obtained in this study, it may be inferred that
starch induces a short term satiety mechanism in preschool children.

The importance of this finding is clearer when both meal times were analyzed together. Preschool
children reduced their intake by 130 g. and 163 kcal when consumption values of high (12%) and low
(4%) starch soups were compared. Consequently, these results show that the inclusion of more starch
in the diets of preschool children would prevent energy compensation in the case the present studys diet
conditions.

The starch satiety effect might be explained by a slow gastric emptying rate (35-38). In terms of foods,
which contribute high levels of starch, rice presents one of the slowest gastric emptying rates and lowest
glycemic curves (39). According to the theory of postpiloric osmeoreceptors, the gastric emptying rate
responds to the molecular concentration of solutions (40). Thus, the higher hydrolyzed soup would have
produced a strong stimulation of osmeoreceptors, causing an accelerated gastric emptying rate as
compared to a high starch soup. On the other hand, it is a known fact that the complex structure of
starch a&c@ luminal digestion rate depends on the proportion of amylose present in starches (38, 41,
42). The mechanisms suggested for this action are related to the gel forming capacity of amylose and to
486 M. ALVlfiA et al.

the compact nature of its lineal chain, which may leave alpha l-4 links less exposed to the action of
amylases, there by slowing digestion and absorption. Both mechanisms would allow flatter and more
sustained glycemic levels over time, an effect that some authors have associated with appetite
suppression (43-44). In this study, medium and low level starch preparations produced less satiety and
were precisely the ones that contained a lower proportion of amylose (hydrolysis was effected in alpha l-
4 bonds prior to consumption).

Most diets in lower socioeconomic populations consist mainly of basic foods, with high starch
concentration. These components absorb large quantities of water when cooked, forming high volume,
highly consistent preparations with low energy density. These diet characteristics have been pointed out
as one of the etiological factors in child malnutrition in these sectors (1, 3, 5, 6). From the opposite
perspective, diets characteristic of higher socioeconomic level in their diet is moderate, but contains a
high energy density. Consumption of these diets produces a high gastric emptying rate, which leads to a
reduced satiety sensation. With less satiety, individuals may consumer a greater amount of food and
increase their risk of obesity.

The relevance of these findings are based on the fact that soup type preparations with a high starch
content should be recommended to reduce energy intakes in overweight or obese children. On the other
hand, hydrolyzed starch preparations may constitute valuable tools to provide energy to children with
undernutrition risk or who are undergoing malnutrition treatment.

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Accepted for publication August 31, 1999.