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Eating Behaviors 9 (2008) 370 375

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Differences in eating behaviors between nonobese, weight stable young and older adults
Kelsey M. Gilmour Flint a , Emily L. Van Walleghen b , Elizabeth H. Kealey c , Sandra VonKaenel c , Daniel H. Bessesen c , Brenda M. Davy a,
Department of Human Nutrition, Foods and Exercise (0430), Virginia Tech Blacksburg, VA 24061, United States University of Kansas, Center for Physical Activity, Nutrition and Weight Management, 1301 Sunnyside Ave, Robinson, RM 100, Lawrence Kansas 66045, United States University of Colorado at Denver Health Sciences Center, 4200 East 9th Avenue Campus Box 263, Denver, CO 80262, United States
b a

Received 8 May 2007; received in revised form 28 August 2007; accepted 26 October 2007

Abstract Habitual dietary intake, dietary cognitive restraint (CR), disinhibition and hunger are eating behaviors that influence energy balance in both young and older adults. Since the prevalence of overweight and obesity in older adults is steadily rising, it is important to identify eating behavior adaptations that allow individuals to maintain a healthy body weight with advancing age. The association of age with habitual dietary intake, dietary CR, dishinhibition and hunger was examined in 30 older (6072 years) and 30 younger (1825 years) nonobese, weight stable, nondieting healthy adults pair-matched by age group for sex, physical activity level (active N 150 min of physical activity per week, sedentary b 150 min of physical activity per week) and BMI. Dietary CR was significantly greater and hunger was significantly less in older compared to young adults (both P b 0.05). Disinhibition scores, habitual energy and macronutrient intake did not differ between age groups. These results indicate that weight management in older, nonobese adults may be facilitated by increased dietary CR and decreased susceptibility to hunger with age. Additionally, changes in energy and macronutrient intake may not be necessary for successful weight management with advancing age. 2007 Elsevier Ltd. All rights reserved.
Keywords: Aging; Nonobese; Dietary cognitive restraint; Hunger; Eating behaviors

1. Introduction Weight gain is commonly associated with advancing age (Roberts & Williamson, 2002). One factor potentially contributing to an age-related increase in body weight is a reduced ability to acutely regulate energy intake (Rolls, Dimeo, & Shide, 1995; Van Walleghen, Orr, Gentile, Davy, & Davy, 2007), which could lead to energy overconsumption and weight gain over time. In young adults, habitual physical activity level may increase accuracy of energy intake regulation (Long, Hart, & Morgan, 2002), but it does not appear to influence acute energy intake regulation

Corresponding author. Tel.: +1 540 231 6784; fax: +1 540 231 3916. E-mail address: bdavy@vt.edu (B.M. Davy). 1471-0153/$ - see front matter 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.eatbeh.2007.10.006

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among older adults (Van Walleghen et al., 2007). However, physical activity level is an important predictor of longerterm weight management in the general population (Kruger, Blanck, & Gillespie, 2006; Pronk & Wing, 1994). The prevalence of overweight and obesity among older adults is currently 71% (Ogden et al., 2006), and is expected to rise in the future. Thus, identifying behavioral characteristics associated with body weight management in this population have important public health implications (Arterburn, Crane, & Sullivan, 2004). Specifically, identification of diet-related behavioral characteristics among nonobese older adults could be used to guide the development of population-specific interventions. Such characteristics include habitual dietary intake, cognitive dietary restraint, disinhibition and susceptibility to hunger (McCrory, Suen, & Roberts, 2002; Rogers, 1999; Stunkard & Messick, 1985). Population-based studies have determined that adults aged 6074 years consume about 21002900 kJ (500 700 kcal) per day less than their younger counterparts aged 2039 years (Briefel & Johnson, 2004). The diets of young (2039 years) and older (6074 years) adults do not differ markedly in macronutrient composition (Trends in intake of energy and macronutrientsUnited States, 19712000, 2004). However, these studies did not account for differences in body mass index (BMI) or physical activity level across age groups. Cognitive dietary restraint (CR), the intentional control of energy intake to promote weight loss or maintain an ideal weight (Hays et al., 2002), is positively associated with weight gain and greater body fatness in normal weight men and women (Beiseigel, 2004; Lauzon-Guillain, 2006). There is some controversy as to whether or not CR is a valid indicator of actual acute/chronic energy intake, as opposed to actual vs. desired intake (van Strien, Engels, van Staveren, & Herman, 2006). However, CR is associated with healthy dietary behaviors in young adults, including greater vegetable consumption (Moreira, de Almeida, & Sampaio, 2005) and greater consumption of low-fat foods (Rideout, McLean, & Barr, 2004). Thus, CR may facilitate weight management in young adults by encouraging healthful eating patterns. Disinhibition, the proclivity for hyperphagia when presented with stimuli that tend to disrupt restraint (Hays et al., 2002), is predictive of greater body size (Bellisle et al., 2004; Hays et al., 2002; Lindroos et al., 1997) and weight gain over time (Bellisle et al., 2004; Hays et al., 2002). Increased susceptibility to hunger is associated with a higher energy intake in obese middle-aged women (Lindroos et al., 1997), but has not been shown to independently predict body size. While the influence of habitual dietary intake, CR, disinhibition, and hunger on body fatness and weight gain over time has been extensively investigated in young and middle-aged adults, there is little information regarding differences in dietary behaviors associated with successful body weight management in older compared with young nonobese adults. Previous work in this area has not accounted for age-related changes in BMI or activity level. Energy intake dysregulation has been observed with advancing age (Rolls et al., 1995; Van Walleghen et al., 2007), thus weight stable, nonobese older adults may engage in dietary behaviors which permit them to successfully manage their weight in spite of a physiological susceptibility to energy overconsumption. Therefore, the purpose of this study was to determine if there are differences in eating behaviors, specifically habitual dietary intake, CR, disinhibition and hunger, in older as compared to young adults while accounting for variations in physical activity level and BMI.
2. Methods 2.1. Subjects Sixty healthy, nonobese (BMI b 30 kg/m2) young (1835 years) and older (6080 years) adults were studied. One female subject with a BMI above this cutpoint (BMI = 31) was included based upon her low body fat percentage (23.5%). All subjects were nondieting and weight stable (within 2 kg of current weight for N12 months). Individuals with chronic diseases (diabetes, thyroid disorders, cancer, cardiovascular, disease, etc), smokers and pregnant or lactating women were excluded. Subjects were screened for eating disorders (Eating Attitudes Test (EAT-26) score b20) (Garner, Olmsted, Bohr, & Garfinkel, 1982) and depression (Centers for Epidemiological Studies Depression Scale (CES-D) score b35) (Radloff, 1977), did not drink excessively (b 2 drinks/day) and were not taking medications known to influence food intake or body weight. The sample included 32 men and 28 women, who were participants in energy balance studies at two sites (Virginia Tech, University of Colorado at Denver Health Sciences Center). Investigations received Institutional Review Board approval prior to study initiation. 2.2. Measurements Height (m) was measured without shoes using a wall mounted stadiometer, and weight (kg) was measured using physician's balance scale. BMI was calculated from height and weight measurements (kg/m2). Body composition was measured using dual energy X-ray absorptiometry (DEXA) (GE Lunar Prodigy, GE Healthcare). Habitual dietary intake was assessed using four day, selfreported food intake records. Subjects were instructed in methods to accurately record their dietary intake by a research dietitian.

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Energy and macronutrient intake was determined using nutritional analysis software (NDS-R 5.0, University of Minnesota). Habitual physical activity level, which included both planned activities (jogging, swimming, lifting weights) and unplanned activities (housework, yardwork, etc), was determined using self-reported minutes per week engaged in moderate and vigorous activity. Intensity was self-rated on a scale of 110 (low intensity, 13; moderate, 46; vigorous, 710). Individuals were considered physically active if they participated in N 150 min of moderate and vigorous physical activity per week; this classification is based upon recommendations for minimum amounts of physical activity to promote and maintain health in adults (Haskell et al., 2007). Estimated resting energy expenditure (REE) was calculated using the Mifflin equation (Frankenfield, Rowe, Smith, & Cooney, 2003). Estimated habitual total daily energy expenditure (TEE) was calculated by multiplying estimated REE by an activity factor based on physical activity group (active, 1.75; sedentary, 1.3) (Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients), 2002). To estimate relative degree of dietary underreporting, the percent difference in estimated TEE minus reported energy intake was calculated. To assess CR, disinhibition and hunger, each subject completed the Three Factor Eating Questionnaire (TFEQ) (Stunkard & Messick, 1985). These three dimensions of eating behaviors assessed using this tool (Stunkard & Messick, 1985) are described as follows: Factor I, the cognitive control of eating behavior; Factor II, disinhibition of control; and Factor III, susceptibility to hunger. This tool may be used to distinguish dieters (e.g., individuals actively restricting their food intake in order to reduce their weight) from free eaters (e.g., individuals who do not seem to consciously control their food intake)(Factors I, II), as well as binge eating tendency/severity (Factors II, III). 2.3. Statistical analysis Young and older subjects were pair-matched by physical activity level (active or sedentary), sex and BMI. Independent samples t-test were used to assess age group differences in TFEQ factors, energy and macronutrient intake, and body composition (SPSS v. 12.0 for Windows). Univariate analysis of variance (ANOVA) was used to test for age group sex interactions, and paired samples ttests were used to compare TEE with self-reported energy intake. Associations among variables were assessed by simple correlational analyses (Pearson's r). Data are expressed as mean SEM. 3. Results Physical and behavioral characteristics of our sample are provided in Table 1. Complete four day food intake records were available for 30 young and 25 older adults, and body composition data was available for 29 young and 23 older adults. As planned, BMI and habitual physical activity level were not significantly different between age groups. Body fat percentage and CR scores were significantly higher in the older compared to the younger adults, while hunger scores in older adults were significantly lower than those of the young adults (see Table 1). There were no age group sex interactions for CR (P = 0.563) or hunger (P = 0.058). There were no significant group differences in energy intake (Table 1) absolute and relative macronutrient intake (Table 1, Fig. 1).
Table 1 Physical and behavioral characteristics of young and older nonobese adults Young (16M, 14F) a Age, years Height, cm Weight, kg BMI, kg/m 2 Body fat, % Cognitive restraint score Disinhibition score Hunger score Habitual physical activity, min/wk b Estimated daily TEE, kcal/ d Reported habitual daily intake Total energy, kcal Fiber, g Fat, g Carbohydrate, g Protein, g 25 0.8 170 2 71.0 1.9 24.6 0.4 23.2 1.8 4.9 0.7 4.10 0.50 5.0 0.6 297 70 2419 24 2129 117 18.4 7.8 77.9 6.0 275.6 15 79.9 6.0 Older (16M, 14F) 68 1 167 4 73.8 3.1 24.7 0.4 29.2 1.8 7.7 0.7 3.90 0.45 2.8 0.4 247 69 2096 77 2013 100 23.3 7.2 74.2 5.3 254.3 13 76.0 4.0 P b0.0001 0.481 0.403 0.753 0.025 0.004 0.765 0.004 0.612 0.010 0.465 0.020 0.635 0.302 0.605

Data are presented as mean SEM. a M, males; F, females. b Reported weekly minutes engaged in moderate + high intensity activity. c Total Energy Expenditure, calculated using the Mifflin equation.

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Fig. 1. Reported dietary macronutrient composition of young and older nonobese adults.

Estimated TEE was significantly higher than self-reported energy intake (P = 0.002), which persisted after excluding subjects who reported a daily energy intake lower than their estimated REE. Dietary underreporting of energy intake in this sample was calculated to be 7.9 +/- 3.2% of estimated TEE; degree of underreporting was not associated with BMI (r = 0.14, P = 0.314), age (r = 0.13, P = 0.348) or minutes per week of habitual physical activity (r = 0.18, P = 0.196). However, the association of CR with degree of underreporting approached statistical significance (r = 0.26, P = 0.058).

4. Discussion The major findings of our investigation are that CR is significantly greater and susceptibility to hunger is significantly less in older compared with young weight stable, nonobese adults. Importantly, this finding cannot be attributed to age group differences in BMI or physical activity level. We did not detect age differences in habitual energy or macronutrient intake, with the exception of dietary fiber. These data suggest that nonobese older adults may adopt some dietary behaviors, particularly increased CR, which permit them to successfully manage their weight with advancing age. While our finding of increased CR may be a psychological weight management strategy in older adults, reduced hunger may be due to physiological changes associated with aging. Previous work has demonstrated that older adults have a reduced sensitivity to sensations of hunger and fullness (Moriguti et al., 2000; Roberts & Rosenberg, 2006; Rolls et al., 1995; Van Walleghen et al., 2007). Despite being associated with greater body fatness in young women (Hays et al., 2002), CR also has a mediating effect on the natural tendency for weight gain with age (Hays et al., 2002; Roberts & Williamson, 2002). The results of our study suggest that the combination of increased CR and decreased hunger allow healthy, nonobese adults to avoid excessive weight gain with advancing age. Although it was surprising that reported energy intake did not differ significantly between young and older adults, this could be attributed to the pair matching process which accounted for three important factors determining energy requirements (physical activity level, BMI and sex). Energy requirements are often thought to decline with advancing age, but it is possible that this reduction may not be significant after accounting for physical activity level, which often declines in older adults. Thus, our findings suggest that nonobese young and older adults of the same sex, BMI and physical activity level eat similar diets despite a significant age difference. There are several limitations of the present study that should be acknowledged. First, reported energy intake was less than calculated TEE, which suggests the possibility of dietary underreporting. Interestingly, we did find that degree of underreporting may be related to CR, as suggested by van Strien et al. (van Strien et al., 2006). Secondly, the cross-

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sectional design of our study does not permit the determination of longitudinal changes in eating behaviors with advancing age. Nevertheless, our findings suggest that aging adults who increase their level of CR may avoid substantial weight gain with advancing age. In summary we found that older, nonobese adults exhibit more CR and less hunger than young, nonobese adults. These adaptations may facilitate body weight management with advancing age. We found that energy and macronutrient intake in sex, BMI and physical activity-matched young and older adults was similar, possibly indicating that changes in dietary energy and macronutrient intake are not necessary to avoid age-related weight gain. Future weight management intervention studies directed toward older adults should test the possibility that increased CR is a useful behavioral strategy to facilitate weight management. References
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