Effects of chewing on appetite, food intake and gut hormones: A systematic review and meta-analysis

Aim: To conduct a systematic review of the effects of chewing on appetite, food intake and gut hormones, and a meta-analysis of the effects of chewing on self-reported hunger. Objectives: To seek insights into the relationship between chewing, appetite, food intake and gut hormones, and to consider potentially useful recommendations to promote benefits of chewing for weight management. Materials and methods: Papers were obtained from two electronic databases (Medline and Cochrane), from searches of reference lists, and from raw data collected from the figures in the articles. A total of 15 papers were identified that detailed 17 trials. All papers were included in the systematic review; however, a further five studies were excluded from the meta-analysis because appropriate information on hunger ratings was not available. The meta-analysis was conducted on a total of 10 papers that detailed 13 trials. Results: Five of 16 experiments found a significant effect of chewing on satiation or satiety using self-report measures (visual analogue scales, VASs). Ten of 16 experiments found that chewing reduced food intake. Three of five studies showed that increasing the number of chews per bite increased relevant gut hormones and two linked this to subjective satiety. The meta-analysis found evidence of both publication bias and between study heterogeneity (IA(2) = 93.4%, tau(2) = 6.52, p < 0.001) which decreased, but remained, when covariates were considered. Analysis of the heterogeneity found a substantial effect of the fasting period where the duration of fasting influenced the decrease in hunger due to chewing. Prolonged mastication significantly reduces self-reported hunger levels (hunger: 231 VAS point, 95% CI 1-4.67, 1.38], p <0.001). Conclusions: Evidence currently suggests that chewing may decrease self-reported hunger and food intake, possibly through alterations in gut hormone responses related to satiety. Although preliminary, the results identify a need for additional research in the area. Focused, uniform, experimental designs are required to clearly understand the relationships that exist between mastication, appetite, satiety, food intake and, ultimately, body weight (C) 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).