Reducing the energy density of multiple meals decreases the energy intake of preschool-age children

Background: The energy density (ED) of an entree affects children's energy intake at a meal consumed ad libitum. However, the effects in children of changing the ED of meals over multiple days are unknown. Objective: We aimed to test the effect of reducing the ED of multiple meals on the ad libitum energy intake of preschool-age children over 2 d. Design: In this crossover study, 3- to 5-y-old children (n = 10 boys, 16 girls) were served manipulated breakfasts, lunches, and afternoon snacks 2 d/wk for 2 wk. Foods and beverages served at these meals during 1 wk were lower in ED than were those served during the other week. ED reductions were achieved by decreasing fat and sugar and by increasing fruit and vegetables. Dinner and an evening snack were sent home with children, but these meals did not vary in ED. The same 2-d menu was served in both conditions. Results: Children consumed a consistent weight of foods and beverages over 2 d in both conditions, and therefore their energy consumption declined by 389 +/- 72 kcal (14%) in the lower-ED condition, a significant decrease (P < 0.0001). Differences in energy intake were significant at breakfast on day 1, and they accumulated at manipulated meals over 2 d (P < 0.01). Intake of the nonmanipulated meals was similar between conditions. Conclusions: Children's energy intake is influenced by the ED of foods and beverages served over multiple days. These results strengthen the evidence that reducing the ED of the diet is an effective strategy for moderating children's energy intake. Am J Clin Nutr 2008; 88: 1459-68.