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The results of a number of studies suggest that the order of satiating efficiency of macronutrients is protein > carbohydrate > fat > alcohol, although this conclusion was not confirmed in one study (Raben et al., 2003). The weak effect of fat on satiety is well documented. In many studies that covertly manipulated the fat content of foods, subjects did not respond to higher fat levels in preloads with subsequent lower hunger ratings and/or lower food and energy intakes. This is a consistent finding across studies with various foods (e.g. foods with fat replacers, regular foods with high/low fat levels) (de Graaf et al., 1996) and with different groups of subjects (Rolls et al., 1994).

The low satiating efficiency of fat is confirmed in short- and long-term studies on the ad libitum energy intake and energy balance from diets with various levels of fat. These studies show that ad libitum energy intake is lower on low-fat diets than on high-fat diets (e.g. Lissner et al., 1987). Astrup et al. (2002) summarized the data from 13 clinical trials on low-fat diet and concluded that 'The evidence strongly supports the low-fat diet as the optimal choice for the prevention of weight gain and obesity.'

The results of a number of studies suggest that, per calorie, protein is the most satiating macronutrient (Raben et al., 2003). This hypothesis was confirmed in a long-term trial (Haulrik et al., 2002) in which it was shown that a high-protein diet led to a lower body weight. The results of some studies suggest that carbohydrates are more satiating than fats (Rolls and Hammer, 1995). In general, high-carbohydrate/low-fat diets lead to a lower energy intake than high-fat/low-carbohydrate diets. However, it is not clear whether this effect is related to the lower energy density of carbohydrates compared with fat. Complex carbohydrates may be more satiating than simple carbohydrates. Initial studies using complex carbohydrates, such as the exopoly-saccharide Reuteran® in low quantities, did not show a clear effect on subjective measures of hunger and satiety nor on hunger-related hormones (Blom et al., 2005). In a small additional clinical study, several tens of grams

Time (min)

Fig. 2.1 Effect of Reuteran® on hunger (VAS score is the score on a visual analog scale).

Time (min)

Fig. 2.1 Effect of Reuteran® on hunger (VAS score is the score on a visual analog scale).

of Reuteran® appeared to postpone feelings of hunger (see Fig. 2.1) and stimulate satiety, but also appeared to suppress blood glucose and insulin levels.

The effect of alcohol on satiety is difficult to investigate because alcohol has strong behavioural effects. Results of studies of de Castro and Orozco (1990) indicated that the energy intakes from meals with alcohol are on average higher than the energy intakes from meals without alcohol.

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