Double Trouble: Energy Density and Portion Size Combine to Increase Preschool Children's Lunch Intake

Little is known about the effects of typical variations in meal energy density (ED; kcal/g) and portion size on preschool children's intake. We investigated responses to meals that were varied in ED and portion size using foods often served in preschools. In a crossover design, lunch was served in 3 childcare centers once a week for 6 weeks to 120 children aged 3‐5 years (14% overweight or obese). For the 6 meals, all items were served at 2 levels of ED (100 or 142%) and 3 levels of portion size (100, 150, or 200%). Lunch items were either lower‐ or higher‐ED commercially available versions of chicken, macaroni and cheese, vegetable, applesauce, ketchup, and milk. Children's ratings of the foods showed that the lower‐ED and higher‐ED items were equally well liked. Varying the ED of food and milk did not affect the total weight consumed across meals; however, serving larger portions significantly increased the weight eaten at both the lower‐ and higher‐ED meals (P<0.0001). Meal energy intake was found to be independently affected by ED and portion size (both P<0.0001). Increasing meal ED by 42% led to a 40% increase in energy intake and doubling portions led to a 24% increase. These effects combined to increase intake by 177±12 kcal or 80% in the meal with the higher ED and largest portions compared to the lower‐ED meal with the smallest portions. Large portions of high‐ED foods are likely to contribute to childhood obesity by promoting the overconsumption of energy. Since the differences in ED did not affect ratings of liking, these results suggest that preschool children could be offered lower‐ED versions of some commonly consumed foods in order to moderate energy intake. Supported by NIH R01‐DK082580 and USDA 2011‐67001‐30117.