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Appl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by Laurentian University on 10/28/17
For personal use only. This Just-IN manuscript is the accepted manuscript prior to copy editing and page composition. It may differ from the final official version of record.
Page 1 of 32
A Randomized, Controlled, Cross-over Study of Appetite-related Sensations after
Consuming Snacks made from Buckwheat
Danielle M. Defries1, Jay C. Petkau2,3, Terri Gregor4 and Heather Blewett2,3,5,6
Affiliations
1
Department of Kinesiology and Applied Health, University of Winnipeg, 515 Portage Avenue,
Winnipeg, Manitoba, R3B 2E9, Canada, email: [email protected]
2
Agriculture and Agri-Food Canada, Morden Research and Development Centre, 101 Route 100,
Unit 100, Morden, Manitoba, R6M 1Y5, Canada
3
Canadian Centre for Agri-Food Research in Health and Medicine, St. Boniface Hospital
Albrechtsen Research Centre, 351 Taché Ave, Winnipeg, Manitoba, R2H 2A6, Canada, email:
[email protected]
4
St. Boniface Hospital, 409 Taché Avenue, Winnipeg, Manitoba, R2H 2A6, Canada, email:
[email protected]
5
Department of Human Nutritional Sciences, 209 Human Ecology Building, University of
Manitoba, Winnipeg, MB, R3T 2N2, Canada
6
Department of Physiology and Pathophysiology, 432 Basic Medical Sciences Building, 745
Bannatyne Avenue, University of Manitoba, Winnipeg, Manitoba, R3E 0J9, Canada
Corresponding author: Heather Blewett
I.H. Asper Clinical Research Institute
CR3131-369 Taché Ave
Winnipeg, MB
R2H 2A6
Tel: 204-237-2954; Fax: 204-231-1236; email: [email protected]
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ABSTRACT
With the rising incidence of overweight and obesity in developed countries, there is an
interest in developing food products that may aid in satiety and reduce energy intake.
Buckwheat is a gluten-free edible seed that has been previously shown to induce changes in postprandial concentrations of satiety hormones; however, subjective measures of appetite-related
sensations and objective measures of energy intake at subsequent meals following buckwheat
consumption have not been measured. Thirty eight healthy adults were recruited to participate in
a randomized, controlled, cross-over trial with the main objective to determine if consuming
snacks made from buckwheat would increase satiety and reduce energy intake compared to
snacks comparable in serving size, physical characteristics, and nutrient composition. Water was
included as a no kilocalorie control. Participants received each of the treatments once separated
by at least 7 days. Appetite related sensations were assessed using visual analog scales at fasting
and after consuming the snack at 30 minute intervals for 180 minutes. Lunch was provided at
the clinic and the amount of food consumed was weighed. Participants recorded food intake for
the rest of the day. Consuming buckwheat groats (32g serving; 141kCal) or pita bread made
from buckwheat flour (50g serving; 135kCal) was not associated with changes in appetite related
sensations or energy consumption compared to reference snack products made from corn or rice
flour. Sensory questionnaires revealed that snacks made from buckwheat were liked to a similar
degree or more as reference snack products, which shows commercial promise for developing
buckwheat-containing snacks.
KEY WORDS: satiety, appetite-related sensations, buckwheat, snacks, energy intake
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INTRODUCTION
Overweight and obesity are significant public health concerns in developed countries
driven by an imbalance between energy intake and energy expenditure. Although the root causes
of overweight and obesity are multifaceted and complex, greater availability and consumption of
processed, energy dense foods has likely contributed to the nearly doubling of global obesity
since 1980 (World Health Organization 2017). In addition, increased eating frequency or
snacking may contribute to the risk of overweight and obesity if additional calories consumed are
not offset by a reduction in energy intake at future eating occasions (Piernas and Popkin 2010).
However, previous studies have shown that snacking and increased eating frequency can
favourably modify body weight, body composition, and biomarkers for cardiovascular disease
risk (Ma et al. 2003; Njike et al. 2016; Titan et al. 2001; Jenkins et al. 1989). These beneficial
effects may be due to the potential for snacking to promote satiety, the feeling of fullness that
persists after eating, thereby preventing excessive energy intake at subsequent meals.
Identifying snack foods that encourage satiety without considerably increasing overall
energy intake may represent a strategy to aid in weight management (Benelam 2009). Several
foods and nutrients have been studied for their potential to promote satiety and among these,
high protein and high fibre foods have shown strong satiety effects compared to snacks with
higher carbohydrate or fat content (Chapelot 2011). Buckwheat is a broad-leafed herbaceous
annual plant that is often treated as a cereal crop, although botanically it is not a grain. Research
previously has demonstrated that consumption of a snack food product made from buckwheat
flour leads to higher post-prandial plasma concentrations of satiety hormones released from the
gastrointestinal tract (Stringer et al. 2013). While these gastrointestinal hormones are known to
mechanistically promote satiety by interacting with satiety centres in the hypothalamus and have
3
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been used as an objective measure of satiety, changes in gastrointestinal hormones do not always
correlate with subjective assessments of satiety or measures of food intake (Mattes and Hollis
2008). Unfortunately, this study assessed neither subjective measures of satiety nor objective
measures of energy consumption during subsequent meals; therefore, the effect of consuming
foods made with buckwheat on satiety and appetite remains unknown. The current study was
designed to provide preliminary information on the satiating effect of snack foods made with
buckwheat in support of a government-approved health claim relating to satiety for front of label
packaging. The primary objective was to assess appetite-related sensations and energy intake
after consuming snack products made from buckwheat.
MATERIALS AND METHODS
Study Design and Participants
The study was designed according to recommendations contained in Health Canada’s Draft
Guidance Document on Satiety Health Claims on Foods (Health Canada 2012). The trial was a
single site, randomized, controlled, cross-over study conducted at the I.H. Asper Clinical
Research Institute in Winnipeg, Manitoba, Canada, from June 2013 to August 2014. Winnipeg
is the largest and capital city of the Province of Manitoba, with a population of approximately
793,000. Participants were recruited using print advertisements posted within the I.H. Asper
Clinical Research Institute and the affiliated St. Boniface Hospital, local community newspapers,
as well as through electronic newsletters distributed to hospital and University staff. Interviews
were also done on local TV news about the study. Interested individuals contacted study staff
and completed a telephone pre-screening interview to assess initial eligibility criteria. Eligible
participants were generally healthy males and females between the ages of 20 and 70, with a
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body mass index (BMI) between 18 and 30 kg/m2. Exclusion criteria included pregnancy or
lactation, daily tobacco use, irregular meal consumption, food allergy or an aversion or
unwillingness to eat the study foods, use of any prescription medication or non-prescription drug,
herbal or nutritional supplement known to affect appetite, changes in medication (dose or type)
or occurrence of a medical event requiring hospitalization in the previous three months, presence
of a gastrointestinal disorder, score >65% on any 1 of the 3 categories of the Three Factor Eating
Questionnaire-R18 and/or intensity of physical activity at work or during leisure time considered
moderate or higher. Intensity of physical activity was assessed using a validated questionnaire
(Johansson and Westerterp 2008).
Those meeting initial eligibility criteria were provided with a copy of the informed
consent form and invited to attend an in-person study overview visit to obtain further details on
study procedures and participant responsibilities. Those wishing to enroll in the study provided
informed consent, after which their height and weight were measured to confirm self-reported
BMI. Participants were then administered the Three-Factor Eating Questionnaire-R18 (TFEQR18), a validated tool used to assess three aspects of eating behaviour: cognitive restraint,
emotional eating, and uncontrolled eating (de Lauzon et al. 2004). A score of 65% or higher on
any one of the three categories of the TFEQ-R18 was considered indicative of disordered eating
and was cause for exclusion.
The study examined the satiating effect of two distinct snack products made from
buckwheat: (1) a snack product made with roasted buckwheat groats (seed study), and (2) a
snack product made with a mixture of buckwheat and pinto bean flours (pita study). Eligible
participants could choose to participate in either or both of the seed and pita studies. For the
seed study, participants received each of the following snacks once, separated by at least 7 days,
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in random order: roasted buckwheat groats (test snack); corn nuts (reference snack); water
(energy-free control). For the pita study, participants received each of the following snacks once
separated by at least 7 days in random order: pita bread made from buckwheat/pinto bean flour
(test snack); rice bread (reference snack); water (energy-free control). Treatment order was
randomly generated by a computer, sealed in sequentially numbered opaque envelopes, and
assigned to participants by study staff at the first study visit.
To obtain a power of 0.80, a sample size of 38 participants per group was necessary to
detect an anticipated 10% difference in appetite ratings between foods. Participants who
dropped out of the study before completion were replaced with a new participant who received
the same treatment order.
Test and reference foods
Due to the differences in physical properties of the two buckwheat containing snacks, the
overall study was composed of two separate studies including product-appropriate control foods,
and results were analyzed separately. The first test food was a snack product made from roasted
buckwheat groats, comparable to a crunchy, seed-based snack. It was formulated and produced
by the Food Development Centre in Portage La Prairie, Canada. The reference food chosen for
the buckwheat groats was commercially-available corn nuts, matched for physical form, and
carbohydrate and lipid content. The second test snack was a gluten-free pita bread made from a
mixture of buckwheat flour and pinto bean flour, comparable to a standard pita bread. To
produce the buckwheat/pinto bean flour, whole buckwheat was stone milled then sieved to 30
mesh to remove hull fragments. Whole pinto beans were impact milled and was sieved to
“regular grind” 20 mesh. The respective flours were combined in a 2:1 ratio of pinto and
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buckwheat flour. The pita was formulated and produced at the Department of Food Science at
the University of Manitoba and the Canadian International Grain Institute in Winnipeg, Canada.
Because the test pitas were gluten-free, the reference product chosen was a commerciallyavailable gluten-free rice bread. Nutrient composition of the test and reference snack foods is
presented in Table 1.
Study visits
On the day of study visits, participants were asked to consume their typical breakfast between
07:00 and 08:00. The participants recorded the breakfast they ate the morning of their first visit,
and were directed to consume the same food items in the same quantity before each study visit.
Participants arrived at the study centre at 09:45, at which time they completed a baseline visual
analogue scale (VAS) to assess hunger, fullness, desire to eat, and prospective food
consumption. The appropriate snack food and 100 mL of water were then presented to
participants, who consumed the snack within 15 minutes. Participants completed a VAS
questionnaire at 30 minute intervals up to 180 minutes after the first bite of the snack.
Participants were allowed to engage in any activity that they desired during the visit, but were
discouraged from conducting strenuous physical activity and were asked to remain awake. At
13:00, participants were presented with a pre-weighed, standardized lunch consisting of soup,
yogurt, a cookie, a fruit cup, and a beverage. Participants were instructed to eat until they felt
full, and could request more food. Uneaten food was weighed and recorded and compared to the
weight of food given to the participant to determine the amount of energy and macronutrients
consumed at lunch. Before leaving the study centre, participants were given a food diary and
asked to record the amount and type of each food and beverage consumed for the remainder of
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the day and asked to provide this information to study staff the next day. Energy consumed at
lunch and for the remainder of the day were quantified from food consumed at lunch and food
diaries using Food Processor Nutrient Analysis Software version 11.0.137 database 11.0.3
(ESHA Research, Salem, OR). Food records were independently entered by two individuals.
Assessment of appetite and satiety quotient
Subjective appetite was measured using a questionnaire that included 4 questions: (1)
“how hungry are you?”; (2) “how full are you?; (3) “how strong is your desire to eat?”; and (4)
“how much do you think you would want to eat right now?”. Each question was followed by a
10 cm line anchored at the left and right ends by the opposing statements “not at all” and
“extremely” for questions 1 and 2, “very weak” and “very strong” for question 3 and “nothing at
all” and “a very large amount” for question 4. Participants indicated their responses by marking
a perpendicular line on the 10 cm line. Scores were determined by measuring the distance in cm
from the left anchor to the perpendicular line. An average appetite score based on answers to the
4 appetite related questions was calculated at each time of measurement for each snack food, as
previously described (Anderson et al. 2002). Overall assessments of hunger, fullness, desire to
eat, and prospective food consumption were calculated by graphing the VAS or appetite scores
over time, and calculating area under the curve (AUC) using the trapezoidal method (Purves
1992).
The satiety quotient, a measure of the satiating efficiency of a food based on its energy
content, was calculated as previously described (Green et al. 1997). Briefly, the difference
between appetite related sensations before and after consuming the snacks was divided by the
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energy content of the portion of the snack consumed. The satiety quotient was calculated for
each of the 30 minutes intervals after the snack products were consumed.
Sensory questionnaires
To determine if the test snack foods and corresponding reference snack foods were
similarly liked, participants completed sensory questionnaires at each visit. Liking of the study
products was assessed using a 5-point hedonic scale (1 = dislike extremely; 2 = dislike very
moderately; 3 = neither like nor dislike; 4 = like moderately; 5 = like extremely) for appearance,
aroma, flavor, taste, texture, and overall liking. To assess willingness to consume the snack
products, participants completed a 5-point successive-category food action rating scale
containing two questions. The first question assessed participant willingness to continue
consuming the study products after completing the study. The second question provided a
definition and example of a health claim approved for placement on food packages in Canada,
and asked participants to indicate their willingness to consume the study product if they
contained a health claim linking consumption of study products to increased satiety. Responses
on the food action rating scale were: 1 = I would eat this every opportunity I had; 2 = I would
frequently eat this; 3 = I would eat this if available, but would not go out of my way; 4 = I would
hardly eat this; 5 = I would eat this only if I was forced to.
Data and statistical analyses
Statistical analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC).
Data from the seed study and pita study were analyzed independently. Differences in AUC for
appetite related sensations and average appetite score were assessed using analysis of covariance
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(ANCOVA) using the Proc GLM procedure, with the following sources of variation included in
the model: snack, visit number, baseline score, visit number x snack, and snack x overweight.
Participants with a BMI between 18.5 and 24.9 were classified as normal weight, while those
with a BMI between 25.0 and 29.9 were considered overweight. ANCOVA was also used to test
the hypothesis of no effect of snack on energy consumption and ratings from the sensory and
food action rating scales with the following sources of variation included in the model: snack,
visit number, visit number x snack and snack x overweight. If a significant main effect or
interaction was found, differences among means were determined using the pdiff option for the
lsmeans statement. Tukey-Kramer was used to adjust p-values for multiple comparisons. Proc
Mixed repeated measures analysis was used to determine the effect of time, snack and their
interaction, with snack as a fixed effect and participant as a random variable for satiety quotient.
Paired T-tests were used to determine significant differences between FACT scores with and
without a health claim. Results were considered statistically significant at p<0.05. Data are
presented as lsmean ± SEM.
RESULTS
Participant demographics and participant flow
In total, 289 people were assessed for eligibility. Of these, 87 chose not to participate after
hearing the detailed description of the study, 152 were determined to be ineligible from the initial
phone screen and study overview visit, and 4 people withdrew after signing the informed consent
form but prior to their first study visit. Of the 46 people that completed the study, 30 people
completed both studies and 16 decided to only participate in 1 study. Therefore, thirty-eight
participants were randomized to complete the seed study and 38 to complete the pita study;
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however, in the seed study, 1 participant was removed from all analyses due to non-compliance,
and 1 removed from analysis of energy intake for the remainder of the day due to a missing food
record. In the pita study, 1 participant was removed from all analyses due to non-compliance,
and 3 removed from analysis of energy intake for the remainder of the day due to missing food
records. Participant characteristics are presented in Table 2.
Appetite related sensations and satiety quotient
Ratings for appetite related sensations at each time point as well as AUC for the seed study and
pita study are presented in Figures 1 and 2. Statistical analysis was not performed on ratings at
single time points (Figure 1A-E and Figure 2A-E) as recommended by Blundell et al. (2010). In
the seed study, there was no significant difference between the buckwheat groats and corn nuts in
AUC for hunger, fullness, desire to eat, prospective consumption, or average appetite score
(Figure 1F). As anticipated, hunger, desire to eat, prospective consumption, and average appetite
score were significantly lower (p<0.0001) and fullness significantly higher (p<0.0001) after
consuming the buckwheat groats or corn nuts compared to water (Figure 1F). A similar pattern
of results was observed for the pita study: while there were no differences in appetite related
sensations between the buckwheat pita and rice bread, hunger, desire to eat, prospective
consumption, and average appetite score were significantly lower (p<0.0001) and fullness
significantly higher (p<0.0001) after consuming the buckwheat pita and rice bread compared to
after consuming water (Figure 2F). The effect of buckwheat on appetite related sensations in
both the seed and pita studies was not altered when adjusted for baseline ratings or weight status.
AUC at 60, 90, 120, and 150 min had the same pattern of results for both the seed study and the
pita study (data not shown).
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When examining the satiety quotient for the buckwheat groats, only a significant effect of
time was detected (p<0.0001; Table 3). However, for the buckwheat pita, there was a significant
effect of time (p<0.0001) and snack (p=0.0002) on satiety quotient, where the buckwheat pita
had a higher satiety quotient at every time point compared to rice bread.
Energy consumption
Figure 3 presents the data for energy intake at lunch, for the remainder of the day following the
study visits, and also the total energy intake when snacks, lunch, and the remainder of the day
were combined.
In the seed study, there was no significant difference in energy consumed at
lunch, for the remainder of the day, or when the snack, lunch, and remainder of the day were
combined (Figure 3A). In the pita study, energy consumed at lunch, energy consumed over the
rest of the day, or combined energy intake from the snack, lunch, and remainder of the day were
not different after consuming any of the study foods in the pita study (Figure 3B). In both
studies, weight status did not affect energy intake at any of the times measured.
Sensory evaluation and willingness to consume study products
The buckwheat groats and corn nuts were similarly liked by participants for appearance, aroma,
taste and overall acceptability, but the texture of the buckwheat groats was rated higher
(p=0.0004) than the corn nuts (Table 4). There were no significant differences in sensory ratings
among the products in the pita study. For the food action rating scale, a lower number indicates
that a food would be eaten more often. There was no difference in mean food action rating scale
scores between the buckwheat groats and corn nuts for likelihood of consuming the study foods
if they were available after the study (3.08 ± 0.16 vs. 3.46 ± 0.16, respectively) or the likelihood
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of consuming the study products if they contained a government approved health claim relating
to satiety (2.76 ± 0.15 vs. 3.04 ± 0.15). Similar results were found for the pita study, as there
were no significant differences in mean scores for likelihood of consuming the study foods if
they were available after the study (2.87 ± 0.14 vs. 3.03 ± 0.14 for the buckwheat pita and rice
bread, respectively) or if they contained a health claim relating to satiety (2.53 ± 0.14 vs. 2.67 ±
0.14 for the buckwheat pita vs. rice bread, respectively). Participants indicated that the
likelihood of consuming the study product if they contained a government approved health claim
relating to satiety would be higher than if a health claim was not present (3.08 ± 0.16 without a
claim vs. 2.76 ± 0.15 with a claim for buckwheat groats, p=0.0033; 3.46 ± 0.15 without a claim
vs. 3.03 ± 0.16 with a claim for corn nuts, p=<0.0001; 2.84 ± 0.15 without a claim vs. 2.51 ±
0.15 with a claim for buckwheat pita, p=0.0033; 3.03 ± 0.12 without a claim vs. 2.68 ± 0.13 with
a claim for rice bread, p=0.0074).
DISCUSSION
Consuming snack foods that enhance satiety could potentially benefit those seeking to
manage or reduce their weight by curbing excess energy intake. The current study was designed
to evaluate the satiety effects of snack foods made from buckwheat in support of a governmentapproved satiety health claim for front of label packaging. We show that consumption of two
separate snack products made from whole buckwheat or buckwheat flour does not affect
subjective appetite related sensations or post-snack energy consumption when compared to
similar commercially-available snack foods. Buckwheat contains several nutrients that have
been linked to satiety and release of gastrointestinal satiety hormones, such as protein and fibre
(Njike et al. 2016; Pais et al. 2016). In our previous study (Stringer et al. 2013), serving sizes of
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the test and reference snack foods were formulated to deliver 50 grams of available carbohydrate
per serving, and as a result, protein content of the buckwheat snack was significantly higher than
in the reference snack in that study. Since both protein and fibre have been shown to promote
satiety, use of two snack products in the current study allowed us to assess the relative
contribution of fibre versus protein to the potential satiety effects of buckwheat snacks, since the
buckwheat groats contained higher protein and the buckwheat pita contained higher fibre
compared to their respective reference snack foods. However, because this study was designed
to evaluate specifically snack foods, portion sizes had to reflect realistic snack-sized portions and
the differences in protein and fibre content between buckwheat snacks and reference snacks in
the small snack sized portions were modest. It is possible that the lack of difference in appetiterelated sensations observed in the current study occurred because higher fibre and protein
content were not of great enough magnitude to elicit an effect on appetite and hunger.
The small serving size of the snack products combined with the timing of the ad libitum
meal is likely the main reason we did not observe effects on satiety in the current study. For
many of the appetite related sensations measured, we observed a return to baseline values by 60
to 90 minutes after consuming the snack products, while the ad libitum lunch meal wasn’t served
until 3 hours after consuming the snack. We chose to serve the ad libitum meal 3 hours after
consuming the snack products to follow the recommendations in Health Canada’s Draft
Guidance Document on Satiety Claims on Foods; however, this period of time is likely too long
to detect differences in subsequent food intake when testing foods with small serving sizes.
Other studies have also demonstrated that timing and satiety signals are not prolonged when
small serving sizes of foods are examined. Twenty grams of yellow pea protein added to tomato
soup was able to reduce food intake when an ad libitum meal was served 30 minutes after
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consuming the soup, but not when the meal was served 2 hours after (Smith et al. 2012). In
another study of yellow peas, appetite scores and food intake were not affected two hours after
consuming yellow peas as part of a standardized mixed meal (Wong et al. 2009); however, the
same serving of yellow peas suppressed appetite and reduced food intake after 4 hours (Mollard
et al. 2011). Collectively, these results suggest that foods may elicit changes in appetite and
food intake in a time-dependent manner. Location of the endocrine cells producing
gastrointestinal satiety hormones within the gastrointestinal tract may explain some of these
time-dependent effects. L-cells secreting the satiety hormones glucagon-like peptide-1 and
peptide YY are most dense in the distal intestine, but are present in the proximal intestine as
well, and activation of these different cell populations may lead to temporal differences in
satiety. Activation of L-cells by nutrients present in the proximal small intestine can lead to
early increases in GLP-1 concentrations and corresponding short-term feelings of satiety (Pais et
al. 2016), while stimulation of L-cells in the distal intestine, potentially by nutrients or, in the
case of fibre, their fermentation products, causes later GLP-1 secretion and a more delayed
increase in satiety.
To effectively promote weight loss, a snack food would ideally promote satiety to the
extent that food intake at other meals is reduced and an energy deficit created. Moreover,
consuming a snack should reduce energy intake at future meals by a value at least equal to the
energy content of the snack itself if an overall increase in total energy intake is to be prevented.
In the current study, we found that consuming snacks made from buckwheat did not reduce
energy intake at lunch or for the remainder of the day. Previous studies have also demonstrated
that snacking does not necessarily lead to changes in energy balance, even if feelings of satiety
are enhanced by the snack. For example, consuming peanuts as a snack has been shown to
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promote satiety, but does not lead to significant changes in energy balance (Alper and Mattes
2002). Interestingly, yogurt supplemented with whey protein consumed as a snack was able to
reduce energy intake at an ad libitum lunch compared to other yogurts, without altering appetiterelated sensations (Doyon et al. 2015).
An important aspect of satiety studies is ensuring that the test and reference food products
are similarly liked by participants, as differences in liking can affect acceptability and
willingness to eat the study products (Yeomans et al. 2004). In our cohort of participants, both
products made from buckwheat were liked similarly for attributes such as appearance, aroma,
taste, and overall liking compared to reference snacks, indicating overall consumer acceptability
of snack products made from buckwheat. Although the likelihood of participants purchasing the
snacks made from buckwheat after study completion was the same as the reference snacks,
participants indicated they would be more likely to purchase any of the snack products if they
contained a government-approved health claim relating to satiety.
The current study has several strengths and limitations. The crossover design strengthens
the validity of our results by minimizing variation due to between-subjects factors. Inclusion of
an energy-free control increases our confidence that the study was adequately powered to detect
differences in appetite-related sensations, because we were able to detect a difference in this
outcome between the snack foods and energy-free control. However, we were unable to detect a
difference in food intake between the water and the snacks. This could be due to the timing of
the food intake measurement, the composition of the lunch meal or participants eating their usual
portion size instead of eating until full. Measurements were included to ensure similar liking of
the snack foods by participants to reduce the likelihood of conscious non-consumption. Test and
reference foods were, to the best of our abilities, matched for composition, physical form, and
16
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Page 17 of 32
food category (i.e. all could be considered snack foods). However, this last point also leads to
one of the biggest limitations of the study: because of the relatively small serving size of these
snack foods, it was challenging to find reference snacks comparable in physical form that
contained a similar nutrient profile, while having a significantly lower protein or fibre content
compared to the buckwheat snacks. Furthermore, although including both male and female
participants is a strength because it increases the generalizability of our results, visits for female
participants were not scheduled at the same phase of the menstrual cycle and fluctuations in
female reproductive hormones known to influence food intake and satiety may have introduced
confounding factors into the study (McNeil and Doucet 2012).
In conclusion, neither a 32 gram portion of a snack product made from whole buckwheat
nor a 50 gram portion of a snack product made from buckwheat flour appear to affect appetite or
energy intake compared to comparable commercially-available snack foods in healthy adults.
However, results from this study alone should not discourage further research studies examining
the satiety effects of snack foods made from buckwheat, as further research is needed to
determine if larger serving sizes, or higher amounts of protein and/or fibre from buckwheat
products would lead to enhanced feelings of satiety and reduced energy intake. This is especially
relevant in light of the results that participants would purchase novel snack products made from
buckwheat if they contained a government-approved health claim relating to satiety.
CONFLICT OF INTEREST STATEMENT
The authors report no conflicts of interest associated with this manuscript.
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Page 18 of 32
ACKNOWLEDGMENTS
The authors would like to thank the Manitoba Agri-Health Research Network, Pulse growers and
Buckwheat growers for providing the funding for this study. We would also like to thank all the
research volunteers who participated in this trial and Brett Hiebert for his guidance with the
statistical analysis
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Table 1. Nutrient composition of snack foods used in the seed and pita studies
Serving size (g)
Energy (kCal)
Fat (g)
% total energy
Carbohydrate (g)
% total energy
Fibre (g)
Protein (g)
% total energy
Sodium (mg)
Seed study
Corn nuts
32.0
141.0
5.4
33.0
23.0
65.0
2.6
3.2
9.0
0.0
Pita study
BW groats
30.0
140.0
4.5
29.0
20.0
57
1.0
4.0
11.0
1.0
Rice bread
50.0
138.0
6.0
39.0
19.0
55.0
1.7
3.4
10.0
241.0
BW pita
50.0
135.0
2.3
16.0
25.0
80.0
2.6
3.6
11.0
182.0
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Table 2. Participant characteristics
Age (years), mean (range)
Sex (M/F)
Body weight (kg), mean (range)
BMI (kg/m2), mean (range)
Ethnicity, n (%)
White
South Asian (East Indian, Pakistani, Sri Lankan)
Black
Filipino
Latin American
Arab
South East Asian (Vietnamese, Cambodian, Laotian, Thai)
West Asian (Iranian, Afghan)
Energy intake at breakfast (kCal), mean (range)
Seed Study
37.7 (20-67)
10/28
67.3 (49.5-93.0)
24.8 (18.7-30.4)
Pita Study
33.5 (20-67)
11/27
66.2 (52.0-93.0)
24.4 (18.7-30.4)
26 (68.4%)
1 (2.6%)
5 (13.1%)
3 (7.9%)
1 (2.6%)
3 (7.9%)
1 (2.6%)
2 (1.3%)
346.2 (15.8-980.4)
22 (57.9%)
2 (5.3%)
8 (21.1%)
3 (7.9%)
1 (2.6%)
3 (7.9%)
1 (2.6%)
0 (0.0%)
381.1(66.7-873.2)
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Table 3. Satiety quotient calculated for hunger from the seed study and pita study
Source of Variation
F-value (p-value)
Time Point (min)
t30
t60
t90
t120
t150
t180
BW groats
0.005
(0.003)
0.002
(0.003)
-0.004
(0.003)
-0.011
(0.003)
-0.019
(0.003)
-0.025
(0.003)
Corn nuts
0.006
(0.003)
0.002
(0.003)
-0.004
(0.003)
-0.009
(0.003)
-0.015
(0.003)
-0.022
(0.003)
BW Pita
0.007
(0.003)
0.004
(0.003)
-0.002
(0.003)
-0.007
(0.003)
-0.015
(0.003)
-0.020
(0.003)
Rice Bread
0.007
(0.003)
0.012
(0.003)
-0.004
(0.003)
-0.013
(0.003)
-0.017
(0.003)
-0.025
(0.003)
Time
Snack
TxS1
55.49
(<.0001)
1.64
(0.201)
0.40
(0.847)
109.39
(<.0001)
13.98
(0.0002)
0.62
(0.616)
Seed Study
Pita Study
1
TxS = time x snack interaction.
Values are mean hunger rating pre-eating episode-hunger rating post eating episode/kcal of eating episode. Data are presented as
lsmean ± SEM (n=37). Proc Mixed repeated measures analysis was used to determine the effect of time, snack and their interaction,
with snack as a fixed effect and participant as a random variable. BW=buckwheat
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Table 4. Sensory ratings of study products
Seed Study
Corn nuts
BW groats
Pita Study
Rice bread
BW pita
Appearance
3.49 ± 0.16
3.57 ± 0.16
3.74 ± 0.14
3.81 ± 0.14
Aroma
3.34 ± 0.11
3.40 ± 0.11
3.39 ± 0.10
3.45 ± 0.10
Taste
3.23 ± 0.20
3.57 ± 0.20
3.67 ± 0.15
3.66 ± 0.15
Texture
2.64 ± 0.19
3.66 ± 0.19*
3.36 ± 0.19
3.49 ± 0.19
Overall
3.05 ± 0.18
3.48 ± 0.18
3.58 ± 0.14
3.64 ± 0.15
Values represent participants’ mean ratings for each attribute measured using a 5 point
hedonic scale with 1= dislike extremely; 2= dislike moderately; 3= neither like or
dislike; 4= like moderately; 5= like extremely.
Data are presented as lsmean ± SEM (n=37).
*
denotes significantly different from corn nuts (F=14.07, p=0.0004) using ANCOVA and differences in lsmeans
after using the Tukey-kramer adjustment for multiple comparisons. BW=buckwheat.
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Figure 1. Appetite related sensations during the seed study. During study visits, ratings for
appetite related sensations of hunger, fullness, desire to eat, and prospective consumption for
each of the snacks was measured using a 10 cm visual analogue scale at the indicated time points
(A-D), and an average appetite score was calculated (F). Appetite score was calculated at each
individual time point as follows= (hunger rating + (100-fullness rating) + desire to eat rating +
prospective consumption rating)/4. Area under the curve (AUC) for appetite related sensations
and appetite score was calculated (E). AUC for appetite related sensations and average appetite
score were assessed using ANCOVA using the Proc GLM procedure, with the following sources
of variation included in the model: snack, visit number, baseline score, visit number x snack, and
snack x overweight. For hunger, there was a significant effect of snack (F=15.77, p<0.0001).
For fullness, there was a significant effect of snack (F=17.23, p<0.0001) and a significant
interaction between snack and visit (F=2.79, p=0.0303). For desire to eat, there was a significant
effect of snack (F=16.93, p<0.0001) and a significant interaction between snack and visit
(F=3.12, p=0.0185). For prospective consumption, there was a significant effect of snack
(F=13.7, p<0.0001) and a significant interaction between snack and visit (F=2.63, p=0.0386).
For average appetite score, there was a significant effect of snack (F=17.61, p<0.0001) and a
significant interaction between snack and visit (F=2.78, p=0.0307). Data are lsmean ± SEM
(n=37). Lsmeans with different letters are statistically significant after using the Tukey-kramer
adjustment for multiple comparisons (p<0.05).
Figure 2. Appetite related sensations during the pita study. During study visits, ratings for
appetite related sensations of hunger, fullness, desire to eat, and prospective consumption for
each of the snacks was measured was measured using a 10 cm visual analogue scale at the
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Page 28 of 32
indicated time points (A-D), and an average appetite score was calculated (F). Appetite score
was calculated at each individual time point as follows= (hunger rating + (100-fullness rating) +
desire to eat rating + prospective consumption rating)/4.
Area under the curve (AUC) for
appetite related sensations and average appetite score was also calculated (E). AUC for appetite
related sensations and average appetite score were assessed using ANCOVA using the Proc
GLM procedure, with the following sources of variation included in the model: snack, visit
number, baseline score, visit number x snack, and snack x overweight. For hunger, there was a
significant effect of treatment (F=22.51, p<0.0001) and a significant interaction between
treatment and visit (F=2.92, p=0.025). For fullness, there was a significant effect of treatment
(F=20.18, p<0.0001). For desire to eat, there was a significant effect of treatment (F=22.34,
p<0.0001). For prospective consumption, there was a significant effect of treatment (F=25.04,
p<0.0001) and a significant interaction between treatment and visit (F=2.55, p=0.0439). For
average appetite score, there was a significant effect of treatment (F=26.94, p<0.0001) and a
significant interaction between treatment and visit (F=2.62, p=0.0394). Data are lsmean ± SEM
(n=37). Lsmeans with different letters are statistically significant after using the Tukey-kramer
adjustment for multiple comparisons.
Figure 3. Energy intake at lunch, for the remaining day, and sum of snack, lunch, and
remaining day (S+L+R) energy intake during the seed sub-study (A) and pita sub-study
(B). Energy intake at lunch was determined by weighing, and energy intake for the remainder of
the day determined from self-reported food records. Data were analysed by ANCOVA using the
Proc GLM procedure, with the following sources of variation included in the model: snack, visit
number, visit number x snack, and snack x overweight. Data are mean ± SEM (n=37 and 36 for
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lunch and remaining day, respectively, in the seed sub-study; n=37 and 34 for lunch and
remaining day, respectively, in the pita sub-study).
3
3
2
2
1
1
0
0
0
30
30
30
60
60
60
90
90
90
120
120
120
150
150
150
180
C
E
31
30
29
28
27
26
25
24
180
0
10
9
9
8
8
7
6
7
5
4
3
3
2
2
1
1
33
32
0
180
0
1200
800
30
0
b b
60
30
a
a a
90
60
b
120
90
120
a
b b
ite
4
Ap
pe
t
5
e
7
on
su
m
6
ire
8
7
C
BW groats
es
Corn nuts
D
8
Fullness (cm)
9
es
s
0
Water
Fu
lln
Hunger (cm)
10
un
ge
r
10
Consume (cm)
0
AUC (cm x min)
Desire (cm)
A
H
Average Appetite Score (cm)
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Figure 1
B
10
9
6
5
4
D
6
5
4
150
180
150
180
F
6000
Corn nuts
5500
BW groats
Water
5000
a
b b
4500
a
b b
400
0
3
2
2
1
1
0
0
0
30
30
30
60
60
60
90
90
90
120
120
120
150
150
150
180
C
6
5
4
3
E
29
28
27
26
180
0
10
9
9
8
8
7
7
2
2
1
1
180
0
30
1200
a
800
a a
b b
a
b
b b
0
ite
4
Ap
pe
t
5
e
7
on
su
m
6
C
8
7
ire
BW Pita
es
Rice bread
D
8
Fullness (cm)
9
es
s
0
Water
Fu
lln
Hunger (cm)
10
un
ge
r
10
Consume (cm)
0
AUC (cm x min)
Desire (cm)
A
H
Average Appetite Score (cm)
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Figure 2
B
10
9
6
5
4
3
D
6
5
4
3
0
30
60
90
120
150
180
0
30
60
90
120
150
180
F
6000
5500
Water
Rice bread
BW Pita
5000
a
b b
4500
a
25
b b
24
400
Energy intake (kCal)
Energy intake (kCal)
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Figure 3
A
2100
1800
0
0
Water
Corn nuts
BW groats
1500
1200
900
300
200
100
Lunch
Lunch
Remaining day
2100
Remaining day
S+L+R
B
Water
Rice bread
BW pita
1800
1500
1200
900
300
200
100
S+L+R
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