EE: Old and Very Old Populations (2006)


Kinabo, JL, Durnin JVGA. Effect of meal frequency on the thermic effect of food in women. Eur J Clin Nutr. 1990; 44: 389-395.

Study Design:
Non-Randomized Controlled Trial
C - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:

To examine the effect on thermic effect of food (TEF) of 2 factors:

  1. Meal composition: high-carbohydrate-low fat (HCLF) and low-carbohydrate-high-fat (LCHF)
  2. Energy content of the ingested meal: 2520 kJ (600 kcal) and 5040 kJ (1200 kcal).


  • Steady state: Not addressed
  • Post-prandial Metabolic Rate (PPMR): Mean values over 6 hrs
  • BMR: Use of term BMR in these publications matches projects definition of RMR, will use RMR in evidence summary.
Inclusion Criteria:
  1. 1. Understand and give written consent
  2. 2. Healthy non-obese women,
  3. Take no medication at the time of study.
Exclusion Criteria:
  1. Refusal to consent
  2. Not meeting inclusion criteria.
Description of Study Protocol:

Outcome(s) and other measures

  1. Basal metabolic rate
  2. 5 h thermic effect of food (TEF).

Blinding used: No

Data Collection Summary:

Each subjects consumed 4 different test meals on separate occasions. The order of the presentation of the meals was randomized.

Assessment of BMR was performed before and after meal.


  • Ht, Wt, BMI, body fat, fat free mass (FFM)


  • Monitored heart rate? No
  • Body temperature? No
  • Medications administered? No

Resting energy expenditure

  • IC type: open circuit IC using Douglas bag techniques
  • Equipment of Calibration: Yes, using standard gas mixtures
  • Coefficient of variation using std gases: No
  • Rest before measure (state length of time rested if available): 30 min
  • Measurement length: baseline: 2 10-min; after intervention: 3 10-min and 5 20-min assessments
  • Steady state: Not addressed
  • Fasting length: overnight
  • Exercise restrictions XX hr prior to test? No
  • Room temp: 18°C
  • No. of measures within the measurement period: after intervention 8 measures in 300 min
  • Were some measures eliminated? No
  • Were a set of measurements averaged? Yes ( 2 10-min were average for RMR baseline)
  • Coefficient of variation in subjects’ measures? Yes
  • Training of measurer? Not addressed
  • Subject training of measuring process? Not addressed


HCLF (meal A: 600kcal; meal C: 1200 kcal)

70% CHO

19% fat

11% PRO

LCHF (meal B: 600kcal; meal D: 1200 kcal)

24% CHO

65% fat

11% PRO

Intervening factor:

Description of Actual Data Sample:

18 healthy non-obese females aged 22±1.5, range 18-34. (See note above)

Statistical tests

  • 2x2 factorial analysis of variance
  • Student’s paired T-test
Summary of Results:

Descriptive (Mean±SE)

  • Eur J Clin Nutr (6-hr measures)
  • Total: 18 Females

8 F
10 F

Age, y

24±2 20±2.4
Wt, kg 55.2±1.5 57.2±2.4

BMI, kg/m2


Fat-free body mass



Body fat, %



Thermic Effect of Food (TEF) (% Energy Intake)

The mean BMR value for subjects who consumed a high CHO, Low Fat meal (Group A; n=8) was 0.90±0.04 kcal/min and for those who consumed a Low CHO, High Fat Meal (Group B; n=10) was 0.91±0.04 kcal/min.


(TEF increase above baseline RMR)

The overall 6-h postprandial metabolic rate values in subjects who consumed the High CHO, Low Fat meal were 1.15±0.02 kcal/min for one large meal (1200 kcal) and 1.12±0.02 kcal/min for the two 600-kcal meals eaten 3 hrs apart.


(TEF increase above baseline RMR)

The overall 6-h postprandial metabolic rate values in subjects who consumed the Low CHO, High Fat meal were 1.15±0.01 kcal/min for one large meal (1200 kcal) and 1.12±0.02 kcal/min for the two small meals eaten 3 hrs apart.

Group mean 6-h thermic effect of food values after consuming one large, Low CHO, High Fat meal was 85±5.5 kcal and 81.0±3.8 kcal for two small meals.


Group mean 6-h thermic effect of food values after consuming one large, High CHO, Low Fat meal was 90±7.2 kcal and 91.0±6.3 kcal for two small meals.

There was no significant (P=0.57) effect of meal composition on TEF. In the feeding regimen of two meals, there was a significant increase in TEF after the second meal was consumed (HCLF, p=0.012; LCHF, P=0.001).

There were no significant differences in the overall 6-h post-prandial metabolic rates between the two feeding regimens (HCLF, P=0.56; LCHF, P=0.20)


The 6 h-TEF values expressed as % of ingested energy were 7.5±0.6 and 7.6±0.5% for ONE 1200 kcal High CHO, Low fat meal and TWO small High CHO, Low fat meals, respectively.

The 6 h-TEF values expressed as % of ingested energy were 7.1±0.5 and 6.8±0.3% for ONE large Low CHO, High fat meal and TWO small Low CHO, High fat meals, respectively.

No significant differences were observed between either the two feeding regimens or between the two meal compositions.



(5 and 6 h measure)N=18


?Fat ?Fat

Time 0 Baseline, kcal/min (Table 1)

1266 kcal/d 1298 kcals/d

0.90 0.90

kcal/min increase ABOVE basal metabolic rate

8 10

Time 5:

~300 min 0.17 0.22

[Taken from Figure 1 in Eur J Clin Nutr, 1980; Did NOT use 300 minute post-prandial data due to inability to verify with discussion section and Table 1].

Time 6:

~370 min 0.12 0.17

[Taken from Figure 1 in Eur J Clin Nutr, 1980; Used 370 minute post-prandial data due to verification with discussion section and Table 1].

SIX HOUR MEASURE [Using the Eur J Clin Nutr with 8 individuals in High CHO, Low fat group and 10 individuals in Low CHO, High Fat Group]

In Table 1, the group mean RMR (kJ/d) in the High CHO, Low Fat group was 5295 kJ/d (1266 kcal/d) and 5429 kJ/d (1298 kcal/d) in the Low CHO, High Fat group.

Subsequently, a 6-hour postprandial measure for a High CHO, Low fat diet (n=8) was 0.5 kJ/min (0.12 kcal/min) and 0.8 kJ/min (0.19 kcal/min) for Low CHO, High fat. Therefore, on average, the 6-hr postprandial RMR was 172 and 240 kcals ABOVE baseline group mean, respectively.

Author Conclusion:

“The results of the present investigation have shown that the frequency of eating meals has no significant influence on the TEF of mixed meals; there was no difference in the 6-h TEF values between one large meal and the combined two small meals.

“The TEF calculated for the feeding regimen of two meals showed that the TEF of the second meal resulted in significantly higher values than that of the first meal in both groups of subjects.”

[Analyst note: Not appraised at this time]

“In spite of the 6 h measurement period in the present study, post-prandial metabolic rate was still 13-27% above pre-meal levels at the end of 6 hours suggesting that total TEF was underestimated in both feeding regimens. Total and accurate measurement of TEF is difficult to achieve. Nevertheless, the proportion of TEF that was NOT measured in this study represented a small fraction of total TEF.

In the 6-h TEF study, the TEF calculated for the feeding regimen for two meals showed that the TEF of the second meal resulted in significantly higher values than that of the first meal in both groups of subjects... this suggests there was a superimposition of the TEF of the first meal onto the second meal but the total TEF did not differ significantly higher than that of a single meal regimen... [and] that under an average feeding pattern of three meals/day, the TEF of one meal merges into the TEF of the next meal, but the overall TEF per day is related to the total energy ingested.
Funding Source:
University/Hospital: University of Glasgow, Sokoine Unviersity of Agriculture (Tanzania)
Reviewer Comments:


  • Inter-subject variability was assessed.
  • Randomization of the sequence of the test meals was performed.
  • Measurement protocol was described in detail.


  • Generalizable only to healthy women.
  • Physical activities, menstrual cycles were not considered in the analysis.
  • Limitations were not discussed.
  • The High CHO, Low Fat diet group had only 8 subjects and were given one large (1200 kcal) or two small (600 kcal) High CHO, Low Fat meals. Due to the importance of capturing the thermic effect of food over the measurement duration of 6 hours. This subgroup was reported.
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? N/A
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? N/A
  1.3. Were the target population and setting specified? N/A
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? N/A
  2.2. Were criteria applied equally to all study groups? N/A
  2.3. Were health, demographics, and other characteristics of subjects described? N/A
  2.4. Were the subjects/patients a representative sample of the relevant population? N/A
3. Were study groups comparable? Yes
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? No
  4.1. Were follow-up methods described and the same for all groups? N/A
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) N/A
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? N/A
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) N/A
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? N/A
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? N/A
  7.2. Were nutrition measures appropriate to question and outcomes of concern? N/A
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? N/A
  7.5. Was the measurement of effect at an appropriate level of precision? N/A
  7.6. Were other factors accounted for (measured) that could affect outcomes? N/A
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? No
  8.1. Were statistical analyses adequately described and the results reported appropriately? N/A
  8.2. Were correct statistical tests used and assumptions of test not violated? N/A
  8.3. Were statistics reported with levels of significance and/or confidence intervals? N/A
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? N/A
  8.6. Was clinical significance as well as statistical significance reported? N/A
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? No
  9.1. Is there a discussion of findings? N/A
  9.2. Are biases and study limitations identified and discussed? N/A
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? N/A
  10.2. Was the study free from apparent conflict of interest? N/A