Hunger can be taught: Hunger Recognition regulates eating and improves energy balance

Figures & data

Figure 1 Estimated versus measured blood glucose of trained subjects (hollow red circles; n = 18) and control (untrained) subjects (hollow black circles; n = 42) reporting to be hungry at the final laboratory investigative session.

Notes: Linear correlation was significant for the trained data (red dashed line; r = 0.92; P = 0.0001) but not for the control data (black dashed line; r = 0.29, P = 0.06). Image courtesy of Ciampolini M, Bianchi R. Training to estimate blood glucose and to form associations with initial hunger. Nutr Metab (Lond). 2006;3:42.³²

Figure 2 Estimated versus measured blood glucose of trained subjects with measured blood glucose < 87 mg/dL at the final session.

Notes: Below this value, 18 subjects reported the EHS (hollow red circles) and 14 subjects reported inanition only but not EHS (filled black squares). These 14 subjects showed an average estimation error of 4.5% ± 3.1% of the measured blood glucose, which did not significantly differ from the estimation error of the 18 trained subjects who reported the EHS (3.2% ± 2.4%; P = 0.20). Linear regression was significant for the hungry subjects reporting EHS (dashed red line; r = 0.92; P = 0.0001) but not for those not reporting EHS (solid black line; r = 0.18; P = 0.54). Image courtesy of Ciampolini M, Bianchi R. Training to estimate blood glucose and to form associations with initial hunger. Nutr Metab (Lond). 2006;3:42.³²
Abbreviation: EHS, Empty Hollow Sensation.

Figure 3 Difference of mean preprandial BG after training versus BG at recruitment for each trained subject.

Copyright © 2011, Dove Medical Press Ltd. Reproduced with permission from Ciampolini M, Sifone M. Differences in maintenance of mean blood glucose (BG) and their association with response to “recognizing hunger.” Int J Gen Med. 2011; 4:403–412.²¹

Notes: Column height shows 5 months after pretraining mean BG difference in each trained subject. Significant increases are indicated by blue bars, significant decreases by red bars, and not significant changes by black bars. Mean BG is reported in sequentially increasing order at recruitment, not in linear correlation with segment length on the X-axis scale. The range of mean blood glucose values at recruitment is indicated by the minimum and maximum values for the first and last subjects (large arrows). The vertical dashed line indicates the most significant division between subjects who showed no mean BG decrease after training (low BG group, n = 34) and those who showed significant decrease of mean BG (high BG group, n = 55; Chi-squared analysis: P = 0.00001). This threshold blood glucose at recruitment (demarcation point) is 81.8 mg/dL (4.5 mmol/L) at recruitment in the randomized controlled studies. Subjects above this threshold accounted for most of the improvements in weight and insulin resistance.^35,36
Abbreviations: BG, blood glucose; HBG, high blood glucose; LBG, low blood glucose.

Table 1 Effects of heavy outdoor work† in 27 trained subjects who remained with high blood glucose at investigation end

	6 HBG†	21 HBG‡
Mean BG (mg/dL)	86.4 ± 4.0	87.1 ± 5.3
Final insulin AUC (mU L^−13h^−1)	124 ± 26	207 ± 99**
Final BG AUC (mg dL^−13h^−1)	536 ± 56	601 ± 82*
Insulin sensitivity index	11.4 ± 2.9	6.68 ± 4.0***
Beta-cell function index	1.29 ± 0.66	1.43 ± 1.22

Notes: Values are expressed as mean ± standard deviation.

* P < 0.05;

** P < 0.01;

*** P < 0.001 (Student’s t-test);

† six HBG subjects reported full days of heavy manual labor in an outdoor environment during a cold winter season. Their reports and measurements suggested that they had complied with the Initial Hunger Meal Pattern. There were no significant differences in the five above parameters at study end from recruitment (mean BG at recruitment = 86.9 ± 5.3 mg/dL). At study end they showed higher insulin sensitivity than the other 21 subjects in the face of a pre-meal BG at study end that was statistically no different from that of the other 21 subjects (87.1 ± 5.3 mg/dL for the 21 subjects);

‡ the 21 HBG subjects included 15 that were low BG after 7 weeks training (at clinical assessment) and six who had higher mean BG than 100 mg/dL at recruitment.

Copyright © 2011, Dove Medical Press Ltd. Reproduced with permission from Ciampolini M, Sifone M. Differences in maintenance of mean blood glucose (BG) and their association with response to “recognizing hunger.” Int J Gen Med. 2011; 4:403–412.²¹

Abbreviations: AUC, area under the curve; BG, blood glucose; HBG, high blood glucose.

Table

Appetite	The desire to eat
Blood glucose estimation
During training	Writing the expected blood glucose value immediately before measuring the blood sample by glucometer
After training and validation	Evaluating one’s own current blood glucose value without measurement
Hunger Recognition	The meal pattern whereby initial hunger is recognized
Initial hunger	Low blood glucose-associated hunger: the empty hollow sensation and/or inanition at their first appearance
Initial hunger meal pattern	A meal pattern in which initial hunger and low blood glucose is present pre-meal for most meals
Inanition	Fatigue or light-headedness associated with lack of food: “A condition of exhaustion resulting from lack of nourishment” (definition from: New Shorter Oxford English Dictionary, 1993)
Migrating motor complex	A cycle of quiescence and contractions of the stomach and small intestine
Phase III contractions	A series of high-amplitude contractions, which form part of the migrating motor complex

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