Research Original Research| Volume 121, ISSUE 3, P446-457, March 2021

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Pregnant Women Consume a Similar Proportion of Highly vs Minimally Processed Foods in the Absence of Hunger, Leading to Large Differences in Energy Intake

Published:October 24, 2020DOI:



      The eating in the absence of hunger (EAH) experimental paradigm measures intake of highly palatable, highly processed foods when sated. However, no studies have examined EAH in pregnant women.


      The objectives were to investigate whether EAH in pregnant women differs by level of food processing and to examine relationships of EAH with hedonic hunger, addictive-like eating, and impulsivity.


      EAH was assessed in a counterbalanced crossover feeding substudy in which participants completed two free-access eating occasions following a standardized meal during their second pregnancy trimester. Hedonic hunger (Power of Food Scale), addictive-like eating (modified Yale Food Addiction Scale), and impulsivity (Barratt Impulsiveness Scale-15) were assessed by self-report during early pregnancy.

      Participants and setting

      Data were collected from March 2015 through September 2016 from a subsample of participants (n = 46) enrolled at ≤12 weeks gestation in an observational, prospective cohort study (the Pregnancy Eating Attributes Study) in North Carolina.


      Participants were presented with highly processed and minimally processed foods in two separate assessments.

      Main outcome measures

      Energy intake (EAH-kcal) and percent consumed (EAH-%) (calculated as 100 × [amount consumed (g) / amount served (g)]) was measured overall and separately for sweet and savory foods.

      Statistical analyses performed

      Linear mixed models estimated the effect of condition on EAH. Hedonic hunger, addictive-like eating, impulsivity and their interaction were examined separately.


      EAH-% was similar across conditions (16.3% ± 1.1% highly processed vs 17.9% ± 1.2% minimally processed; P = 0.76), resulting in 338.5 ± 34.2 kcal greater energy intake in the highly processed vs minimally processed condition (P < 0.001). Hedonic hunger was not significantly associated with EAH; reward-related eating was positively associated with EAH-kcal and EAH-% of savory foods, and Barratt Impulsivity was positively associated with EAH-kcal and EAH-% overall, and with EAH-% of sweet foods (P < 0.05). There was little evidence of an interaction of Barratt Impulsivity with hedonic hunger or reward-related eating.


      EAH in pregnant women occurs for both highly processed and minimally processed foods and correlates positively with self-reported addictive-like eating, but not hedonic hunger. Impulsivity did not modify associations of addictive-like eating with EAH in this sample.


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      K. Burger is an assistant professor, Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill.


      L. M. Lipsky is a staff scientist, Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute for Child health and Human Development, Bethesda MD.


      M. S. Faith is a professor, Department of Counseling, School, and Educational Psychology, University at Buffalo Graduate School of Education, Buffalo, NY.


      A. M. Siega-Riz is dean and a professor, School of Public Health and Health Sciences, University of Massachusetts, Amherst; at the time of the study, she was a professor and associate dean for academic affairs, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill.


      G. E. Shearrer is an assistant professor, Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill.


      A. Liu is a senior investigator, Biostatistics and Bioinformatics Branch, Eunice Kennedy Shriver National Institute for Child health and Human Development, Bethesda, MD.


      T. Nansel is a senior investigator, Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute for Child health and Human Development, Bethesda, MD.