Eating in the Absence of Hunger Is Related to Worse Diet Quality throughout Pregnancy

Published:November 03, 2020DOI:



      Scant research has examined whether laboratory assessments of eating in the absence of hunger (EAH) relates to long-term diet quality.


      This study investigates the association of EAH with diet quality during pregnancy.


      Pregnancy diet quality was assessed using 24-hour diet recalls collected in each pregnancy trimester. EAH was assessed in a counterbalanced, crossover laboratory feeding substudy in which participants completed two free access eating occasions following a standardized meal during their second pregnancy trimester.


      Data were collected from March 2015 to December 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 (HP) and minimally processed (MP) foods in two separate assessments.

      Main outcome measures

      Scores for total Healthy Eating Index-2015 (HEI-2015) and adherence to adequacy and moderation components were calculated from the diet recalls. Higher scores reflect better diet quality.

      Statistical analyses performed

      Linear regressions estimated associations of pregnancy diet quality with EAH (energy, EAH-kcal; and percent offered, EAH-%) in each condition for all foods, and separately for sweet and savory foods.


      Lower pregnancy diet quality (all indicators) was associated with greater EAH (EAH-kcal and EAH-%) of all foods and sweet foods in the HP condition. Each 100-kcal increase in EAH of HP foods was associated with a 2- to 3-point decrease (standard error = 0.7 to 0.8) in HEI-2015 (P < 0.01); each 10% increase in EAH of HP foods was associated with a 5- to 7-point decrease (standard error = 2.0) in HEI-2015 (P < 0.01). Greater EAH (energy and percent offered) of savory food intake in the HP condition was associated with a lower HEI-2015 adequacy component score, but was not associated with the HEI-2015 or HEI-2015 moderation component scores. EAH in the MP condition was not associated with pregnancy diet quality.


      Greater EAH of HP, especially sweet, foods was related to worse pregnancy diet quality. Consuming HP sweets after meal termination may reflect a tendency for eating beyond satiation and may be a useful intervention target for improving maternal diet quality.


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      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.


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


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


      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.


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