614

meals totalling 1320 calories. Good results were reported,though they cannot strictly be compared with those of thepresent study because of the concomitant use of tri-iodothyronine and diuretics, and because the patientswere not selected for refractoriness to the usual dietaryrestrictions. But the concept is contrary to that impliedin the success of " two meals per day " dieting, andfurther investigation is required. The results, however,may simply indicate the necessity for breaking the badfeeding habits acquired by the obese, the method of

achieving this being immaterial.Summary

The results are reported of a trial of a 1000-calorie dietgiven for 12 weeks as two 500-calorie meals each day tothirty-four patients with refractory obesity.The mean loss of weight was 8-9 lb., whereas over the

same months in previous years the same patients hadgained an average of 3-4 lb. The mean weight loss wasgreater than that achieved by several anorectic agents insimilar patients, and it was much the same as that observedduring treatment with formula diet if allowance is madefor the difference in the time of year when the trials wereconducted.The patients who adhered strictly to the regimen showed

a mean weight loss of 11-0 lb., and they experienced noreal difficulty with hunger.The two-meals-per-day regimen thus appears to be an

acceptable form of dieting for obese patients.We are grateful to Miss E. M. Wilson for preparing the diets and

for considerable assistance with the study.REFERENCES

Duncan, L. J. P., Rose, K., Meiklejohn, A. P. (1960) Lancet, i, 1262.Gordon, E. S., Goldberg, M., Chosy, G. J. (1963) J. Amer. med. Ass. 186, 50.Hollifield, G., Parson, W. (1962) J. clin. Invest. 41, 245.Seaton, D. A., Duncan, L. J. P. (1963) Brit. med. J. ii, 219.- - Rose, K., Scott, A. M. (1961) ibid. i, 1009.- Rose, K., Duncan, L. J. P. (1964a) Practitioner (in the press).- - - (1964b) Scot. med. J. (in the press).

Sohar, E. (1959) Amer. J. clin. Nutr. 7, 514.

THE FREQUENCY OF MEALSITS RELATION TO

OVERWEIGHT, HYPERCHOLESTEROLÆMIA,AND DECREASED GLUCOSE-TOLERANCE

P. FÁBRYM.D. Prague

Z. HEJLM.D. Prague

J. FODORM.D. Prague

T. BRAUNM.D. Prague

KAMILA ZVOLÁNKOVÁIng. Mathem. Stat.

From the Institute of Human Nutrition and Institute forCardiovascular Research, Prague 4, Czechoslovakia

EXPERIMENTS on animals have shown that the time-distribution of food intake has metabolic effects. If ratsare given their food in larger amounts at longer intervals

TABLE II-SKINFOLD THICKNESS IN RELATION TO FREQUENCY OF MEALSData are expressed as group averages ± standard deviation. The

number of men investigated is shown in parentheses.

* Evaluated by Student’s t-test.

they display a number of adaptive changes, including notonly alterations in overall energy metabolism (Fabry et al.1963) but also more rapid absorption of glucose and fatfrom the intestine, increased glycogen synthesis, and astriking increase of lipogenesis review Fabry et al. 1962b,Cohn 1963, 1964, Tepperman and Tepperman 1964.Moreover, investigations on volunteers indicate an inverserelation between meal frequency and blood-lipid level

(Cohn 1961, 1964, Gwinup et al. 1963a) and a decreasedglucose-tolerance when all the food is taken in a singlelarge daily meal (Gwinup et al. 1963b). So far as meal

frequency is concerned, however, little is yet known aboutthe consequences of different dietary habits in peopleunder normal living and working conditions.We describe here a survey of 440 men, aged 60-64, in

which body-weight and height, skinfold thickness, serum-cholesterol level, and glucose-tolerance were related tofrequency of food intake.

Methods

The subjects investigated were selected at random torepresent the male population of that age-group in anurban district of Prague. 61 were excluded because theyhad diseases or conditions which call for a special dietinfluencing the meal frequency (e.g., diabetes, peptic ulcer,gastrectomy).The number of meals per day was ascertained at inter-

view with a trained dietitian. The subjects were dividedinto those reporting that they ate three meals or less perday (group I); those who ate three to four meals (group II);those who ate three to four meals with snacks betweenthem (group III); those who ate three to four meals withan additional snack before bedtime (group iv), and finallythose who ate five meals or more (group v).The triceps and subscapular skinfold were measured with a

calliper. The glucose-tolerance was assessed from the blood-sugar level two hours after oral administration of glucose (1 g.per kg), or (in half the subjects examined) in combination withprednisone administered in two 10 mg. doses eight hours andhalf an hour before the glucose.The following upper limits of " normal " values were used

arbitrarily for body-weight, serum-cholesterol, and glucose

TABLE I-INCIDENCE OF OVERWEIGHT, HYPERCHOLESTEROLaeMIA, AND DIMINISHED GLUCOSE-TOLERANCE (FOR CRITERIA SEE TEXT)IN RELATION TO FREQUENCY OF MEALS

The number of men investigated is shown in parentheses.

* Additional snacks between meals. t Additional snack at bedtime. t Evaluated by the x2 test.

615

tolerance: 10% overweight (calculated according to the index100 x body-weight [kg.] Jheight [cm.] above 100 cm.); 260 mg.serum-cholesterol per 100 ml. (i.e., average+ standard deviationQf the value for men of the corresponding age-group in Czecho-slovakia) (Kfikava et al. 1962); and a blood-sugar level up to120 mg. per 100 ml. or 200 mg. in the prednisone-sensitisedtest.

Results

Table I shows that, on the above criteria overweight,hypercholesterolasmia, and diminished glucose-tolerancetend to increase as the frequency of meals decreases. Thedifference between the extreme groups (I and v) is in allparameters statistically significant. In keeping with theincidence of overweight is the skinfold thickness (table 11),which is greatest in group i and smallest in group v. Fromtable I it is moreover apparent that the proportion of menwith normal " values for body-weight, serum-choler-sterol, and glucose-tolerance) is low in group but riseswith meal frequency.

Discussion

These findings are in keeping with those in a group of89 engine-drivers aged 30-50 in which somatometric andbiochemical data were related to diet as assessed by theinventory method. Here too there was an inverse relationbetween meal frequency, on the one hand, and overweight,skinfold thickness, and cholesterol/phospholipid ratio onthe other-even though the group with the lowest mealfrequency had the lowest caloric intake (Hejda and Fabry).

In a previous paper Holeckova and Fabry (1959) pointedout that a regimen in which periods of fasting alternatewith overeating resembles that commonly seen in wildanimals. An enhanced ability to form metabolic reserves,which in the rat is the typical consequence of intermittentfood intake (Fabry 1955, Fabry 1962a and b) is a biologicallyand ecologically useful adaptation. Nevertheless, underconditions when the demands for energy are considerablylimited, these adaptations-e.g., enhanced lipogenesis,or increased release of insulin by the pancreas (Mosingeret al. 1961)-could be pathogenic, promoting for instanceobesity or a relative insufficiency of pancreatic P-cells.May not this be also true for man, who throughout longages adapted himself to fighting for food and existence butis now living under the very different conditions of urbancivilisation ?

Summary379 men aged 60-64 were grouped according to the

frequency of food intake. Excessive weight, increasedserum-cholesterol, and diminished glucose-tolerance wereall significantly commoner among those who took threemeals a day (or less) than among those who took five meals(or more). Men consuming three to four meals, with orwithout additional snacks, showed intermediate values.The technical assistance of Mrs. V. Cerna, Miss V. Sajlerova, and

Mrs. D. Vrbova is gratefully acknowledged.REFERENCES

Cohn, C. (1961) J. Amer. diet. Ass. 38, 433.- (1963) Ann. N.Y. Acad. Sci. 110, 395.- (1964) Fed. Proc. 23, 76.

Fábry, P. (1955) Physiol. Bohemoslov. 4, 33.- Petrásek, R., Braun, T., Bednárek, M., Horáková, E., Konopásek, E.

(1962a) Experientia, 18, 555.- - Horáková, E., Konopásek, E., Braun, T. (1963) Brit. J. Nutr.

17, 295.- - Kujalová, V., Holečková, E. (1962b) Adaptace na zm&ebreve;n&ebreve;ny příjem

potravy (Adaptation to Changed Pattern of Food Intake). Prague.Gwinup, G., Byron, R. C., Roush, W. H., Kruger, F. A., Hamwi, G. J.

(1963a) Amer. J. clin. Nutr. 13, 209.— — — — — (1963b) Lancet, ii, 165.

Hejda, S., Fábry, P. Nutr. Dieta (in the press).Holečková, E., Fàbry, P. (1959) Brit. J. Nutr. 13, 260.Křikava, L., Hejda, S., Hátle, J., Mašek, J., Ošancová, K., Neradilová, M.

(1962) Čs. gastroent. vÝž. 16, 184.Mosinger, B., Kujalová, V., Lojda, Z. (1961) IVe Congr. Féd. int. Diabète,

Geneva.Tepperman, H. M., Tepperman, J. (1964) Fed. Proc. 23, 73.

SERUM-LIPID LEVELS IN A BRAZILIANINDIAN POPULATION

D. PAZZANESE O. P. PORTUGALM.D. São Paulo M.D. São Paulo

O. L. RAMOS A. A. C. FINATTIM.D. Sao Paulo PHARMACIST

W. LANFRANCHI H. P. C. B. BARRETOM.D. São Paulo M.D. Sao Paulo

D. R. SUSTOVICHM.D. São Paulo

From the Medical School, Federal University of São Paulo, andInstitute of Cardiology of the São Paulo State, Brazil

IN the central region of Brazil (latitude 11° S., longitude53-54° W.) there lives an Indian population that forgeographical reason has had very little contact withcivilisation, and has therefore kept to the same habits oflife for many centuries.To assess the prevalence of atherosclerosis among them,

we chose 31 men and 22 women for physical examinationand electrocardiography, and oscillometry of the leg-arteries. At the same time blood was drawn for chemical

assay of the main lipid fractions and for ultracentrifugaldetermination of the low-density lipoproteins.

Population SampleWe judged the age of each individual by physical appearance,

by the probable age of the descendants, and by other indirectmethods. We chose only those who were supposedly over30 years of age. On these arbitrary criteria (the only onespossible) 8 subjects were in the third decade, 22 in the fourth,15 in the fifth, 7 in the sixth, and only 1 in the seventh decadeof life. The men and women were in general small, with a meanbody-surface area of l-58iLO-l sq. m. for the men and1.41+0.41 sq. m. for the women. Yet they showed no apparentsigns of undernutrition, and the men had good musculardevelopment.Ethnology

Several attempts to classify the Indians proved unfruitful,but finally they were separated in to 4 groups (Tupi, Ge,Aruaque, and Caraibas) on the basis of the similarity of thelanguage spoken. Most belonged to the Tupi group, and theothers to the Ge and Aruaque groups.The tribes live relatively close to each other and eat almost

the same kind of,food. The Indians in the Ge group devote lesstime to farming.Food

It was impossible to estimate the total caloric intake and theproportion of the three main constituents in the diets.

Animal protein.-The main source of animal protein is fish.More rarely the people hunt, and, when they do, fowl is theirchoice. An additional source of animal protein is representedby insects and larvae. As a general rule they eat some animalprotein practically every day. The fish or the fowl is cookeddirectly in the fire with no oil or fat. They do not drink milk.

Vegetable protein and carbohydrates.-The Indians cultivatecorn, manioc, peanuts, and sweet potatoes reasonably well.They eat all these in the raw state or directly after being cookedon the fire without fat. The sources of rapidly absorbedcarbohydrates are mainly honey, sugar-cane, bananas, andnative fruits.Fat.-The diet is obviously very low in fat content. No fat

is used for preparing the food; no milk or dairy products areeaten, and the only sources of fat in the diet are meat andpeanuts.

Spices.-No spices are used in cooking.Salt.-No sodium chloride is ever used. The people some-

times prepare potassium chloride, which is used not as a spicein food but mainly as hors d’ceuvres.

Finally, it must be emphasised that Indians do not havescheduled hours for meals; they eat all day long, following no