Journal of Gerontology: MEDICAL SCIENCES
2001, Vol. 56A, No. 4, M206–M211
Copyright 2001 by The Gerontological Society of America
Metabolic, Psychological, and Health Correlates of
Dietary Restraint in Healthy Postmenopausal Women
Gaston P. Bathalon, Nicholas P. Hays, Simin N. Meydani, Bess Dawson-Hughes, Ernst J. Schaefer,
Ruth Lipman, Miriam Nelson, Andrew S. Greenberg, and Susan B. Roberts
Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
Background. Dietary restraint, a term used to describe the intentional control of food intake to prevent weight gain
or promote weight loss, is commonly practiced by older adults, but little is known about its effects on physiology and
metabolism.
Methods. We therefore compared a wide range of parameters between groups of healthy non-obese postmenopausal
women classified psychometrically as unrestrained eaters (body mass index [BMI] 23.8 ⫾ 0.6 [SEM] kg/m2, n ⫽ 28) or
restrained eaters (BMI 24.5 ⫾ 0.5, n ⫽ 39). Measurements were made of reported micronutrient intakes, cardiopulmonary function, hematology, body temperature, skin thickness, bone mass, and immune function; in addition, self-perceived health, mood, and some dimensions of eating behavior were assessed by questionnaire.
Results. Macronutrient and micronutrient intakes were not significantly different between restrained and unrestrained eaters reporting energy intake to within 30% of predicted total energy expenditure. Restrained eaters had significantly lower hemoglobin (12.9 ⫾ 0.1 [SEM] vs 13.2 ⫾ 0.1 g/dl; p ⬍ .05), but values were within the normal range in
both groups. In addition, restrained eaters scored significantly higher on the Eating Attitudes Test ( p ⬍ .01) and drivefor-thinness ( p ⬍ .001) and maturity fears ( p ⬍ .05) subscores of the Eating Disorders Inventory, but values were again
within the normal range. No other parameter differed significantly between groups.
Conclusions. In this normal-weight population, restrained eating was not associated with detrimental effects in a
wide range of physiological, metabolic, and health characteristics. Further work is needed to determine the relevance of
these results to the general population.
T
HE psychological construct “dietary restraint” was introduced by Herman and Mack (1) to describe the
high degree of self-control in eating exhibited by some
women attempting to suppress weight gain or promote
weight loss. The instrument most commonly used to quantify dietary restraint is the Eating Inventory of Stunkard
and Messick (2), and dietary restraint is typically defined
as a score of ⱖ10 on a scale of 0 to 21, a cut-off demarcating the upper 25th percentile of restraint scores in a reference population of German women (3). Restrained eaters
typically report trying to avoid eating foods that might encourage weight gain and eating fewer calories than they
would like to eat, although the effect of these reported behaviors on measurements of energy intake remains controversial, with some studies reporting no effect of dietary restraint on the accuracy of dietary records, and others
identifying significant undereporting (3–5). Of relevance
to this controversy, Mela and Aaron (6) recently reported
that restrained eaters are more likely than unrestrained eaters to anticipate eating differently when recording dietary
intake and are also more likely to eat less than usual of
some foods and more of others.
In a recent survey of healthy U.S. women aged 55 to 65
years (7), more than 50% of the subjects were classified as
restrained eaters, a prevalence which is substantially higher
than in both the German reference population (3) and a
large U.S. population also examined in the late 1980s (8). It
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is not known whether the difference between the studies
might be due to changes in dietary restraint over time or to
the fact that the recent study was conducted in older individuals. Nevertheless, such a high prevalence of dietary restraint in an older population highlights the fact that relatively little is known about the long-term physiological,
metabolic, and health effects of what now appears to be a
very widespread dietary practice (3,9–11). Previous studies
have suggested a high prevalence of ovulatory disturbances
in restrained eaters, which are thought to accelerate bone
loss over time (10,11), as well as alterations in such basic
physiological processes as the cephalic phase response to
food (12), taste preferences (13), and cognitive function
(14). However, almost all work to date has been performed
in young women, and the long-term effects of dietary restraint are not known. Moreover, the animal literature on dietary restriction suggests that, if dietary restraint is accompanied by a persistent reduction in energy intake, there
might potentially be beneficial long-term effects of dietary
restraint, for example, reduced blood pressure and improved
blood lipid profile (15). However, to our knowledge there is
no published information relevant to the long-term positive
and negative effects of dietary restraint.
We therefore conducted a cross-sectional study to test the
hypothesis that reported that habitual dietary restraint is associated with alterations in a broad range of biological parameters in postmenopausal women.
DIETARY RESTRAINT IN HEALTHY WOMEN
METHODS
Subjects
Sixty-seven healthy postmenopausal women aged 55 to
65 years were recruited for the study by local advertisement
and mailing lists to the target population. Subjects were
classified as either highly unrestrained or highly restrained
eaters on the basis of Eating Inventory scores (2). The
scores defining the groups were ⱕ5 and ⱖ13, which are the
25th and 75th percentiles of dietary restraint determined in a
recent U.S. survey of healthy women in the same age range
as those recruited for this study (7). In addition to being categorized by level of dietary restraint, all women reported
stable body weight and dietary restraint over the past 10
years.
Subjects were judged to be free from known disorders
that might affect energy regulation, including obesity (body
mass index [BMI] ⬎31 kg/m2), underweight (BMI ⬍18 kg/
m2), diabetes, cancer, coronary heart disease, eating disorders, depression, alcoholism, inflammatory disorders, and
endocrine, hepatic, renal, and thyroid dysfunction. Individuals were also excluded from the study if they reported that
they were currently smoking, participating in endurance
training (sports or athletic training) of ⬎6 hours per week,
being on a weight loss diet during the past year, or having a
history of hypertension, psychiatric disorders, or the use of
medications known to affect energy intake or expenditure.
In addition, groups were matched for BMI.
The study was conducted in the Metabolic Research Unit
at the Jean Mayer USDA Human Nutrition Research Center
on Aging at Tufts University with ethical approval from the
New England Medical Center/Tufts University Human Investigations Review Committee. Prior to participation in
this study, each subject gave written informed consent
Study Protocol
The study was conducted over an 18-day period. Subjects
arrived at the research center on the morning of Day 1 after
an overnight fast. Measurements were made of body fat and
fat-free mass, bone mineral content (BMC), and cardiopulmonary function. In addition, blood samples were obtained
for the assessment of standard hematologic parameters and
immune function, and questionnaires were administered to
assess eating behavior, perceived health status, and mood.
Subjects then returned home and came back to the center on
the morning of Day 9 to provide a second blood sample, to
repeat measurements of vital signs and anthropometry, and
to start a measurement of delayed-type hypersensitivity
(DTH). They came back to the center a third time on the
morning of Day 11 to complete the DTH test and to repeat
anthropometric and cardiopulmonary function measurements. Sixty-one subjects also weighed and recorded all
foods and beverages consumed during study Days 11
through 17, as described elsewhere (5). On Day 18 they returned the 7-day food records to the center and were discharged from the study.
Body Fat, Fat-Free Mass, and Anthropometry
Body density was determined by hydrostatic weighing
with repeated measurements taken until at least three values
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for total body fat agreed within 1% (16–18). Total body fat
was calculated using the Siri equation (19). Two volunteers
were unable to complete the hydrostatic weighing procedure, and results from dual-energy x-ray absorptiometry
(Lunar DPX; software version 3.6Z, Lunar Corporation,
Madison, WI) were used because there were no significant
differences between data from the two methods (data not
shown).
Body weight was measured to ⫾0.01 kg (8138 Toledo
Weight-Plate; Bay State Scale Co., Cambridge, MA), with
the subject wearing a preweighed gown. Height and waist
and hip circumferences were measured in triplicate using
standard techniques (20). Skin thickness was measured in
tripicate on the back of each hand over the second, third,
and fourth metacarpals with Harpenden calipers, using the
method of Need and colleagues (21).
Cardiopulmonary Function
Subjects were asked to sit quietly for 5 minutes prior to
having their blood pressure measured using standardized indirect auscultation (22). Heart rate was also determined in
triplicate by manual monitoring of the radial pulse. Mean
arterial pressure was calculated as brachial systolic pressure ⫹ (2 ⫻ brachial diastolic pressure)/3, and pulse pressure was calculated as brachial systolic pressure ⫺ brachial
diastolic pressure. Oral temperature was also taken at the
time of blood pressure measurement with a handheld digital
thermometer.
Forced vital capacity (FVC) and forced expiratory volume in the first second of the FVC maneuver (FEV1) were
measured on Days 1 and 11 using standard procedures
(23,24). Measurements were taken in triplicate, with the
subject wearing a nose clip and sitting in a good position,
using a Water Seal Survey Spirometer, which was calibrated using a 3.0-l syringe and an Eagle II Microprocessor
(Warren E. Collins, Inc., Braintree, MA). FVC and FEV1
were corrected to body temperature pressure saturated, assuming a body temperature of 37⬚C, and taken from the best
curve, which was defined as the test meeting the recommended acceptability criteria and giving the largest values
of FVC and FEV1 (23), regardless of which curve the values
come from. Spirometric measurements were standardized
for height using the method of Burr and colleagues (25).
Blood Parameters
Fasting blood samples obtained on Days 1 and 9 were
centrifuged, and plasma and serum were stored at ⫺80⬚C
prior to analysis. Plasma lipid and lipoprotein cholesterol
concentrations were measured by standardized automated
enzymatic methods as previously described (26). Hemoglobin was measured using a Baker 9000/DF (Biochem Immunosystems, Allentown, PA), and glucose was measured by
enzymatic methodology with an automated analyzer (Cobas
Mira; Roche Diagnostic Systems, Somerville, NJ). Insulinlike growth factor 1 (IGF-1) was measured by radioimmunoassay with an IGF-1 100T kit (Nichols Institute Diagnostics, San Juan Capistrano, CA). Serum free triiodothyronine
(FT3), thyroxine (FT4), reverse triodothyronine (rT3), and
thyroid stimulating hormone (TSH) levels were also measured by radioimmunoassay (kits from Bayer Diagnostics,
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BATHALON ET AL.
Walpole, MA; Biodata Diagnostics, Cortland Manor, NY;
and Nichols Institute Diagnostics, San Juan Capistrano, CA).
Immune Function Assessed by DTH
DTH was assessed with multitest CMI (Merieux Institute,
Inc., Miami, FL), a single-use disposable application with
eight heads, each loaded with glycerine control or one of
seven recall antigens (tetanus toxoid, diphtheria toxoid,
streptococcus group C, mycobacterium tuberculosis, candida albicans, tricophyton metagrophytes, and proteus
mirabilis). A trained study nurse, who was blinded to the
eating pattern of the volunteer, applied the skin plant on the
volar aspect of the forearm. The diameter of each reaction
was taken as the mean of induration measurements determined across two diameters at right angles 48.0 ⫾ 1.0 hours
after administration of the test. A mean induration of ⱖ2
mm was considered positive. If a positive reaction to the
glycerine control was observed, the diameter of its induration was subtracted from the mean diameter of each positive
reaction. The antigen score was calculated as the total number of positive antigens, and the cumulative score was calculated as the sum of induration diameters for positive reactions (27).
BMC
Bone mineral density (BMD) and BMC were measured
in a total body scan by dual-energy x-ray absorptiometry
(Lunar Corp.) as described elsewhere (28).
Psychological Parameters
Self-administered questionnaires were completed by a
subset of the subjects (between 62 and 67, depending on the
questionnaire): the Eating Attitude Test and the Eating Disorders Inventory (29), which predict the risk of anorexia and
bulimia (note: actual diagnosis of either of these disorders
was an exclusion criterion for the study), the Profile of
Mood States questionnaire (30) for assessment of different
dimensions of mood, the Geriatric Depression Scale (31) for
specific quantification of symptoms of depression in older
individuals, and the MOS short-form health survey (32) for
determination of self-reported health status.
Statistical Analysis
Values are expressed as the mean ⫾ SEM. The Kolmogorov-Smirnov statistic was used to test the normality of
each variable. Differences between groups were analyzed
using Student’s independent t test (normal distribution) or
Mann-Whitney U test (non-normal distribution), and a onesample t test was used for comparing nutrient intakes
against dietary recommendations. Levene’s test for equality
of group variances was used to assess equal variances with
the reported p value reflecting whether the assumption of
equal variances was achieved. Differences between groups
were considered significant at p ⬍ .05 for single variables
unrelated to other variables (e.g., hemoglobin). A Bonferroni correction was used to adjust for multiple comparisons
within a family of variables (e.g., pulmonary function, dietary intake). The calculations were performed using SPSS
8.0 for Windows (SPSS Inc., Chicago, IL).
RESULTS
The general characteristics of the subjects are summarized in Table 1. By design, the groups were similar in mean
age, BMI, and body fatness but different in dietary restraint
score. In addition, the groups were similar in waist-to-hip
circumference, fat-free mass, age of menopause, and reported disinhibition, hunger, and weight history.
Cardiopulmonary measurements, oral temperature, and
skin thickness data are shown in Table 2. None of the parameters differed significantly between groups. There were
also no significant differences in plasma lipids, fasting glucose, IGF-1, thyroid hormone parameters, or DTH between
groups, but hemoglobin levels were significantly lower in
the restrained eaters (Table 3). The restrained eaters tended
to have higher BMD of than unrestrained eaters, but group
differences did not reach statistical significance (Table 4).
Concerning psychological profiles, the restrained eaters reported significantly higher EAT ( p ⬍ .01) and EDI drive for
thinness ( p ⬍ .001) and maturity fears subscores ( p ⬍ .05)
(Table 5). Other subscale scores of the EDI were not significantly different between the two groups. Similarly, there
were no differences between the groups in self-reported physical function, mood, or symptoms of depression (Table 6).
The reported macronutrient and micronutrient intakes of
the subjects who accurately reported dietary intake [defined
as energy intake within 30% of energy requirements predicted by the equation 1 of Vinken and colleagues (33)] are
summarized in Table 7, which shows there was no significant difference between the groups in any dietary variable.
DISCUSSION
Dietary restraint is a widespread dietary practice, but relatively little is known about its effect on physiology and
Table 1. Subject Characteristics
General Characteristics
Age, y
Age at menopause, y
Weight, kg
Height, cm
BMI, kg/m2
Waist/hip ratio
Fat-free mass, kg
Fat, % by weight
Psychometric Scores
Cognitive restraint
Hunger
Disinhibition
Weight History
Maximum weight, kg
Maximum BMI, kg
Maximum weight loss, kg
Time since maximum weight loss, y
Previous Dieting Attempts
Never
1 to 3 times
4 to 15 times
⬎15 times
Unrestrained
Restrained
60.0 ⫾ 0.6
49.7 ⫾ 1.0
63.9 ⫾ 1.6
163.9 ⫾ 1.2
23.8 ⫾ 0.6
0.81 ⫾ 0.01
40.9 ⫾ 0.8
35.5 ⫾ 1.2
59.2 ⫾ 0.6
48.7 ⫾ 1.0
63.6 ⫾ 1.3
161.1 ⫾ 1.0
24.5 ⫾ 0.5
0.80 ⫾ 0.01
40.2 ⫾ 0.8
36.2 ⫾ 1.4
4⫾0
6⫾1
6⫾1
16 ⫾ 0*
5⫾1
7⫾1
65.9 ⫾ 1.5
24.6 ⫾ 0.5
5.7 ⫾ 0.9
18.2 ⫾ 3.0
67.2 ⫾ 1.4
26.0 ⫾ 0.5
9.0 ⫾ 1.2
20.1 ⫾ 2.1
11
13
4
0
5
7
18
9
Notes: Data are means ⫾ SEM. BMI ⫽ body mass index.
*Significantly different from unrestrained eaters, p ⬍ .01.
DIETARY RESTRAINT IN HEALTHY WOMEN
Table 2. Cardiopulmonary Measures, Oral Temperature, and Skin
Thickness in Postmenopausal Women Classified as Unrestrained
or Restrained Eaters
Heart rate, beats/min
Systolic blood pressure, mm Hg
Diastolic blood pressure, mm Hg
Mean arterial pressure, mm Hg*
Pulse pressure, mm Hg†
Oral temperature, ⬚F
Skin thickness, mm
Pulmonary function
FVC, l
FVC corrected for height, l
FEV1, l
FEV1 corrected for height, l
FEV1/FVC
Residual volume, l
Unrestrained
Restrained
68 ⫾ 1
121 ⫾ 3
74 ⫾ 2
171 ⫾ 3
47 ⫾ 2
96.8 ⫾ 0.1
1.9 ⫾ 0.1
66 ⫾ 1
118 ⫾ 2
73 ⫾ 1
166 ⫾ 3
45 ⫾ 2
96.7 ⫾ 0.1
1.9 ⫾ 0.1
3.24 ⫾ 0.09
3.24 ⫾ 0.07
2.47 ⫾ 0.07
2.47 ⫾ 0.6
0.76 ⫾ 0.01
2.01 ⫾ 0.06
3.03 ⫾ 0.09
3.01 ⫾ 0.07
2.37 ⫾ 0.07
2.36 ⫾ 0.06
0.78 ⫾ 0.01
1.96 ⫾ 0.08
Notes: Data are means ⫾ SEM. FVC ⫽ forced vital capacity; FEV1 ⫽ forced
expiratory volume in one second.
*Calculated as brachial systolic pressure ⫹ [(2 ⫻ brachial diastolic pressure)/3].
†Calculated as brachial systolic pressure ⫺ brachial diastolic pressure. Differences between groups are not significant.
metabolism. In the late 1980s, two large surveys conducted
in Germany and the United States (3,8) indicated that 20%
to 25% of adults had dietary restraint scores ⱖ10 points on
the 21-point scale of the Eating Inventory (2), and more recent work suggests an even higher prevalence among some
population groups in the United States currently (7).
In the present study we examined the association of dietary restraint with a range of variables in older women,
specifically to test the hypothesis that long-term dietary restraint is associated with a range of metabolic and health
Table 3. Hematologic and Immune Characteristics of
Postmenopausal Women Classified as Unrestrained or
Restrained Eaters
Total cholesterol, mg/dl
Triacylglycerol, mg/dl
VLDL-cholesterol, mg/dl
LDL-cholesterol, mg/dl
HDL-cholesterol, mg/dl
Glucose
IGF-1
Hemoglobin, g/dl
TSH, ␮U/ml
Free T3, pg/ml
Free T4, ng/dl
Reverse T3, ng/ml
Antigen score
Cumulative DTH score, mm
Unrestrained
Restrained
206 ⫾ 7
105 ⫾ 9
25 ⫾ 5
119 ⫾ 8
61 ⫾ 3
88 ⫾ 2
144 ⫾ 11
13.2 ⫾ 0.1
3.31 ⫾ 0.55
2.90 ⫾ 0.08
1.49 ⫾ 0.03
0.17 ⫾ 0.01
3⫾0
15 ⫾ 2
200 ⫾ 5
118 ⫾ 9
26 ⫾ 3
109 ⫾ 5
65 ⫾ 3
89 ⫾ 1
164 ⫾ 11
12.9 ⫾ 0.1*
2.62 ⫾ 0.22
2.99 ⫾ 0.29
1.59 ⫾ 0.08
0.19 ⫾ 0.01
3⫾0
14 ⫾ 2
Notes: Data are means ⫾ SEM. VLDL ⫽ very low-density lipoprotein;
LDL ⫽ low-density lipoprotein; HDL ⫽ high-density lipoprotein; IGF-1 ⫽
insulin-like growth factor 1; TSH ⫽ thyroid stimulating hormone; T3 ⫽ triiodothyronine; T4 ⫽ thyroxine; DTH ⫽ delayed-type hypersensitivity. Antigen
score is the total number of positive reactions. Cumulative DTH score is the sum
of induration.
*Significantly different from unrestrained eaters; p ⬍ .05.
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Table 4. Regional Bone Mineral Density and Bone Mineral Content
Measurements of Unrestrained and Restrained Eaters
Region
Unrestrained
Restrained
0.794 ⫾ 0.012
1.102 ⫾ 0.015
1.059 ⫾ 0.015
0.811 ⫾ 0.014
1.104 ⫾ 0.032
1.087 ⫾ 0.014
g/cm2
Bone Mineral Density,
Arms
Legs
Total
Bone Mineral Content, g
Arms
Legs
Total
270.2 ⫾ 7.3
828.7 ⫾ 24.5
2137.5 ⫾ 53.4
267.3 ⫾ 8.6
850.0 ⫾ 25.3
2194.7 ⫾ 53.8
Notes: Data are means ⫾ SEM. Differences between groups are not significant.
outcomes, some negative and some positive. The subjects
were normal-weight, postmenopausal women who were
currently restrained or unrestrained eaters and reported stable body weight and dietary restraint for at least 10 years.
The groups were matched for BMI at the screening examination, so that we could examine the correlates of dietary restraint independent of group differences in body composition, and were subsequently shown to have comparable
mean values for percent body fat and intakes of macronutrients and micronutrients. To our knowledge, this is the first
study that has taken into account the likely effect of body
composition on the relationship between dietary restraint
and metabolic and health outcome variables. It should be
noted that our matching of groups for BMI was also appropriate from the perspective of applicability to the general
population because previous work has indicated no independent effect of dietary restraint on body fatness (34). Both
groups had a lower mean BMI than normative data for this
age group from the most recent U.S. national survey (35),
and, therefore, further work is needed to determine the extent to which the results of this study are relevant to the general population.
The primary finding of this study was that there were
very few differences between the groups. A range of parameters including heart rate, blood pressure, body temperature,
skin thickness, blood lipids, fasting glucose, thyroid hormone, total BMC, immune function as assessed by DTH,
and psychological and self-assessed health variables did not
Table 5. Mean Eating Attitudes Test and Eating Disorders
Inventory Scores in Postmenopausal Women Classified as
Unrestrained or Restrained Eaters
Eating Attitudes Test
Eating Disorders Inventory
Body dissatisfaction
Bulimia
Drive for thinness
Interoceptive awareness
Interpersonal distrust
Ineffectiveness
Maturity fears
Perfectionism
Unrestrained
Restrained
8⫾1
14 ⫾ 1*
8⫾2
3⫾0
0⫾0
0⫾0
1⫾0
1⫾0
1⫾0
5⫾1
9⫾1
3⫾0
3 ⫾ 1*
0⫾0
1⫾0
1⫾0
2⫾0
4⫾1
Note: Data are means ⫾ SEM.
*Significantly different from unrestrained eaters; p ⬍ .01.
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BATHALON ET AL.
Table 6. Mean MOS 36-Item Short-Form Health Survey Health
Concepts Scores and Mood State Scores From the Profile of Mood
States in Postmenopausal Women Classified as Unrestrained or
Restrained Eaters
MOS 36-Item Short Form
Physical functioning
Role functioning—physical
Role functioning—emotional
Social functioning
Bodily pain
Mental health
Vitality
General health perceptions
Profile of Mood State
Tension-anxiety
Depression-dejection
Anger-hostility
Vigor-activity
Fatigue-inertia
Confusion-bewilderment
Total mood disturbance
Geriatric Depression Scale
Unrestrained
Restrained
29 ⫾ 0
8⫾0
6⫾0
10 ⫾ 0
11 ⫾ 0
27 ⫾ 0
20 ⫾ 0
22 ⫾ 0
29 ⫾ 0
8⫾0
6⫾0
10 ⫾ 0
10 ⫾ 0
27 ⫾ 0
19 ⫾ 1
22 ⫾ 0
31 ⫾ 0
34 ⫾ 0
40 ⫾ 1
72 ⫾ 1
37 ⫾ 1
32 ⫾ 1
102 ⫾ 2
2⫾1
31 ⫾ 0
34 ⫾ 0
40 ⫾ 0
69 ⫾ 1
40 ⫾ 1
31 ⫾ 0
106 ⫾ 2
2⫾0
Notes: Data are means ⫾ SEM. Differences between groups are not significant.
differ significantly between the restrained and unrestrained
eaters, and mean values were generally very similar. Restrained eaters did have significantly lower blood hemoglobin despite comparable mean reported micronutrient intakes, but group means for hemoglobin were within normal
ranges. Similarly, restrained eaters differed from unrestrained eaters in some of the psychological variables; in
particular, they had higher Eating Attitude Test scores and
higher drive-for-thinness and maturity fears subscores in the
Eating Disorders Inventory, both suggesting a theoretical
trend toward eating disorders as documented in several (36)
but not all (37) previous studies of younger restrained eaters. It should be noted, however, that these apparent trends
may simply reflect the fact that restrained eating is part of a
normal spectrum of eating behavior that leads to an eating
disorder in extreme cases. Moreover, all individual values
Table 7. Reported Dietary Intake in Postmenopausal Women
Classified as Unrestrained or Restrained Eaters
Nutrient
Unrestrained
(n ⫽ 24)
Restrained
(n ⫽ 20)
Energy, MJ/d
Protein, g/d
Fat, g/d
Carbohydrate, g/d
Ethanol, g/d
Calcium, mg/d
Iron, mg/d
Zinc, mg/d
Vitamin A (retinol equivalents), ␮g/d
Vitamin D, ␮g/d
Vitamin E (␣-tocopherol equivalent), mg/d
Vitamin C, mg/d
8.6 ⫾ 0.2
73 ⫾ 3
73 ⫾ 4
274 ⫾ 11
8⫾2
1165 ⫾ 122
19 ⫾ 2
13 ⫾ 1
1755 ⫾ 177
9⫾1
27 ⫾ 9
185 ⫾ 19
8.0 ⫾ 0.2
78 ⫾ 4
59 ⫾ 4
260 ⫾ 8
10 ⫾ 3
1049 ⫾ 72
21 ⫾ 2
12 ⫾ 1
1482 ⫾ 179
8⫾1
17 ⫾ 4
159 ⫾ 19
Note: Data are means ⫾ SEM.
in the present study were low, and means were well within
the normal range. The combination of these results on diverse outcome measures suggests that dietary restraint is not
associated with significantly adverse metabolic, physiologic, psychological, or health characteristics in older women
without major chronic diseases and who report stable body
weight and dietary restraint over a 10-year period. Thus, our
results are consistent with those previous reports that have
suggested minimal or benign differences between restrained
and unrestrained eaters in hormonal parameters such as fasting thyroid hormone, cortisol, insulin, norepinephrine, and
growth hormone (9,38,39).
In contrast, some previous work has suggested the potential for negative long-term effects of dietary restraint. Most
notably, Barr and colleagues (11) observed a shorter luteal
phase of the menstrual cycle among 40-year-old women
practicing dietary restraint, a finding consistent with the observation of Schweiger and colleagues (10), who noted
shorter menstrual cycles and reduced luteal phase progesterone production in restrained eaters compared with unrestrained eaters. These changes could theoretically put women
at risk of accelerated bone demineralization over time, but
low bone mineral density was not observed in our group of
older long-term restrained eaters. Indeed, mean total mineral density was 3% higher in restrained eaters compared
with unrestrained eaters, although the difference did not
reach statistical significance. It should be noted that there
were no significant differences in dietary macronutrients or
micronutrients between restrained and unrestrained eaters
providing apparently accurate dietary reports [defined as
energy intake within 30% of values predicted using equations predicting total energy expenditure (33)]. Presumably,
this helped to minimize differences in health characteristics
between groups. If there are cultural influences on the nutrition knowledge and the types of foods that restrained eaters
attempt to restrict, this may influence the extent to which
the positive or negative effects of dietary restraint are seen
in studies of other populations of restrained eaters.
In summary, this cross-sectional study of healthy postmenopausal women of normal body weight and reporting
stable weight and dietary restraint over the past 10 years
showed no detrimental effect of dietary restraint on a wide
range of parameters. Our results thus suggest that dietary restraint is consistent with health in older women. Further
studies are needed to confirm this possibility in a population
followed longitudinally and to explore a wider range of parameters than possible in this investigation.
Acknowledgments
We thank the volunteers for participating in the study and the nursing
and recruitment staff of the Metabolic Research Unit for their expert help
with data collection.
This study was funded with NIH Grants AG12829 and B2A600209,
USDA Contract 53-3K06-5-10, and an Army Medical Department Long
Term Civilian Training Scholarship to GPB. Contents of this publication do
not necessarily reflect the views or policies of the U.S. Department of Agriculture or Department of Defense, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
Gaston P. Bathalon’s current affiliation is U.S. Army Research Institute
of Environmental Medicine, Natick, MA.
DIETARY RESTRAINT IN HEALTHY WOMEN
Address correspondence to Susan B. Roberts, Energy Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging
at Tufts University, 711 Washington St., Boston, MA 02111. E-mail:
[email protected]
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Received July 1, 1999
Accepted September 20, 2000
Decision Editor: John E. Morley, MB, BCh