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The use of visual analogue scales to assess motivation to eat in human subjects: a review of their reliability and validity with an evaluation of new hand-held computerized systems for temporal tracking of appetite ratings

Published online by Cambridge University Press:  09 March 2007

R. J. Stubbs ,
D. A. Hughes ,
A. M. Johnstone ,
E. Rowley ,
C. Reid ,
M. Elia ,
R. Stratton ,
H. Delargy ,
N. King  and
J. E. Blundell
R. J. Stubbs*
Affiliation:
Rowett Research Institute, Greenburn Road, Bucksburn, Aberdeen, AB21 9SB, UK
D. A. Hughes
Affiliation:
Rowett Research Institute, Greenburn Road, Bucksburn, Aberdeen, AB21 9SB, UK
A. M. Johnstone
Affiliation:
Rowett Research Institute, Greenburn Road, Bucksburn, Aberdeen, AB21 9SB, UK
E. Rowley
Affiliation:
Rowett Research Institute, Greenburn Road, Bucksburn, Aberdeen, AB21 9SB, UK
C. Reid
Affiliation:
Biomathematics and Statistics, Scotland, Rowett Research Institute, Greenburn Road, Bucksburn, Aberdeen, AB21 9SB, UK
M. Elia
Affiliation:
Clinical Nutrition Group, The Dunn Clinical Nutrition Centre, Hills Road, Cambridge, UK
R. Stratton
Affiliation:
Clinical Nutrition Group, The Dunn Clinical Nutrition Centre, Hills Road, Cambridge, UK
H. Delargy
Affiliation:
Biopsychology Group, Psychology Department, University of Leeds, Leeds LS2 9JT, UK
N. King
Affiliation:
Biopsychology Group, Psychology Department, University of Leeds, Leeds LS2 9JT, UK
J. E. Blundell
Affiliation:
Biopsychology Group, Psychology Department, University of Leeds, Leeds LS2 9JT, UK
*
*Corresponding author: Dr R. James Stubbs, fax +44 (0) 1224 715349, email J.Stubbs@rri.sari.ac.uk
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Abstract

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This present paper reviews the reliability and validity of visual analogue scales (VAS) in terms of (1) their ability to predict feeding behaviour, (2) their sensitivity to experimental manipulations, and (3) their reproducibility. VAS correlate with, but do not reliably predict, energy intake to the extent that they could be used as a proxy of energy intake. They do predict meal initiation in subjects eating their normal diets in their normal environment. Under laboratory conditions, subjectively rated motivation to eat using VAS is sensitive to experimental manipulations and has been found to be reproducible in relation to those experimental regimens. Other work has found them not to be reproducible in relation to repeated protocols. On balance, it would appear, in as much as it is possible to quantify, that VAS exhibit a good degree of within-subject reliability and validity in that they predict with reasonable certainty, meal initiation and amount eaten, and are sensitive to experimental manipulations. This reliability and validity appears more pronounced under the controlled (but more artificial) conditions of the laboratory where the signal: noise ratio in experiments appears to be elevated relative to real life. It appears that VAS are best used in within-subject, repeated-measures designs where the effect of different treatments can be compared under similar circumstances. They are best used in conjunction with other measures (e.g. feeding behaviour, changes in plasma metabolites) rather than as proxies for these variables. New hand-held electronic appetite rating systems (EARS) have been developed to increase reliability of data capture and decrease investigator workload. Recent studies have compared these with traditional pen and paper (P&P) VAS. The EARS have been found to be sensitive to experimental manipulations and reproducible relative to P&P. However, subjects appear to exhibit a significantly more constrained use of the scale when using the EARS relative to the P&P. For this reason it is recommended that the two techniques are not used interchangeably.

Keywords

Visual analogue scalesElectronic appetite rating systemsAppetiteHunger
Type
Review article
Information
British Journal of Nutrition , Volume 84 , Issue 4 , October 2000 , pp. 405 - 415
Copyright
Copyright © The Nutrition Society 2000

References

Bland, JM and Altman, DG (1986) Statistical methods for assessing agreements between two methods of clinical measurement. Lancet 1, 307–310.CrossRefGoogle ScholarPubMed
Blundell, JE (1979) Hunger, appetite and satiety — constructs in search of identities. In Nutrition and Lifestyles, pp. 21–42 [Turner, M, editor]. London: Applied Science Publishers.Google Scholar
Blundell, JE and Hill, AJ (1988) On the mechanism of action of dexfenfluramine: effect on allesthesia and appetite motivation in lean and obese subjects. Clinical Neuropharmacology 11, S121–S134.Google Scholar
Blundell, JE & Stubbs, RJ (1998) Diet composition and the control of food intake in humans. In International Handbook of Obesity [Bray, GA, Bouchard, C and James, WPT, editors]. New York, NY: Dekker Inc.Google Scholar
Campfield, LA, Smith, FJ, Rosenbaum, M and Geary, N (1992) Human hunger monitoring of motivation to eat. International Journal of Obesity 20 (Suppl. 4), 104.Google Scholar
de Castro, J and Elmore, DK (1988) Subjective hunger relationships with meal patterns in the spontaneous feeding behaviour of humans, evidence for a casual connection. Physiology and Behaviour 43, 159–165.CrossRefGoogle Scholar
De Graaf, C (1993) The validity of appetite ratings. Appetite 21, 156–160.CrossRefGoogle ScholarPubMed
De Graaf, C, Schreurs, A and Blauw, GH (1993) Short term effects of different amounts of sweet and non sweet carbohydrates on satiety and energy intake. Physiology and Behaviour 54, 833–843.CrossRefGoogle Scholar
Delargy, HJ, Lawton, CL, Smith, FC, King, NA and Blundell, JE (1996) Electronic appetite rating system (EARS): validation of continuous automated monitoring of motivation to eat. International Journal of Obesity 20 (Suppl. 4), 104.Google Scholar
Downie, WW, Leatham, PA, Rhind, VM, Wright, V, Branco, JA and Anderson, JA (1978) Studies with pain rating scales. Annals of Rheumatic Disease 37, 378–281.CrossRefGoogle ScholarPubMed
Drummond, HE, Ghosh, S, Ferguson, A, Brackenridge, D and Tiplady, B (1995) Electronic quality of life questionnaires: a comparison of pen-based electronic questionnaires with conventional paper in a gastrointestinal study. Quality of Life Research 4, 21–26.CrossRefGoogle Scholar
Freyd, MT (1923) The graphic rating scale. Journal of Educational Psychology 14, 83–102.CrossRefGoogle Scholar
Hill, AJ and Blundell, JE (1982) Nutrients and behaviour: research strategies for the investigation of taste characteristics, food p, hunger sensations and eating patterns in man. Journal of Psychological Research 17, 203–212.CrossRefGoogle Scholar
Hill, AJ and Blundell, JE (1990) Sensitivity of the appetite control system in obese subjects to nutritional and serotoninergic challenges. International Journal of Obesity 14, 219–233.Google ScholarPubMed
Hill, AJ, Rogers, PJ and Blundell, JE (1995) Techniques for the experimental measurement of human eating behaviour and food intake: a practical guide. International Journal of Obesity 19, 361–375.Google ScholarPubMed
Hunt, SM, McKenna, SP, McEwen, J, Williams, J and Papp, E (1981) The Nottingham Health Profile: subjective health status and medical consultations. Social Science and Medicine 15, 221–229.Google ScholarPubMed
Johnstone, AM, Stubbs, RJ and Harbron, CG (1996) Effect of overfeeding macronutrients on day-to-day food intake in man. European Journal of Clinical Nutrition 50, 418–430.Google ScholarPubMed
Keys, A, Brozek, J, Henschel, A, Mickelsen, O & Taylor, HL (1950) The biology of human starvation. Minneapolis, MN: University of Minnesota Press.Google Scholar
Lappalainen, R, Mennen, L, van Weert, L and Mykkanen, H (1993) Drinking water with a meal: a simple method of coping with feelings of hunger, satiety and desire to eat. European Journal of Clinical Nutrition 47, 815–819.Google Scholar
Leathwood, P and Pollet, P (1988) Effects of slow release carbohydrates in the form of bean flakes on the evolution of hunger and satiety in man. Appetite 10, 1–11.CrossRefGoogle ScholarPubMed
Lissner, L, Levitsky, D, Strupp, B, Kalkwarf, H and Roe, D (1987) Dietary fat and the regulation of energy intake in human subject. American Journal of Clinical Nutrition 46, 886–892.CrossRefGoogle Scholar
Mattes, R (1990) Hunger ratings are not a valid proxy measure of reported food intake in humans. Appetite 15, 103–113.CrossRefGoogle Scholar
Mayer, J (1955) The regulation of energy intake and body weight. Annals of the New York Academy of Sciences 63, 15–43.CrossRefGoogle ScholarPubMed
Monello, MF and Mayer, J (1967) Hunger and satiety sensations in men, women, boys and girls. American Journal of Clinical Nutrition 20, 253–261.CrossRefGoogle ScholarPubMed
Ohnhaus, EE and Alder, R (1975) Methodological problems in the measurement of pain: a comparison between the verbal rating scale and the visual analogue scale. Pain 1, 379–384.CrossRefGoogle Scholar
Pi-Sunyer, X, Kissileff, HR, Thornton, J and Smith, GP (1982) C-terminal octopeptide of cholescystokinin decreases food intake in obese men. Physiology and Behaviour 29, 627–630.CrossRefGoogle Scholar
Raben, A (1995) Appetite and carbohydrate metabolism. PhD Thesis., Royal Veterinary and Agricultural University, Copenhagen.Google Scholar
Raben, A, Tagliabue, A and Astrup, A (1995) The reproducibility of subjective appetite scores. British Journal of Nutrition 73, 517–530.CrossRefGoogle ScholarPubMed
Reid, CA, Harbron, CG and Blundell, JE & Stubbs, RJ (1998) What are psychometric assessments of appetite asking: a preliminary multivariate analysis. International Journal of Obesity 22 (Suppl. 3), 151A.Google Scholar
Rogers, PJ, Carlyle, J, Hill, AJ and Blundell, JE (1988) Uncoupling sweet taste and calories: comparison of the effects of glucose and three intense sweeteners on hunger and food intake. Physiology and Behaviour 43, 547–552.CrossRefGoogle ScholarPubMed
Rolls, BJ, Hetherington, M and Laster, LJ (1988) Comparison of the effects of aspartame and sucrose on appetite and food intake. Appetite 11, 62–67.Google ScholarPubMed
Silverstone, T & Goodall, E (1986) Measurement of hunger and food intake. In Disorders of Eating Behaviour, a Psychoneuroendocrine Approach, pp. 129–134 [Ferrari, E, editor]. Oxford: Pergamon Press.Google Scholar
Speigel, TA, Stunkard, AJ, Shrager, EE, O'Brian, CP, Morrison, MF and Stellar, E (1987) Effect of naltrexone on food intake, hunger and satiety in obese men. Physiology and Behaviour 40, 135–141.CrossRefGoogle Scholar
Spitzer, L and Rodin, J (1981) Human eating behaviour: a critical review of studies in normal weight and overweight individuals. Appetite 2, 293–329.CrossRefGoogle Scholar
Stratton, RJ, Stubbs, RJ and Elia, M (1998) Appetite and food intake during artificial nutrition. Proceedings of the Nutrition Society 57, 96A.Google Scholar
Stratton, RJ, Stubbs, RJ, Hughes, DA, King, N, Blundell, JE and Elia, M (1998) Comparison of the traditional paper visual analogue scales questionnaires with an Apple Newton electronic rating system (EARS) in free living subjects feeding. ad libitum. European Journal of Clinical Nutrition 52, 737–741.CrossRefGoogle ScholarPubMed
Stubbs, RJ (1995) Macronutrient effects on appetite. International Journal of Obesity 19 (Suppl. 5), S11–S19.Google ScholarPubMed
Stubbs, RJ, Harbron, CG, Murgatroyd, PR and Prentice, AM (1995) Covert manipulation of dietary fat and energy density: effect on substrate flux and food intake in men feeding. ad libitum. American Journal of Clinical Nutrition 62, 316–330.CrossRefGoogle ScholarPubMed
Stubbs, RJ, Johnstone, AM, Harbron, CG and Reid, C (1998) Covert manipulation of the mixed energy density diets: effect on. ad libitum food intake in "pseudo free-living" humans. International Journal of Obesity 22, 980–987.CrossRefGoogle ScholarPubMed
Stubbs, RJ, Johnstone, AM, O'Reilly, LM and Poppitt, SD (1998) Methodological issues relating to the measurement of food, energy and nutrient intake in human laboratory-based studies. Proceedings of the Nutrition Society 57, 357–372.CrossRefGoogle Scholar
Stubbs, RJ, O'Reilly, LM, Johnstone, AM, Franklin, MF and Reid, C (1998) Description and evaluation of an experimental model to examine changes in qualitative and quantitative feeding behaviour in humans. European Journal of Clinical Nutrition 53, 13–21.CrossRefGoogle Scholar
Stubbs, RJ, Rowley, E, Hughes, DA, Johnstone, AM, Reid, CA, King, N, Blundell, J, Elia, M and Stratton, RJ (1997) Evaluating a new electronic appetite rating system (EARS). International Journal of Obesity 21 (Suppl. 2), 391.Google Scholar
Stubbs, RJ, Van Wyk, MCW, Johnstone, AM and Harbron, C (1996) Breakfasts high in protein, fat or carbohydrate: effect on within-day appetite and energy balance. European Journal of Clinical Nutrition 50, 409–417.Google ScholarPubMed
Thompson, DA and Campbell, RG (1977) Hunger in humans induced by 2 deoxy-D-glucose glucoprivic control of taste p and food intake. Science 198, 1065–1068.CrossRefGoogle ScholarPubMed
Thompson, DA & Campbell, RG (1978) Experimental hunger in man: Behavioural and metabolic correlates of intracellular glucopenia. In Central Mechanisms of Anorectic Drugs, pp. 437–445 [Garrattini, S and Samanin, R, editors]. New York, NY: Raven Press.Google Scholar
Thompson, DA, Welle, Sl, Lilavivat, U, Penicaud, L and Campbell, RG (1982) Opiate receptor blockade in man reduces 2-deoxy-D-glucose induced food intake but not hunger, thirst, and hypothermia. Life Sciences 31, 847–852.CrossRefGoogle Scholar
Trenchard, E and Silverstone, T (1983) Naloxone reduces the food intake of normal human volunteers. Appetite 4, 43–50.CrossRefGoogle ScholarPubMed
Westrate, JA (1992) Effect of nutrients on the regulation of food intake. In Unilever Research. Vlaardingen: Unilever.Google Scholar
Wolkowitz, OM, Breier, A, Doran, A, Rubinow, D and Berrettini, W (1988) Prednisone-induced behavioural and biological changes in medically healthy volunteers. Psychopharmacology Bulletin 24, 492–494.Google ScholarPubMed
Yeomans, MR, Gray, RW, Mitchell, CJ and True, S (1997) Independent effects of palatability and within meal pauses on intake and appetite ratings in human volunteers. Appetite 29, 61–76.CrossRefGoogle ScholarPubMed