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Nutrition label serving sizes are determined primarily based on typical consumption when such data are available. However, such data are not available for certain foods such as spray cooking oil (cooking spray). Our study assessed cooking spray use by the United States (US) adults compared to the 0.25‐s serving size used on US‐sold cooking spray labels. Adults (n = 1041, aged 33 ± 16.7 years) completed a 13‐question survey on cooking spray use and perceptions. In the survey, participants reported using cooking spray for 1.9 ± 0.9 s per use, and 42.3%–43.1% of participants reported being more likely to purchase products if they were labelled calorie‐ or fat‐free. Next, 30 adults (aged 29.7 ± 11.0 years) completed a laboratory‐based study which assessed cooking spray durations for seven cookware items. Spray times ranged from 1.0 ± 0.5 (smallest pan) to 2.5 ± 1.3 s (largest baking sheet), with 100% of sprays (210/210) exceeding the 0.25‐s US serving size. Our results suggest that cooking spray serving size should be increased to 1 s to better reflect actual consumption, and this would have the added benefit of aligning better with cooking spray serving sizes in other developed countries (0.5–1.0 s). A 1‐s serving size would also preclude cooking spray advertised as calorie‐ or fat‐free, allowing consumers to make more informed choices on the dietary implications of using cooking spray. [ABSTRACT FROM AUTHOR]

Objectives This study investigated the nutritional differences between sweet and salty snacks and beverages in South Korea (Korea) and the United States (US). Nutritional content and healthiness were determined using back- and front-of-package nutrition labeling (FoPNL) systems. Methods Three snack and three beverage categories popular in Korea and the US were selected. Statistical data were used to determine the top 10–15 best-selling products in each category in each country. The selected products included chips (n = 15), cookies (n = 10), chocolate (n = 13), carbonated drinks (n = 10), fruit juices/drinks (n = 10, 5/5), and energy drinks (n = 10). The study excluded products that were artificially sweetened. Nutritional information and percentages of fruit and vegetable content in each product were collected from brand websites and grocery stores in each country. The FoPNL system was used to assess the healthiness of the products, which included multiple traffic light labels, a Health Star Rating, and a Nutri-Score. Results Overall, Korean snacks contained significantly more protein, total fat, saturated fat, and cholesterol than US snacks. However, the US chips and carbonated drinks contained more sodium, while the US energy drinks contained more caffeine than Korean products. The serving size of US carbonated drinks was significantly larger than that of Korean drinks, whereas the serving size of US chips was smaller than that of Korean products. The FoPNL system classified the majority of products as ‘less healthy.’ Conclusion Our results suggest that Korean and US food manufacturers should improve the nutritional quality and/or serving size of commonly consumed food products. Policymakers in both countries should work to improve the presentation of nutrient information on nutrition labels to assist consumers in making healthier food choices.

Serving size may be the appropriate reference for calculating food nutritional value. We aimed to assess the nutritional values of Japanese foods based on serving sizes rather than per 100 g by adapting the Meiji Nutritional Profiling System (Meiji NPS). Given the variability in serving sizes across countries, we used Japanese serving sizes to calculate the Meiji NPS scores. We confirmed the convergent validity of the Meiji NPS scores per serving size with the Nutrient-Rich Food Index 9.3 using Spearman's correlation coefficients (r = 0.51, p < 0.001). Food groups recommended by official guidelines, such as pulses, nuts and seeds, fish and seafood, fruits, vegetables, and milk and milk products, scored relatively high. Furthermore, the nutrient density scores of food items with small serving sizes, such as mushrooms, algae, seasonings, and fats and oils, were moderated when calculated by per serving size, despite having considerably higher or lower scores per 100 g. These results indicate that calculating NPS per serving size allows for the assessment of the nutritional value of food items in accordance with actual consumption quantities. Therefore, the Meiji NPS calculated per serving size, alongside the per 100 g version, may be useful for dietary management depending on specific purposes. [ABSTRACT FROM AUTHOR]

Abstract Background Smaller serving sizes of alcoholic drinks could reduce alcohol consumption across populations thereby lowering the risk of many diseases. The effect of modifying the available range of serving sizes of beer and cider in a real-world setting has yet to be studied. The current study assessed the impact on beer and cider sales of adding a serving size of draught beer and cider (2/3 pint) that was between the current smallest (1/2 pint) and largest (1 pint) standard serving sizes. Methods Twenty-two licensed premises in England consented to taking part in the study. The study used an ABA reversal design, set over three 4-weekly periods, with A representing the non-intervention periods, during which standard serving sizes were served and B the intervention period when a 2/3 pint serving size of draught beer and cider was added to the existing range, along with smaller 1/2 pint and larger 1 pint serving sizes. The primary outcome was the daily volume of beer and cider sold, extracted from sales data. Results Fourteen premises started the study, of which thirteen completed it. Twelve of those did so per protocol and were included in the primary analysis. After adjusting for pre-specified covariates, the intervention did not have a significant effect on the volume of beer and cider sold per day (3.14 ml; 95%CIs -2.29 to 8.58; p = 0.257). Conclusions In licensed premises, there was no evidence that adding a smaller serving size for draught beer and cider (2/3 pint) when the smallest (1/2 pint) and largest (1 pint) sizes were still available, affected the volume of beer and cider sold. Studies are warranted to assess the impact of removing the largest serving size. Trial registration ISRCTN: https://doi.org/10.1186/ISRCTN33169631 (08/09/2021), OSF: https://osf.io/xkgdb/ (08/09/2021).

Background: Smaller serving sizes of alcoholic drinks could reduce alcohol consumption across populations thereby lowering the risk of many diseases. The effect of modifying the available range of serving sizes of beer and cider in a real-world setting has yet to be studied. The current study assessed the impact on beer and cider sales of adding a serving size of draught beer and cider (2/3 pint) that was between the current smallest (1/2 pint) and largest (1 pint) standard serving sizes. Methods: Twenty-two licensed premises in England consented to taking part in the study. The study used an ABA reversal design, set over three 4-weekly periods, with A representing the non-intervention periods, during which standard serving sizes were served and B the intervention period when a 2/3 pint serving size of draught beer and cider was added to the existing range, along with smaller 1/2 pint and larger 1 pint serving sizes. The primary outcome was the daily volume of beer and cider sold, extracted from sales data. Results: Fourteen premises started the study, of which thirteen completed it. Twelve of those did so per protocol and were included in the primary analysis. After adjusting for pre-specified covariates, the intervention did not have a significant effect on the volume of beer and cider sold per day (3.14 ml; 95%CIs -2.29 to 8.58; p = 0.257). Conclusions: In licensed premises, there was no evidence that adding a smaller serving size for draught beer and cider (2/3 pint) when the smallest (1/2 pint) and largest (1 pint) sizes were still available, affected the volume of beer and cider sold. Studies are warranted to assess the impact of removing the largest serving size. Trial registration: ISRCTN: https://doi.org/10.1186/ISRCTN33169631 (08/09/2021), OSF: https://osf.io/xkgdb/ (08/09/2021). [ABSTRACT FROM AUTHOR]

Abstract Background Over-consumption is a common adverse outcome from cannabis edibles. States such as Colorado require each serving of cannabis edible to carry a THC symbol. This study aimed to test whether packaging edibles in separate servings and/or indicating the THC level per serving improves consumer understanding of serving size. Methods An 3 × 2 experimental task was conducted as part of the 2019 International Cannabis Policy Study online survey. Respondents from Canada and the US (n = 45,504) were randomly assigned to view an image of a chocolate cannabis edible. Packages displayed THC labels according to 1 of 6 experimental conditions: packaging (3 levels: whole multi-serving bar; individual chocolate squares; separately packaged squares) and THC stamp (2 levels: stamp on each square vs. no stamp). Logistic regression tested the effect of packaging and THC stamp on odds of correctly identifying a standard serving, among edible consumers and non-consumers separately. Edible consumers were also asked about their awareness of a standard THC serving. Results Only 14.6% of edible consumers reported knowing the standard serving of THC for cannabis edibles. In the experimental task, among non-consumers who saw stamped bars, the multi-serving bar (AOR = 1.16 (1.08, 1.24) p 0.05 for all). Among edible consumers, there was no effect of the packaging (p = 0.992) or stamp manipulation (p = 0.988). Among both edible consumers and non-consumers, respondents in US states with legal recreational cannabis performed better than Canadians (p

This research investigates how provision of calories-per-serving information on serving size labels affects snack consumption quantity. Drawing from expectancy-disconfirmation theory, this research shows that providing calories-per-serving information can ironically create a consumption backfire effect (consumers eat more when presented with calories-per-serving information) for snacks perceived as unhealthy but not for snacks perceived as healthy. The authors find that this effect arises when calorie expectations are higher than the posted calories-per-serving level—a frequent occurrence due to stated serving sizes that are typically smaller than amounts consumed in one sitting. The authors also show that attention to calorie information plays a key role such that the backfire effect occurs among consumers who pay more attention to calorie information. Furthermore, motivational factors including individual differences and perceptions of the risk associated with consuming a snack also play a role in driving consumption differences. The authors offer managerial, policy, and consumer welfare implications, including proposing and testing larger stated serving sizes as an intervention. [ABSTRACT FROM AUTHOR]

This review summarises the evidence on the impact of serving and container size on how much people drink, interventions that have the potential to reduce alcohol consumption across populations, thereby improving health. A rapid search identified 10 published reports of 15 studies and 1 review. Four studies focused on serving size, eight studies and the review on glass size, two studies on bottle size and one on both glass and bottle size. Twelve studies and the review focused on wine, one study on beer and two on both. All were conducted in England, by just two research groups. Removing the largest serving size of wine decreased wine sales by 7.6% (95% CI −12.3%, −2.9%) in a study in 21 licenced premises, reflecting findings from two prior studies in semi-naturalistic settings. Adding a serving size for beer that was a size smaller than the largest was assessed in one study in 13 licenced premises, with no evident effect. Reducing the size of wine glasses in restaurants decreased wine sales by 7.3% (95% CI −13.5%, −1.5%) in a mega-analysis of eight datasets from studies in five licensed premises. Using smaller wine glasses at home may also reduce consumption, but the evidence from just one study is less certain. No studies have assessed the impact of glass size for drinking beer. The effect of bottles smaller than the standard 750 mL on wine consumed at home was assessed in two studies: 500 mL bottles reduced consumption by 4.5% (95% CI −7.9%, −1.0%) in one study, but in another, using 375 mL bottles there was no evident effect. No studies assessed the impact of bottle or other container size for drinking beer. Reducing the size of servings, glasses and bottles could reduce wine consumption across populations. The impact of similar interventions for reducing consumption of other alcoholic drinks awaits evaluation. Further studies are also warranted to assess the generalisability of existing evidence. [ABSTRACT FROM AUTHOR]

We evaluated the accuracy of the estimated serving size using digital photographs in a newly developed food atlas. From 209 food items in the food atlas, we selected 14 items with various appearances for evaluation. At the study site, fifty-four participants aged 18–33 years served fourteen foods in the amount they usually ate. After they left, each food item was weighed by a researcher. The following day, the participants estimated the quantity of each food they served based on food photographs using a web-based questionnaire. We compared the weights of the foods the participants served (true serving sizes) and those determined based on the photographs (estimated serving sizes). For ten of the fourteen food items, significant differences were observed between the estimated and true serving sizes, ranging from a 29⋅8 % underestimation (curry sauce) to a 34⋅0 % overestimation (margarine). On average, the relative difference was 8⋅8 %. Overall, 51⋅6 % of the participants were within ±25 % of the true serving size, 81⋅9 % were within ±50 % and 93⋅4 % were within ±75 %. Bland–Altman plots showed wide limits of agreement and increased variances with larger serving sizes for most food items. Overall, no association was found between estimation errors and participant characteristics. The food atlas has shown potential for assessment of portion size estimation. Further development, refinement and testing are needed to improve the usefulness of the digital food photographic atlas as a portion size estimation aid.

Abstract Background The consumption of non-carbonated sugar-sweetened beverages (NCSSBs) has many adverse health effects. However, the sugar and energy content in NCSSBs sold in China remain unknown. We aimed to investigate the sugar and energy content of NCSSBs in China and how these contents were labelled. Methods A cross-sectional survey was conducted in 15 supermarkets in Haidian District, Beijing from July to October 2017. The product packaging and nutrient information panels of NCSSBs were recorded to obtain type of products (local/imported), serving size, nutrient contents of carbohydrate, sugar and energy. For those NCSSBs without sugar content information, we used carbohydrate content as a replacement. Results A total of 463 NCSSBs met the inclusion criteria and were included in our analysis. The median of sugar content and energy content was 9.6 [interquartile range (IQR): 7.1–11.3] g/100 ml and 176 (IQR: 121–201) kJ/100 ml. The median of sugar contents in juice drinks, tea-based beverages, sports drinks and energy drinks were 10.4, 8.5, 5.0 and 7.4 g/100 ml. Imported products had higher sugar and energy content than local products. There were 95.2% products of NCSSBs receiving a ‘red’(high) label for sugars per portion according to the UK criteria, and 81.6% products exceeding the daily free sugar intake recommendation from the World Health Organization (25 g). There were 82 (17.7%) products with sugar content on the nutrition labels and 60.2% of them were imported products. Conclusions NCSSBs had high sugar and energy content, and few of them provided sugar content information on their nutrition labels especially in local products. Measures including developing better regulation of labelling, reducing sugar content and restricting the serving size are needed for reducing sugar intakes in China.

The present work was aimed to determine the glycaemic index (GI) and glycaemic load (GL) of commonly consumed Thai fruits for the potential risk of chronic diseases. Healthy subjects consumed 25 g available carbohydrate (fruits and glucose) in random order. Eighteen fruits were classified as low GI (26.5 - 54.8%) including jujube, unripe mango, banana (Kluai-Namwa, Kluai-Khai, and Kluai-Leb-Mu-Nang varieties), guava, tamarind, jackfruit, durian (Monthong and Chanee varieties), tangerine, longan, starfruit, pomelo (Thong Dee variety), sapodilla, white dragon fruit, sala, and rambutan. Fruits with medium GI (55.4 - 69.6%) includes pomelo (Kao Nampheung variety), banana (Kluai Hom variety), red dragon fruit, watermelon, coconut, mangosteen, longkong, ripe mango, papaya, rose apple, and lychee. Pineapple has a high GI value. Most of the studied fruits were classified as low GL except for tamarind, red dragon fruit, mangosteen, lychee, and pineapple which were classified as medium GL. Various kinds of Thai fruits provided different GI and GL values. Therefore, low GI fruit with low GL regimen can be considered as alternative food sources to be used for diet manipulation in diabetic patients as well as in healthy population. [ABSTRACT FROM AUTHOR]

Background: The high consumption of sugar-sweetened beverages (SSBs) has been linked to overweight and chronic disease. Since Thailand launched its sugar taxation policy, the sugar content of SSBs remains unknown. Objective: To assess product sugar content as g/100 mL and the number of products that meet the sugar tax criteria and to compare sugar content levels across various SSB categories. Materials and Methods: Between April and May 2020, a cross-sectional survey was conducted in Bangkok and five provinces in health region 2, which are Sukhothai, Phitsanulok, Phetchabun, Tak, and Uttaradit, using major supermarket retailers and local convenience stores. Data were collected from product packaging and nutrition information panels (NIP) of each SSB via photograph. Data were analyzed using descriptive statistics. The Kruskal-Wallis H test was used to compare sugar content across various SSB categories. Results: From 1,316 SSBs, the products without NIPs (n=79) were excluded, along with duplicate products in different packaging sizes (n=248). The remaining 989 items were included in the authors' analyses. The median sugar content of all products was 7.5 (IQR 5.0 to 10.0) g/100 mL. The maximum sugar content was 24.0 g/100 mL in fermented milk and the minimum was 0.2 g/100 mL in herbal beverages. Flavored drinking yogurts had the highest median sugar content, at 11.7 (IQR 7.5 to 13.9) g/100 mL, while flavored water had the lowest median, at 4.5 (IQR 3.0 to 8.6) g/100 mL. There were statistically significant differences in sugar content between SSBs categories (p<0.001). Of all 989 products, 393 (39.7%) had a sugar content below 6 g/100 mL and were subjected to zero tax. Conclusion: Most of SSBs have low sugar content level with respect to excise sugar tax rate. However, the sugar content in drinkable dairy products and carbonated soft drink are of concern. [ABSTRACT FROM AUTHOR]

Abstract Childhood malnutrition, associated with poor diet, is a clear public health threat in Sri Lanka, with high rates of under‐nutrition and micronutrient deficiencies coupled with the growing risk of overweight/obesity in urban locations. This study explored the dietary diversity and food intake of urban living Sri Lankan preschool children. A cross‐sectional analysis of the baseline data from a cohort study was conducted with parents/caregivers of children aged 2–6 years, from 21 preschool centres in Kurunegala District, Sri Lanka. Demographic and socio‐economic factors, dietary diversity score (DDS) (n = 597) and food intake (n = 458) (using a food frequency questionnaire) were assessed. Children had a mean DDS of 4.56 ± 0·85 out of 9, with most (91.1%) in the medium DDS category (DDS of 3.1–6.0), consuming rice as most common food. Lentils were consumed more than any meat or alternative food groups at all DDS levels. Child DDS differs with parent/caregiver age and ethnicity. Mean daily intakes of fruit (1.02) and vegetables (0.84) servings align with approximately half of national recommendations, with less than 20% of children meeting daily recommendations. More than one‐third consumed sugary snacks and confectionaries daily and 1 in 10 had them twice a day. Around 40% reported watching television while eating the evening meal. Despite the majority having reasonable DDSs (medium category), findings highlighted inadequate intakes of fruits and vegetables, excessive intakes of sugary snacks and unhealthy dietary and social behaviours, suggests the need for population‐based interventions to promote healthier dietary habits.

Introduction: This study aimed to analyze the main pictorial representations of food-based vegetarian dietary guidelines from different countries as a starting point to design a new guide for this specific population in Spain. Material and methods: Searching in evidence-based databases and webs. Associations of dieticians and nutritionists, research groups, universities, and private entities endorsed by nutritionists were chosen. Format, target population, type and number of dietetic (as food grouping, servings, quantities), nutritional and lifestyle messages were compared. Messages’ content and visual aspects, their position in the illustrations and their esthetic style were also analyzed. Results: Eleven healthy eating guidelines with illustration for the vegetarian population worldwide were selected. Most of the graphics were intended for vegans and vegetarians; eight of them were pyramids, two were plates and one food shelving. Five food groups were always present: vegetables, fruits, cereals and derivative products, pulses and soybean products, and nuts. Messages about physical activity were present in four of them and vitamin B12 supplementation in five. One of the illustrations contained a message about environmental sustainability; most of them (7 out of 11) reached up to fourteen dietetic and nutritional messages and more than 45 food, supplements and lifestyle icons. None has a hypertext or use digital tools in the online version. Conclusions: There are differences in the position and composition of food grouping in vegetarian food guide illustrations. The main recommendation to consume grains, vegetables, fruits, pulses, soybean products and nuts daily was consistent in all the illustrations included. There is a need for more information on quantities and servings, foods rich in calcium or omega-3, vitamin B12 supplementation and environmental sustainability. Adding recommendations about the consumption of iodized salt would be important in the Spanish context.

Childhood malnutrition, associated with poor diet, is a clear public health threat in Sri Lanka, with high rates of under‐nutrition and micronutrient deficiencies coupled with the growing risk of overweight/obesity in urban locations. This study explored the dietary diversity and food intake of urban living Sri Lankan preschool children. A cross‐sectional analysis of the baseline data from a cohort study was conducted with parents/caregivers of children aged 2–6 years, from 21 preschool centres in Kurunegala District, Sri Lanka. Demographic and socio‐economic factors, dietary diversity score (DDS) (n = 597) and food intake (n = 458) (using a food frequency questionnaire) were assessed. Children had a mean DDS of 4.56 ± 0·85 out of 9, with most (91.1%) in the medium DDS category (DDS of 3.1–6.0), consuming rice as most common food. Lentils were consumed more than any meat or alternative food groups at all DDS levels. Child DDS differs with parent/caregiver age and ethnicity. Mean daily intakes of fruit (1.02) and vegetables (0.84) servings align with approximately half of national recommendations, with less than 20% of children meeting daily recommendations. More than one‐third consumed sugary snacks and confectionaries daily and 1 in 10 had them twice a day. Around 40% reported watching television while eating the evening meal. Despite the majority having reasonable DDSs (medium category), findings highlighted inadequate intakes of fruits and vegetables, excessive intakes of sugary snacks and unhealthy dietary and social behaviours, suggests the need for population‐based interventions to promote healthier dietary habits. [ABSTRACT FROM AUTHOR]

Soups are major components of Ghanaian dishes. The composite nature of Ghanaian soups, in general, tend to make the calorie and macronutrient composition highly variable. This study sought to determine the proximate composition of selected Ghanaian soups from defined recipes and to photographically present quantities of the soups, measured with common Ghanaian household food measures, equivalent to servings of protein and carbohydrates. Two types of each conveniently selected soup (light soup, groundnut soup, kontomire (cocoyam leaves) soup and palm nut soup) were prepared; one with animal protein and the other without. The soups prepared include; LS1-light soup with garden eggplant (African eggplant); LS2-light soup with garden eggplant and chicken GS1-groundnut (peanut butter) soup without animal protein; GS2-groundnut soup with chicken; PS1-palm nut soup without animal protein; PS2-palm nut soup with smoked catfish and herrings. Proximate analysis was done to determine macronutrient content of all the soups. Each soup was measured using a household food measure (150 ml soup ladle) to obtain a 15 g carbohydrate and 7 g protein equivalent and then photographed. Carbohydrate content of the soups ranged between 1.18 g-8.43 g, protein was between 0.34 g-4.31 g and 0.14 g-7.78 g for fat per 100 g of edible portion. Palm nut soup with animal source protein had the highest carbohydrate (8.43 ± 0.86 g) and fibre (1.99 ±0.22 g) content. Soups with the highest protein and fat content were GS2 (4.29 ± 0.14 g) and PS1 (20.39 ± 3.54 g) respectively. Serving sizes of the soups prepared ranged approximately between 1-8½ soup ladles (using 150 ml soup ladle) per 15 g carbohydrate equivalence and 1-13 soup ladles (using 150 ml soup ladle) per 7 g protein equivalence. It took variable quantities of the prepared soups to obtain the target serving sizes with PS2 having the least quantity (~1 soup ladle) for 15 g carbohydrate serving and PS1 having the least amount (~1 soup ladle) for 7 g protein serving. The large serving size of most of the soups required to meet a serving of protein implied that those soups should be eaten together with food sources rich in protein, in order to appreciably enhance the protein intake of individuals. [ABSTRACT FROM AUTHOR]

Objective: To assess sugar content and child-oriented promotional features on packaging among cereals manufactured by companies with varying Children’s Food and Beverage Advertising Initiative (CFBAI) participation. Design: Ready-to-eat dry cereals (n = 159) were purchased from southeastern US grocery stores in September 2018. Content analysis of 159 ready-to-eat dry cereal boxes, coded for sugar content and presence of 8 child-oriented features. Main Outcome Measures: Frequencies of each promotional feature and number of features per box, level of participation in CFBAI, and sugar content by serving and ounce. Analysis: Chi-square tests of independence analyzed correspondence between measures of sugar content. Extent of features per box based on sugar content and CFBAI participation were assessed with analyses of variance (ANOVAs). Results: Most cereals (81%) contained <13 g of sugar per serving, meeting the sugar content requirement for child-directed advertising. Cereals’ sugar content classifications varied between sugar per serving and sugar per ounce metrics (P < .001). Among low-sugar per serving cereals, 28% were classified as moderate-sugar per ounce, whereas 55% of moderate-sugar per serving cereals had high-sugar per ounce. Games/ activities and trade characters were especially common (62% and 49%, respectively), particularly on high-sugar per ounce cereals (P < .001, respectively). Child-oriented features were rare on low-sugar cereals and highest on cereals with higher sugar content per ounce produced by CFBAI-participating companies (F8,158 = 12.33, P < .001). Conclusions and Implications: Variable cereal-suggested serving sizes may contribute to consumers’ misunderstanding of sugar content. CFBAI manufacturers continue to market cereals with high sugar to children. Food and beverage regulatory policy could be strengthened if CFBAI companies apply marketing pledges to brand mascots, adopt standardized metrics for sugar content, and limit added sugar content to the recommended <6 g/serving target used by the Special Supplemental Nutrition Program for Women, Infants, and Children program. [ABSTRACT FROM AUTHOR]

Background Reducing sugar in packaged foods and beverages could help protect children's future health. Clear methods for the development of feasible yet impactful sugar reduction program targets are needed. Objectives To outline methods for the development of program targets that would reduce, by 20%, the total sugar content of packaged foods and beverages commonly consumed by children. New Zealand (NZ) is used as a case study. Methods Sugar content and pack size targets were developed using a 6-step process informed by the UK sugar and salt reduction programs. Food groups contributing ≥2% to children's total sugar intake were identified using national dietary survey data. Consumption volume, sugar content, and pack size were obtained from household panel data linked with a packaged food composition database. Category-specific targets were set as 20% reductions in sales-weighted means adjusted for feasibility, i.e., ∼1/3 of products already meeting the target, and alignment with existing, relevant targets. Results Twenty-two food groups were identified as major contributors to NZ children's total sugar intake. Mean reductions required in sugar content and pack size to meet the targets were 5.2 g  per 100 g/mL (26%) and 61.2 g/mL/pack (23%), respectively. The percentage of products already meeting the sugar targets ranged from 14% for electrolyte drinks and flavored dairy milk to 50% for cereal bars, and for pack size targets compliance ranged from 32% for chocolate confectionary to 62% for fruit juices and drinks. Estimated reductions in annual household sugar purchases if the sugar and pack size targets were met were 1459 g (23%) and 286 g (6%), respectively. Conclusions Methods for the development of sugar and pack size reduction targets are presented, providing a robust, step-by-step process for countries to follow. The results of the case study provide a suggested benchmark for a potential national sugar reduction program in NZ. [ABSTRACT FROM AUTHOR]

Nutritional labels are mandatory on virtually all packaged food items sold in the United States. The nutritional information on these labels is reported on a 'per-serving-size' basis. However, unbeknownst to many consumers, current Food and Drug Administration regulations allow manufacturers some discretion in setting serving sizes-a factor that the authors hypothesize has implications for consumer behavior. For example, adopting a smaller serving size allows marketers to reduce the reported calories, fat, sugar, and carbohydrates in a product serving, which in turn can influence the anticipated consequences of consumption. Three studies show that manipulating the serving size, and thus calories per serving, for equivalent consumption amounts influences the anticipated guilt of consumption, purchase intentions, and choice behavior. However, the results also show that individual difference and context variables, which heighten consumer attention to nutritional information in general, often focus attention on calorie information but not serving size. This leads to the counterintuitive finding that more nutritionally vigilant consumers are more heavily influenced by serving size manipulations. The authors discuss the managerial and public policy implications. [ABSTRACT FROM AUTHOR]

Abstract Background Serving sizes on the Nutrition Facts table (NFt) on Canadian packaged foods have traditionally been unregulated and non-standardized. The federal government recently passed legislation to regulate the serving sizes listed on the NFt. The objective of this study was to compare the serving sizes on food product NFts to the recommendations in the 2003 Nutrition Labelling regulation (Schedule M) reference amounts, the Canadian Food Inspection Agency (CFIA) ranges, and Canada’s Food Guide recommendations. An additional objective was to determine if food and beverage products that report smaller serving sizes have a higher calorie density, compared to similar products with a larger serving size. Methods Data for 10,487 products were retrieved from the 2010 Food Label Information Program (FLIP) database and categorized according to Schedule M categories. Correlations between calorie density and manufacturer stated serving size were tested and the proportion of products meeting recommendations were tabulated. Results 35% of products had serving sizes on the NFt that were smaller than the Schedule M reference amount and 23% exceeded the reference amount. 86% of products fell within the CFIA’s recommended serving size ranges; however, 70% were within the lower-half of the range. Several bread and juice categories exceeded CFG’s recommendations, while several dairy product categories were smaller than the recommendations. Of the 50 Schedule M sub-categories analyzed, 31 (62%) exhibited a negative correlation between serving size and calorie density. Conclusion While most products fell within the CFIA’s recommended serving size ranges, there was a tendency for products with a higher calorie density to list smaller serving sizes.

Poor diet, resulting from high intake of ultra-processed packaged foods, is increasingly recognised as a key contributing factor to ill health. Food labels provide information on the nutritional content of packaged foods to consumers, which may influence consumption of nutrients such as energy, fat, saturated fat, trans-fats, sodium and added sugars. This review aims to summarise the current evidence for the association between use of food labels and dietary intake. The systematic search was conducted in August 2017 using six databases, with 6325 results. Twenty-six studies were included, including cross-sectional studies (n = 20), a cohort study (n = 1) and randomised controlled trials (n = 5). Studies were assessed using the American Dietetic Association Quality Criteria Checklist. Results were inconsistent in reporting a relationship between diet and food label use but indicated that reading the nutrition facts label is associated with healthier diets, measured by food frequency questionnaires and 24 h recalls. However, there is insufficient research on the association between dietary consumption and use of ingredients lists, serving size information and front-of-pack labels. Using health-related claims may be associated with poor diets, however evidence is inconclusive. Apart from health-related claims, using food labels is associated with healthier diets and should continue to be promoted through policies and education programs. Further research in this area is warranted to provide additional information on the impact of ingredients lists, serving sizes, front-of-pack labels and health-related claims on dietary intake. [ABSTRACT FROM AUTHOR]

Aim: Cakes and muffins are commonly consumed discretionary foods that have increased significantly in portion size over the past decades. The present study aimed to (i) investigate serving sizes and energy per serving of cakes and muffins sold in supermarkets and coffee chains, (ii) compare to standard discretionary serves and (iii) propose feasible and appropriate serving size recommendations. Methods: Serving sizes and energy content of cakes and muffins were collected from four major Australian supermarkets (n = 219) and eight coffee chains (n = 248) between March and April 2017 and classified into eight categories and compared using Mann–Whitney tests. Median energy per serving of cakes and muffins from supermarkets and coffee chains were compared to the Australian Dietary Guidelines standard serve of 600 kJ for discretionary food. Results: The median serving size of cakes and muffins from supermarkets, 58 g (interquartile range, IQR: 47–83) and their energy content, 915 kJ (IQR: 745–1243) were significantly smaller compared with coffee chain equivalents, 148 g (IQR: 115–171, P < 0.001) and 1805 kJ (IQR: 1436–2004, P < 0.001), respectively. The majority of cakes and muffins exceeded the Australian Dietary Guidelines standard serve (78% from supermarkets and 99% from coffee chains). Conclusions: The larger servings of cakes and muffins sold in coffee chains contain nearly double the energy content of smaller servings sold in supermarkets. We recommend reference serving sizes for industry and food retail are set for this category, in combination with consumer education to guide consumers to select appropriate portion sizes. [ABSTRACT FROM AUTHOR]

Studies indicate a 'portion size effect' association between increased portion size and energy intake, but direct links with obesity remain unproven. UK portion size guidance is outdated and evidence suggests that on-pack serving-sizes have increased in some energy-dense foods. Serving-sizes are compared with consumed portion sizes in popular energy, fat and sugar-dense foods, and patterns explored. Data was analysed for adults aged 19-64y (excluding under-reporters) from the UK National Diet & Nutrition Survey 2008-2014 (n = 2377) for consumed portion sizes and a commercial product database of major UK retailers provided serving-sizes. Popular energy-dense food groups were split into 45 product-based subgroups. Means of consumed portion size and on-pack serving-size were calculated and compared and nutrition per 100 g and per serve was explored. Just 57% products had serving-size compared to 97% with pack-size information. Serving-size ranges were wide and varied across food groups. Consumed portion sizes were significantly higher than on-pack serving-size in all main food groups and most subgroups. The greatest difference between consumed portion size and on-pack serving-size was Crisps (44%), and within this, 'popcorn' (151%). In Chocolate and Crisps, food subgroups with the largest on-pack serving-sizes were also the most macronutrient dense. Serving-size was unavailable for many products. However, where available, consumed portion sizes were higher than on-pack serving-size in all main food groups and most subgroups. The results could inform updated portion size guidance of energy-dense foods. Further work is needed to clarify whether smaller serving and pack sizes lead to lower total consumption and energy/nutrient intake. [ABSTRACT FROM AUTHOR]

Abstract Background Extensive work has focused on the effects of nutrition label information on consumer behavior on the one hand, and on the effects of packaging graphics on the other hand. However, little work has examined how serving suggestion depictions - graphics relating to serving size - influence the quantity consumers serve themselves. The current work examines the prevalence of exaggerated serving size depictions on product packaging (study 1) and its effects on food serving in the context of cereal (study 2). Methods Study 1 was an observational field survey of cereal packaging. Study 2 was a mixed experimental cross-sectional design conducted at a U.S. university, with 51 student participants. Study 1 coded 158 US breakfast cereals and compared the serving sizes depicted on the front of the box with the suggested serving size stated on the nutrition facts panel. Study 2 measured the amount of cereal poured from exaggerated or accurate serving size depictions. Study 1 compared average servings via t-tests. Study 2 used a mixed model with cereal type as the repeated measure and a compound symmetry covariance matrix. Results Study 1 demonstrated that portion size depictions on the front of 158 cereal boxes were 64.7% larger (221 vs. 134 calories) than the recommended portions on nutrition facts panels of those cereals. Study 2 showed that boxes that depicted exaggerated serving sizes led people to pour 17.8% more cereal compared to pouring from modified boxes that depicted a single-size portion of cereal matching suggested serving size. This was 42% over the suggested serving size. Conclusions Biases in depicted serving size depicted on cereal packaging are prevalent in the marketplace. Such biases may lead to overserving, which may consequently lead to overeating. Companies should depict the recommended serving sizes, or otherwise indicate that the depicted portion represents an exaggerated serving size.

Context In recent decades, portion sizes have increased significantly. Although previous research indicates that food labels impact on product choice and healthiness perception, their impact on portion sizes consumed is less clear. Objective This systematic review examined whether food label information influenced portion size consumption. Data sources A search of 7 major electronic databases for studies published from 1980 to April 2016 was conducted. Data extraction Two reviewers independently screened 11 128 abstracts. Data were extracted from 32 articles (comprising 36 studies). Results Based on the test food used, the overall effects were found to be: no effect, a positive effect, or a negative effect. Labels displaying energy content (n = 15 studies, 17 effects) and fat content information (n = 13 studies, 14 effects) were evaluated most commonly, with exercise equivalent labels evaluated least (n = 2 studies, 2 effects). Conclusions Nutrition and health information presented on food labels has varying impacts on portion sizes consumed, from increased to decreased intake. Recommendations for future research include evaluating more recent food label types and achieving more consistent reporting standards. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To test whether reducing the standard serving size of alcoholic beverages would reduce voluntary alcohol consumption in a laboratory (study 1) and a real‐world drinking environment (study 2). Additionally, we modelled the potential public health benefit of reducing the standard serving size of on‐trade alcoholic beverages in the United Kingdom. Design: Studies 1 and 2 were cluster‐randomized experiments. In the additional study, we used the Sheffield Alcohol Policy Model to estimate the number of deaths and hospital admissions that would be averted per year in the United Kingdom if a policy that reduces alcohol serving sizes in the on‐trade was introduced. Setting: A semi‐naturalistic laboratory (study 1), a bar in Liverpool, UK (study 2). Participants: Students and university staff members (study 1: n = 114, mean age = 24.8 years, 74.6% female), residents from local community (study 2: n = 164, mean age = 34.9 years, 57.3% female). Interventions and comparators: In study 1, participants were assigned randomly to receive standard or reduced serving sizes (by 25%) of alcohol during a laboratory drinking session. In study 2, customers at a bar were served alcohol in either standard or reduced serving sizes (by 28.6–33.3%). Measurements: Outcome measures were units of alcohol consumed within 1 hour (study 1) and up to 3 hours (study 2). Serving size condition was the primary predictor. Findings: In study 1, a 25% reduction in alcohol serving size led to a 20.7–22.3% reduction in alcohol consumption. In study 2, a 28.6–33.3% reduction in alcohol serving size led to a 32.4–39.6% reduction in alcohol consumption. Modelling results indicated that decreasing the serving size of on‐trade alcoholic beverages by 25% could reduce the number of alcohol‐related hospital admissions and deaths per year in the United Kingdom by 4.4–10.5% and 5.6–13.2%, respectively. Conclusions: Reducing the serving size of alcoholic beverages in the United Kingdom appears to lead to a reduction in alcohol consumption within a single drinking occasion. [ABSTRACT FROM AUTHOR]

It is known the existence of a clear relationship between dietary habits and health. People's dietary habits have been evolving due to different factors (labor, social, etc.). It is important to know what we eat when we buy at supermarkets, when we choose a menu or a course or which culinary techniques we use. Nowadays, there is a wide offer of processed food products at supermarkets which numerous ingredients. The food label informs us about the ingredients and part of the food composition as salt, added sugars, total fat, saturated and cholesterol. The usefulness of this information in order to choose the right food depends on the consumer to have an education on the main concepts of food and nutrition and to read them. In general, nutritional value of a specific food product is not one of the main criteria on its election, being the price, availability and sensory properties (flavor) of the product the main ones. At restaurants, the new culinary techniques and the use of processing aids don't make knowing what we are eating and which is its nutrient content easy. We know that culinary techniques can alter the nutritional composition of a recipe due to nutrient loss or the gain or loss of fats and/or water. It is also important to know how much we eat. The increase of the size of the available portions in the last 40 years and the absence of recommended portions in the food-based dietary guidelines could provoke high energy and other nutrients intakes that could have a negative effect on health. [ABSTRACT FROM AUTHOR]

Declared serving sizes on food packaging are unregulated in Australia, and variations in serving size within similar products reduces the usability of this information. This study aimed to (i) assess the variations in declared serving sizes of packaged foods from the Five Food Groups, and (ii) compare declared serving sizes to the Australian Dietary Guidelines standard serves and typical portion sizes consumed by Australian adults. Product information, including serving size, was collected for 4046 products from four major Australian retailers. Within product categories from the Five Food Groups, coefficients of variation ranged from 0% to 59% for declared serving size and 9% to 64% for energy per serving. Overall, 24% of all products displayed serving sizes similar (within ±10%) to the standard serves, and 23-28% were similar to typical portion sizes consumed by adults, for females and males, respectively. In conclusion, there is substantial variation in the declared serving sizes of packaged foods from the Five Food Groups, and serving sizes are not aligned with either the Dietary Guidelines or typical portion sizes consumed. Future research into effective means of standardising serving sizes is warranted. [ABSTRACT FROM AUTHOR]

The French Observatory of Food Quality (Oqali) aims at collecting all nutritional data provided on the labels of processed foods (nutritional information and composition), at the branded products level, in order to monitor changes in food composition (including reformulation) and nutritional labelling over time. This study involved a cross-sectional analysis of both the range of processed foods available and the associated nutritional information labelling according to the type of brand (national brands, retailer brands, entry-level retailer brands, hard discount and specialised retailer brands). On the basis of the data collected for 16 081 products from 24 food sectors between 2008 and 2011, the range of entry-level retailer brands was concentrated on the most basic and traditional recipes: for instance among Fresh dairy products, there were 30% Fresh creams, liégeois and flavoured jellied milk (n = 19), 24% Classic sweet yogurts (n = 15), and 17% Classic plain fresh cheeses with no added sugar (n = 11), but no Light and/or sweetened fresh dairy desserts (n = 0). Analysis of nutritional information labelling showed that retailer brand products carried the highest frequency of nutrition labelling (94%), guideline daily amounts (54%), and serving sizes (78%). National brand products displayed the highest frequency of claims (28% for nutrition claims and 8% for health claims). Entry-level retailer brand products displayed the lowest amount of nutritional information. [ABSTRACT FROM AUTHOR]

Many consumers do not pay attention to nutrition information, a necessity to make healthy food choices. We measure attention to a Nutrition Facts Panel (NFP) currently used in the U.S. and to a modified NFP that emphasizes key information, using eye-tracking in a between-subjects experiment. We test for differences between attention to the current and modified NFP but also for differences across food items. We find asymmetric effects, depending on the product. For healthier items more attention is paid to the modified NFP than to the current NFP. For less healthy items less attention is paid to the modified NFP than to the current NFP. Results suggest that a single modified design may not be uniformly effective. [ABSTRACT FROM AUTHOR]

Background: Institutionalization is a risk factor for malnutrition. Low energy intake and/or nutrient deficiencies are considered to be the main causes.Objective: To evaluate the quality of meals and meal service as well as the nutritional value of the main menus (regular menu, menu for diabetics, and pureed menu) offered in three long-term care (LTC) homes located in the metropolitan area of Granada (Spain).Methods: Cross-sectional study. A validated "quality of meals and meal service" set of indicators was applied. The menus were assessed by weighed food records on 14 consecutive days. The results were compared with the dietary reference intakes (DRIs) and the recommended number of servings.Results: Important deficiencies in the quality of meals and meal service have been reported. Average energy varies from 1,788 to 2,124 kcal/day in the regular menus, from 1,687 to 1,924 kcal/day in the menus for diabetics, and from 1,518 to 1,639 kcal/day in the pureed menus. Average protein varied from 71.4 to 75.4 g/day, from 72.6 to 76.1 g/day, and from 50.5 to 54.7 g/day, respectively. None of the menus complied with the recommendations for fiber, potassium, magnesium, iodine, vitamin D, vitamin E, folate, nor for vegetables, fruit, milk products, olive oil, legumes, or nuts.Conclusions: It is necessary to ensure the implementation of regular routines for controlling the quality of meals and meal service as well as the nutritional value of the menus offered in LTC homes. [ABSTRACT FROM AUTHOR]

Background: Serving sizes on the Nutrition Facts table (NFt) on Canadian packaged foods have traditionally been unregulated and non-standardized. The federal government recently passed legislation to regulate the serving sizes listed on the NFt. The objective of this study was to compare the serving sizes on food product NFts to the recommendations in the 2003 Nutrition Labelling regulation (Schedule M) reference amounts, the Canadian Food Inspection Agency (CFIA) ranges, and Canada's Food Guide recommendations. An additional objective was to determine if food and beverage products that report smaller serving sizes have a higher calorie density, compared to similar products with a larger serving size.Methods: Data for 10,487 products were retrieved from the 2010 Food Label Information Program (FLIP) database and categorized according to Schedule M categories. Correlations between calorie density and manufacturer stated serving size were tested and the proportion of products meeting recommendations were tabulated.Results: 35% of products had serving sizes on the NFt that were smaller than the Schedule M reference amount and 23% exceeded the reference amount. 86% of products fell within the CFIA's recommended serving size ranges; however, 70% were within the lower-half of the range. Several bread and juice categories exceeded CFG's recommendations, while several dairy product categories were smaller than the recommendations. Of the 50 Schedule M sub-categories analyzed, 31 (62%) exhibited a negative correlation between serving size and calorie density.Conclusion: While most products fell within the CFIA's recommended serving size ranges, there was a tendency for products with a higher calorie density to list smaller serving sizes. [ABSTRACT FROM AUTHOR]

Background: Extensive work has focused on the effects of nutrition label information on consumer behavior on the one hand, and on the effects of packaging graphics on the other hand. However, little work has examined how serving suggestion depictions - graphics relating to serving size - influence the quantity consumers serve themselves. The current work examines the prevalence of exaggerated serving size depictions on product packaging (study 1) and its effects on food serving in the context of cereal (study 2).Methods: Study 1 was an observational field survey of cereal packaging. Study 2 was a mixed experimental cross-sectional design conducted at a U.S. university, with 51 student participants. Study 1 coded 158 US breakfast cereals and compared the serving sizes depicted on the front of the box with the suggested serving size stated on the nutrition facts panel. Study 2 measured the amount of cereal poured from exaggerated or accurate serving size depictions. Study 1 compared average servings via t-tests. Study 2 used a mixed model with cereal type as the repeated measure and a compound symmetry covariance matrix.Results: Study 1 demonstrated that portion size depictions on the front of 158 cereal boxes were 65.84% larger (221 vs. 134 calories) than the recommended portions on nutrition facts panels of those cereals. Study 2 showed that boxes that depicted exaggerated serving sizes led people to pour 20% more cereal compared to pouring from modified boxes that depicted a single-size portion of cereal matching suggested serving size. This was 45% over the suggested serving size.Conclusions: Biases in depicted serving size depicted on cereal packaging are prevalent in the marketplace. Such biases may lead to overserving, which may consequently lead to overeating. Companies should depict the recommended serving sizes, or otherwise indicate that the depicted portion represents an exaggerated serving size. [ABSTRACT FROM AUTHOR]

Objective: To test modifications to nutrition label serving size information on understanding of energy (calorie) content among youth and young adults.Design: Participants completed two online experiments. First, participants were randomly assigned to view a beverage nutrition label with a reference amount of per serving (250 ml), per container (473 ml) or a dual-column format with both reference amounts. Participants were then randomized to view a cracker nutrition label which specified a single serving in small font, a single serving in large font, or the number of servings per bag with single serving information below. In both experiments, participants estimated energy content. Logistic regression analysis modelled correct energy estimation. Finally, participants reported their preference for serving size display format.Setting: Canada.Subjects: Canadian youth and young adults (n 2008; aged 16-24 years).Results: In experiment 1, participants randomized to view the nutrition label with per container or dual column were more likely to correctly identify energy content than those using per serving information (P<0·01). For experiment 2, the serving size display format had no association with correct energy estimation. The majority of participants (61·9 %) preferred the serving size format that included servings per package.Conclusions: Labelling foods with nutrition information using a serving size reference amount for the entire container increased understanding of energy content. Consumers prefer nutrition labels that include more prominently featured serving size information. Additional modifications that further improve consumers' accuracy should be examined. These results have direct implications for nutrition labelling policy. [ABSTRACT FROM AUTHOR]

Background: Obesity disproportionately affects children from low-income families and those from racial and ethnic minorities. The relationship between snacking and weight status remains unclear, although snacking is known to be an important eating episode for energy and nutrient intake particularly in young children. The purpose of this pilot study was to examine the snack intake of minority preschool children enrolled in the Head Start Program in four centers in Detroit, Michigan, and investigate differences by child weight status. Methods: This secondary data analysis used snack time food observation and anthropometric data from a convenience sample of 55 African American children (44% girls, mean age = 3.8 years). Snack intake data was obtained over a mean of 5 days through direct observation of children by dietetic interns, and later converted into food group servings according to the United States Department of Agriculture (USDA) meal patterns and averaged for each child. Height and weight measurements were systematically collected and BMI-for-age percentiles were used to classify children into weight categories. One sample, paired samples and independent samples t-tests were performed to test for differences within and between means. Results: Based on BMI-for-age percentiles, 72.7% of the sample was under/healthy weight and 27.3% was overweight/obese. Average (mean ± SD) intake of milk (0.76 ± 0.34) and overall fruits/vegetables (0.77 ± 0.34) was significantly lower than one USDA serving, while average intake of grains and breads (2.04 ± 0.89), meat/meat alternates (2.20 ± 1.89) and other foods (1.43 ± 1.08) was significantly higher than one USDA serving (p = 0.05). Children ate more when offered canned versus fresh fruits (0.93 ± 0.57 vs. 0.65 ± 0.37, p = 0.007). Except for a significantly higher milk intake in the overweight/obese group compared to the under/healthy weight group (0.86 ± 0.48 vs. 0.72 ± 0.27, p = 0.021], no relationship was found between snack food intake and weight category. Only in the overweight/obese group was the intake of milk and fresh fruits not significantly different than one USDA serving. Conclusions: Findings suggest that regardless of weight status low-income minority preschool children are consuming larger serving sizes when offered less healthy versus healthier snack foods. Continued efforts should be made to provide healthful snack foods at preschool settings to prevent obesity and promote healthier food habits. [ABSTRACT FROM AUTHOR]

Objective: Food packaging often pictures supplementary extras, such as toppings or frosting, that are not listed on the nutritional labelling. The present study aimed to assess if these extras might exaggerate how many calories† are pictured and if they lead consumers to overserve. Design: Four studies were conducted in the context of fifty-one different cake mixes. For these cake mixes, Study 1 compared the calories stated on the nutrition label with the calories of the cake (and frosting) pictured on the box. In Studies 2, 3 and 4, undergraduates (Studies 2 and 3) or food-service professionals (Study 4) were given one of these typical cake mix boxes, with some being told that cake frosting was not included on the nutritional labelling whereas others were provided with no additional information. They were then asked to indicate what they believed to be a reasonable serving size of cake. Settings: Laboratory setting. Subjects: Undergraduate students and food-service professionals. Results: Study 1 showed that the average calories of cake and frosting pictured on the package of fifty-one different cake mixes exceed the calories on the nutritional label by 134%. Studies 2 and 3 showed that informing consumers that the nutritional information does not include frosting reduces how much people serve. Study 4 showed that even food-service professionals overserve if not told that frosting is not included on the nutritional labelling. Conclusions: To be less misleading, packaging should either not depict extras in its pictures or it should more boldly and clearly state that extras are not included in calorie counts. [ABSTRACT FROM AUTHOR]

Objective: To assess the mean package size and manufacturer-recommended serving size of sweet beverages available in four high-income countries: Australia, Canada, the Netherlands and New Zealand.Design: Cross-sectional surveys.Setting: The two largest supermarket chains of each country in 2012/2013.Subjects: Individual pack size (IPS) drinks (n 891) and bulk pack size (BPS) drinks (n 1904).Results: For all IPS drinks, the mean package size was larger than the mean serving size (mean (sd)=412 (157) ml and 359 (159) ml, respectively). The mean (sd) package size of IPS drinks was significantly different for all countries (range: Australia=370 (149) ml to New Zealand=484 (191) ml; P<0·01). The mean (sd) package size of Dutch BPS drinks (1313 (323) ml) was significantly smaller compared with the other countries (New Zealand=1481 (595) ml, Australia=1542 (595) ml, Canada=1550 (434) ml; P<0·01). The mean (sd) serving size of BPS drinks was significantly different across all countries (range: Netherlands=216 (30) ml to Canada=248 (31) ml; P<0·00). New Zealand had the largest package and serving sizes of the countries assessed. In all countries, a large number of different serving sizes were used to provide information on the amount appropriate to consume in one sitting.Conclusions: At this point there is substantial inconsistency in package sizes and manufacturer-recommended serving sizes of sweet beverages within and between four high-income countries, especially for IPS drinks. As consumers do factor serving size into their judgements of healthiness of a product, serving size regulations, preferably set by governments and global health organisations, would provide consistency and assist individuals in making healthier food choices. [ABSTRACT FROM AUTHOR]