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The first step in quantitative microbial risk assessment (QMRA) is to determine the distribution of pathogen contamination among servings of the food in question at some point in the farm-to-table chain. In the present study, the distribution of Salmonella contamination among servings of chicken liver for use in the QMRA was determined at meal preparation. Salmonella prevalence (P), most probable number (MPN, N), and serotype for different serving sizes were determined by use of a combination of five methods: (i) whole sample enrichment; (ii) quantitative PCR; (iii) culture isolation; (iv) serotyping; and (v) Monte Carlo simulation. Epidemiological data also were used to convert serotype data to virulence (V) values for use in the QMRA. A Monte Carlo simulation model based in Excel and simulated with @Risk predicted Salmonella P, N, serotype, and V as a function of a serving size of one (58 g) to eight (464 g) chicken livers. Salmonella P of chicken livers was 72.5% (58 of 80) per 58 g. Four Salmonella serotypes were isolated from chicken livers: (i) Infantis (P = 28%, V = 4.5); (ii) Enteritidis (P = 15%, V = 5); (iii) Typhimurium (P = 15%, V = 4.8); and (iv) Kentucky (P = 15%, V = 0.8). Salmonella N was 1.76 log MPN/58 g (median) with a range of 0 to 4.67 log MPN/58 g, and the median Salmonella N was not affected (P > 0.05) by serotype. The model predicted a nonlinear increase (P ≤ 0.05) of Salmonella P from 72.5%/58 g to 100%/464 g, a minimum N of 0 log MPN/58 g to 1.28 log MPN/464 g, and a median N from 1.76 log MPN/58 g to 3.22 log MPN/464 g. Regardless of serving size, predicted maximum N was 4.74 log MPN per serving, mean V was 3.9 per serving, and total N was 6.65 log MPN per lot (10,000 chicken livers). The data acquired and modeled in this study address an important data gap in the QMRA for Salmonella and whole chicken liver. HIGHLIGHTS

Sarcopenia is a core contributor to several health consequences, including falls, fractures, physical limitations and disability. The pathophysiological processes of sarcopenia may be counteracted with the proper diet, delaying sarcopenia onset. Dietary pattern analysis is a whole diet approach used to investigate the relationship between diet and sarcopenia. Here, we aimed to investigate this relationship in an elderly Chinese population. A cross-sectional study with 2423 participants aged more than 60 years was performed. Sarcopenia was defined based on the guidelines of the Asian Working Group for Sarcopenia, composed of low muscle mass plus low grip strength and/or low gait speed. Dietary data were collected using a FFQ that included questions on 100 food items along with their specified serving sizes. Three dietary patterns were derived by factor analysis: sweet pattern, vegetable pattern and animal food pattern. The prevalence of sarcopenia was 16·1 %. The higher vegetable pattern score and animal food pattern score were related to lower prevalence of sarcopenia (Ptrend = 0·006 and < 0·001, respectively); the multivariate-adjusted OR of the prevalence of sarcopenia in the highest v. lowest quartiles were 0·54 (95 % CI 0·34, 0·86) and 0·50 (95 % CI 0·33, 0·74), separately. The sweet pattern score was not significantly related to the prevalence of sarcopenia. The present study showed that vegetable pattern and animal food pattern were related to a lower prevalence of sarcopenia in Chinese older adults. Further studies are required to clarify these findings.

Adopting a sustainable diet is an alternative to address the pandemics of obesity, undernutrition and climate change that are threatening human health. Sustainable diet considers the health aspect as well as the environmental impact of diets. There is a scarcity of research on sustainable diet and lack validated tools for its measurement. This article aimed to describe the protocol on the development and validation of a Sustainable Diet Index (SDI) among Malaysian adults. A Sustainable Diet Index (SDI) was developed based on previous studies and available dietary guidelines on sustainable diet. Five indicators (rice, animal-based food, plant-based food, food waste and packaging) were included in the SDI. The index will be validated among Malaysian adults using mobile food record as the dietary assessment tool. The index has the potential to measure the level of healthy and sustainable diet behaviour of an individual. The use of mobile food record provides images of each eating occasion for the evaluation of serving size and the information on waste management. Health and environmental impacts from the diet can be evaluated through the integration of all indicators in the SDI. The index developed is novel and expected to provide a feasible measurement to assess the level of sustainable diet of an individual.

Background and aims Food preferences are often modified in populations during stressful, unanticipated events. We examined how a U.S. population's food choices changed during the beginning of the COVID-19 stay-at-home orders, specifically during the spring of 2020. Methods and results Daily dietary intake data from a digital behavior change weight loss program, which includes an interface for logging meals, beverages, and snacks, were analyzed to assess self-reported food choices from March 5-March 11, 2020 ("Start-COVID") and during the first week of the COVID-19 lockdown (March 12-March 18, 2020; "during-COVID"). The final sample consisted of 381,564 participants: 318,076 (83.4%) females, the majority who were aged 45–65 years (45.2%). Results indicate that self-reported servings of fresh fruit and vegetable intake decreased from start-to during-COVID, while intake of red meat and starchy vegetables increased. More men than women increased their intake of red meat and processed meat. Less overall change in fruit and vegetable consumption was seen in those 66 and older, compared to aged 18–35. Lean meat and starchy vegetable intake increased in older participants, but the change was negligible in younger subjects. More subjects aged 18–35 years reduced their intake of caffeine, desserts, lean meat, and salads compared to older participants. No changes were observed in snack or alcohol intake logged. Conclusion This study revealed that particular food groups were altered according to age and gender during the first weeks of COVID lockdown. Understanding changes in food choices during a crisis may be useful for preparing supply chains and public health responses.

This study aimed to describe the development of a Thai semiquantitative food frequency questionnaire (Thai semi-FFQ) for people at risk people for metabolic syndrome. Data from the Thailand National Food Consumption Survey was used to analyze food lists and portion sizes of single food items. Data for Thai mixed dishes were lacking. Hence, data on mixed dishes were collected from five cafeterias at Siriraj Hospital in Thailand. Three samples of each food item were used to weigh the major ingredients. The nutritive values were calculated using Thai food composition software. Nutrient profiling criteria (NP) were used to classify the selected food items. Ninety-one food items of eight food groups and five serving sizes were included in the Thai semi-FFQ. The food groups were fruits (n = 18), beverages (n = 10), snacks and desserts (n = 29), a la carte (n = 7), noodles (n = 11), rice with toppings (n = 8), eggs (n = 3), and salads (n = 5). The Thai mixed dishes were classified into three groups: a la carte, noodles, and rice with toppings. All mixed dishes were scored by NP criteria, with 13% receiving a ‘grade A’ (score > 16). Thirty four percent were classified as ‘grade B’ (score 12–16), and 53% were given a ‘grade C’ (score

Currently there is little research investigating awareness or use of dietary guidelines in Saudi Arabia. This study aims to investigate Saudi Arabian mother’s knowledge of current dietary guidelines regarding food groups and portion sizes and to investigate its relation to the sociodemographic factors. This cross-sectional study used community-based family events to recruit mothers and children. Health stands offering nutrition information and advice were used at these events for study recruitment and nutritional advices to attract them. A short online questionnaire was used to interview mothers during the events to measure their knowledge of dietary guideline and portion sizes. The questionnaire included questions to assess knowledge of dietary guidelines and portion sizes. Questions about the serving size of each food groups and the dietary guideline ‘MyPlate’ were included; the study recruited a convenience sample of 101 participants. Quantitative analysis using Chi-square and Kruksan-Wallis tests. We found 29.1 % of the participants were aware of the MyPlate guidelines and 51.5 % said that they are affected by healthy plate choices. Being married was significantly associated with knowing about the MyPlate Image (P= 0.004). Correct identification of food groups on the MyPlate Image and correct identification of serving sizes of food group was less than 50% for most food groups. A significantly greater percentage of those with a postgraduate education were accurate about the correct servings of fruit, vegetables and grains (P=0.049). Nutrition knowledge of food groups and serving sizes was poor in the sample of Saudi Arabian women. This research provides evidence that nutrition education is needed in the Saudi Arabia and the finding are relevant for future health promotion strategies. The study has also identified sociodemographic groups that possibly may need to be targeted with more attention in future nutrition education programs such as those with low income, lower education level and unmarried women.

Background Since 1950, the portion size of many snack foods has more than doubled and obesity rates have tripled. Portion size determines energy intake, often unwittingly. Purpose This paper tests whether salient visual cues to portion size on the packaging of high fat, sugar, or salty (HFSS) snacks can reduce consumption. Methods Two preregistered randomized controlled trials (N = 253 and N = 674) measured consumption in a lab and the home environment. Cues were salient, labeled stripes that demarcated single portions. Participants were randomized to cue condition or control. Consumption was measured without awareness. Results The main preregistered effect of the visual cue was not statistically significant. There was some variation by subgroup. In Study 1, men were more likely to eat the whole can of potato chips than women but significantly reduced consumption when visual cues were on the pack. The effect size was large: the number of men eating more than the recommended portion fell by 33%. Study 2 monitored household consumption of chocolate biscuits (cookies) sent to family homes in gift packs. Again, the main effect was nonsignificant but there was significant subgroup variation. When the person receiving the biscuits was female, households were more likely to eat more than the recommended portion per person per day, but less likely when the visual cues were displayed. The gender of the eaters was not known. The effect size was again large: the number of households eating more than the recommended portion fell by 26%. Households with children were also less likely to open packs with visual cues compared to control packs. Both studies recorded significant increases in the likelihood of observing serving size information, together with confusion about what it means. Conclusions The studies offer some evidence that salient visual cues could play a role in tackling the high consumption of unhealthy snacks, but the effects are confined to specific subgroups and warrant further investigation.

Salmonella is a leading cause of foodborne illness (i.e., salmonellosis) outbreaks, which on occasion are attributed to ground turkey. The poultry industry uses Salmonella prevalence as an indicator of food safety. However, Salmonella prevalence is only one of several factors that determine risk of salmonellosis. Consequently, a model for predicting risk of salmonellosis from individual lots of ground turkey as a function of Salmonella prevalence and other risk factors was developed. Data for Salmonella contamination (prevalence, number, and serotype) of ground turkey were collected at meal preparation. Scenario analysis was used to evaluate effects of model variables on risk of salmonellosis. Epidemiological data were used to simulate Salmonella serotype virulence in a dose-response model that was based on human outbreak and feeding trial data. Salmonella prevalence was 26% (n = 100) per 25 g of ground turkey, whereas Salmonella number ranged from 0 to 1.603 with a median of 0.185 log per 25 g. Risk of salmonellosis (total arbitrary units (AU) per lot) was affected (p ≤ 0.05) by Salmonella prevalence, number, and virulence, by incidence and extent of undercooking, and by food consumption behavior and host resistance but was not (p > 0.05) affected by serving size, serving size distribution, or total bacterial load of ground turkey when all other risk factors were held constant. When other risk factors were not held constant, Salmonella prevalence was not correlated (r = -0.39; p = 0.21) with risk of salmonellosis. Thus, Salmonella prevalence alone was not a good indicator of poultry food safety because other factors were found to alter risk of salmonellosis. In conclusion, a more holistic approach to poultry food safety, such as the process risk model developed in the present study, is needed to better protect public health from foodborne pathogens like Salmonella.

The chicken chili sauce was made by sautéing chili, onion, garlic, salt, sugar, monosodium glutamate, and chicken using palm oil. The chili sauce nutrition was improved by adding chicken meat because it contains animal protein which was liked by the community. This study was examined the chemical content, daily values, and microbiology of chicken chili sauce. The chemical content parameters tested included water content, fat, protein, carbohydrate, energy, and vitamin C. The nutritional adequacy rate was calculated based on the chemical content of chili sauce with a serving size of 20 g. The microbiological parameters tested were total plate count, Salmonella, Staphylococcus, and Coliform. The data obtained were analyzed descriptively. The results showed that the chemical content of chicken chili sauce consisted of 12.18% water, 0.88% ash, 7.88% protein, 55.91% fat, 3.14% carbohydrate, 3.69% sugar, 627 kcal energy, 41 mg sodium, 5 mg vitamin C, and 7 mek O2/kg peroxide numbers. The daily values of chicken chili sauce were calculated based on the average energy sufficiency of 2,150 kcal per person per day with a serving size of 20 g then by consuming chili sauce per serving can meet the daily needs of fat 16.69%, protein 2.63%, carbohydrate 1.42%, sodium 0.55%, and vitamin C 1.11%. The chicken chili sauce was safe for consumption because the bacterial contamination was still low with a total plate count of 1.4x102 CFU/mg, Salmonella, Staphylococcus, and Coliform were negative.

Food choices with high antioxidant and low glycemic values may benefit the body's health. High total phenolic content will influence the antioxidant activity that works as a body shield from free radicals. On the other hand, higher glycemic values will increase the risk of non-communicable disease, specifically diabetes mellitus. It will be thoughtful to know the antioxidant activity and glycemic values of the food that consumed. Such in the case of non-meat products, including patty burger, which intended for meat patty burger substitution. This study aims to analyze the values of total phenolic content, antioxidant activity, glycemic response, glycemic index, and glycemic load of the non-meat burger patty. This is an experimental study with a completely randomized design. The total phenolic content was determined by Folin-ciocalteu method. Antioxidant activity was determined by DPPH method. The glycemic values were determined by an incremental area under the curve (iAUC) method. The values of total phenolic content and antioxidant activity of non-meat patty burger was in line. More phenolic content results in a higher antioxidant activity. Non-meat patty burger has a lower glycemic response compared to a reference food. Its glycemic index is high. However, it has a low glycemic load. Non-meat burger patty has phenolic substances result in antioxidant activity, while its consumption with the right serving size may contribute a low glycemic effect and protect blood glucose stability.

The consumption of sugar-sweetened beverages is a known contributory factor of childhood obesity that is documented around the globe. More importantly, reducing the consumption of sugar-sweetened beverages could reduce weight gain among overweight or obese children. Although sugar is present in many natural foods, artificial sugar is added into sugar-sweetened beverages, which has little or no nutritional value. However, the calories obtained from the sugar-sweetened beverages are linked to overweight and obesity, and an increase serving sizes of sugar-sweetened beverages over the years partly contributed to the alarming rise of childhood obesity around the globe. The sugar-sweetened beverages not only contain a high amount of sugar, but also contain a high amount of phosphate, and the possibility exists for an enhancing dual adverse health effects of sugar and phosphate. Increasing health awareness and limiting marketing approaches targeted towards the younger population are essential to reduce long-term health burdens that are linked to the overconsumption of sugar-sweetened beverages.

BackgroundElevated serum uric acid concentrations have been associated with metabolic syndrome. However, only limited information is available on the prevalence of hyperuricaemia in adolescents. Therefore, the aim of our cross-sectional study was to study the prevalence of hyperuricaemia and dietary patterns in adolescents aged 13–16 years living in Yangzhou, China.MethodsAdolescents were asked to complete a 20-item food frequency questionnaire (FFQ) and provide an overnight fasting finger-prick sample. Principal component analysis (PCA) with varimax rotation was used to derive the dietary patterns that might be associated with high uric acid concentrations.ResultsA total of 1070 adolescents were recruited. Of these, 53.6% (n = 574) were females, and 58.5% (n = 625) were within the normal body mass index (BMI) range. The males had a significantly higher serving size and frequency in their weekly food consumption, including meat, poultry, Chinese cereal staple foods and Western-style fast foods, than the females (all p ConclusionsThe prevalence of hyperuricaemia was relatively high in Chinese adolescents. The prevention of hyperuricaemia measures should be strengthened in adolescents to effectively control for obesity and gout, which tend to persist into adulthood.

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.

Objective To evaluate the opinions of primary health-care providers and patients regarding the use of the Healthy Heart Score 20-year cardiovascular disease risk assessment tool in the clinical setting. Methods Semi-structured in person or phone interviews among 20 patients with no self-reported cardiovascular disease diagnoses and 20 health-care providers in Central (Columbus) and Southeastern (Athens) regions of Ohio. The researchers independently coded transcribed interviews, discussed codes to resolve discrepancies, and agreed on common themes. Results Participants suggested ways to best utilize and improve the tool, including adding graphics for visual reference of serving size. Patients showed interest in cardiovascular disease primordial prevention and expressed willingness to take the assessment prior to seeing a health-care provider. Health-care providers said that they would recommend the assessment to their patients and would be willing to use the tool in their practice. Health-care providers stated few barriers to using the tool, yet discussed numerous challenges to successful primordial prevention. Conclusions Our findings support the utilization of the Healthy Heart Score as a cardiovascular disease primordial prevention tool in the clinical setting. Additional research implementing the tool into the clinical setting will provide deeper insight into how the tool can impact behavior change and cardiovascular disease prevention.

Introduction: This study aimed to add value to Arabic Gum (AG) and the blueberry discarded harvest from Northwest of Argentina, developing functional dietary beverages with AG at three concentrations of 0; 5; 10 and 15 g/100 mL, and to assess the sensory acceptability, physicochemical characteristics and antioxidant properties. Material and methods: Blueberries (BB) at 30 g/100 mL and steviol glycosides (0.03 g/100 mL) were used. Results: The beverage with 10 g/100 mL of AG had the best scores for sensory acceptability and was preferred by consumers. It has a pH of 3.88, soluble solid content of 14.97 °Brix, density of 1.05 g/cm3 and a colour which showed a tendency from red to blue. The Total Caloric Value (per 100 mL of beverage) was 53.4 Kcal, 13.53 g of carbohydrates, 8.80 g of total dietary fibre, and a sodium content of 12.26 mg. The total polyphenol content was 214.23 mg GAE /100 g. Conclusions: The serving size of functional beverage covers 70% of the daily dietary fibre recommendation.

Introduction: Elderly population is more likely to suffer from malnutrition, thereby requiring appropriate nutrition education as part of nutrition intervention to overcome this issue. This review aims to identify content suitable for developing a nutrition resource kit that provides nutritional guidance to combat malnutrition among malnourished and at-risk elderly in health clinics setting, particularly in Malaysia. Methods: A literature search was conducted up to 15th December 2019 in four databases: PubMed, Scopus, COCHRANE, and ProQuest Health & Medical Collection. Potential literature on nutrition education, suitable dietary guidelines and existing educational materials for elderly in the community, in English and Malay languages, were searched to identify suitable content for the nutrition resource kit. All relevant documents were included based on inclusion and exclusion criteria. Data were extracted and analysed according to the PRISMA-ScR guidelines. Results: A total of 27 documents consisting of articles, printed materials and guidelines were included for analysis. Suitable content included information related to malnutrition such as definition, signs and symptoms, cause-consequences, and nutrition management, which included food plate, serving size, menu suggestion, examples of recipes, tips to increase energy and protein intakes through food or drink, texture modification, a guide to using oral nutritional supplements, tips for maintaining nutrient content in food and drink, tips to encourage to eat, and oral health. Conclusion: A nutrition resource kit tailored for malnourished and at-risk elderly would be a beneficial nutrition intervention. There is a need to incorporate these information in the development of a nutrition resource kit to improve their dietary intake.

Energy intake is the product of portion size (PS)—the energy content of an ingestive event—and ingestive frequency (IF)—the number of ingestive events per unit time. An uncompensated alteration in either PS or IF would result in a change in energy intake and body weight if maintained over time. The objective of this meta-analysis was to assess the independent effects of PS and IF on energy intake and body weight among healthy adults in randomized controlled trials (RCTs). A total of 9708 articles were identified in PubMed, Web of Science, Cochrane, and CINAHL databases. The articles were divided among 10 researchers; each article was screened for eligibility by 2–3 independent reviewers. Exclusion criteria included: populations 65 y, unhealthy populations (i.e. participants with an acute or chronic disease), assessments

BackgroundChildhood obesity has been associated with increased odds of adult obesity and co-morbidities in later life. Finding the key determinants may help in designing the most appropriate and effective interventions to prevent obesity. This study aimed to identify the determinants of obesity among school adolescents in a sub-urban state of Malaysia.MethodsThis cross-sectional study involved 1,404 school adolescents aged 12 years (46% boys and 54% girls). Socio-demographic, dietary and physical activity data were collected using questionnaires whilst body weight and height were measured and body mass index was classified based on WHO BMI-for-age Z-scores cut-off.ResultsA multivariable linear regression model showed that BMI z-score was positively associated with parents’ BMI (PP=0.003), and serving size of milk and dairy products (P=0.036) whilst inversely associated with household size (P=0.022). Overall, 13.1% of the variances in BMI Z-scores were explained by parents’ BMI, birth weight, servings of milk and dairy products and household size.ConclusionThis study found important determinants of body weight status among adolescents mainly associated with family and home environmental factor. This evidence could help to form the effective and tailored strategies at the earliest stage to prevent obesity in this population.

Background: Dietary supplements promoted for brain health and enhanced cognitive performance are widely available. Claims made for these products are directed not only to the elderly wishing to prevent or mitigate cognitive decline, but also young healthy populations looking to boost their cognitive performance. It is unclear whether these claims made on product bottles and through advertising match the science. Objectives: To explore the evidence on the efficacy and safety of single dietary supplement ingredients frequently marketed with claims of enhanced cognitive performance among healthy adults. Design: A systematic review. Results: Nine of 54 dietary supplement ingredients identified through a scoping review met the eligibility criteria with at least 3 published studies identified per ingredient, yielding 69 unique publications. Ingredients evaluated included Bacopa monnieri, choline, creatine, omega-3 fatty acids, Ginkgo biloba, ginseng, Rhodiola rosea, tyrosine, and valerian root, all in supplement form and compared with a placebo, at various serving sizes and durations of use. Conclusions: The low level of certainty in the state of the science, coupled with not always knowing what is in a dietary supplement product, make weighing risks and benefits difficult; these data hinder the ability to develop recommendations about using such ingredients for consumers interested in boosting their cognitive performance. Whereas certain trends regarding promising serving sizes or duration for use, are pointed to in this synthesis, when combined, studies are inconsistent and imprecise, and many are methodologically flawed. Potential solutions to address research gaps are offered, for future research next steps, which is needed to strengthen the evidence and inform decisions.

Consumption of diet beverages (DB) containing low-calorie sweeteners (LCS) is widespread in the United States. LCS are ingested by nursing infants upon maternal DB consumption, which may impact infants’ weight and health. This study aims to examine cross-sectional associations between infants’ LCS exposure via maternal DB intake during lactation and infants’ health outcomes. Six hundred and eighty-two mother–infant dyads at three months postpartum, from the Infant Feeding Practices Study II, 2005–2007, were included in the analysis. Maternal DB consumption during lactation was estimated using the serving size and frequency of DB consumption reported on the diet history questionnaire. Infants’ LCS exposure was estimated by multiplying maternal DB consumption and breastfeeding intensity. Infant outcomes included weight, weight-for-age and BMI-for-age z-scores, overweight, and gastrointestinal (GI) symptoms including diarrhea, reflux, and vomiting. Associations between infants’ LCS exposure and continuous and categorical outcomes were examined using linear and logistic regressions adjusting for confounders, respectively. Forty-three percent of lactating women reported DB consumption. While no significant associations were observed between infants’ LCS exposure and BMI-for-age or risk of overweight, infants’ LCS exposure was associated with a 2.78-fold increased risk of vomiting (95% confidence interval 1.05–7.34). Potential adverse effects of LCS exposure on GI symptoms require further study, and null findings on infant weight should be interpreted with caution, given the small sample size. Additional research is needed to inform recommendations for or against DB consumption during lactation.

The presence of milk in meals and products consumed daily is common and at the same time the adoption of a milk-free diet increases due to milk allergy, lactose intolerance, vegan diets, and others. Therefore, there is an increasing demand for plant-based beverages, which present variable and, sometimes, unknown nutritional characteristics. This study sought to compare the nutritional aspects of plant-based beverages used as substitutes for cow’s milk described in scientific studies. Therefore, we used a review of the scientific literature on PubMed, Google Scholar, Scopus, Web of Science, Google Patents, Embase, and ScienceDirect databases. The inclusion criteria were scientific studies referring to plant-based beverage used as an alternative to cow’s milk; published in the English language; present data on the serving size, ingredients, and nutritional composition, containing at least data on energy and macronutrients of plant-based beverages. Ingredients and data on energy, macronutrients, and, if available, dietary fiber and some micronutrients of plant-based beverages were collected. Data were obtained from 122 beverages of 22 different matrices, with soy being the most used (27.87%, n = 34). The variation in the amount of nutrients found was 6–183 Kcal/100 mL for energy value; 0.00–22.29 g/100 mL for carbohydrate; 0.06–12.43 g/100 mL for protein; 0.00–19.00 g/100 mL for lipid; 0.00–4.40 g/100 mL for dietary fiber; 0.00–1252.94 mg/100 mL for calcium; 0.04–1.40 mg/100 mL for iron; 0.84–10,178.60 mg/100 mL for magnesium; 0.00–343.43 mg/100 mL for sodium. Salt was the most commonly found added ingredient in plant-based beverages. Some beverages have reached certain amounts of cow’s milk nutrients. However, studies have pointed out differences in their qualities/types. Thus, attention is needed when replacing milk with these alternatives.

Dietary guidelines recommend consuming 30 g of nuts per day to reduce the risk of chronic disease. A ‘handful’ is commonly used to guide consumers. Research is lacking on how this translates into actual gram amounts. This study quantified the grams of nuts represented by different portion size measures, including a ‘handful’ and ‘30 g serving’ among 120 participants. Each participant was randomised to a sequence where they received three of six different nut types (from almonds, cashews, hazelnuts, macadamias, peanuts, and walnuts) and were instructed to take a: ‘usual serving’, ‘handful’, ‘small handful’, ‘large handful’, and ‘30 g serving’ of each. Combining all nut types, the median ‘handful’ was 36.3 g, compared to 28.7 g for the estimated ‘30 g serving’ and 24.8 for the ‘usual serving’. The ‘large handful’ was approximately double the ‘handful’ (61.3 g), whereas the ‘small handful’ was about half (16.7 g). Eighty-three percent of portions chosen were at least 80% of the recommended 30 g intake when participants were asked to take a ‘handful’, compared to 63% for the ‘30 g serving’. It appears a ‘handful’ can be used as a practical tool to guide recommended nut intakes, and increases the amount selected compared to instructions to take a ‘30 g serving’.

Portion control utensils and reduced size tableware amongst other tools, have the potential to guide portion size intake but their effectiveness remains controversial. This review evaluated the breadth and effectiveness of existing portion control tools on learning/awareness of appropriate portion sizes (PS), PS choice, and PS consumption. Additional outcomes were energy intake and weight loss. Published records between 2006–2020 (n = 1241) were identified from PubMed and WoS, and 36 publications comparing the impact of portion control tools on awareness (n = 7 studies), selection/choice (n = 14), intake plus related measures (n = 21) and weight status (n = 9) were analyzed. Non-tableware tools included cooking utensils, educational aids and computerized applications. Tableware included mostly reduced-size and portion control/calibrated crockery/cutlery. Overall, 55% of studies reported a significant impact of using a tool (typically smaller bowl, fork or glass; or calibrated plate). A meta-analysis of 28 articles confirmed an overall effect of tool on food intake (d = –0.22; 95%CI: –0.38, –0.06; 21 comparisons), mostly driven by combinations of reduced-size bowls and spoons decreasing serving sizes (d = –0.48; 95%CI: –0.72, –0.24; 8 comparisons) and consumed amounts/energy (d = –0.22; 95%CI: –0.39, –0.05, 9 comparisons), but not by reduced-size plates (d = –0.03; 95%CI: –0.12, 0.06, 7 comparisons). Portion control tools marginally induced weight loss (d = –0.20; 95%CI: –0.37, –0.03; 9 comparisons), especially driven by calibrated tableware. No impact was detected on PS awareness; however, few studies quantified this outcome. Specific portion control tools may be helpful as potentially effective instruments for inclusion as part of weight loss interventions. Reduced size plates per se may not be as effective as previously suggested.

Overweight and obesity has reach pandemic levels, with two-thirds (67%) of adult Australians classified as overweight or obese. As two of the most significant behavioral risk factors for obesity are modifiable (diet and exercise), there exists an opportunity for treatment through workplace health promotion initiatives. As one of Australia’s largest industries with its own unique workplace factors, the mining industry has previously reported higher than population levels of overweight and obesity. This represented an opportune setting to test the RESHAPE workplace wellness program. RESHAPE is an eight-step framework (based on the WHO ‘Health Workplace Framework and Model’) which aims to provide a sustained approach to wellness in the workplace. This paper presents baseline findings from a pilot study that aimed to implement RESHAPE at three mine sites in NSW, Australia, and investigates the issue of overweight and obesity in the coal mining industry. Across three mine sites, 949 coal miners were examined cross-sectionally on a range of workplace, wellness, health, diet, and exercise factors using a paper-based survey. This was a predominantly male sample (90.4%) with the majority (59.2%) of participants aged 25–44 years. Self-reported height and weight measures indicated that less than 20 percent (18.9%) of participants were in a healthy BMI range, while there were effectively equal numbers of overweight (40.9%) and obese (39.1%) participants. Only 3.5% of participants met the daily recommendation for vegetables (5 serves) and shift-workers had greater association with elevated BMI compared to non-shift workers (B = 1.21, 95% CI: 0.23, 2.20, p = 0.016). Poor nutrition is likely to be a key component in elevated levels of overweight and obesity within this industry, with workplace factors compounding challenges workers face in implementing health behavior change. Future studies would benefit from assessing diet and physical activity knowledge in relation to recommendations and serving sizes.

Background: Endometriosis, defined as the attendance of endometrial-like lesions in extra uterine locations, causes pain, infertility, and reduced quality of life. Objective: To evaluate the relationship between food consumption and nutrient intake with risk of endometriosis. Materials and Methods: Of the 156 women approached for the study, 78 women had endometriosis and 78 healthy women were included in the control group. Dietary data were collected using a validated 147-item semi-quantitative Food Frequency Questionnaire (FFQ) with the standard serving size. A logistic regression model was used to determine the association of macronutrients and energy intake with the risk of endometriosis. Results: In women with higher intake of protein, especially animal protein, monounsaturated fatty acids, soluble and insoluble fiber, oleic acid, eicosapentaenoic acid, and docosahexaenoic acid endometriosis is less common (p < 0.05). High consumption of vegetables, fruits, red meat, yellow vegetables, potatoes, legumes, dairy products, liquid oil, and low intake of fried potatoes was associated with a lower risk of endometriosis (p < 0.05). Conclusion: Regarding the association of dietary intake on endometriosis risk, counseling about improving the dietary structure can contribute toward the prevention and control of endometriosis. Key words: Endometriosis, Macronutrient, Diet, Case-control study.

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.

Background Diet plays a key role in development of diabetes, and there has been recent interest in better understanding the association of dairy food intake with diabetes. Objective This study examined the associations of full-fat and low-fat dairy food intake with incident diabetes among American Indians-a population with a high burden of diabetes. Methods The study included participants from the Strong Heart Family Study (SHFS), a family-based study of cardiovascular disease in American Indians, free of diabetes at baseline (2001-2003) (n = 1623). Participants were 14-86-y-old at baseline and 60.8% were female. Dairy food intake was assessed using a Block food frequency questionnaire. Incident diabetes was defined using American Diabetes Association criteria. Parametric survival models with a Weibull distribution were used to evaluate the associations of full-fat and low-fat dairy food intake with incident diabetes. Serving sizes were defined as 250 mL for milk and 42.5 g for cheese. Results We identified 277 cases of diabetes during a mean follow-up of 11 y. Reported intake of dairy foods was low [median full-fat dairy food intake: 0.11 serving/1000 kcal; median low-fat dairy food intake: 0.03 serving/1000 kcal]. Participants who reported the highest full-fat dairy food intake had a lower risk of diabetes compared to those who reported the lowest full-fat food dairy intake [HR (95% CI): 0.79 (0.59, 1.06); P-trend = 0.03, comparing extreme tertiles, after adjustment for age, sex, site, physical activity, education, smoking, diet quality, and low-fat dairy food intake]. Low-fat dairy food intake was not associated with diabetes. Conclusions American Indians who participated in the SHFS reported low dairy food intake. Participants who reported higher full-fat dairy food intake had a lower risk of diabetes than participants who reported lower intake. These findings may be of interest to populations with low dairy food intake.

Background Food protein–induced enterocolitis syndrome (FPIES) is a non–IgE-mediated food allergy that is diagnosed based on clinical findings, but can be confirmed with oral food challenge (OFC). OFC is more often performed to assess the development of tolerance. Most studies describing OFCs in FPIES are limited in size. Objective We sought to describe our experience with OFCs using our FPIES protocol. Patients were given one-third of serving size with a 4-hour observation period, followed by home titration to full dose. Methods We conducted a retrospective chart review of patients who underwent OFC via the FPIES protocol from 2014 to 2017. Data regarding the history of reaction, age at the time of challenge, and reactions during challenge or with home introduction were collected. Results A total of 169 OFCs were completed under the FPIES protocol, in 119 patients to 19 different foods. Thirty challenges (18%) were positive, with 17 challenges (10%) during initial challenge and 13 (7.7%) during home dosing. Most reactions during initial challenge required intravenous fluids (IVF), but hypotension was uncommon. One hundred thirty-nine (82%) OFCs were negative with home introduction, indicating tolerance to the challenged foods. The mean age of passing a challenge to milk, soy, and grain was earlier than that of other solid foods. Conclusions: Our data suggest that our FPIES OFC protocol is safe. Early administration of IVF may prevent the development of hypotension. It is difficult to stratify the risk of severe or delayed reaction based on patient characteristics, and more data are needed to identify those appropriate for home introduction.

Background: Morbidity and mortality in China are increasingly associated with lifestyle behaviors, e.g., smoking, poor nutritional choices, and physical inactivity. Lifestyle-related non-communicable diseases (e.g., hypertension, stroke, heart disease, lung disease) are at critical levels globally, in turn their socioeconomic burdens. Knowledge of lifestyle-related health behaviors and beliefs of mainland Chinese would help inform the design and targeting of cost-effective health education for individuals and campaigns in the interests of promoting and protecting health, and preventing disease. This study’s objective was to describe the lifestyle behaviors and beliefs of a sample of urban mainland Chinese, and their congruence with evidence-based guidelines for maximal health. Methods: A cross-sectional interview questionnaire study was conducted in which 835 mainland Chinese (55% men, 45% women) from four urban areas participated. Results: About half (52%) reported smoking to some degree with 21% being habitual smokers; 33% being above average weight; 62.1% met physical activity guidelines for health benefits; 92% being sedentary for 5.8 ± 3.40 h/d; 66% experiencing moderate/high stress; and sleeping 7.1 ± 1.31 h nightly with 35% reporting sleeping poorly. When standard serving sizes were considered, daily consumption of grains, fruits, and vegetables was reported to be consistent with dietary recommendations for good health, however, added salt (3.7 ± 7.42 tsp) and sugar (3.9 ± 12.99 tsp) exceeded recommendations. Life stress was rated moderate by 59.6% of respondents, with personal and family health stresses ranking highest (43% and 55%, respectively). Regarding beliefs about importance of lifestyle behaviors to health, respondents’ understanding was not consistent with evidence-based recommendations. Only 64% of participants believed smoking abstinence is highly important to health; 56% regular exercise; and 37% consumption of whole grains, 62% fruit and vegetables; and 54% maintaining a healthy body weight. Conclusion: To be congruent with established guidelines for healthy living, health promotion and disease prevention education for individuals and public campaigns warrants targeting health knowledge and beliefs of urban Chinese as well as lifestyle-related health behaviors. The roles of gender, education and living rurally, on lifestyle behaviors and beliefs of the Chinese, warrant elucidation.Background: Morbidity and mortality in China are increasingly associated with lifestyle behaviors, e.g., smoking, poor nutritional choices, and physical inactivity. Lifestyle-related non-communicable diseases (e.g., hypertension, stroke, heart disease, lung disease) are at critical levels globally, in turn their socioeconomic burdens. Knowledge of lifestyle-related health behaviors and beliefs of mainland Chinese would help inform the design and targeting of cost-effective health education for individuals and campaigns in the interests of promoting and protecting health, and preventing disease. This study’s objective was to describe the lifestyle behaviors and beliefs of a sample of urban mainland Chinese, and their congruence with evidence-based guidelines for maximal health. Methods: A cross-sectional interview questionnaire study was conducted in which 835 mainland Chinese (55% men, 45% women) from four urban areas participated. Results: About half (52%) reported smoking to some degree with 21% being habitual smokers; 33% being above average weight; 62.1% met physical activity guidelines for health benefits; 92% being sedentary for 5.8 ± 3.40 h/d; 66% experiencing moderate/high stress; and sleeping 7.1 ± 1.31 h nightly with 35% reporting sleeping poorly. When standard serving sizes were considered, daily consumption of grains, fruits, and vegetables was reported to be consistent with dietary recommendations for good health, however, added salt (3.7 ± 7.42 tsp) and sugar (3.9 ± 12.99 tsp) exceeded recommendations. Life stress was rated moderate by 59.6% of respondents, with personal and family health stresses ranking highest (43% and 55%, respectively). Regarding beliefs about importance of lifestyle behaviors to health, respondents’ understanding was not consistent with evidence-based recommendations. Only 64% of participants believed smoking abstinence is highly important to health; 56% regular exercise; and 37% consumption of whole grains, 62% fruit and vegetables; and 54% maintaining a healthy body weight. Conclusion: To be congruent with established guidelines for healthy living, health promotion and disease prevention education for individuals and public campaigns warrants targeting health knowledge and beliefs of urban Chinese as well as lifestyle-related health behaviors. The roles of gender, education and living rurally, on lifestyle behaviors and beliefs of the Chinese, warrant elucidation.

We read with great interest the paper Miceli Sopo et al.1 published. The authors described their experience with performing an oral food challenge (OFC) for acute food protein-induced enterocolitis syndrome (FPIES), with a single dose in a full serving size for the age of the culprit food, followed by a 4-hour observation period. The main aim of that study was to assess the safety of their OFC protocol.

Background: Consuming larger portion sizes, i.e., in excess of a typically recommended serving size, has been attributed to the obesity epidemic. The workplace acts as an efficient target for health promotion activities. Aims: To assess the effectiveness of a food portion size educational programme in increasing knowledge among the employees of a software company in Puducherry. Methodology: An interventional study was conducted with a pre-post design. A single group of software company employees (N = 120), age ≥30 years selected by simple random sampling was included in the study. The intervention consisted of a health education programme on the portion sizes of common food items including fruits and vegetables. A self-administered questionnaire was used to collect information on personal and sociodemographic details. Self-regulation on eating was assessed using the Self-Regulation of Eating Behaviour Questionnaire (SREBQ). Results: The mean age of the study participants was 27 ± 5 years. Most of the participants were males, i.e., 72 (60%). Of the total, 55 (47.8%) participants were obese and 18 (15.7%) were overweight. The median number of meals and snacks consumed by the participants was 3 (1–3) and 1 (1–2), respectively. The median (interquartile range [IQR]) knowledge scores of the food portion size significantly increased from 9 (0–16) to 14 (5–19) (P < 0.05). Conclusions: This study has demonstrated that an educational intervention in the workplace setting is feasible and effective in increasing the knowledge of food portion size over a short term.

Risk for colorectal cancer (CRC) is increased in adults with poor diet quality, low socioeconomic status, and increased body mass index (BMI). Cooked meats contain high contents of mutagenic compounds related to CRC risk. To explore differences in meat-based carcinogen exposure, a 99-item Qualtrics survey was issued to 1648 US adults. Average monthly serving size, degree of doneness, and cooking methods of meat products were obtained. The National Cancer Institute CHARRED database was used to quantify exposure to HCAs, PAHs, and Ames Predicted and Estimated mutagenicity. Questions from validated instruments assessed food security status (FSS) and demographic variables, while height and weight were self-reported to calculate BMI. Sex, FSS and obesity status (BMI > 30 kg/m2) were compared using two-sample t-tests and multivariate regression models to determine differences in meat intake and carcinogen exposure. Statistical significance was set at P

There exists an intermediate group of individuals whose glucose levels do not meet the criteria for diabetes yet are higher than those considered normal (prediabetes mellitus (preDM)). Those people have a higher risk of developing diabetes in the future. Gynura bicolor (GB) is a red-purple-colored vegetable, which is common in Taiwan. GB has shown antioxidant, anti-inflammatory and anti-hyperglycemic effects in previous studies. The aim of this study was to assess the effects of serving two serving sizes of GB every day on the glycemic control and antioxidant ability of preDM subjects. According to the age and anthropometry data of the participates, we assigned them into a control or GB group for the 8-week intervention and 4-week washout period. Data of anthropometry and biochemical analysis were collected at 0, 8 and 12 weeks. Oral glucose tolerance tests were performed, and we collected dietary records on the baseline and Week 8. Both groups received nutrition education and a diet plan individually. After intervention, the fasting glucose and malondialdehyde (MDA) values were significantly decreased in the GB group. HOMA-IR and QUICKI values were improved, and antioxidant activity was increased in the GB group. GB could improve glycemic control and decrease oxidative stress because of its large amounts of polyphenols.

BACKGROUND: Few cohort studies have modelled replacements of red meat with other sources of protein on subsequent risk of type 2 diabetes using dietary changes.OBJECTIVES: To determine whether replacing red meat with other food sources of protein is associated with a lower risk of type 2 diabetes.METHODS: We used data from the Danish Diet, Cancer, and Health cohort (n = 39,437) of middle-aged (55-72 years old) men and women who underwent 2 dietary assessments roughly 5 years apart to investigate dietary changes. The pseudo-observation method was used to model the average exposure effect of decreasing the intake of red meat while increasing the intake of either poultry, fish, eggs, milk, yogurt, cheese, whole grains, or refined grains on the subsequent 10-year risk of developing type 2 diabetes, compared with no changes in the intakes of these foods.RESULTS: Replacing 1 serving/day (100 g/day) of red meat with 1 serving/day of eggs [risk difference (RD), -2.7%; 95% CI: -4.0 to -1.1%; serving size: 50 g/day], milk (RD, -1.2%; 95% CI: -2.1 to -0.4%; 200 g/day), yogurt (RD, -1.5%; 95% CI: -2.4 to -0.7%; 70 g/day), whole grains (RD, -1.7%; 95% CI: -2.5 to -0.9%; 30 g/day), or refined grains (RD, -1.2%; 95% CI: -2.0 to -0.3%; 30 g/day) was associated with a reduced risk of type 2 diabetes. Analyses of replacements with poultry or cheese, but not fish, also suggested a lower risk, but with wide CIs. After further adjustment for potential mediators (BMI, waist circumference, and history of hypertension or hypercholesterolemia), only the replacement with eggs was associated with a reduced risk (RD, -1.7%; 95% CI: -3.0 to -0.5%; 50 g/day).CONCLUSIONS: Replacing red meat with eggs in middle-aged adults may reduce the risk of type 2 diabetes. In models not adjusted for potential mediators, replacing red meat with milk, yogurt, whole grains, or refined grains was also associated with a reduced risk of type 2 diabetes.

In food safety, process pathway risk assessments usually estimate the risk of illness from a single hazard and a single food and can inform food safety decisions and consumer advice. To evaluate the health impact of a potential change in diet, we need to understand not only the risk posed by the considered hazard and food but also the risk posed by the substitution food and other potential hazards. We developed a framework to provide decision-makers with a multi-faceted evaluation of the impact of dietary shifts on risk of illness. Our case study explored exposure to inorganic arsenic (iAs) and aflatoxins through consumption of infant cereals and the risk of developing lung, bladder and liver cancer over a lifetime. The estimated additional Disability-Adjusted Life Year (DALY) in the U.S. from exposure to iAs and aflatoxin based on available contamination and consumption patterns of infant rice and oat cereal is 4,921 (CI 90% 414; 9,071). If all infant cereal consumers shift intake (maintaining equivalent serving size and frequency) to only consuming infant rice cereal, the predicted DALY increases to 6,942 (CI 90% 326; 12,931). If all infant cereal consumers shift intake to only consuming infant oat cereal, the predicted DALY decreases to 1,513 (CI 90% 312; 3,356). Changes in contaminant concentrations or percent consumers, that could occur in the future, also significantly impact the predicted risk. Uncertainty in these risk predictions is primarily driven by the dose-response models. A risk-risk analysis framework provides decision-makers with a nuanced understanding of the public health impact of dietary changes and can be applied to other food safety and nutrition questions.

Objective:The present study aimed to assess the effect of different types of breakfast cereal (BC) on portion size and the nutritional implications of potential under or overserving.Design:A cross-sectional analysis was performed using one BC from the seven established BC manufacturing methods (flaking (F), gun puffed (GP), oven puffed (OP), extruded gun puffed (EGP), shredded wholegrain (SW), biscuit formed (BF) and granola). Participants were asked to pour cereal as if they were serving themselves (freepour). Difference between the freepour and recommended serving size (RSS) was calculated (DFR). The Friedman test followed by Dunn’s multiple comparison test was used to test for a significant differences between cereal categories.Setting:City of Chester, North West of the UK.Participants:Adults (n 169; n 110 female, 32 (sd 18) years).Results:Freepour values were greater than RSS for all categories of BC. Median values for denser cereals such as SW, granola and oats were significantly (P < 0·001) greater than all other categories with granola having the highest median freepour value of 95 g. Median (and range of) DFR weight values for granola were significantly higher than other BC (50·0 g (−24·0 to 267·0 g), P < 0·001). BC with the lowest median DFR were F1 (7·0 g (−20 to 63·0 g)), GP (6·0 g (−26·0 to 69·0 g)), EGP (6·0 g (−26·0 to 56·0 g)), OP (5·0 g (−27·0 to 53·0 g)) and BF (0·0 g (−28·2 to 56·4 g)).Conclusions:The degree of overserving may be related to the type of BC with denser cereals more readily overserved. Encouraging manufacturers to reformulate cereals and improving their nutritional properties may have benefit in reducing excess energy intake.

[EN] Introduction: Food servings are standard amounts of food stuffs or drinks to help dietetic advice to promote and preserve health. The aim is to establish the serving size of fruits and vegetables (FH) to be used in food based dietary guidelines (FBDG). Material and Methods: Methodology of the United States Department of Agriculture (USDA) was adapted to establish serving sizes for FBDG, along of the followed by the food exchange system. Data was collected from the FH portion sizes reported in nutritional surveys and common sizes available in the Spanish market, and they were adjusted to an easily recognisable quantities of food with equivalence on key nutrients: the compliance with public health goals for FH consumption was evaluated. Results: Portion sizes typically reported in Spanish nutrition surveys are scarce and not homogeneous, and no data published in scientific journals on portion sizes were available. The Spanish FBDG, in spite of showing a range of serving size for FH, do not assure that they are interchangeable nor specify the method to obtein them.The serving of vegetables was 139,44g (DS:+/- 21.98, CV:0.16), 137,68g (DS:+/- 49,61, CV:0,36) for fruits and 28.00g (DS:+/- 7,53, CV:0.27) for dried fruits. Conclusions: With the established servings, the recommendation of consuming "at least 5 servings of FH a day" would allow reaching the Public Health goals for FH established in 600g (net weight)/person/day. It is recommended that the Spanish Agency for Consumers, Food Safety and Nutrition (AECOSAN) uses this methodology to establish serving sizes for the rest of food groups that make up the FBDG for the Spanish population., [ES] Introducción: Las raciones de consumo son cantidades estándar de alimentos o bebidas sugeridas para asesorar sobre la cantidad de alimento a consumir para preservar un estado de salud adecuado. El objetivo principal de este trabajo es establecer los tamaños de ración de consumo de frutas y hortalizas (FH) para uso en guías alimentarias. Material y Métodos: Se adaptó la metodología de la United States Department of Agriculture (USDA) para el establecimiento de los tamaños de ración de consumo para guías, y la del Sistema de Intercambios. Se recopilaron datos de porción reportados en encuestas y calibres comunes en el mercado, se ajustó a cantidades de alimento fácilmente reconocibles y con equivalencia de nutrientes clave y se evaluó el grado de cumplimiento de los objetivos de salud pública para el consumo de FH. Resultados: Los tamaños de porción típicamente reportados en encuestas españolas son escasos y poco homogéneos, y no se encontraron datos publicados en revistas científicas sobre los calibres. Las guías alimentarias españolas, a pesar de mostrar un rango de tamaño de ración para FH no aseguran que sean intercambiables ni especifican el método para llegar a las mismas. La ración de hortalizas obtenida ha sido de 139,44g (DS:±21,98; CV:0,16), de 137,68g (DS:±49,61; CV:0,36) para frutas y 28,00g (DS:±7,53; CV:0,27) para frutas desecadas. . Conclusiones: Con las raciones establecidas, el mensaje ¿consume al menos 5 raciones entre FH al día¿ permitiría alcanzar los objetivo de Salud Pública para FH establecidos en 600g (peso neto)/persona/día. Se recomienda a la Agencia Española de Consumo, Seguridad Alimentaria y Nutrición (AECOSAN) que use esta misma metodología para el establecimiento de raciones en el resto de grupos de alimentos que configuran la Guía Dietética Basada en Alimentos para la población española.

Background The method of performing oral food challenge (OFC) in acute food protein-induced enterocolitis syndrome (FPIES) has not been systematically studied. Therefore, there is a certain variability in the choice of the various centers. Methods Since 2011, we have been performing OFC for acute FPIES with a single dose of culprit food, a full serving size for age. In case of atypical FPIES (skin prick test, SPT, positive), we applied this protocol only if the description of previous adverse reactions was compatible with that of a classic acute FPIES, if other IgE-mediated food allergies were absent, and if the mean diameter of the wheal evoked by the SPT with the challenged food was ≤5 mm. We have retrospectively analyzed 222 OFCs from 2011 to 2020. The grading of reactions was carried out according to the International Consensus Guidelines on FPIES of 2017. Results Forty-eight of 222 OFC (21.6%) failed. The mild reactions were 22 of 48 (45.8%), the moderate ones 22 of 48 (45.8%), and the severe ones 4 of 48 (8.4%) failed OFCs. The tested food processing (in the case of cow milk and chicken egg) did affect neither probability nor severity of the reaction. Patients with positive SPT for the tested food presented four times more severe reactions (2 of 9 failed OFC, 22.2%) than patients with negative SPT (2 of 39 failed OFC, 5.1%) (P = .316). Conclusions The administration of a single dose in a full serving size for age appears to be a sufficiently safe method for OFC for acute FPIES, with the benefit of saving time. In patients with positive SPT for the tested food, it may be prudent to start with a smaller dose carrying on, in the absence of adverse reactions, with the administration of the full dose after a 4-hour observation.

Introduction Interventions aimed at promoting healthy eating habits in adolescence can help prevent chronic diseases and promote healthy ageing. The aim of this paper is to describe the fruit and vegetables consumption habits of adolescents in Dhaka, Bangladesh as well as to identify the socio-environmental, personal, and behavioral factors that influence these habits. Materials and methods The baseline data from an intervention study involving 823 grade ten students from two randomly selected secondary schools in a semi-urban area of Dhaka were analyzed. The intake of fruit and vegetables was measured in terms of serving size per day. Hierarchical multiple regression was used to assess the ability of socio-environmental factors such as social support, perceived barriers, and living with patient with chronic diseases; personal factors such as knowledge, self-rated practice, behavioral intention, and body mass index; and behavioral factors such as physical activity, sedentary hours, and sleep duration to predict the level of daily fruit and vegetables intake, after controlling the effect of demographic characteristics of adolescents. Results The average daily consumption of fruit and vegetables was 1.22 and 1.99 servings, respectively. Only one-fifth of the respondents (21%) reported eating five servings of fruit and vegetables a day. Inaccessibility at home was reported as the most perceived barrier for both fruit and vegetables intake. Adolescents’ higher fruit and vegetables intake was found to be associated with higher maternal educational attainment, more social support, adequate self-rated practice, positive behavioral intention, higher body mass index, better physical activity, and adequate daily sleeping. Conclusion The findings revealed insufficient fruit and vegetables intake among adolescents in a semi-urban area of Bangladesh and associated socio-environmental, personal, and behavioral factors that were utilized in developing an intervention program for this transient age group. Trial registration Trial was registered at ClinicalTrials.gov (NCT03975335) https://clinicaltrials.gov/ct2/show/NCT03975335 on June 01, 2019.

The authors would like to extend their gratitude and acknowledgments to all study participants and to all Foundations, Institutions, and Societies that supported the survey, helping in the process of dissemination: Asociacion Colombiana de Dietistas y Nutricionistas, ACODIN, Asociacion Colombiana de Facultades de Nutricion y Dietetica (ACOFANUD), Asociacion de Egresados de Nutricion y Dietetica de la Universidad Nacional (ANDUN), Colegio colombiano de nutricionistas Dietistas-COLNUD, Observatorio de Soberania y Seguridad alimentaria y Nutricional de la Universidad Nacional de Colombia (OBSSAN UN). The authors are also thankful to Gloria Esperanza Prada Gomez from Universidad Industrial de Santander (Facultad de Salud, Escuela de Nutricion y Dietetica), who also supported the dissemination of the survey in the Eastern region of Colombia. Sonia Liliana Pertuz Cruz is thankful to Fundacion Carolina, for a doctoral scholarship award., The aim of this study was to evaluate the impact of coronavirus SARS-Cov2 (COVID-19) confinement measures in Colombia on the dietary behaviors of a large population sample, at national and regional levels. A survey was conducted to assess dietary behaviors during the COVID-19 confinement. The survey involved 2,745 participants, aged 18 years or older, from six regions of the country (Atlantica, Bogota, Central, Oriental, Orinoquia and Amazonia, and Pacifica). Dietary intake of foods and foods groups in grams per day before and during the confinement was estimated by considering standard serving sizes of foods. One-way ANOVA was used to analyze differences between the regions with regard to dietary behavior changes during the confinement. Differences were deemed significant at p-value < 0.05. Dietary patterns (DPs) before and during the confinement were derived from principal component analysis. Certain dietary habits were adopted by the study population during the confinement (e.g., higher frequency of snacking and home cooking), with significant differences by regions with regard to these habits, as well as regarding culinary processes. The levels of consumption of several foods also changed during the confinement, nationally and regionally. We identified three DPs before the confinement (protein-rich, carbohydrate-rich, and sugar foods patterns) and four DPs during the confinement (westernized, carbohydrate-rich, protein-rich, fish and fruits-vegetable patterns), with an explained total variance of 33 and 45%, respectively. The profile of these DPs varied to some extent between the regions; their adherence to each DP also varied (p-value < 0.001). Our results show that there were marked differences by regions in the dietary behaviors of this population during the confinement, with an overall trend toward unhealthier DPs. These results may help to shape public health nutrition interventions in Colombia during the COVID-19 pandemic and in a post-COVID stage., Fundacion Carolina, Asociacion Colombiana de Dietistas y Nutricionistas, ACODIN, Asociacion Colombiana de Facultades de Nutricion y Dietetica (ACOFANUD), Asociacion de Egresados de Nutricion y Dietetica de la Universidad Nacional (ANDUN), Colegio colombiano de nutricionistas Dietistas-COLNUD, Observatorio de Soberania y Seguridad alimentaria y Nutricional de la Universidad Nacional de Colombia (OBSSAN UN)

OBJETIVO Desenvolver um Questionário de Frequência Alimentar (QFA) quantitativo para adultos da região Nordeste do Brasil, com o fim de identificar a frequência de consumo de alimentos considerados de proteção e risco para doenças crônicas não transmissíveis (DCNT), agrupando os itens alimentares por nível de processamento. MÉTODOS Para desenvolver o QFA foram utilizados dados de 7.516 adultos do Nordeste do Brasil, extraídos da Pesquisa de Orçamentos Familiares 2008–2009. As listas de alimentos foram elaboradas segundo a metodologia da contribuição relativa do item, nas quais foram identificados os itens alimentares com maior contribuição relativa para macronutrientes, fibra, gordura saturada, gordura trans, sódio e potássio. Tais listas foram compostas de todos os alimentos cujo somatório de contribuição foi de até 90%. Na estrutura final do QFA, os itens alimentares foram organizados de modo a respeitar a imagem mental das refeições. RESULTADOS O QFA resultou em 83 itens alimentares, distribuídos em minimamente processados, processados e ultraprocessados. O ano anterior foi escolhido como tempo para estimar o consumo dos alimentos, e as opções de frequência variaram de “nunca” até “10 vezes”. O instrumento inclui orientações para preenchimento e colhe dados sobre o tamanho das porções (pequena, média, grande e extragrande), bem como informações complementares sobre as preparações culinárias. Registrou-se um percentual elevado de pessoas com excesso de peso (44,1%). CONCLUSÃO O estudo culminou em um QFA para identificar a frequência de consumo de alimentos considerados de proteção e risco para DCNT. O instrumento pode subsidiar estudos epidemiológicos que avaliem desfechos relacionados à dieta de adultos considerando o nível de processamento de alimentos, em consonância com o Guia alimentar para a população brasileira .

While there are several factors that contribute to the diet quality of children in childcare, one contributing factor in Family Childcare Homes (FCCHs) is the provider&rsquo, s ethnicity. However, research examining the food items provided in this setting is limited, in particular, with regards to differences between FCCHs of Latino and non-Latino providers. The aim of this study was to identify and describe the food items that contribute to food group intake in preschool-aged children attending FCCHs, and to examine differences by provider ethnicity. This secondary data analysis used baseline data from Healthy Start/Comienzos Sanos: a cluster-randomized trial. Children&rsquo, s dietary intake was collected using the Dietary Observation in Child Care method and entered into Nutrition Data System for Research software. Food groups were based on the Nutrition Coordinating Center classification. Contribution of food items to their respective food group was calculated as a proportion, using ratio of means and presented as a percentage. Ethnic differences were tested with ANCOVA (p &lt, 0.05) with Bonferroni adjustments for multiple comparisons. All providers (n = 120) were female and 67.5% were Latino. Most fruit consumed by children was in the form of juice (85%), three-fourths of the grains consumed were refined (75%), and half of the sweets consumed were syrup/honey/jelly (50%). Most of the vegetables consumed were non-starchy (61%), nearly three-fourths of dairy consumed was low-fat (71%), and vegetable oils contributed the most to the fats group (89%). Food items differed by provider&rsquo, s ethnicity, with children cared for by non-Latino providers consuming a higher proportion of fruit juice, animal fats and a lower proportion of legumes (p &lt, 0.001 for all). Children with Latino providers consumed a lower proportion of non-starchy vegetables, low-fat dairy, and nuts/seeds (p &lt, 0.001 for all). FCCH providers could offer more whole fruits and grains and a greater variety of vegetables. Differences by ethnicity suggest providers could benefit from culturally tailored recommendations.

Visual perception plays a key role in the selection of nutritious and healthy foods. Color, as one of the most important senses of vision, can be used as an indicator of food quality/defects and grade. It is recommended consumers include various colors in their plate to obtain various vitamins and minerals. Color is also thought to be related to antioxidant capacity. Within this regard, this study investigated the relationship between color and antioxidant capacity in various fruits and vegetables. The results indicate the color hues analyzed by computer vision based image analysis can be related with TAC of fruits and vegetables, but with some limitations and can be used as a guide for food selection to increase daily antioxidant intake. Most of fruits and vegetables having hue values above 180° and below 20°, have high antioxidant capacity (>10 mmol TE/kg fresh weight). The results also emphasized the importance of the serving size of fruits and vegetables in terms of their contribution to daily antioxidant intake. Based on these results, fruits and vegetables could be categorized into low-, medium-, and high-antioxidant groups according to their TAC and potential contributions to fulfill the recommended daily antioxidant intake. Finally, daily antioxidant intake was evaluated with a healthier scenario created by doubling vegetable portion and reducing fruit portion by half in the meal., Graphical abstract Image 1, Highlights • Color is related to antioxidant capacity in some fruits and vegetables. • Anthocyanin-rich purple, red, blue fruits and vegetables have more TAC. • Serving size should be considered when evaluating the overall antioxidant contribution of a meal. • Food selection could be guided by color to increase TAC content, while also considering total calorie intake.

Legalization and commercial sale of non-medical cannabis has led to increasing diversity and potency of cannabis products. Some of the American states that were the first to legalize have seen rises in acute harms associated with cannabis use, e.g. Colorado has seen increases in emergency department visits for cannabis-related acute psychological distress and severe vomiting (hyperemesis), as well as a number of high-profile deaths related to ingestion of high doses of cannabis edibles. Over-ingestion of cannabis is related to multiple factors, including the sale of cannabis products with high levels of THC and consumers' confusion regarding labelling of cannabis products, which disproportionately impact new or inexperienced users. Based on our review of the literature, we propose three approaches to minimizing acute harms: early restriction of cannabis edibles and high-potency products; clear and consistent labelling that communicates dose/serving size and health risks; and implementation of robust data collection frameworks to monitor harms, broken down by cannabis product type (e.g. dose, potency, route of administration) and consumer characteristics (e.g. age, sex, gender, ethnicity). Ongoing data collection and monitoring of harms in jurisdictions that have existing legal cannabis laws will be vital to understanding the impact of cannabis legalization and maximizing public health benefits.

BACKGROUND: Pancreatic cancer is a highly deadly disease with a poor prognosis. There is limited knowledge about prevention of the disease; thus, identification of risk factors is important to reduce the disease incidence.OBJECTIVE: The aim of the present study was to prospectively investigate associations between incidence of pancreatic cancer and whole-grain intake measured in 2 ways: as whole-grain product intake (g whole-grain products/d) and as whole-grain intake (grams of whole grains/d). Moreover, the intake of subgroups of these was also investigated: whole-grain products (rye bread, whole-grain bread, and oatmeal/muesli) and cereals (rye, wheat, and oats).METHODS: In total, 55,995 Danish adults aged 50-64 y, of whom 446 developed pancreatic cancer (17.5 y mean follow-up), were included in the study. Detailed information on daily intake of whole-grain products was available from a validated self-administered FFQ, and intake of whole-grain cereals (wheat, rye, and oats) was estimated using information from a 24-h dietary recall. The association between the whole-grain exposures and incidence of pancreatic cancer was investigated by Cox regression analyses adjusted for potential confounders.RESULTS: Total whole-grain product intake was associated with a 7% lower incidence of pancreatic cancer per serving (50 g/d) (HR: 0.93; 95% CI: 0.86, 1.00), and in the sex-specific analyses, an inverse association was found only in men. No association was found for total whole-grain intake (per 16-g serving size; HR: 0.96; 95% CI: 0.89, 1.03). When investigating specific whole-grain products and cereals individually, none were alone associated with lower incidence of pancreatic cancer.CONCLUSION: Our findings indicate that intake of whole grains is associated with lower risk of pancreatic cancer in middle-aged men. Consuming ample amounts of whole grains may prove beneficial in terms of lowering pancreatic cancer risk.

Background Food industry led reformulation efforts have attempted to address the prevalence of obesity by modifying nutrient compositions in food products. This study explored progress in nutrient composition alterations in products in Irish supermarkets by comparing the nutrient labels of products sold in 2014 and 2017. Methods We conducted two supermarket audits in 2014 and 2017 to examine the changes in the nutrient profile of cereals, breads, spreads, unflavoured milks, yogurts and juices. Information on the nutrients of interest to the study (energy, protein, fat, carbohydrate, saturated fat, salt, sugar and some micronutrients) were extracted and stored in Microsoft Excel. The nutrient profile of each product was compared across the two timepoints. Our study shows that the mean level of sugars in cereals remains high and that the mean level of salt remains high in cereals, breads, and spreads. Results In total, 143 products were directly compared (86 cereals, 26 breads, 17 spreads and 14 milks). Our study shows that the composition of salt and sugar in cereal, bread, spreads and milk has declined by 12 and 7%, respectively. Saturated fat has declined in cereals (7%), but has increased in breads (12%), spreads (1%), and milks (5%). Manufacturers increased the serving sizes in nine cereals and one milk. Conclusions From a population health perspective, the results are encouraging but care should be exercised by the food industry not to allow total fat and saturated fat levels to creep upwards. Further research and engagement of public health specialists and the food industry are needed.

Food allergy affects up to 6% of Europeans. Allergen identification is important for the risk assessment and management of the inadvertent presence of allergens in foods. The VITAL® initiative for voluntary incidental trace allergen labeling suggests protein reference doses, based on clinical reactivity in food challenge studies, at or below which voluntary labelling is unnecessary. Here, we investigated if current analytical methodology could verify the published VITAL® 2.0 doses, that were available during this analysis, in serving sizes between 5 and 500 g. Available data on published and commercial ELISA, PCR and mass spectrometry methods, especially for the detection of peanuts, soy, hazelnut, wheat, cow's milk and hen's egg were reviewed in detail. Limit of detection, quantitative capability, matrix compatibility, and specificity were assessed. Implications by the recently published VITAL® 3.0 doses were also considered. We conclude that available analytical methods are capable of reasonably robust detection of peanut, soy, hazelnut and wheat allergens for levels at or below the VITAL® 2.0 and also 3.0 doses, with some methods even capable of achieving this in a large 500 g serving size. Cow's milk and hen's egg are more problematic, largely due to matrix/processing incompatibility. An unmet need remains for harmonized reporting units, available reference materials, and method ring-trials to enable validation and the provision of comparable measurement results.

Background and aims Dairy products are a very diverse food group with multiple effects on the cardiac health of men and women. The aim of this work was to evaluate the sex-specific association between dairy products (total and subtypes) and 10-year first fatal/nonfatal cardiovascular disease (CVD) incidence. Methods and results In 2001–2002, n = 1514 men and n = 1528 women (>18 years old) from greater Athens area, Greece, were enrolled. Dietary assessment was based on a validated semi-quantitative food frequency questionnaire. Dairy product consumption was examined in relation to 10-year CVD incidence. Follow-up (2011–2012) was achieved in n = 2020 participants (n = 317 CVD cases). Ranking from lowest ( 2 servings/day) total dairy intake, CVD incidence in men was 17.8%, 15.0%, and 10.9% (p = 0.41), while in women it was 14%, 6.0%, and 5.7% (p = 0.02). Multiadjusted analysis revealed that total dairy intake protected against CVD only in women [Hazard Ratio (HR) = 0.48 and 95% Confidence Interval (95% CI) (0.23, 0.90)], irrespective of the fat content. Further analysis revealed that only fermented products (yogurt and cheese), protected against CVD. For per 200 g/day yogurt consumption, CVD risk was 20%–30% lower with this claim being more evident in women, while for per 30 g/day cheese intake, about 5% lower risk was observed particularly in men. As for butter, nonsignificant associations were highlighted. These associations were mainly retained in the case of hepatic steatosis, insulin resistance, and systemic inflammation. Conclusions This work provides incentives for researchers to elucidate the diversity of ingredients and mechanisms through which dairy products exert their effect on cardiac health separately for men and women.

Edible cannabis products have increased in popularity, particularly in jurisdictions that have legalized nonmedical cannabis. Rates of adverse events from cannabis edibles have also increased, in part because of difficulties identifying and titrating tetrahydrocannabinol (THC) levels. The current study tested whether packaging cannabis in separate units enhances consumer understanding of serving sizes.An experimental task was conducted as part of the 2018 International Cannabis Policy Study online survey. Participants were recruited from the Nielsen Global Insights Consumer Panel. A total of 26,894 participants (61.5% female) ages 16-65 years from Canada and the United States were randomly assigned to view a cannabis brownie packaged according to one of three conditions: (a) multiserving edible ("control condition"), (b) single-serving edible, and (c) single-serving edible packaged separately ("unit-dose packaging"). Participants were asked to identify a standard serving based on information on the product label. Logistic regression was used to test the influence of packaging condition on the likelihood of a correct response, adjusting for key covariates.Compared with the multiserving edible control (50.6%), participants were significantly more likely to correctly identify the serving size in the single-serving edible condition (55.3%; adjusted odds ratio = 1.22, CI [1.15, 1.29], p.001) and the unit-dose packaging condition (54.3%; adjusted odds ratio = 1.17, CI [1.10, 1.24], p.001).Packaging in which each product unit contained one dose of THC enhanced consumers' ability to identify how much of a product constitutes a standard serving or dose. Packaging products as individual doses eliminates the need for mental math and could reduce the risk of accidental overconsumption of cannabis.