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The single-serve packaging of discretionary foods is becoming increasingly popular, but evidence is limited on whether smaller package sizes can reduce food intake. The aim of this scoping review is to assess the effect of reducing the package size of energy-dense, nutrient-poor (EDNP) snacks and drinks on consumption, intentions, and perception, and to examine the effects of potential moderators or mediators. The search was conducted in six selected databases and grey literature sources, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for the scoping review process (PRISMA-ScR) guidelines. After screening 5562 articles, 30 articles comprising 47 intervention studies were included. Twelve of 15 studies found a significant effect in lowering the actual or intended consumption when a single smaller package was offered compared with a single larger package. When the total serving size was held constant between varying package conditions, such as a multipack, single package, or unpackaged, the results on the actual and intended consumption were inconsistent and varied according to the presence of moderators. Overall, these findings suggest that an overall reduction in the size of a single package is a more promising strategy than providing multipacks to reduce consumption. Changes to the current food environment to promote single smaller packages of EDNP snacks and drinks are necessary to support the better selection of appropriate portion sizes and reduce consumption.

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.

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.

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.

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.

Street food is popular in Eastern Europe, but its diversity and nutritional value are unknown. This study aimed to characterise the street food environment in Chişinău, Moldova, including the vending sites and vendors, food availability and nutritional composition of foods and beverages. All street food vending sites (single point of sale) located in a 1-km buffer centred on the main public market were systematically selected (n 439; n 328 participants). Data on vending sites’ characteristics (mobility, type of physical set-up and access to electricity), operating periods and food availability were collected. Samples of the most commonly available foods of unknown composition were collected (twenty-eight home-made and twenty-four industrial). Macronutrients, Na and K were quantified through chemical analysis. Fruits, beverages and food other than fruits were available in 2·5, 74·3 and 80·8 % of the vending sites, respectively. Among the latter, 66·4 % sold only industrial foods (e.g. pretzels, biscuits, wafers, chocolate and ice cream), 21·5 % only home-made (e.g. savoury and sweet pastries) and 12·1 % both. Home-made foods presented larger serving sizes and energy/serving (median kJ/serving: 1312·5 v. 670·3, P = 0·022); industrial foods were more energy-dense (median kJ/100 g: 1797·0 v. 1269·8, P = 0·002). High SFA, trans-fat and Na contents were found, reaching 10·9 g/serving, 1·4 g/serving and 773·7 mg/serving, respectively. Soft drinks and alcoholic beverages were available in 80·7 and 42·0 % of the vending sites selling beverages, respectively. Concluding, industrial snacks and home-made pastries high in Na and unhealthy fat were frequent in Chişinău. Prevention of diet-related diseases in Moldova may benefit from the improvement of the nutritional profile of street food. The FEEDcities project was funded by the World Health Organization Europe (WHO registration 2015/591370 and 2017/698514). This study was funded by national funds through FCT - Fundação para a Ciência e a Tecnologia, I.P., under the projects UIDB/04750/2020 and UID/QUI/50006/2020. Individual PhD grants attributed to G. A. (SFRH/BD/118630/2016) and S. S. (SFRH/BD/130650/2017) were funded by FCT and the ‘Programa Operacional Capital Humano’ (POCH/FSE).

Background Large portion sizes encourage overconsumption. Prior studies suggest that this may be due to errors in anticipating the effects of portion size, although the studies were limited to adults and energy-dense foods. Objective Our aim was to investigate potential anticipation errors related to the effects of portion size on hunger, eating enjoyment, and healthiness ratings among 8-to-11-year-old children, for snacks differing in energy density and healthiness perception, and as a function of initial hunger. Methods In a within-subject design, 83 children aged 8 to 11 years old were first asked to anticipate how much they would enjoy, how hungry they would feel after eating, and how healthy it would be to eat a recommended serving size, a 50% larger portion, and a 125% larger portion of brownie or applesauce. Over six subsequent sessions, the children were asked to eat all of each of these portions and then rate their post-intake enjoyment, residual hunger, and healthiness perceptions. We also measured hunger at the beginning of each session. Results For both snacks, larger portions reduced anticipated and experienced residual hunger similarly. In contrast, larger portions increased anticipated but not experienced eating enjoyment for both snacks; although larger portions increased anticipated and experienced enjoyment ratings among extremely hungry children. All children under-anticipated how much they would enjoy the smaller portion sizes. Healthiness ratings were unaffected by portion size for both snacks but differed across foods (applesauce vs. brownie). Conclusions Children anticipate the effects of portion size on hunger change accurately, overestimate the effects of portion size on eating enjoyment, and rate food healthiness on food type and not portion size. Helping children better anticipate the enjoyment from smaller (recommended) portion sizes and understand that food quantity, not just quality, matters for healthy eating may be a solution to improve portion control.

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.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.Frequencies of each promotional feature and number of features per box, level of participation in CFBAI, and sugar content by serving and ounce.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).Most cereals (81%) contained13 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).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 recommended6 g/serving target used by the Special Supplemental Nutrition Program for Women, Infants, and Children program.

Food serving sizes are on the rise and this increase is one factor contributing to both obesity and food waste. Hence, reducing serving size is a potentially effective strategy for lessening overconsumption and food waste—but it carries the risk that consumers may perceive the smaller serving size as too small, lowering satisfaction. This research examines the role of serving size, unit size, and self-serving on the amount of food served, consumed, and wasted, with the main objective of reducing both overconsumption and food waste while maintaining consumer satisfaction. Across four experiments, we demonstrate that consumers who are served food in smaller units consume less but waste more, while consumers who serve themselves food in smaller unitsconsume less and waste less. When self-serving food in smaller units, consumers benefit from pause moments providing decision-making opportunities that draw attention to the serving decision, as reflected in longerserving times and greater overestimation of the served amount of food. Consequently, consumers presented with smaller unit sizes serve themselves less food—resulting in decreased consumption and waste, without lesseningconsumer satisfaction. These findings offer a wide range of win–win implications that are of relevance to consumers as well as to managers of restaurants, food services, and health professionals.

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

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.

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.

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 This study builds on previous research that seeks to estimate kilocalorie intake through microstructural analysis of eating behaviors. As opposed to previous methods, which used a static, individual-based measure of kilocalories per bite, the new method incorporates time- and food-varying predictors. A measure of kilocalories per bite (KPB) was estimated using between- and within-subjects variables. Objective The purpose of this study was to examine the relationship between within-subjects and between-subjects predictors and KPB, and to develop a model of KPB that improves over previous models of KPB. Within-subjects predictors included time since last bite, food item enjoyment, premeal satiety, and time in meal. Between-subjects predictors included body mass index, mouth volume, and sex. Participants/setting Seventy-two participants (39 female) consumed two random meals out of five possible meal options with known weights and energy densities. There were 4,051 usable bites measured. Main outcome measures The outcome measure of the first analysis was KPB. The outcome measure of the second analysis was meal-level kilocalorie intake, with true intake compared to three estimation methods. Statistical analyses performed Multilevel modeling was used to analyze the influence of the seven predictors of KPB. The accuracy of the model was compared to previous methods of estimating KPB using a repeated-measured analysis of variance. Results All hypothesized relationships were significant, with slopes in the expected direction, except for body mass index and time in meal. In addition, the new model (with nonsignificant predictors removed) improved over earlier models of KPB. Conclusions This model offers a new direction for methods of inexpensive, accurate, and objective estimates of kilocalorie intake from bite-based measures.

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

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.

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.

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)

Pasta represents a staple food in many populations and, in recent years, an increasing number of pasta items has been placed on the market to satisfy needs and trends. The aims of this work were: (i) to investigate the nutritional composition of the different types of pasta currently sold in Italy by collecting the nutrition facts on their packaging, (ii) to compare energy, nutrient and salt content per 100 g and serving in fresh and dried pasta, (iii) to compare the nutrition declaration in pairs of products with and without different declarations (i.e., gluten free (GF), organic, and nutrition claims (NC)). A total of 756 items, made available by 13 retailers present on the Italian market, were included in the analysis. Data showed a wide difference between dried and fresh pasta, with high inter-type variability. A negligible amount of salt was observed in all types of pasta, except for stuffed products, which had a median high quantity of salt (&gt, 1 g/100 g and ~1.5 g/serving). Organic pasta had higher fibre and lower protein contents compared to conventional pasta. GF products were higher in carbohydrate and fat but lower in fibre and protein than not-GF products, while only a higher fibre content was found in pasta with NC compared to products not boasting claims. Overall, the results show high variability in terms of nutrition composition among the pasta items currently on the market, supporting the importance of reading and understanding food labels for making informed food choices.

Nudge theory predicts that consumers will select smaller portions of high energy density (HED) foods and drinks when packaging presents physical or other limits. To test the feasibility and acceptability of packaging concepts designed to limit portion sizes for children, two mixed methods studies were conducted. Packaging with functional serving size reminders, visual narrative, and metaphor were developed using 3-D prototypes. In each study, packaging prototypes were assessed, either in person (Study 1, n = 50) or via an online survey (Study 2, n = 297). In Study 1, parents visiting a Science museum poured servings for their children of HED foods/drinks and provided feedback on prototypes designed to limit portions of these items. Responses were recorded via questionnaire and interview. In Study 1, parents significantly adjusted amount poured for children based on age and in alignment with recommended portion sizes; they reported that the packaging prototypes would facilitate portion control through education, convenience and autonomy but raised concerns about costs and recyclable/reusable materials. In Study 2 parents responded to the same prototypes online providing measures of willingness to pay (WTP), forced choice and open-ended feedback for each concept. Parents were WTP more for downsizing packaging concepts, choosing them over their regular brand in most cases and confirming a generally positive view of the designs. However, WTP magnitude depended on consumer segmentation (price concerns, health motives). Innovative design concepts can be used to nudge towards smaller portions, but this depends on parental motivation.

Background Facts Up Front (FUF) nutrition labels are used by food manufacturers to highlight selected nutrition information on the front of the package. Differences in serving sizes between similar products may go unnoticed by consumers, leading to misinterpretations of the nutritional information displayed in the FUF. Objective To examine consumer attention to FUF labels on 2 similar cereal products with differing serving sizes. Study Design, Setting, Participants Utilizing a nationally representative sample, 1,022 adults participated in an online survey. Measurable Outcome/Analysis Participants were shown images of 2 cereals with FUF labels that differed in serving size and nutrient amounts. Attention to the FUF and serving sizes was assessed, and participants were asked comparative questions about the nutrient content of the cereals. Descriptive statistics and multinomial logistic regressions were performed. Results While 64.5% of participants reported looking at the FUF, only 21.3% were correct when asked which of the 2 cereals had the bigger serving size. The majority of participants incorrectly indicated that there were no differences between the cereals with respect to the nutrients presented, though these inaccuracies were less likely among participants who looked at the FUF. What seemed to go unnoticed by most participants were the marked nutritional differences between the products if the servings are equalized to 1 cup. In fact, when the serving sizes are equalized, the cereal with the larger listed serving size (and with seemingly higher amounts of less healthful nutrients such as sugar and sodium) actually had lower amounts of these nutrients in comparison to the cereal with the smaller listed serving size. Conclusion Attention to differences in the FUF and serving sizes was lacking. Participant inattention to the inequalities in serving sizes between cereals could mean they perceive them as being equal. Significant nutritional differences between products may be obscured by the failure of consumers to take different serving sizes into consideration.

Food sensory imagery - creating a vivid mental image of the sensory experience of eating - can lead to the selection of smaller portions because it serves as a reminder that eating enjoyment does not necessarily increase with portion size. The evidence is mostly limited to adults and to energy-dense foods for which it is particularly difficult to predict the satiating effects of consumption quantity. The objective was to study how food sensory imagery influences portion size selection of foods varying in energy density (brownie and applesauce) by 7- to 11-year-old children. During after-school time, 171 children were randomized into two conditions. Children in the food sensory imagery condition were asked to imagine the taste, smell, and texture of eating palatable foods, i.e., chocolate cereal, chocolate waffle, and chocolate candies. Children in the control condition performed a similar sensory imagery task for non-food-related activities. Children were then asked to choose between the recommended serving size, a 50% larger portion, and a 125% larger portion of either brownie or applesauce. One week later, they were placed in the same condition for the other food. Compared to the control condition, food sensory imagery led children to choose 7.1% less brownie but had no effect on applesauce portion selection. Exploratory findings showed that the food sensory imagery intervention was especially effective at reducing brownie portion size selection among children who were moderately hungry, who usually eat fast, and whose parents pressure them to eat. In conclusion, food sensory imagery may be a useful intervention to nudge children towards healthier portion size choices because it reduces the selected portion size of an energy-dense snack without reducing the selected portion size of a healthier snack.

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.

There is insufficient evidence that restaurant menu labeling policies are cost-effective strategies to reduce obesity and diet-related non-communicable diseases (NCDs). Evidence suggests that menu labeling has a modest effect on calories purchased and consumed. No review has been published on the effect of menu labeling policies on transnational restaurant chains globally. This study conducted a two-step scoping review to map and describe the effect of restaurant menu labeling policies on menu reformulation. First, we identified national, state, and municipal menu labeling policies in countries from global databases. Second, we searched four databases (i.e., PubMed, CINHAL/EBSCO, Web of Science, and Google Scholar) for peer-reviewed studies and gray-literature sources in English and Spanish (2000–2020). Step 1 identified three voluntary and eight mandatory menu labeling policies primarily for energy disclosures for 11 upper-middle and high-income countries, but none for low- or middle-income countries. Step 2 identified 15 of 577 studies that met the inclusion criteria. The analysis showed reductions in energy for newly introduced menu items only in the United States. We suggesr actions for governments, civil society organizations, and the restaurant businesses to develop, implement, and evaluate comprehensive menu labeling policies to determine whether these may reduce obesity and NCD risks worldwide. Published version

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.

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.

Studies have reported that nut consumption is potentially beneficial in preventing cardiovascular disease. However, data are insufficient regarding the association between nut consumption and left ventricular hypertrophy (LVH).In the Kangbuk Samsung Health Study, the participants were 34,617 men and 12,257 women who completed a food-frequency questionnaire for nut consumption and received echocardiography. Nut consumption was evaluated only for peanuts, pine nuts, and almonds defining 15 g as one serving/servings dose. Multivariable adjusted odds ratio (OR) and 95% confidence interval (CI) for LVH were evaluated according to the consumption frequency of one serving dose of nut. The frequency of nut consumption was categorized into five groups (1/month, 1/month-1/week, 1-2/week, 2-4/week, and ≥4/week). The subgroup analysis was conducted by dividing the participants into the following two groups: the nonhypertensive/nondiabetic group and hypertensive or diabetic group. In women, nut consumption ≥2/week had the lower multivariable adjusted OR and 95% CI for LVH (2-4/week: 0.46 [0.26-0.81] and ≥4/week: 0.48 [0.25-0.92]) when compared with nut consumption 1/month. This association was identically observed in the subgroup analysis for women without hypertension and diabetes mellitus (DM) and women with hypertension or DM. However, men did not show the significant association.In women, nut consumption ≥2/week was associated with the decreased probability of LVH. Further research studies should investigate whether the beneficial effect of nut consumption on LV structure results in better cardiovascular prognosis.

Background Consumption of large portions of energy‐dense foods promotes weight gain in children. Breakfast cereal boxes often show portions much larger than the recommended serving size. Objective This experimental study investigated whether front‐of‐package portion size depictions influence children's self‐served portions and consumption. Methods In a between‐subjects design, 41 children aged 7‐11 years (M= 9.0 ± 1.5y) served themselves breakfast cereal from a box, the front of which depicted either a recommended serving size of cereal (30g) or a larger, more typical front‐of‐pack portion (90g). Cereal served and consumed and total caloric intake (including milk) was recorded. Height and weight, demographic information and measures of children's food responsiveness and enjoyment of food were collected. Results MANOVA revealed that children exposed to the larger portion size served themselves (+7g, 37%) and consumed (+6g, 63%) significantly more cereal than those exposed to the smaller portion. Despite this, overall caloric intake (milk included) did not differ between conditions, and no other measured variables (hunger, BMI) significantly affected the outcomes. Conclusion This study provides novel evidence of the influence portion‐size depictions on food packaging have on children's eating behaviour. This offers possible avenues for intervention and policy change; however, more research is needed. ispartof: Pediatric Obesity vol:15 issue:2 ispartof: location:England status: Published online

Obesity is a major health problem facing the European population; over two thirds (67%) of UK adult men and 58% women are overweight or obese (1). The positive association between on-pack serving-size and food intake is known as the ‘portion size effect’. However, although direct links with obesity remain unproven, evidence suggests that limiting consumed portion size contributes to reduced energy intake and therefore reduced weight gain (2). UK portion size guidance is outdated and evidence suggests that on-pack serving-sizes have increased in some energy-dense foods (3). This study explores consumed portion sizes and on-pack serving-sizes in popular energy, fat and sugar-dense foods.The UK National Diet & Nutrition Survey 2008–2014 (n = 2377) dataset was used to identify commonly consumed energy, fat and sugar-dense foods. Data was analysed for adults aged 19–64y (excluding under-reporters) for consumed portion sizes, and a commercial product database of major UK retailer and manufacturer data provided serving-sizes. Commonly consumed energy, fat and sugar-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 details, whereas 97% had pack-size information; Chocolate had the least products with serving-size information (35%). Lack of on-pack serving-size guidance is therefore a widespread issue, particularly in some energy-dense snack foods. 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%). There is a real need for policies aimed at setting product pack and serving-sizes that help individuals consume smaller portions. However, further consideration is needed on how consumers understand on-pack serving-size messaging, front-of-pack labelling and pack size.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. These results could inform updated portion size guidance of energy-dense foods. Further work is needed to clarify whether smaller serving and pack sizes would lead to lower total consumption and energy/nutrient intake.

Food Based Dietary Guidelines (FBDG) are dietary recommendations described in terms of amounts of foods that should be consumed. They are designed to support healthy eating through simple messaging and indicate how to achieve a nutritionally adequate diet. However, assessing compliance with FBDG targets can be difficult. The quantity of food either being consumed or prescribed and the amount of that food that constitutes a serving are needed to calculate the contribution of the food towards a food group target. The aim of this study was to define the serving weight of foods, guided by definitions from Irish FBDG, to the McCance and Widdowson Composition of Foods Integrated Dataset 2015 (CoFID). This will enable the automatic assessment of compliance to FBDG using Nutritics nutrition analysis software. Foods from CoFID were categorised into six food groups as defined by Ireland's FBDG. Quantified servings from the Irish FBDG were matched to foods. Calculation criteria were developed to establish a serving size for remaining foods within each food group. For fats and oils, as well as raw fruits and vegetables, household measurements were converted to grams, using Food Portion Sizes from the Food Standards Agency. Quantities for cooked fruits and vegetables were calculated using weight-change factors published by Bognar. For the breads, cereals and potatoes group a serving size was calculated using the midpoint for the calorie bands in this group, as defined by the Food Safety Authority of Ireland. For the dairy group, a serving size was determined by calculating the quantity needed to provide 250 mg of calcium. This was in line with achieving the total daily recommended amount of calcium from the dairy group from 3 servings. For meat, fish and alternatives (MFA), serving sizes were developed using the recommended amount of protein per body weight reference value for males and females. For foods high in fat, sugar and salt, serving sizes were defined using 100kcal as the recommended amount of energy provided for snacks. Out of 3,291 foods, 1,980 were grouped into 6 food groups. Quantified servings were available for 694 foods in 3 food groups. Calculated serving sizes were developed for the remaining 1,276 foods. The quantity of each food that constitutes a serving will be integrated into Nutritics to automatically assess compliance to FBDG. This will enable Health Care and Food Industry Professionals to deliver informed advice on meeting population health targets.

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.

The objective of this study was to assess the potential of dried apple to regulate acute blood glucose, insulin, satiety, and total plasma antioxidant levels, and to explore the effect of dried apple on cognitive responses. Twenty-one healthy, normal-weight subjects completed the study which used a randomized crossover design with repeated measures. After a fast of 10 h, a standardized serving size of either dried apple or muffins was consumed. Blood glucose, insulin, and antioxidant concentrations were measured at 0, 15, 30, 45, 60, 90, and 120 min postprandial, and satiety was assessed every 15 min for 2 h. Cognitive tests were administered before and 2 h after consumption of the test food. The dried apple had significantly higher phenolic content and antioxidant activities than the muffin (P ≤ .05). Consumption of the dried apples produced significantly lower glucose concentrations at 30- (P ≤ .01; 95% CI [2.93-16.64]), 45- (P ≤ .02; 95% CI [2.41-17.88]), 60- (P ≤ .02; 95% CI [2.10-14.56]), and 120-min (P ≤ .01; 95% CI [8.16-16.80]) time points, and significantly lower (P ≤ .03; 95% CI [0.60-8.70]) insulin concentrations at a 15-min time point than the muffins but offered little consistent differences in antioxidant status, satiety, and cognitive function. These findings suggested that the intake of dried apples could reduce postprandial blood glucose and potentially increase the effectiveness of insulin responses in healthy individuals but offered little consistent differences in antioxidant status, satiety, and cognitive function.

Diet comprises factors with anti and pro-inflammatory potential that can contribute to modulate obesity-induced inflammation. We aimed to assess the association between food intake and high-sensitivity C-reactive protein (hsCRP) levels in adolescents.A cross-sectional analysis of 991 adolescents aged 13 years old was conducted as part of the EPITeen cohort, Porto, Portugal. Food intake was assessed by a food frequency questionnaire and thirteen food groups were defined. Anthropometric assessment was performed and serum hsCRP was measured in a fasting blood sample. hsCRP concentrations above the 75th percentile were considered high. Logistic regression was fitted to estimate the association between the intake frequency of the food groups and hsCRP, stratified by BMI and adjusted for sex, parental education and total energy intake. Median (25-75th percentiles) hsCRP concentrations increased with increasing values of BMI [normal weight: 0.20 (0.10-0.50); overweight: 0.40 (0.20-0.80); obese: 1.10 (0.40-2.15) mg/l, p 0.001]. After adjustment for sex, parental education and total energy intake, no statistically significant associations were found amongst normal weight and overweight participants. However, among obese individuals, having as reference the first frequency category (1 per day), a higher frequency of vegetables/legumes intake showed a decreased odds of high hsCRP levels (OR: 0.10, 95%CI 0.03-0.38, 1-3 per day; and OR: 0.14, 95%CI 0.04-0.52,3 per day).Among participants with obesity-induced higher hsCRP levels, a higher frequency of vegetable/legume intake was inversely related to hsCRP.

Hunger, caused by mild amount of food deprivation, is an everyday physiological state familiar to us all. Ongoing research has pinpointed the way hunger affects people's physiological functions as well as their attitudes and allocation of attention toward domain-specific, food-related objects. Yet, little is known about the way food deprivation affects basic perceptual abilities. Here, we utilized size-contrast visual illusions commonly associated with food to explore the way deprivation affects relative processing of food size. In two experiments (Nexp1 = 32 females, mean age: 24.31; Nexpt2 = 41 females, 40 males, mean age: 23.84), we examined the effect food deprivation has on participants' susceptibility to the Delboeuf illusion, which biases the perceived size of a neutral or of a food-related object when it is placed within the context of another object (e.g., a pizza is perceived as smaller when placed on a larger plate or tray). The results showed that food deprivation reduces the illusory bias for food-related but not for neutral stimuli. Such reduction in the illusory effect indicates reliance on analytic, rather than on relative processing style, for domain-specific stimuli when in the state of hunger.

Introducción: Los alimentos ultraprocesados tienen formulaciones industriales altas en azúcar, grasas saturadas, sodio, estabilizadores y preservantes con mercadeo agresivo. El objetivo del estudio fue identificar los alimentos con contenido excesivo de nutrientes según el modelo de perfil de nutrientes de la Organización Panamericana de la Salud (OPS 2016). Material y métodos: Estudio descriptivo realizado de julio a noviembre 2016 en el laboratorio de nutrición (Universidad Zamorano, Honduras). Una muestra exhaustiva fue elaborada de los diferentes alimentos ultraprocesados ofertados en los principales centros de venta de representatividad nacional. Se agruparon 520 alimentos en once categorías, según el modelo de perfil de nutrientes OPS 2016. Las etiquetas nutricionales fueron fotografiadas, revisadas y una base de datos fue creada en Excel© (Microsoft, 2010) con 28 variables (categoría, tipo, nombre, empresa, país de origen, tamaño de porción, aporte calórico, nutrientes reportados). Resultados: Los productos procedieron de 21 países y 138 empresas. El 75% de los productos totales examinados por porción presentaron exceso de azúcares, 37% sodio, 33% grasas totales y 30% contenían edulcorantes (diferentes al azúcar). El 96% de las bebidas azucaradas, chocolates, caramelos y lácteos con azúcar presentaron exceso de azúcares. El 92%, 88% y 95% de los quesos con sal añadida, embutidos y snacks contenían exceso de sodio respectivamente. El 82% de las galletas contenían exceso de azúcares y 71% de grasas. El 91% de los cereales con azúcares añadidos presentaron exceso de azúcares y 64% de sodio. Conclusiones: Regular y/o disminuir la publicidad de los alimentos ultraprocesados; implementar obligatoriamente el contenido de azúcares añadidos y adoptar el etiquetado frontal.

Purpose This study aims to examine consumer involvement with nutrition labels in the USA. Although food label information including nutrition, size and color are standardized and mandated by Food and Drug Administration, consumers perceive some food labels more confusing than others and many ignore the information by seeing them as unimportant. This study measures the importance of different nutrients and examines the differences between consumers that read nutrition labels and consumers that do not read nutrition labels. Design/methodology/approach In total, 300 consumers were surveyed using Qualtrics internet panel about the importance of nutrition information on food labels. Importance of food nutrients and food serving, size as they impact consumer involvement with food labels, was measured using structural equation modeling. Findings The results indicate perceived risk associated with nutrition labels, and food serving size information impacts consumer involvement with nutrition labels. Practical implications There are a variety of important public policy implications for government agencies and food manufacturers in educating the public about the use of nutrition information on food labels. Originality/value This study expands previous research by adding three more nutrients to the dietary scale from nutrition labels (sodium, cholesterol and carbohydrates) and focuses mainly on the nutrients that are considered to be negative for most people.

Objective Food environments can influence food selection and hold the potential to reduce obesity, non-communicable diseases and their inequalities. 'Consumer nutrition environments' describe what consumers encounter within a food retail outlet, including products, price, promotion and placement. This study aimed to summarize the attributes that have been examined in existing peer-reviewed studies of Australian consumer nutrition environments, identify knowledge gaps and provide recommendations for future research. Methods A systematic search of peer-reviewed literature was conducted. Sixty-six studies that assessed an aspect of within-store consumer nutrition environments were included. Results Most studies were published from 2011 onwards and were conducted in capital cities and in supermarkets. Studies assessed the domains of product (40/66), price (26/66), promotion (16/66) and placement (6/66). The most common research themes identified were assessment of the impact of area socioeconomic status (13/66), remoteness (9/66) and food outlet type (7/66) on healthy food prices; change in price of healthy foods (6/66); variety of healthy foods (5/66); and prevalence of unhealthy child-orientated products (5/66). Conclusions This scoping review identified a large number of knowledge gaps. Recommended priorities for researchers are as follows: (1) develop consistent observational methodology, (2) consider consumer nutrition environments in rural and remote communities, (3) develop an understanding of food service outlets, (4) build on existing evidence in all four domains of product, price, placement and promotion and (5) determine effective policy and store-based interventions to increase healthy food selection.

Pulses, defined as dry-harvested leguminous crops, include several varieties of beans, peas, lentils, and chickpeas. There is no consensus around a recommended serving size of pulses within a balanced diet, which prevents the development of transregional strategies that rely on consistent messaging to drive increases in consumption. The purpose of this review is to define and disseminate an appropriate target for a minimum serving size of pulses on any given day that can be used in international or collaborative strategies to promote the consumption of pulses. Relevant data were reviewed to examine dietary guidelines across jurisdictions, determine consumption levels of pulses across the globe, evaluate the nutritional composition of pulses in the context of dietary nutrient insufficiency, and assess the impact of pulses on dietary quality. Across a variety of pulses, 100 g of cooked pulses aligned with most regional serving sizes for pulses and provides significant levels of nutrients that are underconsumed by specific age-sex groups. Moreover, 100 g of pulses provides a number of nutrients that qualify for nutrient content claims under regional regulatory frameworks. The data demonstrate that 100 g or 125 mL (0.5 metric cup) of cooked pulses is a reasonable target for aligning strategies that promote the dietary and nutritional attributes of these legumes.

Supporting children's self-regulation in eating through caregivers' practice of responsive feeding is paramount to obesity prevention, and while much attention has been given to supporting children's self-regulation in eating through parents' responsive feeding practices in the home setting, little attention has been given to this issue in childcare settings. This qualitative study examines childcare providers' perspectives on using responsive feeding practices with young children (2-5years). Individual semi-structured interviews were conducted with providers until saturation was reached. Data was analyzed using thematic analysis. The final sample included 18 providers who were employed full-time in Head Start or state-licensed center-based childcare programs, cared for children (2-5y), and were directly responsible for serving meals and snacks. Providers were primarily (67%) employed in childcare programs that served children from low-income families and received reimbursement for meals and snacks from the US Department of Agriculture's Child and Adult Care Food Program. Three factors emerged that shaped childcare providers' experiences using responsive feeding practices: the providers' perspectives about whether or not young children can self-regulate food intake, their understanding of Child and Adult Care Food Program (CACFP) portion size regulations, and the availability of food at the center where they worked. Future research should examine how childcare providers' understanding of children's ability to self-regulate their food intake, the appropriate use of the CACFP regulations in relationship to serving sizes, and having food available to offer seconds promotes providers' use of responsive feeding practices in center-based childcare programs and children's dietary behaviors.

Background Accurate assessment of dietary intake continues to challenge researchers, especially in field, or non-laboratory settings. Objective In this study, digital food photography (DFP) methodology was used to assess nutritional intake (NI) of Soldiers participating in the US Army's Ranger Selection and Assessment Program (RASP). Methods During this high-intensity six-week course, Soldiers complete simulated operational missions, perform various military tasks, and importantly, eating time is severely limited. Therefore, this study provided an opportunity to evaluate the utility of DFP methods for accurate assessment of energy balance in conditions where consumption of large numbers of subjects must be completed in a very short periods of time (≤20 min). NI of 131 male, enlisted Soldiers (21 ± 4 years, 178±7 cm, and 78±8 kg) enrolled in the RASP course was assessed in their garrison dining facility using DFP utilizing visual estimation of pre- and post-meal photos of participant meals concurrently with photos of weighed, standardized portions. Total daily energy expenditure (TDEE) was assessed using doubly-labeled water (2H218O) in a sub-group of 19 volunteers. Results During the study, data loss (i.e., missing meal photos) was less than 5% per meal, and during the visual estimation process discrepancies in food identification averaged less than 10% per meal, while approximately a third of serving size estimations required a third party adjudication prior to finalization and calculation NI. Conclusions We conclude that the use of DFP allows an adequately reliable approach for quantifying NI in real-world scenarios involving large numbers of participants who must be assessed very rapidly, and researchers must have a small footprint.

Nutrient profiling (NP) models rate the nutritional quality of individual foods, based on their nutrient composition. Their goal is to identify nutrient-rich foods, generally defined as those that contain more nutrients than calories and are low in fat, sugar and salt. NP models have provided the scientific basis for evaluating nutrition and health claims and regulating marketing and advertising to children. The food industry has used NP methods to reformulate product portfolios. To help define what we mean by healthy foods, NP models need to be based on published nutrition standards, mandated serving sizes and open-source nutrient composition databases. Specifically, the development and testing of NP models for public health should follow the seven decision steps outlined by the European Food Safety Authority. Consistent with this scheme, the nutrient-rich food (NRF) family of indices was based on a variable number of qualifying nutrients (from six to fifteen) and on three disqualifying nutrients (saturated fat, added sugar, sodium). The selection of nutrients and daily reference amounts followed nutrient standards for the USA. The base of calculation was 418·4 kJ (100 kcal), in preference to 100 g, or serving sizes. The NRF algorithms, based on unweighted sums of percent daily values, subtracted negative (LIM) from positive (NRn) subscores (NRn – LIM). NRF model performance was tested with respect to energy density and independent measures of a healthy diet. Whereas past uses of NP modelling have been regulatory or educational, voluntary product reformulation by the food industry may have most impact on public health.

Background: Internationally, ready-to-eat breakfast cereals (RTEBC) make an important contribution to the nutritional intake of children. Significant differences have been found between the nutritional quality of children and non-children’s RTEBC. South Africa has strict legislation regarding the use of nutrition claims to promote products.Objectives: To determine i) differences in nutritional quality between children’s and non-children’s RTEBC; and, ii) compliance of nutrition claims with current legislation.Outcome measures: An analysis of the nutrient content per 100 g and per recommended serving size; an audit of nutrient content claims.Design: This study examined the packages of 134 RTEBC that were categorised into children’s cereal and six types of non-children’s cereal.Results: Children’s cereals formed 21% (n = 28) of the sample and were significantly more likely to have sugar as the first or second ingredient listed. Per 100 g, children’s cereals contained significantly more carbohydrates, sugar ...

Malnutrition in institutionalised elderly increases morbidity and care costs. Meat and dairy foods are high-quality protein sources so adequate intakes may reduce malnutrition risk. We aimed to determine whether inadequate intakes of meat and dairy foods contribute to malnutrition in institutionalised elderly. This cross-sectional study involved 215 elderly residents (70·2 % females, mean age 85·8 years) from twenty-one aged-care facilities in Melbourne, Australia. Dietary intake was assessed using observed plate waste. Food groups and serving sizes were based on the Australian Guide to Healthy Eating. Nutrient content was analysed using a computerised nutrient analysis software (Xyris). Malnutrition risk was assessed using the Mini Nutrition Assessment (MNA) tool; a score between 24 and 30 indicates normal nutritional status. Data were analysed using robust regression. Mean MNA score was 21·6 (sd 2·7). In total, 68 % of residents were malnourished or at risk of malnutrition (MNA score≤23·5). Protein intake was 87 (sd 28) % of the Australian recommended dietary intake (RDI). Consumption averaged 1 serving each of dairy foods and meat daily. Number of dairy and meat servings related to proportion of protein RDI (both PP24 points). Provision of meat and dairy foods did not meet recommended levels. On the basis of current dietary intakes in aged-care residents, increasing consumption of dairy foods to the recommended four servings daily ensures protein adequacy and may reduce malnutrition risk in institutionalised elderly, and so reduce risk of comorbidities and costs associated with malnutrition.