Differences in Portion Sizes in Brazil, France, and the USA

Portion size is recognized as a major determinant of food intake, at least over the short term, and could be related to overconsumption and obesity. In this study, we developed and evaluated a new visual measure of portion size (PS), examined whether the PS of chicken, ice cream, and soda varied among people in Brazil, France, and the USA, and tested whether PS was related to gender, body mass index, body weight, and socioeconomic status. We conducted a cross-sectional study using online convenience samples of university students (total N = 1391). Across all three foods, French personal and country PSs were significantly smaller than the other three countries. Estimated country PS was reliably larger than personal PS. Women's personal PSs were smaller than men's, but women's and men's estimates for country PS were similar. French personal and country PSs were the lowest. Some PSs had a weak but significant correlation with SES but were not significantly related to either weight or BMI. The study confirms French-American differences in personal PS and demonstrates that perceived norms correspond to individual PS.

Evolution of beverage portion sizes consumed in Brazil between 2008 and 2018

Objective

To describe the evolution of beverage portion sizes consumed in Brazil between 2008 and 2018.

Methods

Data from the dietary surveys of 2008-2009 and 2017-2018 Brazilian Household Budget Surveys, conducted with 34,003 and 46,164 individuals, respectively, were used to analyze the portion size of beverages. Food consumption data were used to group beverages according to nutritional characteristics, type and size of portions into eight groups: high-calorie soft drinks, fruit refreshments, alcoholic beverages, coffee/tea, fruit juices, milk and milk substitutes and ultra-processed milk-based beverages. The two-day food record and recall were considered to analyze the consumed portions. Comparisons between the surveys were done using Chi-Square tests and linear regression models.

Results

Between 2008 and 2018, the average portion consumed showed a significant increase for the group of alcoholic beverages (+29%), flavored juices (+11%), caloric soft drinks (+8%), milk and milk substitutes (+6%) and fruit juices (+5%); and reduction for the coffee/tea group (-11%). Analyzes by age group showed that among individuals between 20 and 40 years of age, the soft drinks and alcoholic beverage groups showed the greatest increase in portion size, +12 and +44%, respectively.

Conclusion

The beverage portion sizes consumed in Brazil between 2008 and 2018 increased for the group of alcoholic beverages, flavored juices, caloric soft drinks, milk and milk substitutes, and fruit juices.

The development of food portion sizes suitable for 4-18-year-old children used in a theoretical meal plan meeting energy and nutrient requirements

BACKGROUND

Healthy eating guidelines for school-aged children are available but without advice on portion sizes. This is a concern because consuming large portions is associated with an increased risk of overweight/obesity. The present study aimed to calculate recommended portion sizes for school-aged children based on weight for age and use them to develop a meal plan to meet nutritional needs within energy requirements.

METHODS

Portion size data on foods consumed by school-aged children (4-18 years) were extracted from two sources: (i) British National Diet and Nutrition Survey (1997) and (ii) Avon Longitudinal Study of Parents and Children (1997-2006). Foods were allocated to groups based on the UK Eatwell Guide and the US My Plate Model. Portion sizes were developed for a variety of foods. A meal plan that included portion size guidance and met healthy eating guidelines was developed based on the number of portions of each food group needed to meet dietary requirements.

RESULTS

Portion sizes were developed for 131 foods that were commonly eaten by children in age groups 4-6, 7-10, 11-14 and 15-18 years. The meal plan met requirements for energy and nutrients as specified by UK dietary reference values, except for vitamin D for which there are few dietary sources.

CONCLUSIONS

Food portion sizes informed by usual intake in UK children can help inform dietary advice for a range of childhood settings and for parents. The meal plan included a wide variety of foods to encourage dietary diversity and meet energy and nutrient needs for school-aged children.

An Interactive Mobile Phone App (SMART 5-A-DAY) for Increasing Knowledge of and Adherence to Fruit and Vegetable Recommendations: Development and Pilot Randomized Controlled Trial

Background

Fruit and vegetable consumption is important for health, but many individuals fail to consume adequate amounts for health benefits. Although many individuals are aware of current fruit and vegetable consumption recommendations, research suggests that adherence to these is hampered by low knowledge of the details of these recommendations.

Objective

This paper reports the development and details of a pilot randomized controlled test of a novel interactive mobile phone app for addressing low knowledge of the UK 5-a-day fruit and vegetable recommendations.

Methods

Requirements for the app were first defined by researchers and potential end users and prioritized using the MoSCoW (Must have, Should have, Could have, Won’t have) method. Second, a prototype mobile phone app was developed using an agile approach. Third, the prototype app was tested in a randomized controlled pilot trial for impacts on knowledge and intake of fruit and vegetables. Volunteers were randomized to either receive (n=50) or not receive the app (n=44) for 2 or 4 weeks, and fruit and vegetable knowledge, intake, and behavior were assessed at the beginning of the study and after 1 and 2 weeks or after 2 and 4 weeks, respectively. App usage and qualitative feedback were also investigated. All findings then informed the development of a final app.

Results

Low knowledge of consumption recommendations centered around portion sizes and the need for variety, and an interactive mobile phone app was considered a suitable tool for improving this knowledge in a practical manner that would be available both at time of consumption and outside of these times. The pilot test revealed improved behavior after 2 weeks compared with baseline in volunteers who received the app, but improvements in knowledge on fruit and vegetable recommendations were found in both groups, and no improvements in fruit and vegetable intakes were found in formal measures. Patterns of app usage and qualitative feedback also suggested a number of modifications. The resultant final app incorporates several behavior change techniques (goal-setting, self-monitoring, and personalized feedback) as well as aiming to improve knowledge.

Conclusions

A novel interactive mobile phone app was successfully developed based on requirements, and when tested in a pilot randomized controlled trial, this app was found to have some impacts on fruit and vegetable outcomes. Although benefits from the app were small, impacts will likely increase as a result of recent modifications. The final SMART 5-A-DAY app is available in the Google Play Store and now needs testing in the target population.

Trial Registration

ClinicalTrials.gov NCT02779491; https://www.clinicaltrials.gov/ct2/show/NCT02779491

Larger Food Portion Sizes Are Associated with Both Positive and Negative Markers of Dietary Quality in Irish Adults

Reduction in portion size, particularly for energy-dense foods, is increasingly addressed in healthy eating guidelines in a bid to tackle the obesity epidemic. The effect of portion size on other aspects of dietary quality, such as nutrient intakes, is less studied. The aim of the current work was to investigate associations between food portion sizes and key indicators of dietary quality, namely energy-adjusted intakes of saturated fat, dietary fibre, sodium, calcium, iron, folate and vitamin D, and dietary energy density (DED), in Irish adults on the days the foods were consumed. Data from the Irish National Adult Nutrition Survey (2008–2010) (n = 1274, 18–64 years, 4-day semi-weighed record) were used for the analysis. DED was lower on the days larger portions of boiled potatoes, fruit, vegetables and baked beans were consumed, and higher on the days larger portions of white bread, ready-to-eat breakfast cereals (RTEBCs), frying meats, cheese, butter, biscuits, chocolate and sugar-sweetened beverages were consumed. Micronutrient intakes were higher on the days larger portions of brown bread, RTEBCs, vegetables and low-fat spreads were consumed, and lower on the days larger portions of white bread, butter, biscuits, chocolate, sugar-sweetened beverages and beer/cider were consumed, with the exception of folate. The study identifies foods for which larger portion sizes may be associated with positive dietary attributes, as well as the opposite. It provides an important evidence base from which more specific dietary guidance on food portion sizes might be developed for Irish adults.

Structural Validation of a French Food Frequency Questionnaire of 94 Items

Background

Food frequency questionnaires (FFQs) are used to estimate the usual food and nutrient intakes over a period of time. Such estimates can suffer from measurement errors, either due to bias induced by respondent’s answers or to errors induced by the structure of the questionnaire (e.g., using a limited number of food items and an aggregated food database with average portion sizes). The “structural validation” presented in this study aims to isolate and quantify the impact of the inherent structure of a FFQ on the estimation of food and nutrient intakes, independently of respondent’s perception of the questionnaire.

Methods

A semi-quantitative FFQ (n = 94 items, including 50 items with questions on portion sizes) and an associated aggregated food composition database (named the item-composition database) were developed, based on the self-reported weekly dietary records of 1918 adults (18–79 years-old) in the French Individual and National Dietary Survey 2 (INCA2), and the French CIQUAL 2013 food-composition database of all the foods (n = 1342 foods) declared as consumed in the population. Reference intakes of foods (“REF_FOOD”) and nutrients (“REF_NUT”) were calculated for each adult using the food-composition database and the amounts of foods self-reported in his/her dietary record. Then, answers to the FFQ were simulated for each adult based on his/her self-reported dietary record. “FFQ_FOOD” and “FFQ_NUT” intakes were estimated using the simulated answers and the item-composition database. Measurement errors (in %), spearman correlations and cross-classification were used to compare “REF_FOOD” with “FFQ_FOOD” and “REF_NUT” with “FFQ_NUT”.

Results

Compared to “REF_NUT,” “FFQ_NUT” total quantity and total energy intake were underestimated on average by 198 g/day and 666 kJ/day, respectively. “FFQ_FOOD” intakes were well estimated for starches, underestimated for most of the subgroups, and overestimated for some subgroups, in particular vegetables. Underestimation were mainly due to the use of portion sizes, leading to an underestimation of most of nutrients, except free sugars which were overestimated.

Conclusion

The “structural validation” by simulating answers to a FFQ based on a reference dietary survey is innovative and pragmatic and allows quantifying the error induced by the simplification of the method of collection.

Low fruit and vegetable consumption is associated with low knowledge of the details of the 5-a-day fruit and vegetable message in the UK: findings from two cross-sectional questionnaire studies

BACKGROUND

This project aimed to understand the details of the 5-a-day fruit and vegetable (FV) message (which foods are included, portion sizes, the need for variety, reasons for consumption) least known by UK consumers, and most associated with low FV consumption.

METHODS

Study 1 assessed FV consumption, knowledge of the details of the message, and relationships between these, using a short questionnaire administered face-to-face to an opportunity sample of one large UK city. Study 2 assessed the same variables using a comprehensive postal questionnaire administered across the UK to a representative population sample.

RESULTS

Five hundred and seven respondents completed Study 1 and 247 respondents completed Study 2. The majority of individuals in both studies were aware of the 5-a-day message and could recount this correctly. In both studies, however, knowledge of the details of the message was low, and lower knowledge was associated with lower FV consumption. Respondents had lowest knowledge of the details of the message related to portion sizes and the need for variety. However, FV consumption was not independently associated with knowledge of any one aspect of the message.

CONCLUSIONS

These findings suggest that, although most of the UK population sampled were aware of the 5-a-day FV message and could recount this correctly, details of the 5-a-day FV message were not well known, and that FV consumption was related to this knowledge. These findings suggest that strategies to increase FV consumption will benefit from increasing UK consumers' knowledge of the details of the 5-a-day FV message.

One man's tall is another man's small: how the framing of portion size influences food choice

Labels such as 'Large' or 'Super-size' are often used to describe portion sizes. How do these normative labels influence consumer choice and how much they ultimately either consume or waste? Although one might believe that firms use normative labels to impact choice behavior through loss aversion, a field experiment shows consumer's willingness to pay is inconsistent with a loss aversion explanation. Although portions were clearly visible, individuals appeared to use the labels as objective information about their size. Importantly, a second study showed these labels also led people to eat less when food was given a larger sounding name than a smaller name (double vs. regular; regular vs. half-size). If labels are used as size information, policies governing normative names could help reduce food consumption or reduce waste.

Evidenced-based, practical food portion sizes for preschool children and how they fit into a well balanced, nutritionally adequate diet

BACKGROUND

Healthy eating guidelines for 1-4-year-old children are available but evidence-based portion sizes have not been specified. Parents and early-years providers are concerned about under- or over-feeding young children. The present study aimed to report detailed information about appropriate average portion size ranges and suggest a practical food plan for feeding preschool children, providing adequate nutrient intakes within energy requirements.

METHODS

Two sources of information were used to obtain an appropriate portion size range for the types of foods normally eaten by this age group. Median portions of a variety of foods were combined into a food plan fulfilling healthy eating guidelines regarding the number of servings from each food group. The nutrient and energy content of the plan was assessed and compared with recommended adequate nutrient intakes and percentage energy contributions from macronutrients. UK children, aged 1-4 years, taking part in Avon Longitudinal Study of Parents and Children and National Diet and Nutrition Survey, were used in the present study.

RESULTS

Portion size ranges were developed for 164 foods. The theoretical food plan using foods with high to medium nutrient density was shown to provide an adequate intake of all nutrients, except vitamin D, for which there are very few food sources.

CONCLUSIONS

These practical food portion size ranges could be used both in early years settings and in advice to parents. The food plan emphasises the need to include a variety of nutrient-dense foods if a balanced diet is to be achieved for preschool children.

Food form and portion size affect postprandial appetite sensations and hormonal responses in healthy, nonobese, older adults

Data are limited concerning the dietary factors that influence appetite control in older adults. This study examined the effects of food form and portion size on appetite in 43 older adults (age: 72 +/- 1 years; BMI: 25.6 +/- 0.3 kg/m(2)). Subjects were assigned to groups based on portion size of the test meal (12.5% (n = 18) vs. 25% (n = 25) of estimated energy need). Subjects randomly consumed, on two separate days, the respective solid or beverage test meal. Appetite sensations and hormonal responses were measured over 4 h. Main effects of food form (P < 0.05) and/or portion size (P < 0.05) were observed for each appetite sensation. Postprandial hunger and desire to eat were greater following beverage vs. solid meal (between 12.5% vs. 25%), whereas fullness was lower after beverage vs. solid meal (P < 0.05). Main effects of food form and/or portion size were observed for glucose, insulin, and ghrelin. Postprandial glucose and insulin concentrations were lower after beverage vs. solid meal (between 12.5% vs. 25%; all comparisons, P < 0.05) whereas beverage meal led to greater 4-h ghrelin vs. solid meal (P = 0.09). No main effects were observed for glucagon-like peptide-1 (GLP-1) or cholecystokinin (CCK). When adjusting for age, food form remained significant for postprandial hunger and fullness; portion size remained significant for postprandial glucose. Greater hunger and reduced satiety with accompanying glucose, insulin, and ghrelin following the beverage vs. solid meals, and to some extent, in smaller vs. larger portions suggest that appetite control is influenced by food form and portion size in older adults. These findings may enhance the development of appropriate dietary strategies that help to regulate energy balance.

Comparison between optical readable and open-ended weighed food records

Background

A simplified optically readable food record (ORFR) was developed and compared with an open-ended weighed record (WR).

Objective

To compare intake of nutrients and foods using a seven-day ORFR with intake estimated using a seven-day WR. The results from each method were validated against 24-h urinary nitrogen excretion and energy intake (EI)/estimated basal metabolic rate (BMR) cut-off values.

Design

The study comprised 73 free-living, healthy 70-year-old Swedish men. Dietary data were collected during seven consecutive days, starting either with WR or ORFR.

Results

Average intakes of energy and several nutrients were significantly lower when estimated using ORFR than when using WR. However, when adjusted for nutrient density, only a few nutrients were still lower with ORFR. Spearman correlation coefficients between the two methods regarding intakes of energy and energy-yielding nutrients were moderate to high, i.e. 0.4–0.6, while figures for most micro-nutrients were in the range 0.3–0.5. A large proportion of subjects under-reported their EIs, a higher proportion doing so when using ORFR. Protein intake obtained using ORFR was 31% lower than the values calculated from the 24-h urine nitrogen excretion, and 22% lower than those obtained from WR. Average intakes of milk, cheese and other milk products as well as coffee, tea and alcohol were significantly higher when estimated using ORFR than when using WR, while intakes of vegetables, meat and meat products, fish, bread and cereal products as well as number of sweet foods were significantly lower with ORFR.

Conclusions

Based on these results, adjustments of some portion sizes in ORFR are suggested. In view of the advantages of ORFR with respect to lower response burden and rapid processing of data, such adjustments would make ORFR a suitable dietary assessment tool for use in dietary surveys, including larger resource-demanding epidemiological investigations.