Where and when are portion sizes larger in young children? An analysis of eating occasion size among 1.5-5-year-olds in the UK National Diet and Nutrition Survey (2008-17)

Objective To identify eating occasion-level and individual-level factors associated with the consumption of larger portions in young children and estimate their relative importance. Design Cross-sectional. Setting Data from parent-reported 4-day food diaries in the UK National Diet and Nutrition Survey (2008-17) were analysed. Multilevel models explored variation in eating occasion size (kJ) within (n=48,419 occasions) and between children (n=1962) for all eating occasions. Eating contexts; location, eating companion, watching TV, and sitting at a table and individual characteristics; age, gender, ethnicity, and parental socioeconomic status were explored as potential correlates of eating occasion size. Participants Children aged 1.5-5 years. Results Median eating occasion size was 657kJ (IQR 356, 1117) Eating occasion size variation was primarily attributed (90%) to differences between eating occasions. Most (73%) eating occasions were consumed at home. In adjusted models, eating occasions in eateries were 377kJ larger than at home. Eating occasions sitting at a table, vs. not, were 197kJ larger. Eating in childcare, with additional family members and friends, and whilst watching TV were other eating contexts associated with slightly larger eating occasion sizes. Conclusions Eating contexts that vary from one eating occasion to another are more important than demographic characteristics that vary between children in explaining variation in consumed portion sizes in young children. Strategies to promote consumption of age-appropriate portion sizes in young children should be developed, especially in the home environment, in eating contexts such as sitting at the table, eating with others and watching TV.

FOOD-RELATED COPING STRATEGIES ADOPTED BY SOME HOUSEHOLDS DURING COVID-19 LOCKDOWN IN NIGERIA

As part of the measures to contain the spread of the COVID-19 virus in Nigeria during the early stages of the pandemic, a lockdown of movements within and from outside the country was declared by the federal government. This article presents findings on food-related coping strategies adopted during the COVID-19 lockdown in Nigeria. A cross sectional survey using an online based questionnaire received responses from 883 households regarding information on food consumption, health seeking behaviour and food coping strategies during the COVID-19 lockdown. Food Coping Strategy Index (FCSI) was computed from the data received based on standard methods. Analysis and presentation of data was done using descriptive and inferential statistics. The key findings show that daily mealtimes generally reduced from an average of 3 to 2 times. The storage capacity of households showed an average of 2-week food stock of staples, and most of the respondents had started reducing either their usual portion sizes or frequency of meals in order to cope with food shortages. As regards health seeking behavior, older respondents were more likely to take prophylactic medication (p<0.004) and there was a higher preference for fruits and Vitamin C as prophylactic items. A negative correlation between FCSI with mealtime during COVID-19 lockdown (p<0.000) and monthly income (p<0.000) was observed. The findings presented provide information for policy intervention in the areas of social safety nets and palliatives disbursement in the event of similar lockdown restrictions in the future.

The Effect of Downsizing Packages of Energy-Dense, Nutrient-Poor Snacks and Drinks on Consumption, Intentions, and Perceptions—A Scoping Review

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.

Portion Sizes of Ultra-Processed Foods in the United States, 2002 to 2021

Objectives. To assess the US food industry’s response to calls from public health authorities to reduce portion sizes by comparing current with past sizes of selected examples of single-serve ultra-processed packaged and fast foods. Methods. We obtained manufacturers’ information about current portion sizes and compared it with sizes when first introduced and in 2002. Results. Few companies in our sample reduced portion sizes since 2002; all still sold portions of ultra-processed foods in up to 5-times-larger sizes than when first introduced. Conclusions. Policies and practices focused on reducing portion size could help discourage the consumption of excessive amounts of ultra-processed foods. (Am J Public Health. 2021;111(12):2223–2226. https://doi.org/10.2105/AJPH.2021.306513 )

Reproducibility and feasibility of an online self-administered food frequency questionnaire for use among adult Norwegians

Background: New methods of dietary assessment are increasingly making use of online technologies. The development of a new online food frequency questionnaire warranted investigation of its feasibility and the reproducibility of its results. Objective: To investigate the feasibility and reproducibility of a newly developed online FFQ (WebFFQ). Design: The semiquantitative WebFFQ was designed to assess the habitual diet the previous year, with questions about frequency of intake and portion sizes. Estimations of portion sizes include both pictures and household measures, depending on the type of food in question. In two independent cross-sectional studies conducted in 2015 and 2016, adults were recruited by post following random selection from the general population. In the first study, participants (n = 229) filled in the WebFFQ and answered questions about its feasibility, and in two subsequent focus group meetings, participants (n = 9) discussed and gave feedback about the feasibility of the WebFFQ. In the second study, the WebFFQ’s reproducibility was assessed by asking participants (n = 164) to fill it in on two separate occasions, 12 weeks apart. Moreover, in the second study, participants were offered personal dietary feedback, a monetary gift certificate, or both, as incentives to complete the study. Results: In the feasibility study, evaluation form results showed that participants raised issues regarding the estimation of portion size and the intake of seasonal foods as being particularly challenging; furthermore, in the focus group discussions, personal feedback on diet was perceived to be a more motivating factor than monetary reward. In the reproducibility study, total food intake was lower in the second WebFFQ; however, 63% of the food groups were not significantly different from those in the first WebFFQ. Correlations of food intake ranged from 0.62 to 0.90, >86% of the participants were classified into the same or adjacent quartiles, and misclassification ranged from 0 to 3%. Average energy intake was 3.5% lower (p = 0.001), fiber showed the least difference at 1.6% (p = 0.007), and sugar intake differed the most at −6.8% (borderline significant, p = 0.08). Percentage energy obtained from macronutrients did not differ significantly between the first and second WebFFQs. Conclusion: Our results suggest that at group level, the WebFFQ showed good reproducibility for the estimations of intake of food groups, energy, and nutrients. The feasibility of the WebFFQ is good; however, revisions to further improve portion size estimations should be included in future versions. The WebFFQ is considered suitable for dietary assessments for healthy adults in the Norwegian population.

Downsizing food: A systematic review and meta-analysis examining the effect of reducing served food portion sizes on daily energy intake and body weight

Background. Portion sizes of many foods have increased over time and reducing food portion sizes has been proposed as a public health strategy to reduce obesity. However, the extent to which reducing food portion sizes affects daily energy intake and body weight is unclear. Objective. To systematically review and meta-analyse experimental studies that have examined the effect that serving smaller vs. larger portion sizes has on total daily energy intake. Design. We used systematic review methodology to search identify eligible articles that used an experimental design to manipulate portion size served to human participants and measured energy intake for a minimum of one day. Multi-level meta-analysis was used to used to pool effects of portion size on daily energy intake. Results. Fourteen eligible studies were included and 85 effects were included in the primary meta-analysis. There was a moderate-to-large reduction in daily energy intake when comparing smaller vs. larger portions (SMD = -.709 [95% CI: -.956 to -.461], p < .001, I2 = 80.6%) and evidence of a dose dependent response. Larger reductions to portion size and reducing portion sizes of multiple meals per day both resulted in larger decreases in daily energy intake. There was also evidence of a curvilinear relationship between portion size and daily energy intake, whereby reductions to daily energy intake were markedly smaller when reducing portion size from very large portions. In a subset of studies that measured body weight (n=5), being served smaller portions was associated with less weight gain than larger portions (SMD = .536 ([95% CI: .268 to .803], p < .001, I2 = 47.0%). Conclusions. Smaller food portion sizes substantially decrease daily energy intake and there is evidence that over time this results in lower body weight. Reducing food portion sizes may be an effective population level strategy to reduce obesity.

Impact of decreasing the proportion of higher energy foods and reducing portion sizes on food purchased in worksite cafeterias: A stepped-wedge randomised controlled trial

Background Overconsumption of energy from food is a major contributor to the high rates of overweight and obesity in many populations. There is growing evidence that interventions that target the food environment may be effective at reducing energy intake. The current study aimed to estimate the effect of decreasing the proportion of higher energy (kcal) foods, with and without reducing portion size, on energy purchased in worksite cafeterias. Methods and findings This stepped-wedge randomised controlled trial (RCT) evaluated 2 interventions: (i) availability: replacing higher energy products with lower energy products; and (ii) size: reducing the portion size of higher energy products. A total of 19 cafeterias were randomised to the order in which they introduced the 2 interventions. Availability was implemented first and maintained. Size was added to the availability intervention. Intervention categories included main meals, sides, cold drinks, snacks, and desserts. The study setting was worksite cafeterias located in distribution centres for a major United Kingdom supermarket and lasted for 25 weeks (May to November 2019). These cafeterias were used by 20,327 employees, mainly (96%) in manual occupations. The primary outcome was total energy (kcal) purchased from intervention categories per day. The secondary outcomes were energy (kcal) purchased from nonintervention categories per day, total energy purchased per day, and revenue. Regression models showed an overall reduction in energy purchased from intervention categories of −4.8% (95% CI −7.0% to −2.7%), p < 0.001 during the availability intervention period and a reduction of −11.5% (95% CI −13.7% to −9.3%), p < 0.001 during the availability plus size intervention period, relative to the baseline. There was a reduction in energy purchased of −6.6% (95% CI −7.9% to −5.4%), p < 0.001 during the availability plus size period, relative to availability alone. Study limitations include using energy purchased as the primary outcome (and not energy consumed) and the availability only of transaction-level sales data per site (and not individual-level data). Conclusions Decreasing the proportion of higher energy foods in cafeterias reduced the energy purchased. Decreasing portion sizes reduced this further. These interventions, particularly in combination, may be effective as part of broader strategies to reduce overconsumption of energy from food in out-of-home settings. Trial registration ISRCTN registry ISRCTN87225572.