When do children learn how to select a portion size?

The reduction of portion sizes supports weight-loss. This study looks at whether children have a conceptual understanding of portion size, by studying their ability to manually serve a portion size that corresponds to what they eat. In a clinical setting, discussion around portion size is subjective thus a computerised portion size tool is also trialled, with the portion sizes chosen on the screen being compared to amounts served manually. Children (n = 76) age 5-6, 7-8 and 10-11 were asked to rate their hunger (VAS scale), liking (VAS scale) and 'ideal portion size for lunch' of eight interactive meal images using a computerised portion size tool. Children then manually self-served and consumed a portion of pasta. Plates were weighed to allow for the calculation of calories served and eaten. A positive correlation was found between manually served food portions and the amount eaten (r = 0.53, 95%CI [0.34, 0.82, P < .001), indicating that many children were able to anticipate their likely food intake prior to meal onset. A regression model demonstrates that age contributes to 9.4% of the variance in portion size accuracy (t(68) = -2.3, p = .02). There was no relationship between portion size and either hunger or liking. The portion sizes chosen on the computer at lunchtime correlated to the amount manually served overall (r = .34, 95%CI [0.07, 0.55], p < .01), but not in 5-6-year-old children. Manual portion-size selection can be observed in five-year olds and from age seven, children's 'virtual' responses correlate with their manual portion selections. The application of the computerised portion-size tool requires further development but offers considerable potential.

Reliability and responsiveness of virtual portion size creation tasks: Influences of context, foods, and a bariatric surgical procedure

Food portion size influences energy intake and sustained high-energy intake often leads to obesity. Virtual portion creation tasks (VPCTs), in which a participant creates portions of food on a computer screen, predict intake in healthy individuals. The objective of this study was to determine whether portions created in VPCTs are stable over time (test-retest reliability) and responsive to factors known to influence food intake, such as eating contexts and food types, and to determine if virtual portions can predict weight loss. Patients with obesity scheduled for bariatric surgery (n = 29), and individuals with a normal BMI (18.5-24.9 kg/m2, controls, n = 29), were instructed to create virtual portions of eight snack foods, which varied in energy density (low and high) and taste (sweet and salty). Portions were created in response to the following eating situations, or "contexts": What they would a) eat to stay healthy (healthy), b) typically eat (typical), c) eat to feel comfortably satisfied (satisfied), d) consider the most that they could tolerate eating (maximum), and e) eat if nothing was limiting them (desired). Tasks were completed before, and 3 months after, surgery in patients, and at two visits, 3 months apart, in controls. Body weight (kg) was recorded at both visits. Virtual portions differed significantly across groups, visits, eating contexts, energy densities (low vs. high), and tastes (sweet vs. salty). Portions created by controls did not change over time, while portions created by patients decreased significantly after surgery, for all contexts except healthy. For patients, desired and healthy portions predicted 3-month weight loss. VPCTs are replicable, responsive to foods and eating contexts, and predict surgical weight loss. These tasks could be useful for individual assessment of expectations of amounts that are eaten in health and disease and for prediction of weight loss.

Comparing supermarket loyalty card data with traditional diet survey data for understanding how protein is purchased and consumed in older adults for the UK, 2014-16

Background

Our ability to understand population-level dietary intake patterns is dependent on having access to high quality data. Diet surveys are common diet assessment methods, but can be limited by bias associated with under-reporting. Food purchases tracked using supermarket loyalty card records may supplement traditional surveys, however they are rarely available to academics and policy makers. The aim of our study is to explore population level patterns of protein purchasing and consumption in ageing adults (40 years onwards).

Methods

We used diet survey data from the National Diet and Nutrition Survey (2014–16) on food consumption, and loyalty card records on food purchases from a major high street supermarket retailer (2016–17) covering the UK. We computed the percentage of total energy derived from protein, protein intake per kg of body mass, and percentage of protein acquired by food type.

Results

We found that protein consumption (as the percentage of total energy purchased) increased between ages 40–65 years, and declined thereafter. In comparison, protein purchased in supermarkets was roughly 2–2.5 percentage points lower at each year of age. The proportion of adults meeting recommended levels of protein was lowest in age groups 55–69 and 70+. The time of protein consumption was skewed towards evening meals, with low intakes during breakfast or between main meals. Meat, fish and poultry dominated as sources of protein purchased and consumed, although adults also acquired a large share of their protein from dairy and bread, with little from plant protein.

Conclusions

Our study provides novel insights into how protein is purchased and consumed by ageing adults in the UK. Supermarket loyalty card data can reveal patterns of protein purchasing that when combined with traditional sources of dietary intake may enhance our understanding of dietary behaviours.

Caregiver Influences on Eating Behaviors in Young Children: A Scientific Statement From the American Heart Association

A substantial body of research suggests that efforts to prevent pediatric obesity may benefit from targeting not just what a child eats, but how they eat. Specifically, child obesity prevention should include a component that addresses reasons why children have differing abilities to start and stop eating in response to internal cues of hunger and satiety, a construct known as eating self‐regulation. This review summarizes current knowledge regarding how caregivers can be an important influence on children's eating self‐regulation during early childhood. First, we discuss the evidence supporting an association between caregiver feeding and child eating self‐regulation. Second, we discuss what implications the current evidence has for actions caregivers may be able to take to support children's eating self‐regulation. Finally, we consider the broader social, economic, and cultural context around the feeding environment relationship and how this intersects with the implementation of any actions. As far as we are aware, this is the first American Heart Association (AHA) scientific statement to focus on a psychobehavioral approach to reducing obesity risk in young children. It is anticipated that the timely information provided in this review can be used not only by caregivers within the immediate and extended family but also by a broad range of community‐based care providers.

No evidence of flavour-nutrient learning in a two-week 'home exposure' study in humans

Flavour-nutrient learning is robust in animals but remains elusive in humans. Recent evidence suggests flavour-nutrient learning may be more likely to occur with beverages that contain relatively few calories (compared to no calories), while others show that learned associations can influence satiation, without an effect on preference. The objective of this research was to determine whether acquired liking for a caloric drink could be observed in a 'home learning' context over 2 weeks, and whether it is impacted by viscosity. In combination, we also explored changes in learning relating to fullness and expected satiety. In a double-blind study, participants (N = 83; BMI = 23.3 kg/m²) were randomly allocated to one of four groups differing in either calories (0 kcal vs. 112.5 kcal) or viscosity (low vs. high) and consumed a novel-flavoured drink over 15 days. Measures of flavour (10 ml sample) and beverage liking, grip force (a measure of beverage reward value), fullness, and expected satiety were taken at the start and the end of the study. While the high-viscous beverages were less liked (M = 40.3 mm, SD = 24.7) than the low viscous beverages (M = 64.4 mm, SD = 15.3; p = .022), there was no evidence that repeated exposure to a calorie-containing beverage impacted subsequent liking for the flavour (p = .115) or for the beverage (p = .448), grip force (ps > .26), fullness, and expected satiety (ps > .12). Accordingly, we conclude that we found no evidence of flavour-nutrient learning and flavour-satiety learning. This null finding accords with previous observations indicating that humans do not acquire flavour-nutrient associations as readily as some non-human animals.

Protein Valuation in Food Choice Is Positively Associated with Lean Mass in Older Adults

BACKGROUND

Calorie for calorie, protein is more satiating than carbohydrate or fat. However, it remains unclear whether humans perceive calories derived from these macronutrients equally and whether lean mass is associated with a tendency to "value" protein when dietary decisions are made.

OBJECTIVES

This study aimed to determine the test-retest reliability of a novel method for quantifying macronutrient valuations in human volunteers and to determine whether "protein valuation" is associated with a higher fat-free mass index (FFMI) in older adults.

METHODS

A 2-alternative, forced-choice task in which 25 foods were compared in 300 trials was undertaken in 2 studies. In study 1, participants (age range 19-71 y, n = 92) attended 2 test sessions, spaced 1 wk apart. In study 2, older adults (age range 40-85 y; n = 91) completed the food-choice task and assessed the test foods for liking, expected satiety, and perceived healthiness. Body composition and habitual protein intake were assessed in both studies. Data were analyzed through the use of individual binomial logistic regressions and multilevel binomial logistic regressions.

RESULTS

In study 1, measures of macronutrient valuation showed excellent test-retest reliability; responses in the forced-choice task were highly correlated (week 1 compared with week 2; protein, r = 0.83, P < 0.001; carbohydrate, r = 0.90, P < 0.001; fat, r = 0.90, P < 0.001). Calorie for calorie, protein and carbohydrate were stronger predictors of choice than fat (P < 0.001). In study 2, protein was a stronger predictor than both carbohydrate (P = 0.039) and fat (P = 0.003), and a positive interaction was observed between protein valuation and FFMI (OR = 1.64; 95% CI: 1.38, 1.95; P < 0.001). This was the case after controlling for age, gender, liking for foods, and habitual protein consumption.

CONCLUSIONS

Together, these findings demonstrate that adult humans value calories derived from protein, carbohydrate, and fat differently, and that the tendency to value protein is associated with greater lean mass in older adults.

A systematic review and meta-analysis of the social facilitation of eating

BACKGROUND

Research suggests that people tend to eat more when eating with other people, compared with when they eat alone, and this is known as the social facilitation of eating. However, little is known about when and why this phenomenon occurs.

OBJECTIVES

This review aimed to quantify the evidence for social facilitation of eating and identify moderating factors and underlying mechanisms.

METHODS

We systematically reviewed studies that used experimental and nonexperimental approaches to examine food intake/food choice as a function of the number of co-eaters. The following databases were searched during April 2019: PsychInfo, Embase, Medline, and Social Sciences Citation Index. Studies that used naturalistic techniques were narratively synthesized, and meta-analyses were conducted to synthesize results from experimental studies.

RESULTS

We reviewed 42 studies. We found strong evidence that people select and eat more when eating with friends, compared with when they eat alone [Z = 5.32; P < 0.001; standardized mean difference (SMD) = 0.76; 95% CI: 0.48, 1.03]. The meta-analysis revealed no evidence for social facilitation across studies that had examined food intake when participants ate alone or with strangers/acquaintances (Z = 1.32; P = 0.19; SMD = 0.21, 95% CI: -0.10, 0.51). There was some evidence that the social facilitation of eating is moderated by gender, weight status, and food type. However, this evidence was limited by a lack of experimental research examining the moderating effect of these factors on the social facilitation of eating among friends. In 2 studies, there was evidence that the effect of the social context on eating may be partly mediated by longer meal durations and the perceived appropriateness of eating.

CONCLUSIONS

Findings suggest that eating with others increases food intake relative to eating alone, and this is moderated by the familiarity of co-eaters. The review identifies potential mechanisms for the social facilitation of eating and highlights the need for further research to establish mediating factors. Finally, we propose a new theoretical framework in which we suggest that the social facilitation of eating has evolved as an efficient evolutionary adaptation.

A review of evidence supporting current strategies, challenges, and opportunities to reduce portion sizes

Although there is considerable evidence for the portion-size effect and its potential impact on health, much of this has not been successfully applied to help consumers reduce portion sizes. The objective of this review is to provide an update on the strength of evidence supporting strategies with potential to reduce portion sizes across individuals and eating contexts. Three levels of action are considered: food-level strategies (targeting commercial snack and meal portion sizes, packaging, food labels, tableware, and food sensory properties), individual-level strategies (targeting eating rate and bite size, portion norms, plate-cleaning tendencies, and cognitive processes), and population approaches (targeting the physical, social, and economic environment and health policy). Food- and individual-level strategies are associated with small to moderate effects; however, in isolation, none seem to have sufficient impact on food intake to reverse the portion-size effect and its consequences. Wider changes to the portion-size environment will be necessary to support individual- and food-level strategies leading to portion control.

Portion size influences intake in Samburu Kenyan people not exposed to the Western obesogenic environment

For people in the modernized food environment, external factors like food variety, palatability, and ubiquitous learned cues for food availability can overcome internal, homeostatic signals to promote excess intake. Portion size is one such external cue; people typically consume more when served more, often without awareness. Though susceptibility to external cues may be attributed to the modernized, cue-saturated environment, there is little research on people living outside that context, or with distinctly different food norms. We studied a sample of Samburu people in rural Kenya who maintain a traditional, semi-nomadic pastoralist lifestyle, eat a very limited diet, and face chronic food insecurity. Participants (12 male, 12 female, aged 20-74, mean BMI = 18.4) attended the study on two days and were provided in counterbalanced order an individual serving bowl containing 1.4 or 2.3 kg of a familiar bean and maize stew. Amount consumed was recorded along with post-meal questions in their dialect about their awareness of intake amount. Data were omitted from two participants who consumed the entire portion in a session. Even though the 'smaller' serving was a very large meal, participants consumed 40% more when given the larger serving, despite being unable to reliably identify which day they consumed more food. This result in the Samburu demonstrates the portion size effect is not a by-product of the modern food environment and may represent a more fundamental feature of human dietary psychology.

Breaking the fast: Meal patterns and beliefs about healthy eating style are associated with adherence to intermittent fasting diets

Many believe that eating three meals each day is healthy and that skipping meals can be detrimental. What remains unclear is whether this belief undermines attempts to restrict energy intake by skipping meals. In an online survey, participants (N = 312) with experience of intermittent fasting (IF) reported their beliefs about healthy meal and snack frequency, as well as their non-fasting-dasy and fasting-day eating patterns. They also reported their level of concern with fasting-day meal patterns and their concern to generate fullness when selecting foods. Individuals currently following an IF diet (Current-IF dieters) and those who had previously attempted an IF diet but were non-adherent (Former-IF dieters) took part. Former-IF dieters were more likely to believe that it is healthy to eat three meals a day, punctuated by several snacks. On fasting-days, Former-IF dieters were also more likely to eat breakfast, a mid-morning snack, lunch, and a mid-afternoon snack whereas Current-IF dieters tended to save their eating for dinner and a late evening snack. Former-IF dieters were also more likely to be concerned about the negative consequences of missing a meal, to eat in anticipation of future hunger, and to prioritise fullness over taste when selecting foods. These findings reveal how beliefs about a healthy eating style can play an important role in shaping dietary patterns. Interventions aimed at modifying beliefs about healthy meal patterns may promote IF diet adherence.

Protein for Life: Review of Optimal Protein Intake, Sustainable Dietary Sources and the Effect on Appetite in Ageing Adults

With an ageing population, dietary approaches to promote health and independence later in life are needed. In part, this can be achieved by maintaining muscle mass and strength as people age. New evidence suggests that current dietary recommendations for protein intake may be insufficient to achieve this goal and that individuals might benefit by increasing their intake and frequency of consumption of high-quality protein. However, the environmental effects of increasing animal-protein production are a concern, and alternative, more sustainable protein sources should be considered. Protein is known to be more satiating than other macronutrients, and it is unclear whether diets high in plant proteins affect the appetite of older adults as they should be recommended for individuals at risk of malnutrition. The review considers the protein needs of an ageing population (>40 years old), sustainable protein sources, appetite-related implications of diets high in plant proteins, and related areas for future research.

Intermittent fasting, energy balance and associated health outcomes in adults: study protocol for a randomised controlled trial

Background

Prior studies have shown that intermittent fasting is capable of producing improvements in body weight and fasted health markers. However, the extent to which intermittent fasting incurs compensatory changes in the components of energy balance and its impact on postprandial metabolism are yet to be ascertained.

Methods

A total of 30–36 lean participants and 30–36 overweight/obese participants will be recruited to provide two separate study groups who will undergo the same protocol. Following an initial assessment of basic anthropometry and key health markers, measurements of habitual energy intake (weighed food and fluid intake) and physical activity energy expenditure (combined heart rate and accelerometry) will be obtained over 4 weeks under conditions of energy balance. Participants will then be randomly allocated to one of three experimental conditions for 20 days, namely (1) daily calorie restriction (reduce habitual daily energy intake by 25%), (2) intermittent fasting with calorie restriction (alternate between 24-hour periods of fasting and feeding to 150% of habitual daily energy intake), (3) intermittent fasting without calorie restriction (alternate between 24-hour periods of fasting and feeding to 200% of habitual daily energy intake). In addition to continued monitoring of energy intake and physical activity during the intervention, participants will report for laboratory-based assessments of various metabolic parameters both before and after the intervention. Specifically, fasting and postprandial measurements of resting metabolic rate, substrate oxidation, appetite, food preference, and plasma concentrations of key metabolites and hormones will be made, in addition to subcutaneous abdominal adipose tissue biopsies in the fasted state and an assessment of body composition via dual-energy x-ray absorptiometry.

Discussion

Comparing observed changes in these measures across the three intervention arms in each group will establish the impact of intermittent fasting on postprandial metabolism and the components of energy balance in both lean and overweight/obese populations. Furthermore, this will be benchmarked against current nutritional interventions for weight management and the relative contributions of negative energy balance and fasting-dependent mechanisms in inducing any observed effects will be elucidated.

Trial registration

Trial retrospectively registered at clinicaltrials.gov under reference number NCT02498002 (version: IMF-02, date: July 6, 2015).

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2451-8) contains supplementary material, which is available to authorized users.

Undervalued and ignored: Are humans poorly adapted to energy-dense foods?

In many species the capacity to accurately differentiate the energy density (kcal/g) of foods is critical because it greatly improves efficiency in foraging. In modern humans this ability remains intact and is expressed in a selective preference for types of fruit and vegetables that contain more calories. However, humans evolved consuming these low energy-dense foods (typically < 1.75 kcal/g) and it remains unclear whether they can also discriminate more energy-dense foods that now feature in modern Western diets. In two experiment participants (both N = 40) completed four tasks that assessed the 'value' of different sets of 22 foods that ranged in energy density (0.1 kcal/g-5.3 kcal/g and range 0.1 kcal/g to 6.2 kcal/g in Experiment 1 and 2, respectively). In Experiment 1 three measures (expected fullness, calorie estimation, and food choice), and in foods less than approximately 1.5 kcal/g (typically fruits and vegetables), the relationship between perceived value and energy density is linear. Above this, we observed clear compressive functions, indicating relative and progressive undervaluation of higher energy-dense foods. The fourth task (rated liking) failed to provide evidence for any relationship with energy density. In Experiment 2 the same pattern was replicated in measures of expected fullness, and in two different assessments of subjective calorie content. Consistent with the concept of 'evolutionary discordance,' this work indicates that modern human physiology is poorly adapted to evaluate foods that have a historically unusual (high) energy density. This has implications both for our understanding of how 'modern' energy-dense foods affect choice and energy intake, and for strategies aimed at removing calories from highly energy-rich foods.