Portion Size Research Articles

Validation of a Food Frequency Questionnaire: VioScreen-Allergy

Background/Objectives: An adapted version of an online pictorial food frequency questionnaire (FFQ), VioScreen-Allergy, assesses total dietary intake and intake of allergens and foods in the maternal diet index (MDI), linked to offspring allergy. This study assessed intermethod reliability, test–retest reliability, and external validity of the VioScreen-Allergy. Methods: Females of childbearing age were recruited at Denver Health and Children’s Hospital, Colorado, USA, and were asked to complete four 24 h recalls and two VioScreen-Allergy FFQs over the course of a month. All those with at least two 24 h dietary recalls and both VioScreen-Allergy assessments were analyzed. Energy-adjusted and non-adjusted linear mixed models (1) compared MDI scores and intake of nutrients and allergens as measures of intermethod reliability; (2) evaluated VioScreen-Allergy test–retest reliability as differences between repeated measurements; and (3) assessed external validity by modeling associations between VioScreen-Allergy-derived intake of beta-carotene and orange vegetables and Veggie Meter®-assessed skin carotenoids. Bonferroni corrections controlled multiple comparisons within the assessment. Results: Of 53 participants enrolled, 25 demographically dissimilar participants were included in the analysis. There were no significant differences between 24 h recall and VioScreen-Allergy mean intakes of macronutrients, micronutrients, allergens, or MDI, except for Vitamin C, niacin, and cashew allergen protein. There were no significant differences between repeated measurements of VioScreen-Allergy, either energy-adjusted or unadjusted. Both beta-carotene and orange vegetable servings were significantly associated with Veggie Meter®. Conclusions: Although non-significance could have been due to low power, clinical as well as statistical assessments of intermethod reliability, test–retest reliability, and external validity suggest that VioScreen-Allergy has reasonable utility for trials assessing food allergens and MDI in the context of overall intake. The VioScreen questionnaire can also be used in future studies to assess macro- and micronutrient intake. Additional validation studies assessing different portion sizes and foods eaten by infants and young children are currently undergoing.

Portion Size Norms of Discretionary Foods and Eating Settings: A Repeated Cross-Sectional Study

Background: The increase in serving sizes of energy-dense nutrient-poor discretionary foods over time, with attractively presented large servings and package sizes, has led to portion distortion and a new ‘normal’ for serving sizes. Little data exists on the variations of portion size norms of discretionary foods across settings. This study aimed to examine the differences in the range of normal portion sizes of commonly consumed foods between home and out-of-home settings (coffee shops, restaurants). Methods: A repeated cross-sectional design was used, with nine selected discretionary foods and beverages included in a validated online image-series questionnaire. Participants completed the questionnaire at two time points to report their normal portion sizes in home and out-of-home settings. Quantile regression models were used to examine differences in the range of normal portion sizes (17th to 83rd percentile, representing the majority of the study population) between settings. Results: A final sample of 295 participants was included in the analysis (51% females, mean age 40 ± 14 years). The ranges of normal portion sizes did not differ by settings for all test foods except for sugar-sweetened beverages (SSB) tested in both containers and glassware. SSB showed smaller normal portion sizes at home compared to fast food restaurants (in a bottle/can and in a glass/cup; p < 0.001). Conclusions: These findings suggest that the portion size norms of many discretionary foods are mostly consistent in home and out-of-home settings. As the typical serving sizes available to consumers in the out-of-home settings are large, it is essential to establish practical serving size guidelines directed at the food industry to increase the availability of smaller size options and empower consumers towards better portion control.

Does the way workplace canteens are managed influence users’ plate waste?

Abstract Background Plate waste (PW) is part of the food waste and is defined as the amount of edible food served not eaten. There are few estimates of PW in the food services, mainly in school canteens, where PW appears to differ depending on the provider. Our aim was to analyse the role of different canteen management in determining PW in three hospital canteens in Italy. Methods On 5 working days between August and September 2022, healthcare workers’ trays were photographed before and after meal consumption. We compared two canteens managed by an external catering service (EC) with one internally managed (IC). The two canteens with similar sample size had different management. A modified visual Comstock scale was used to assess the PW. The Carbon Footprint (CF), Water Footprint (WF), energy and nutrient content were estimated using the SU-EATABLE LIFE database and the Italian Food Composition Database for Epidemiological Studies (www.bda-ieo.it). Significance was set at p < 0.05. Results 1227 trays were analysed (1026 in EC; 201 in IC), most of which contained no waste. The percentage of trays with leftovers was higher in EC (34%) than in IC (21%), as was the mean amount of PW (104g EC vs 60g IC) (p < 0.001). The PW contained significantly more energy (125 kcal vs 73 kcal) and protein (6.0g vs 2.4g) and had higher CF (204 CO2eq EC vs 76 CO2eq IC) and WF (178 LH20 EC vs 75 LH20 IC) in CE than in IC. The significance was confirmed independently to the sample size of the canteens, and when the analysis was repeated and only the first access of each user was considered. Conclusions Results suggest that an internally managed canteen produces less leftovers than a canteen operated by an external provider. This could be because an internally managed canteen is more adaptable to users in terms of food offerings and portion sizes, despite a smaller number of food options. However, further studies are needed to confirm our findings and to identify the causes of PW in food service. Key messages • Internally managed canteens seem to reduce plate waste, probably due to certain flexibility according to users’ plate waste. • Non-served food of the canteen should be estimated to confirm our data.

How big is too big? A qualitative study of discretionary food portion size norms among Australian consumers.

The high availability of energy-dense nutrient-poor discretionary foods in large serving and package sizes may have shifted portion size norms (described as a typical perception of how much people choose to eat from a given food at a single eating occasion) towards larger sizes. Few public health recommendations exist around appropriate discretionary food portion sizes. This qualitative study aimed to explore the underlying rationale of portion size norms of discretionary foods among Australian adults 18-65 years. Four focus group sessions were conducted. Collected data were analysed using inductive thematic analysis. Focus groups were held online via Zoom between September and October 2023. Thirty-four participants were recruited in the study (mean age 38 years, 19 females). The key themes raised from inductive analysis were personal factors, eating context factors, and food environment factors relevant to the portion size norms. A framework was established to illustrate the interaction across these themes during the conceptualisation of the norms. For serving size availability, consumers found that there were limited serving size choices when making portion size selections and lacked the knowledge and skills in portion control. These findings highlight the need to make positive changes to the current food environment and develop relevant public health guidelines around appropriate portion sizes to promote healthier portion size norms and enable better portion control.

Assessment of Obesity Among Pregnant Women in the Volta Region of Ghana

Background: Obesity remains a rising challenge in both developed and developing countries, and maternal obesity has become one of the most occurring risk factors, which can lead to gestational diabetes, pre-eclampsia and prematurity in obstetric practice for both the mother and the child. Pregnancy is a timeline where obesity cannot be effectively worked on as the mother is more likely to live unhealthy lifestyle such as unhealthy diet, binge eating and less physical activity, which would most likely affect foetal health. This is an issue as most pregnant women in Volta Region are either overweight or obese. This research assessed the prevalence of obesity among pregnant women in the Volta Region of Ghana. Material and Method: A full structured questionnaire was administered to 220 participants based on their knowledge of obesity and its effect on pregnancy, food choices, mealtimes and portion sizes, as well as physical activity during pregnancy. Body weight and height were measured using standardized procedures and body mass index (BMI) was calculated. Overweight and obesity were defined based on WHO criteria. Data analysis was performed using SPSS version 20.0. Results: Based on excessive gestational weight gain, prevalence of obesity among the pregnant women was 54% (119). Majority of respondents had poor knowledge of obesity and its effect on the mother and the foetus, which represented a significant correlation (p< 0.0001) between their caloric intake and high gestational weight gain. Physical activity showed no significant effect (p = 0.2) on gestational weight gain. However, pre-pregnancy BMI of the expectant mothers was directly linked to high gestational weight gain with age being the significant risk factor (p<0.02) for obesity before pregnancy. Conclusion: This research found limited awareness of excessive gestational weight gain and its health consequences among pregnant women and the unborn baby. Therefore, monitoring gestational weight gain using diverse approaches to integrate and manage the condition in routine antenatal care needs consideration.

Evaluating User Experiences and Preferred Features of a Web-Based 24-Hour Dietary Assessment Tool: Usability Study.

Intake24, a web-based 24-hour dietary recall tool developed in the United Kingdom, was adapted for use in New Zealand (Intake24-NZ) through the addition of a New Zealand food list, portion size images, and food composition database. Owing to the customizations made, a thorough evaluation of the tool's usability was required. Detailed qualitative usability studies are well suited to investigate any challenges encountered while completing a web-based 24-hour recall and provide meaningful data to inform enhancements to the tool. This study aims to evaluate the usability of Intake24-NZ and identify improvements to enhance both the user experience and the quality of dietary intake data collected. We used a mixed methods approach comprising two components: (1) completion of a single 24-hour dietary recall using Intake24-NZ with both screen observation recordings and collation of verbal participant feedback on their experience and (2) a survey. A total of 37 participants aged ≥11 years self-completed the dietary recall and usability survey (men and boys: 14/37, 38% and women and girls: 23/37, 62%; Māori: 10/37, 27% and non-Māori: 27/37, 73%). Although most (31/37, 84%) reported that Intake24-NZ was easy to use and navigate, data from the recorded observations and usability survey revealed challenges related to the correct use of search terms, search results obtained (eg, type and order of foods displayed), portion size estimation, and associated food prompts (eg, did you add milk to your tea?). This comprehensive usability study identified challenges experienced by users in completing a dietary recall in Intake24-NZ. The results informed a series of improvements to enhance user experience and the quality of dietary data collected with Intake24-NZ, including adding new foods to the food list, optimizing the search function and ordering of search results, creating new portion size images, and providing clearer instructions to the users.

Integrating TRA and SET to Influence Food Waste Reduction in Buffet-Style Restaurants: A Gender-Specific Approach

As one of the major greenhouse gas emission contributors, the food service industry, particularly buffet-style restaurants, is responsible for reducing food waste. This study explores the factors that shape consumer behavior toward food waste reduction in buffet-style restaurants based on the Theory of Reasoned Action (TRA) and Social Exchange theory (SET), as well as analyzing the gender differences in these determinants, offering practical insights for the restaurant industry. This study also uses structural equation modeling and group analysis to examine a total of 547 valid responses gathered through an online survey, including 286 male (52.3%) and 258 female (47.2%) respondents. The findings underscore the attitudes, subjective norms, and establishment policies that emerge as critical drivers of consumer behavior in buffet-style dining settings. Notably, significant gender differences are observed in attitudes and establishment policies. In light of these results, we recommend strategies that include enhancing consumer attitudes and implementing penalty policies within restaurant operations. Restaurants could display visual signs and images related to reducing food waste, provide detailed portion size information, and apply monetary fines for excess waste to reduce consumers’ food waste intentions. These strategies are particularly effective for male consumers, who are more influenced by these factors compared to female consumers. This research contributes valuable guidance for the industry’s efforts to address food waste concerns, emphasizing gender differences and promoting environmentally responsible behavior among consumers.

Development and Pilot Study of myfood24 West Africa—An Online Tool for Dietary Assessment in Nigeria

Background and objective: Tools to accurately and efficiently measure dietary intake in Nigeria are lacking. We aimed to develop and assess the usability of a new online dietary assessment tool for Nigeria—myfood24 West Africa. Methods: We developed the myfood24 West Africa database using data from existing food composition tables, packaged foods labels and research articles. The development followed seven steps: identified data sources, selected foods, processed/cleaned the data, calculated the nutrient content of recipes, created and allocated portion sizes, quality-checked the database and developed food accompaniments. To pilot the tool, we recruited 179 university staff in Nigeria using a cross-sectional design. Usability was assessed using a questionnaire that included the System Usability Scale (SUS) and a feedback session. Results: The database included 924 foods, with up to 54 nutrients and 35 portion-size images allocated to foods. Sixty percent of the data were sourced from the 2019 West Africa Food Composition Table, 17% from back-of-pack labels of packaged foods, 14% from the 2017 Nigerian Food Composition Table, 5% from generated recipes and 4% from the published literature. Of the participants, 30% (n = 53) self-recorded their food intake, with a total of 1345 food and drink entries from both self- and interviewer-collected data. The mean SUS score of 74 (95% CI: 68,79) indicated good usability. The feedback showed that the tool was user-friendly, educational and included a variety of local foods. Conclusions: This new tool will enhance the dietary assessment of the Nigerian population. More work will expand coverage to include more foods from the region.

Insect-Based Foods: A Preliminary Qualitative Study Exploring Factors Affecting Acceptance and New Product Development Ideas through Focus Groups

While insect-based foods could contribute towards sustainable protein consumption and production, their successful adoption relies largely on consumer acceptance. This case study aims to explore factors affecting acceptance and to identify the insect-based foods that participants would like to be developed and introduced to the market. Three focus groups incorporating optional tasting sessions of insect-based foods were conducted in Ireland, a country where these foods were unavailable at the time of the study. Findings showed that before the tasting sessions, public opinion, portion size comparisons (insects vs. meat), and witnessing entomophagy-related disturbing experiences through television were some of the factors that negatively influenced acceptance. Lack of availability in Ireland was the main factor that hindered consumption among participants willing to consume these foods. Participants’ usual food choice motives, sensory attributes, and inclusion percentages of insects in food were some factors which affected acceptance following the tasting sessions. A variety of insect-based foods was suggested for product development, which were mostly components of a main meal. The findings of this study could give an initial indication of product ideas that could be explored further for product development in regions where insect-based foods are not readily available on the market. These findings could contribute to future studies that would aim to build quantitative tools.

6369 Weiss-Kruszka Syndrome and Growth Hormone Deficiency, Adrenal Insufficiency, and Morbid Obesity

Abstract Disclosure: T. Falcon-Rodriguez: None. N. Solano: None. A. Diaz: None. Background: Weiss-Kruszka syndrome (WKSA) is a rare autosomal dominant genetic disorder caused by heterozygous loss-of-function variants in the ZNF462 gene. Individuals affected by this condition exhibit distinctive craniofacial features, ptosis, dysgenesis of the corpus callosum, hearing loss, intellectual disability, and hypotonia. There is one other case report that described a boy with empty sella syndrome with growth hormone deficiency and delayed puberty. Case Presentation: We present the case of a 15-year-old boy who initially came under the care of endocrinology at age 9 due to severe obesity and short stature. Past medical history included ADHD (for which he was on stimulants since age 5), microcephaly, VUR, asthma, and developmental delay. He grew along the 2nd percentile for height from the ages of 6 and 13, after which his growth velocity notably decelerated. His initial bone age at 9 years old was advanced by 3 years. His BMI had exceeded the 99th percentile since age 3. His family history was relevant for maternal type 1 diabetes mellitus, paternal height of 165 cm, and maternal height of 160 cm. Upon physical examination, notable findings included short stature, severe obesity, a low anterior hairline, arched eyebrows, upslanted palpebral fissures, low-set ears, a tubular and short nasal bridge, and an exaggerated cupid's bow. At age 9, the patient was diagnosed with growth hormone (GH) deficiency following a clonidine and glucagon stimulation test, with a GH peak of 1.9 ng/mL (normal >7 ng/mL). Additionally, he was diagnosed with adrenal insufficiency (cortisol peak of 5 ug/dL, after 250 mcg of cosyntropin). A brain/sella MRI revealed a hypoplastic pituitary gland. Subsequently, hydrocortisone replacement was initiated at a dose of 6 mg/m2/day, and GH treatment at a weekly dose of 0.3 mg/kg. Despite treatment with growth hormone and IGF-1 levels on the upper side of the normal range, his growth velocity did not improve significantly. He reached his peak adult height of 150 cm at age 15. His BMI had consistently been at the 99th percentile. According to his mother, he did not have issues with satiety, and his portion sizes were considered normal. He did not consume fast foods or sugary drinks, and his level of physical activity was suboptimal. Whole Exome Sequencing identified a heterozygous de novo pathogenic variant in the ZNF462 gene, specificallyc.2664 C>A, p.(C888*) (NM_021224.4), consistent with the diagnosis of Weiss-Kruszka syndrome (OMIM # 618619). Conclusion: We present, to our knowledge, the first report of morbid obesity and central adrenal insufficiency in a child with WSKA. GH deficiency had been previously reported in 1 patient with WSKA. The finding of a hypoplastic pituitary gland supports the diagnosis of GH deficiency and central adrenal insufficiency. Presentation: 6/3/2024

Influence of qualitative menu labeling on diners' food choices: A controlled quasi-experiment in self-service buffet restaurants

Menu labeling is a strategy to promote healthier food choices in restaurants. This study aimed to analyze the influence of a qualitative menu labeling on the healthfulness of diners' food choices in self-service buffet restaurants. A controlled quasi-experiment comparing parallel groups at baseline and intervention periods was conducted in a control restaurant and an intervention restaurant. Qualitative labels provided information on the name and ingredients list of the dish, highlighting the use of organic vegetables. The same food menu was served in both restaurants. Menu labeling was implemented at the intervention restaurant for six dishes each day, three considered healthier and three less healthy. Dishes were weighed at the beginning and at the end of the service to estimate the average portion size (g) of diners, during five consecutive days at baseline and intervention. Diners who had lunch at the intervention restaurant were invited to participate in a survey on the use of menu labels. Of the 153 interviewed diners, 31% reported noticing menu labels. Of these, 57% said menu labeling had influenced their food choices at the restaurant. No changes in portion sizes were observed between baseline and intervention periods within control and intervention restaurants. However, it was found that the provision of qualitative menu labeling sparked the interest of restaurant managers in improving meal quality and modifying recipes to eliminate ultra-processed ingredients. Thus, the implementation of the proposed menu labeling model can promote healthier food choices through the reformulation of culinary recipes. However, it is essential to adopt strategies to enable its direct impact.

Residual Performance and Biomechanical Asymmetries During Jumping Tasks in Female Athletes at 9 Months After Anterior Cruciate Ligament Reconstruction.

Biomechanics and anterior cruciate ligament injury mechanisms differ in males and females. There is a need for more data on between-limb biomechanical differences after anterior cruciate ligament reconstruction (ACLR) in females. To explore biomechanical asymmetries throughout the kinetic chain during the single-legged (SL) and double-legged (DL) countermovement jump (CMJ) and drop jump (DJ) in female athletes after ACLR. Descriptive laboratory study. Kinematic and kinetic between-limb differences were analyzed during the SL and DL CMJ and DJ in 67 female athletes 9 months after ACLR. Biomechanical and performance asymmetries between limbs during the jumps and isokinetic strength testing were analyzed with statistical parametric mapping. The entire stance phase was used for the paired t tests of the biomechanical variables, with Cohen d effect sizes of significant portions of the stance phase (reported as % of stance) calculated in a point-by-point manner. Decreased vertical ground-reaction force, internal knee abduction moment, knee internal rotation angle, hip external rotation angle, internal ankle eversion, and external rotation moments were seen in the ACLR limb during all 4 vertical jump tests. The greatest number and highest value of differences were found during the DLDJ, with asymmetries having medium to large effect sizes. They tended to appear more frequently in the concentric phase (50% to 100% of stance) during the SLCMJ and DLCMJ and in the eccentric (0% to 49% of stance) and concentric (50% to 100% of stance) phase during the SLDJ and DLDJ. For the SLCMJ, SLDJ, and quadriceps strength, performance asymmetries of >15% were detected but not for change of direction. The findings suggest that return-to-play testing in female athletes should examine the entire stance phase and include assessments of kinetic and kinematic variables throughout the kinetic chain. Greater deficits were highlighted in the DJ than in the CMJ, and greater performance asymmetries were evident in the SL tasks, with greater kinetic and kinematic and compensatory strategies evident in the DL tests. Biomechanical analysis focusing on contralateral compensation strategies and sex-specific interventions are necessary before return to play.

Improving Continuous Loss-in-weight Feeding Accuracy by a Novel Hopper Design

PurposePowder feeding is a vital unit operation in the continuous manufacturing of pharmaceutical products. Loss-in-weight twin-screw feeders are commonly used in continuous manufacturing lines. The feeding performance, i.e., the accuracy and consistency of feeding, influences the content uniformity of the final drug product. In this study, a redesigned hopper for K-Tron KT20 twin-screw feeder was designed, implemented, and investigated to improve feeding performance. The basic idea was to design the hopper in such a way that the stresses on top of the screw entrance are independent of the fill level.MethodsOur study compared the novel system to that of the original cylindrical hopper. The effect of the redesigned hopper on the start-up, the process’ sensitivity to refill level, and the refill portion size were studied. A free-flowing, barely compressible powder and a compressible blend were used in this study to evaluate the feeding performance and the refill effects.ResultsWhen using compressible powders, the results showed a larger process window for refilling in the redesigned hopper and a lower refill-level sensitivity compared to the original hopper.ConclusionThe homogenization of stresses in the redesigned hopper allowed operating at lower refill levels, and variability, especially due to refilling, was reduced. This study demonstrates novel design approaches for successfully implementing hard-to-feed materials in continuous manufacturing.

The Usability and Feasibility of a Dietary Intake Self-Monitoring Application in a Population with Varying Literacy Levels.

Our aim was to study how hemodialysis patients with varying levels of literacy would use a diet and fluid intake monitoring mobile application (DIMA-P) and what would be its impact on their dietary behaviors. We developed a mobile application using user-centered methods and informed by the Integrated Theory of Health Behavior Change (ITHBC). Eight hemodialysis patients were recruited to use the application to record and monitor their diet and fluid intakes for a 6-week study. Overall, the participants had low literacy, numeracy, and technical skills. We collected the data on application usage and administered usability and context-of-use questionnaires to gain insights into the participants' interaction with the application. The participants' portion estimation skills and dietary self-regulation self-efficacy were assessed using various tests. In addition, interdialytic weight gain data were collected to assess the impact of app usage on the participants' health outcomes. The application usage patterns varied, with a general trend towards frequent use (n = 5) correlating with engagement in self-monitoring. The participants gave high comprehensibility, user-friendliness, satisfaction, and usefulness ratings, suggesting that the app was well designed and the target users could easily navigate and interact with the features. While the participants improved in estimating portion sizes, the impact on measuring skills was variable. There was also an improvement in the participants' dietary self-regulation self-efficacy post-study. The interdialytic weight gain trends indicated a slight improvement in fluid and diet management. People with different literacy skills can effectively use icon-based interfaces for portion size estimation and develop personalized usage patterns to self-regulate their fluid and dietary intakes. Moreover, they can experience an enhancement in their dietary self-efficacy skills by using a mobile application aimed at providing nutritional feedback. Furthermore, this research shows that the constructs of the ITHBC are effective in promoting dietary behavior change in a population with varying literacy skills. The target users can benefit from explicitly visualizing the relationship between their health outcomes and the factors influencing those outcomes. These user ambitions could be supported by developing machine learning models. Future research should also focus on enhancing the mechanisms by which technology can further enhance each component of the ITHBC framework.

The relationship between food insecurity, purchasing patterns and perceptions of the food environment in urban slums in Ibadan, Nigeria

BackgroundRapid urbanisation without concomitant infrastructure development has led to the creation of urban slums throughout sub-Saharan Africa. People living in urban slums are particularly vulnerable to food insecurity due to the lack of physical and economic accessibility to food. Hence, it is important to explore how vulnerable groups living in slums interact with the food environment. This study assessed the relationships between food insecurity, including restrictive coping strategies, food purchasing patterns and perceptions about the food environment among dwellers of selected urban slums in Ibadan, Nigeria.MethodsThis community-based cross-sectional study was conducted with people responsible for food procurement from 590 randomly selected households in two urban slums in Ibadan. Food insecurity and restrictive coping strategies were assessed using the Household Food Insecurity Access Scale and the Coping Strategy Index, respectively. We examined purchasing patterns of participants by assessing the procurement of household foodstuffs in different categories, as well as by vendor type. Participants’ perceptions of the food environment were derived through a five-item composite score measuring food availability, affordability and quality. Chi-square tests and logistic regression models analysed associations between food insecurity, purchasing patterns and perceptions of the food environment.ResultsThe prevalence of food insecurity in the sample was 88%, with 40.2% of the households experiencing severe food insecurity. Nearly a third (32.5%) of the households used restrictive coping strategies such as limiting the size of food portions at mealtimes, while 28.8% reduced the frequency of their daily meals. Participants purchased food multiple times a week, primarily from formal and informal food markets rather than from wholesalers and supermarkets. Only a few households grew food or had livestock (3.2%). Food insecure households had a lower perceived access to the food environment, with an approximate 10% increase in access score per one-unit decrease in food insecurity (AOR = 0.90, 95% CI: 0.84, 0.96). The most procured foods among all households were fish (72.5%), bread (60.3%), rice (56.3%), yam and cassava flours (50.2%). Food-secure households procured fruit, dairy and vegetable proteins more frequently.ConclusionFood insecurity remains a serious public health challenge in the urban slums of Ibadan. Perceptions of greater access to the food environment was associated with increasing food security. Interventions should focus on creating more robust social and financial protections, with efforts to improve livelihoods to ensure food security among urban slum-dwellers.

Evidence on the Effectiveness-Acceptance Trade-Off Between Forced Active Choice and Default Nudging: A Field Study to Reduce Meat Consumption in Cafeterias

Overconsumption of meat remains common in Western diets. In a cafeteria setting, we assessed the impact of two interventions on reducing meat consumption: forced active choice (explicitly choosing meat portion size) and default nudge (offering a reduced meat portion with an opt-out option). Our field study, involving 5,966 food choices and feedback from 125 cafeteria users, revealed both interventions were effective and perceived as ethical. Across 11 meat dishes, both interventions increased the selection of reduced meat portions. Notably, the default nudge had a more substantial impact, with 90.6% opting for reduced portions compared to 38.5% for active choice. Interestingly, gender differences are most pronounced during the active choice phase and reduced through a default condition. We predict that in biased food choice environments where one option is clearly favored, differences in food choices influenced by socio-demographic factors are likely to diminish.

Modern Approaches to the Diagnosis o Food Allergy in Children: Oral Food Challenges (Review)

The diagnosis of food allergies significantly impacts the lives of patients and their families, restricting diets and social activities. A misdiagnosis can lead to severe allergic reactions, making accurate diagnosis crucial. Immunoglobulin E (IgE)-mediated food allergies are diagnosed using skin tests or serum-specific IgE levels. However, for most allergens, the only reliable method for confirming the diagnosis remains the oral food challenge (OFC). Objective — elucidation of the importance of oral provocation tests in the diagnosis of food allergy and their relevance for the future treatment of food allergy. Materials and methods. A search for information on OFC was conducted in scientometric databases such as Web of Science, Scopus, Google Scholar, ScienceDirect and PubMed using the following keywords: «food allergy», «oral food challenge», «children». After reviewing the publications, professional sources that met the query criteria and were published between 2017 and 2024 were selected for the review. Results and discussion. OFCs help determine allergen sensitivity and reaction severity, which is useful for further management. They also have therapeutic value, reducing anxiety related to food allergies and improving quality of life. Psychological aspects play an important role in food allergies, as the fear of severe reactions often exceeds actual risks.One limitation of OFCs is the need for substantial resources and specialized knowledge, available only in specialized medical centers. This leads to long waiting lists and delays in food introduction, increasing the risk of developing allergies. Additionally, OFCs are often conducted in controlled environments, which may not reflect real-world accidental exposures.OFC results can include false positives, false negatives, and inconclusive outcomes. They are also time-consuming and may affect school or work attendance for patients and caregivers. It is essential to standar­dize doses for each food according to portion sizes and patient age. Conclusions. The frequency of food allergies is currently increasing in Ukraine, highlighting the need for allergists to master the technique and implement oral food challenges in general allergy practice to establish food allergies in children.

Food waste reduction and its environmental consequences: a quasi-experimental study in a campus canteen

BackgroundFood waste is the third-largest contributor to greenhouse gas emissions, which has severe environmental and economic effects. This study presents a two-level intervention to estimate the quantity and environmental consequences of food waste at a campus canteen, offering innovative solutions to reduce food waste and its environmental footprint.MethodologyThis study involved 300 students and consisted of three main stages: initial food waste assessment, environmental and economic impact evaluation, and qualitative exploration of the causes of food waste through interviews with students. The assessment included direct measures and weighing of leftover food, and the environmental and economic impact was calculated. A two-level intervention was implemented for students and staff, and a re-assessment of food waste was conducted to evaluate the intervention’s impact. Statistical analysis was performed using SPSS.ResultsThe study monitored 26 meals, finding that the total amount of food waste in the university canteens was (mean = 60.65 g/person), and the intervention reduced food waste by 16.35% per meal (50.73 g/person). Moreover, after the intervention, the amount of food waste costs and total water waste were reduced by 30.14% and 16.66%, respectively. Grey water was reduced significantly by 12.5% (p = 0.033). Interviews with students identified low-quality meals, unpleasant taste, large portions, and a limited menu as the main causes of food waste.ConclusionsIt is possible to tackle food waste effectively with educational intervention, decreasing portion size, and improving the quality and variety of food.

Development and validation of food frequency questionnaire screener software for sodium intake among palestinian population

BackgroundHigh sodium intake has been linked to negative health effects, including cardiovascular and renal diseases. Traditional dietary sodium assessment methods are time-consuming and subjected to errors. Using technology may increase the efficiency and accuracy of dietary assessment. The objective of this study is to develop and validate a food frequency questionnaire (FFQ) screener using software to assess sodium intake among the Palestinian population. Methodology: The study was conducted in four phases. In Phase 1, Palestinian foods were categorized and subcategorized according to their mode of consumption, sodium content, and food groups. The sodium content values were calculated from Palestinian food composition database. Content validity was done in Phase 2, while in Phase 3, a pilot study was conducted to determine test-retest reliability. In Phase 4, the criterion validity of the screener was assessed by comparing the results of sodium intake from the FFQ screener with the results from a 24-hour urinary sodium test and a 3-day diet recall. Correlations between the sodium intake values from the three methods were analyzed using Pearson correlation tests, and the difference was assessed using the Bland-Altman test.ResultsThe developed FFQ screener sodium screener included 41 food items categorized into nine groups, with photo-based portion size estimation and frequency of consumption. The reliability test showed a Pearson correlation coefficient of 0.7, p < 0.01 using test and retest. For criterion validity, the correlation coefficient between dietary sodium intake using the FFQ screener software and the 24-hour urine sodium test was (0.6, p < 0.000). The correlation coefficient between dietary sodium intake using the FFQ screener software and dietary sodium intake using a 3-day recall was (0.3, p < 0.000). Sodium intake was significantly correlated with preferences for low-sodium food and previous salt reduction, p < 0.05.ConclusionsUsing the FFQ screener software was a valid and reliable method for assessing dietary sodium intake. Using the photo-based method to estimate portion size improved precision and accuracy in diet assessment.

Image-based dietary assessment skills of undergraduate nutrition and dietetics students in a multicultural developing country

Background: Image-based dietary assessment is a digital method relatively new in nutrition education. We aimed to evaluate the nutrient estimation skills of nutrition and dietetics students in Malaysia using image-based dietary assessment, and develop a tool to assess their image-based dietary assessment skills. Methods: The study was performed among undergraduate nutrition and dietetics students in two phases. Phase One (n=75) was conducted in four steps: 1) photography of food/beverage at two angles (45° and 90°) with and without a fiducial marker (ruler/dessert spoon); 2) study tool establishment; 3) pre-testing; and 4) conduct of the study. Incorporating changes from Phase One, 55 students participated in Phase Two. Participants were evaluated on their accuracy in recognizing and estimating portions and nutrients of a food/beverage. Data analysis included response frequency and percentages, and statistical differences (Wilcoxon Signed Rank test) in estimating nutrient content. Results: In both phases, the participants scored above 80% for the correct identification of most food items. Participants scored the lowest when estimating nutrient content in local snacks [median (IQR): Phase One, 12.5% (25.0); Phase Two, 16.7% (16.7)]. Participants in Phase One showed better nutrient estimation skills with both fiducial markers, however, no significant difference was observed in Phase Two [without: 21.1% (7.9%); with the dessert spoon: 19.0% (13.8%), p=0.197]. Participants’ knowledge, skills, and food images were the main barriers to accurate nutrient estimation. Conclusion: Our study found poor nutrient estimation skills among Malaysian undergraduate nutrition and dietetics students. These key findings warrant urgent attention to address this through innovative dietary assessment training on food and portion size from images.