Background Shifting to more sustainable diets can reduce environmental impact and improve population health. Food-based dietary guidelines (FBDGs) offer an opportunity to incorporate sustainability into nutritional recommendations. Objectives This study primarily examined the inclusion of environmental sustainability messaging across European FBDGs. A secondary analysis assessed how such messaging was associated with recommendations for 2 key food groups relevant to the transition toward sustainable healthy diets, namely meats and pulses. Methods Three FBDG document types were reviewed: consumer-facing guidelines, resources for health care professionals, and scientific background reports. Eighteen sustainability criteria derived from Food and Agriculture Organization/World Health Organization (FAO/WHO) and the British Dietetic Association’s recommendations were examined. Criteria were coded as explicitly linked to sustainability, included without sustainability reference, or missing. Recommended daily intakes for total, red and processed meat, and pulses were extracted from consumer-facing documents where available. Results FBDGs from 36 countries were analyzed. Guidelines referencing sustainability were generally more recently published, with explicit sustainability messaging most commonly found in scientific background documents. Across document types, criteria related to reducing animal-based foods, increasing plant-based foods, and minimizing environmental impact were most frequently included. Guidance related to locally produced or seasonal foods was included in consumer-facing materials, whereas recommendations regarding food waste were rarely mentioned. FBDGs that included messages promoting plant-based foods generally recommended lower meat and higher pulse intakes, although trends between messages and recommended amounts were not always consistent. For example, messages related to reducing animal foods, animal protein, or red meat were not consistently associated with lower recommended intakes of total meat. However, FBDGs specifically addressing red or processed meat intake generally recommended lower red and processed meat consumption and higher pulse intakes. Conclusions Overall, European FBDGs increasingly incorporate environmental sustainability, but gaps remain. Consumer-facing guidance remains largely health-focused. Greater coherence is needed in the translation of sustainability principles into FBDGs.

Excessive consumption of discretionary food is a global concern linked to obesity prevalence. Providing reference portion sizes and reducing portion size is a potential solution to tackle this issue. The aim of this study was to model the impact of systematically established portion values, without changing food choices, on discretionary energy and public health-sensitive nutrients using nationally representative datasets from the United States (NHANES), United Kingdom (NDNS), and France (INCA3). Diet modeling was used to adjust large portions to reference portion sizes per eating occasion for selected discretionary, energy-dense food categories. Nutritional quality and adherence to World Health Organization guidelines were compared before and after substitutions. Linear regressions assessed whether reductions in daily total energy and added/free sugar were associated with participants’ demographic and anthropometric characteristics. After substitution, daily energy from discretionary foods decreased by 5.4 percentage points for NHANES (mean ± SD from 20.7 ± 13.1 to 15.3 ± 9.8

IntroductionFood-based dietary guidelines (FBDGs) are essential public health tools for delivering dietary recommendations, and generally include guidance on portion sizes. Despite existing guidelines on developing and implementing FBDGs, there is still no consensus on best practices for their formulation. This paper compares the methodologies used by public health organizations to create FBDGs and examines how both methodology and geographical location may influence recommended portion sizes.MethodsDocuments on FBDG development were obtained from the Food and Agriculture Organization online repository of FBDGs, either directly from consumer-facing FBDG or from corresponding scientific reports. Methodological details in FBDG development were extracted and categorized. Recommended portions in grams per day were extracted for 15 food categories to enable comparison across development methods and global regions.ResultsFBDGs from 96 countries were accessed and translated. Of these, n = 83 were based on consensus/review, n = 15 used data-based approaches, and n = 30 included other minor calculations. Thirty-nine FBDGs were derived from a combination of consensus/review and another method. Of the countries providing portion size information, only one did not report its methodological approach. Comparisons of median portions sizes of food groups across methodologies showed no significant differences. Analyses across regions revealed that portion recommendations were generally consistent, with significant differences found only for one food group, namely, Fish & shellfish, where portion size recommendations were significantly higher in Europe compared to those in Latin America and the Caribbean.DiscussionResults indicate little variation in the recommendations for portion size across development methods, and for most food groups, across global regions. These findings suggest there is potential to harmonize portion size derivation in FBDGs at regional or global levels. However, further research is needed to assess whether harmonized guidance can apply to other aspects of FBDGs.

Background: Child diet can influence risk for obesity and other related noncommunicable diseases. Few studies have used the Healthy Eating Index (HEI)-Toddlers-2020 to assess diet quality among toddlers (children aged 12 to 23.9 months). Objective: The aim of this study was to examine diet quality among toddlers participating in the Feeding Infants and Toddlers Study, 2016, and determine differences by sociodemographic characteristics. Caregiver perception of how their toddler's diet aligns with HEI-Toddlers-2020 diet quality scores was also assessed. Design: This cross-sectional study used 24-hour dietary records collected in 2016. Participants and setting: Data were collected on toddlers ages 12 to 23.9 months (N = 1133) participating in the Feeding Infants and Toddlers Study, 2016. Main outcome measures: Diet quality was assessed using the HEI-Toddlers-2020. Statistical analyses performed: The population ratio method was used for all analyses using weighted data to estimate HEI-Toddlers-2020 scores overall and within subgroups. To determine significant differences of the HEI-Toddlers-2020 score between subgroups, pairwise t tests were used. Statistical significance at P < .05 was used as a cutoff for all 2-sided P values. Results: Average HEI-Toddlers-2020 score among toddlers ages 12 to 23.9 months participating in the Feeding Infants and Toddlers Study, 2016, was 71.2 out of a possible 100. Total scores (mean, standard error) varied by race and ethnicity with Hispanic toddlers having higher scores compared with non-Hispanic White toddlers (76.4 +/- 2.5 vs 69.0 +/- 1.2; P = .03) and by federal poverty level with those >200% of the poverty level having higher scores compared with those <100% of the poverty level (74.7 +/- 1.5 vs 67.0 +/- 2.6; P = .01). Conclusions: Opportunities for improvement in dietary intake were identified using the new HEI-Toddlers-2020 to assess diet quality among children ages 12 to 23.9 months. Scores were indicative of toddlers consuming excess added sugars and lower-than-recommended amounts of seafood and plant proteins, greens and beans, whole grains, and vegetables. Interventions to improve diet quality in toddlers may benefit from focusing on foods children should eat more of along with foods to consume in moderation.

Provision of nutrition information is mandated for packaged foods, but few countries regulate serving sizes. Our objective was to develop a methodology to establish globally consistent portion size recommendations for both nutrient-dense and discretionary foods. A stepwise systematic approach incorporated portion values from serving size regulations (n = 10), food-based dietary guidelines (FBDG; n = 90, aggregated into 6 regions), and reported food intakes from Europe and Australia. Global Portion Values (GPVs) for 50 food groups were derived as the median of all data inputs. Consistency was evaluated using 25th and 75th percentiles and dispersion of input values (percent of median absolute deviations (MAD)/median). GPVs were calculated for 50 food groups organized into nine food categories: Milk/Dairy (n = 6 food groups), Protein Foods (n = 5), Mixed Dishes (n = 4), Grains (n = 7), Fruits/Vegetables (n = 5), Snacks/Sweets (n = 12), Sauces/Condiments (n = 5), Fats/Oils/Sugars (n = 4) and Beverages (n = 2). Data inputs for each portion value ranged from 6 to 18; only 4 foods had < 10 inputs; 21 had ≥ 15. Dispersion ranged from 0 to 33

Introduction:As packaged foods consumption increases in low- and middle-income countries (LMICs), certain governments have introduced front-of-pack labeling (FOPL) schemes to promote healthier food choices. This study assesses the evolution and nutritional quality of packaged foods in LMICs from 2015 to 2023 and examines trends in countries where FOPLs have been implemented. Methods:On-pack information from products in the top 20 packaged food categories was retrieved from the Mintel Global New Product Database (2015-2023) in 19 LMICs. The number of new products introduced and median content of energy, sugars, sodium, saturated fatty acids (SFA), protein, and fiber were analyzed by product category, country, region and type of FOPL implemented. Evolution of the percentage of products with an improved nutritional content was compared from 2015-2017 to 2021-2023. Results:Our findings indicate that from 2015 to 2023, the percentage of packaged meat and coffee products increased in LMICs, while more indulgent products such as cookies declined. The nutritional quality of products improved, particularly toward a reduction in total sugars and an increase in protein content. The implementation of FOPL was associated with further reductions in total sugars, and, depending on the type of scheme implemented, with reduction in sodium. Discussion:These findings offer insights on the food environment in LMICs undergoing a nutrition transition, and on how certain food policies can be associated with reformulation of packaged foods in those countries.

BACKGROUND:The Food and Drug Administration's Closer to Zero Action Plan aims to reduce toxic element exposure from foods infants and toddlers eat. Rice has been identified as a source of inorganic arsenic in the diets of infants and toddlers. OBJECTIVE:Evaluate consumption of rice and rice-containing foods from the Feeding Infants and Toddlers Study (FITS) 2016. DESIGN:FITS was a national cross-sectional survey conducted in 2016. Dietary intakes were collected by trained nutritionists using multiple-pass 24-hour recalls by telephone with parents and caregivers of infants and toddlers. PARTICIPANTS:Participants from FITS 2016 (n = 2635) are from a national sample weighted to be representative of US infants and toddlers 0-24 months of age. MAIN OUTCOME MEASURES:Rice grain consumption among infants and toddlers and distribution of rice grain consumed was determined using 1-day intakes. Per capita mean grams rice/day from infant cereal was determined for infants aged 0-12 months. STATISTICAL ANALYSES:Sources of rice were identified from 24-hour dietary recalls. A percentage of rice grain was assigned to each food source, and descriptive statistics were used to estimate intakes and distributions. RESULTS:Percentage consuming rice or rice-containing foods was highest for infants aged 6-11.9 months (58.2%), including snacks (32.1%), infant cereal (27.9%), baby food purees (11.1%), and cooked rice (7.7%). Among infants 6-11.9 months of age who consumed rice, mean intake of rice from all sources was 11.9 ± 0.8 g/d (mean ± standard error [SE]), and although most frequently reported, snacks provided the least quantity of rice (2.0 ± 0.2 g/d). For infants 0-11.9 months of age, mean per capita rice intake from infant cereal was 3.3 ± g/day. CONCLUSIONS:Older infants consume rice from a variety of foods. Rice-containing snacks contribute minimal quantities of rice to the daily diet. To reduce exposure to inorganic arsenic, infants should be offered a variety of grains as part of a well-balanced diet.

Over the past decades, increased food intakes have contributed to rising obesity rates. This worldwide phenomenon partly results from the consumption of larger portion sizes. In this context, food-based dietary guidelines (FBDGs) have been described as an essential public health tool to guide populations toward achieving a healthier and balanced diet and reducing the risk of non-communicable diseases. Recent literature has underlined the wide variability in portion size recommendations as a future challenge to the derivation and success of FBDGs and has highlighted the need for common standard portions. This review aims to report the recommended portions of nine common food groups within existing FBDGs for the general adult population. The methods used to derive recommended portion sizes are also compared, including the type and scope of data used and the statistical approaches applied. The government-endorsed food-based dietary guidelines listed by the Food and Agriculture Organisation (FAO) were analysed, as well as their related scientific reports. Results from 99 FBDGs show that several countries (n = 11) promote the consumption of a variety of foods, without providing further reference quantities for daily food intake or portion size. Furthermore, some guidelines (n = 13) derive recommendations from local or national food consumption surveys, which may not necessarily align with appropriate or recommended intakes. When used, statistical methods for the derivation of recommended portions combine diverse criteria, including reported dietary habits (median food type/group intakes) and recommended levels of macronutrients and micronutrients of concern in the population. The inconsistencies in methodological approaches reflect uneven access to relevant dietary data, which in turn seems to drive the observed variability. This review informs the reader of the range and sources of variability in food group portion size recommendations across countries and constitutes a basis for the future elaboration of a global methodological framework to derive harmonised reference portions.

A promising strategy to encourage portion control involves clear guidance and portion information on product packaging alongside nutrition details. However, literature on the impact of this information on serving sizes is conflicting. To gather more objective evidence about how consumers interact with on-pack portion guidance, we conducted a laboratory-based eye-tracker study with 66 participants completing two portion-size estimation tasks. In the first, participants estimated serving sizes indirectly by gauging how many people a product pack could serve. The second task involved direct portion size selection using pictorial representations of the food portion on a virtual plate. Additionally, we explored how participants’ familiarity with products affected their portion estimations. Results: when portion guidance was presented, errors in portion estimation significantly decreased only in the indirect task, where 85% of participants showed an improved accuracy. This suggests that the way individuals are prompted to estimate portion sizes influences their approach and their reliance on the provided guidance. Higher error rates occurred when participants were more familiar with the products. For less familiar products, the lower portion estimation errors were associated with the longer fixations on the portion graphic in the indirect task. In addition, participants who quickly noticed the portion graphic provided more accurate portion size estimates. This emphasizes the practical importance of swiftly locating portion information on-pack to enhance estimation accuracy.

Portion sizes have increased substantially over the past several decades and are thought to contribute to rising rates of overweight and obesity.(1) People eat more when provided with larger portions, and over time, consider larger portions as normal.(2) Providing descriptive labeling and visual cues can be helpful in guiding consumers to appropriate portion selection.(3) Globally, few countries regulate servings sizes for packaged foods. Instead, Nutrition Facts are reported per 100g or 100mL, and/or per amount declared by the manufacturer. These variations lead to inconsistencies in on-pack portion sizes and may cause consumer confusion.(4) Our objective was to develop a methodology to establish globally relevant portion size recommendations for both nutrient-dense and discretionary foods that could be implemented in countries where permitted.A stepwise and systematic approach incorporated values from regulated serving sizes (n = 10), portion recommendations from food-based dietary guidelines (FBDG; n = 90, aggregated into 6 regions), and food consumption data from Europe (n = 24 countries) and Australia for a total of 18 possible data inputs. These inputs were used to derive Global Portion Values (GPVs) as the median of all values for 50 food and beverage categories including both nutrient-dense and discretionary foods. To better understand the consistency of input values, 25th and 75th percentiles, and dispersion of input values, assessed as percent of median absolute deviations (MAD)/median, were calculated.GPVs were calculated for milk and dairy (n = 6 food groups), protein foods (n = 5), mixed dishes (n = 5), grains (n = 7), fruits and vegetables (n = 5), snacks and sweets (n = 11), sauces and condiments (n = 5), fats, oils and sugars (n = 4) and beverages (n = 2). The number of inputs for each portion value ranged from 6 (Appetizers/hors d’oeuvres) to 18 (juices). Only 5 of 50 food groups had fewer than 10 inputs;21 had ≥15. Dispersion ranged from 0-33%; 88% of GPVs were considered “consistent” (dispersion<25%) and 8 categories had 0% variation, indicating high consistency across all inputs. ExampleGPVs for nutrient-dense foods include: 240mL for milk (16 inputs, 8% dispersion); 30g for cheese (17 inputs, 0% dispersion); 90g for main dishes (meat, poultry, fish) without sauce (16 inputs, 13% dispersion); 50g for bread and rolls (17 inputs, 20% dispersion); 130g for canned vegetables (10 inputs, 2% dispersion). Example GPVs for discretionary foods include: 30g for chocolate (15 inputs, 17% dispersion); 30g for potato chips and crisps (12 inputs, 17% dispersion); and 30mL for salad dressing (13 inputs, 0% dispersion).This novel method incorporating regulated serving sizes, portions from FBDGs and actual intakes can be used to derive portion recommendations for commonly consumed foods and beverages. If adopted, these values could improve consistency in portion labeling in countries where they are permitted and therefore guide consumers to more appropriate portions.

Micronutrient deficiencies, undernutrition, and overweight/obesity are prevalent in low- and middle-income countries (LMICs). Nutrient profiling models (NPMs), initially developed to help reduce the prevalence of diet-related chronic diseases in Western countries, could be one solution to promote nutrient-dense foods in LMICs. This study reviewed government-endorsed NPMs implemented in LMICs and assessed their key components in relation to country-specific nutritional challenges. The peer-reviewed and grey literature were systematically reviewed to identify government-endorsed NPMs implemented in LMICs to promote healthier choices among adults. Their key metrics, including scope, components, units, and validation method, were extracted. The prevalence of undernutrition; overweight/obesity; and iron, vitamin A, and iodine deficiencies were extracted from the Global Health Observatory and the Global Burden of Disease study. NPMs have been implemented in 16 LMICs to encourage healthier choices, mostly through front-of-pack labeling schemes. Warning Label schemes are used to strongly discourage the consumption of energy-dense products in countries where overnutrition affects most of the population, such as Latin American LMICs. A “Keyhole” front-of-pack labeling scheme was implemented only in North Macedonia. It limits sugar, fat, and salt while promoting fibers, fruits, vegetables, nuts, and legumes to prevent overnutrition and diet-related chronic diseases. “Choices” schemes that focus on positive messages have been implemented in Southeast Asia and Zambia where over- and undernutrition coexist. “Choices” criteria encourage the consumption of category-specific vitamins and minerals, in addition to advocating limiting certain nutrients. In LMICs, NPMs focus on discouraging the consumption of sugar, fat, and salt. Additionally, NPMs promote category-specific micronutrients in countries where undernutrition remains prevalent or food components associated with a reduced risk of diet-related chronic diseases, including whole grains and fibers, in countries where overnutrition is the main nutrition-related public health issue.This study was registered at PROSPERO as CRD42023468807.

Food-Based Dietary Guidelines (FBDGs) are valuable tools for providing dietary recommendations to different population groups across the globe(1). However, while the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) have issued guidelines to support the development of FBDGs(2), a lack of consistency persists in how these are applied by individual countries in their derivation approach and monitoring efforts(3,4). This review compares the methodologies used by public health bodies to develop FBDGs.Documents describing FBDGs and their development were obtained via the FAO online repository of FBDGs, and information could be found directly from the FBDG or from their joint scientific report. A spreadsheet was created to report details on the approaches used to derive dietary guidance for the general adult population, with a focus on the type and specificities of the data used, when applicable (characteristics of the study population, food intake assessment methodology, analysed consumption patterns, and nutritional requirements inputted if diet modelling was applied). General information such as the year of issue and stakeholders involved in the elaboration of the guidelines was also retrieved.A total of 96 FBDGs were accessed and translated into English for analysis: 11 in Africa, 16 in Asia, 34 in Europe, 29 in Latin America and the Caribbean, 4 in the Near East, and 2 in North America, published on average in 2014. Of these, 60 FBDGs (63%) were developed based on scientific consensus, 43 (45%) mentioned a review of current evidence on the associations between dietary patterns and health outcomes, 26 (27%) derived the recommendations according to energy and/or nutritional requirements, and 15 (16%) used a statistical/mathematical optimisation method to develop quantitative guidance. 10 FBDGs (10%) did not provide any information on the rationale used to derive the values.The general lack of FBDG revision using up-to-date evidence as well as the low use of typical consumption resources and specifically of national intake data represents a limitation to the development of relevant guidelines for food consumption. Ultimately, although consideration of local cultural practices is necessary, this study highlights the need for harmonisation of strategies to enhance the accuracy and therefore the effectiveness of FBDGs in promoting healthier eating habits.

Background Food systems are complex networks of supply and demand value chains that have profound effects on human health, environmental sustainability, and economic development. Concerns about the social, environmental, and economic sustainability of these systems have become increasingly acute due to challenges such as population growth coupled with an emerging middle class, urbanization, resource competition, geopolitical tensions, and climate change. The United Nations has set Sustainable Development Goals (SDGs) to address the interplay between social, economic, and environmental factors but the specific steps needed to transition from the current state towards the targets are less clear. Scope and approach This review aims to explore the role of value chains, specifically the value addition brought by food processing, in transforming food systems outcomes towards achieving SDGs. Both benefits and challenges associated with food processing were assessed in producing safe, nutritious, and affordable food while optimizing resource use. Key findings and conclusions The review emphasizes the importance of food processing for food safety and supply, its impact on the nutritional value of foods, and it showcases examples of converging nutritional and environmental goals. It highlights the potential of digital tools and systemic perspectives in accelerating the required transformations within food systems. These require efficient collaborations to effectively address the trade-offs that arise when pursuing multiple transformation goals. Accurate, reliable and evidence-based information should be shared among stakeholders and be used for consumer information to empower their informed decisions about the safety, quality, ethical, and sustainability aspects of the food they consume.

Objective:Since large food portion sizes (PS) lead to overconsumption, our objective was to review PS recommendations for commonly consumed food groups reported in Food-Based Dietary Guidelines (FBDGs) globally and to assess variation in PS across countries and regions. Methods:Consumer-oriented FBDGs from the Food and Agriculture Organization (FAO) online repository were used to evaluate dietary recommendations, PS and number of portions for common food groups. Guidelines were classified for each group as qualitative, quantitative, or missing. A standardized approach was applied to convert PS recommendations given as household measures, cup equivalents, pieces and other measures into grams for cross comparison. Variation of recommended PS of common food groups within and across regions was examined. Results:Among 96 FBDGs, variations were found both across and within regions. At a regional level, the highest median PS recommendations were seen in Europe for Meat, Fish and Pulses, in the Near East for Dairy products, and in Africa for most grain-based foods. Recommendations for Fruits and Vegetables showed the highest consistency across FBDGs worldwide, whereas guidance on Meat, fish & eggs and Cooked cereals/grains showed discrepancies in the classification of foods into categories, as well as in the number of portions per day. Discussion:While some variation in PS recommendations across countries can be expected due to cultural and regional dietary practices, inconsistent definitions to refer to a portion and varied derivation methods may further produce discrepancies. Harmonizing development methods for FBDG could help establish more consistent reference portion sizes and therefore provide clearer guidance to consumers.

BackgroundMetabolic programming of glucose homeostasis in the first 1,000 days of life may impact lifelong metabolic and cardiovascular health. Continuous glucose monitoring (CGM) devices may help measure the impact of dietary intake on glucose rhythms and metabolism in infants during the complementary feeding period.ObjectivesDemonstrate the feasibility of CGM to measure and quantify glucose variability in response to infant feeding and to evaluate associations between macronutrient meal composition and glucose variability.MethodsThe “FreeStyle Libre Pro®” device interstitial glucose meter was applied to the anterior thigh of 10 healthy 6–12-month-old infants. Parents recorded food intake, time of feeding, and used daily dairies to record sleep time and duration. Descriptive statistics were employed for food intake, sleep and key glycemic parameters over three full days. Mixed linear models were used to assess glycemic changes.ResultsMid-day, afternoon, and evening feeds contained >30 g carbohydrate and induced higher 2-h iAUC (3.42, 3.41, and 3.50 mmol/L*h respectively) compared to early and mid-morning feedings with ≤25 g carbohydrates (iAUC 2.72 and 2.81 mmol/L*h, p < 0.05). Early morning and evening milk feedings contained approximately 9 g of fat and induced a longer time to reach maximal glucose value (Tmax; 75 and 68 min, respectively) compared to lower fat feedings (2.9–5.9 g; Tmax range: 34–60 min; p < 0.05). Incremental glucose value at time of food intake (C0) increased significantly from 0.24 ± 0.39 mM in early morning to 1.07 ± 0.57 mM in the evening (p < 0.05). Over the day, 70% of glucose values remained within the normal range (3.5–5.5 mmol/L), 10% were between 5.5–10 mmol/L, and 20% were < 3.5 mmol/L.ConclusionOur data support the feasibility of using CGM to measure glucose in 6–12-month-old infants. The observation of possible diurnal glucose variability and typical glucose values may have implications for future studies investigating metabolic adaptation to nutritional intake in early life.