Portion Size: What We Know and What We Need to Know

There is increasing evidence that the portion sizes of many foods have increased and in a laboratory at least this increases the amount eaten. The conclusions are, however, limited by the complexity of the phenomenon. There is a need to consider meals freely chosen over a prolonged period when a range of foods of different energy densities are available. A range of factors will influence the size of the portion size chosen: amongst others packaging, labeling, advertising, and the unit size rather than portion size of the food item. The way portion size interacts with the multitude of factors that determine food intake needs to be established. In particular, the role of portion size on energy intake should be examined as many confounding variables exist and we must be clear that it is portion size that is the major problem. If the approach is to make a practical contribution, then methods of changing portion sizes will need to be developed. This may prove to be a problem in a free market, as it is to be expected that customers will resist the introduction of smaller portion sizes, given that value for money is an important motivator

Dietary catechins in relation to coronary heart disease death among postmenopausal women

Catechins, one of the major groups of flavonoids, are bioactive compounds present in a variety of plant foods and beverages. Experimental data suggest that they might prevent chronic diseases in humans. We studied whether the intake of catechins was inversely associated with the risk of coronary heart disease death in a prospective study of postmenopausal women from Iowa. Between 1986 and 1998, 767 of 34,492 participants initially free of cardiovascular diseases died from coronary heart disease. There was a strong inverse association between the intake of ( )-catechin and (-)-epicatechin and coronary heart disease death, which was somewhat attenuated after multivariate adjustment (risk ratios from lowest to highest quintile: 1.00, 0.95, 0.97, 0.77, 0.76). This inverse association was most pronounced in women at low risk of coronary heart disease (non-smokers, free of diabetes mellitus and cardiovascular diseases). A high intake of "gallates," catechins typical of tea, was not associated with coronary heart disease death. Of the major catechin sources, apples and wine were inversely associated with coronary heart disease death. Our data suggest that preventive effects might be limited to certain types of catechins, or that these are indicators of other dietary components or a healthy lifestyle in general

Dietary catechins and cancer incidence among postmenopausal women: the Iowa Women's Health Study (US)

Catechins are bioactive flavonoids present in tea, fruits, and vegetables. Previous epidemiological studies regarding tea and cancer risk were inconclusive, possibly because catechins are also present in other plant foods. We investigated whether a high intake of catechins are associated with cancer incidence among postmenopausal women. Methods: A cohort of 34,651 postmenopausal cancer-free women aged 55–69 years were followed from 1986 to 1998. At baseline, data on diet, medical history, and lifestyle were collected. Incident cancers were obtained through linkage with a cancer registry. Cox proportional hazards analysis was used to estimate risk ratios. Results: After adjustment for potential confounders, catechin intake was inversely associated with rectal cancer incidence only (risk ratios from lowest to highest quartile: 1.00, 0.93, 0.73, and 0.55; p for trend 0.02). Non-significant inverse trends were found for cancer of the upper digestive tract, pancreas, and for hematopoietic cancers. Catechins derived primarily from fruits, ( )-catechin and (-)-epicatechin, tended to be inversely associated with upper digestive tract cancer, whereas catechins derived from tea were inversely associated with rectal cancer. Conclusions: Among several cancers studied, our data suggest that catechin intake may protect against rectal cancer. The distinct effects found for catechins derived from solid foods (fruits) and beverages (tea) may be due to differences in bioavailability or metabolism of the catechins, or to their interactions with other dietary components

Longitudinal trends in diet and effects of sex, race, and education on dietary quality score change: the Coronary Artery Risk Development in Young Adults study

Background: The food supply and dietary preferences have changed in recent decades. Objective: We studied time- and age-related individual and population-wide changes in a dietary quality score and food groups during 1985–2006. Design: The Coronary Artery Risk Development in Young Adults (CARDIA) study of 5115 black and white men and women [aged 18–30 y at year 0 (1985–1986)] assessed diet at examinations at study years 0, 7 (1992–1993), and 20 (2005–2006). The dietary quality score, which was validated by its inverse association with cardiovascular disease risk, summed 46 food groups rated by investigators as positive or negative on the basis of hypothesized health effects. We used repeated-measures regression to estimate time-specific mean diet scores and servings per day of food groups. Results: In 2652 participants with all 3 diet assessments, the mean (±SD) dietary quality score increased from 64.1 ± 13.0 at year 0 to 71.1 ± 12.6 at year 20, which was mostly attributable to increased age. However, the secular trend, which was estimated from differences of dietary quality scores across time at a fixed age (age-matched time trend) decreased. The diet score was higher in whites than in blacks and in women than in men and increased with education, but demographic gaps in the score narrowed over 20 y. There tended to be increases in positively rated food groups and decreases in negatively rated food groups, which were generally similar in direction across demographic groups. Conclusions: The CARDIA study showed many age-related, desirable changes in food intake over 20 y of observation, despite a secular trend toward a lower diet quality. Nevertheless, demographic disparities in diet persist

Alcohol intake and ovarian cancer risk: a pooled analysis of 10 cohort studies

Alcohol has been hypothesized to promote ovarian carcinogenesis by its potential to increase circulating levels of estrogen and other hormones; through its oxidation byproduct, acetaldehyde, which may act as a cocarcinogen; and by depletion of folate and other nutrients. Case-control and cohort studies have reported conflicting results relating alcohol intake to ovarian cancer risk. We conducted a pooled analysis of the primary data from ten prospective cohort studies. The analysis included 529 638 women among whom 2001 incident epithelial ovarian cases were documented. After study-specific relative risks (RR) and 95% confidence intervals (CI) were calculated by Cox proportional hazards models, and then were pooled using a random effects model; no associations were observed for intakes of total alcohol (pooled multivariate RR = 1.12, 95% CI 0.86-1.44 comparing ≥ 30 to 0 g day-1 of alcohol) or alcohol from wine, beer or spirits and ovarian cancer risk. The association with alcohol consumption was not modified by oral contraceptive use, hormone replacement therapy, parity, menopausal status, folate intake, body mass index, or smoking. Associations for endometrioid, mucinous, and serous ovarian cancer were similar to the overall findings. This pooled analysis does not support an association between moderate alcohol intake and ovarian cancer risk. © 2006 Cancer Research. Chemicals / CAS: acetaldehyde, 75-07-0; folic acid, 59-30-3, 6484-89-5; Contraceptives, Ora

What is really behavioral in behavioral health policy? And does it work?

Across health systems, there is increasing interest in applying behavioral economics insights to health policy challenges. Policy decision makers have recently discussed a range of diverse health policy interventions that are commonly brought together under a behavioral umbrella. These include randomized controlled trials, comparison portals, information labels, financial incentives, sin taxes, and nudges. A taxonomy is proposed to classify such behavioral interventions. In the context of risky health behavior, each cluster of policies is then scrutinized under two respects: (i) What are its genuinely behavioral insights? (ii) What evidence exists on its practical effectiveness? The discussion highlights the main challenges in drawing a clear mapping between how much each policy is behaviorally inspired and its effectiveness