The COVOSMIA-19 trial: Preliminary application of the Singapore smell and taste test to objectively measure smell and taste function with COVID-19.

Sudden loss of smell and/or taste has been identified as an early symptom of SARS-CoV-2 2019 (COVID-19) infection, and presents an effective target for prompt self-isolation and reducing community spread. The current study sought to develop and test a novel, rapid, self-administered test to objectively measure smell and taste losses associated with COVID-19, and administered self-report questionnaires to characterise symptoms associated with COVID-19 in Singapore. Participants (N = 99) completed questionnaires to record recent changes in smell and taste ability. This was followed by the 'Singapore Smell and Taste Test' (SSTT), a personal, objective testing kit for daily self-assessment of smell and taste function at their place of residence. Seventy-two recruited participants were confirmed as COVID-19 positive at baseline, of which 58 completed the SSTT at home. Of these, 36.2% had objectively measured smell and/or taste loss. The SSTT measures of smell and taste function were positively associated with participants' self-reported smell and taste acuity, and rated smell intensity of 6 common household items. This study presents the first application of the SSTT as a rapid, cost-effective, objective tool to self-monitor smell and taste function in a residential setting, and ensures comparability across individuals through the use of standardised stimuli. The SSTT has potential for future application in populations with limited access to formal COVID-19 testing as a self-administered objective method to monitor sudden changes in smell and taste, and to prompt early self-isolation, in order to reduce community transmission of COVID-19.

Limited Evidence of Associations Between Executive Functioning and Alcohol Involvement In UK Adolescents.

AIMS: Deficits in motor inhibitory control and working memory have been hypothesized to be both a cause and consequence of heavy alcohol use. Adolescence is a critical developmental stage for inhibitory control and working memory, and it is also a stage when individuals are most likely to initiate alcohol use. This study aimed to examine whether inhibitory control and working memory would predict alcohol use and involvement in a group of UK adolescents. METHODS: We recruited 220 (N = 178, female) adolescents, aged between 16 and 18, from eight higher education settings in the Merseyside region of the UK. Alcohol use was examined using the Timeline Follow-Back and involvement (and related problems) using the Adolescent Alcohol Involvement Scale. A reward-based inhibitory control task (Go/No-Go) was used to examine the inhibition and reward sensitivity, and a self-ordered pointing task was used to measure working memory. RESULTS: Multiple regression demonstrated that neither inhibitory control (b = 0.02 (95% confidence interval (CI): -0.21, 0.24)) nor working memory (b = -0.12 (95% CI: -0.30, 0.07)) were significant predictors of alcohol use (units consumed). Inhibitory control (b = 0.61 (95% CI: 0.12, 1.09), specifically, in the no reward condition and school deprivation (b = 0.67 (95% CI: 0.06, 1.28) significantly predicted alcohol-related problems. CONCLUSIONS: Our findings demonstrated limited evidence that deficits in specific mechanisms of executive functioning (i.e. motor inhibition and working memory) were associated with alcohol-related problems in UK adolescents. This study adds to an increasing body of literature suggesting weak or non-existent links between inhibitory control, working memory and alcohol use.

The energy and nutritional content of snacks sold at supermarkets and coffee shops in the UK.

BACKGROUND: Snacking is associated with a higher daily energy intake and dietary guidelines recommend snacks of no more than 200 kcal for adults and 100 kcal for children. The present study examines the energy content, nutritional quality and price of single-serving snack food products sold by major supermarket and coffee shop chains in the UK. METHODS: Energy content, nutritional content and price of single-serving snack products were recorded in 2019 via the websites of 14 major chains (seven supermarkets; seven coffee shops). RESULTS: The mean energy content of all eligible snack products (n = 2283) was 186 kcal [95% confidence interval (CI) = 182-190]. The mean energy content of the snack products sold at coffee shops (n = 379; 282 kcal [95% CI = 269-295]) was significantly higher than the energy content of the snack products sold at supermarkets (n = 1904; 167 kcal [95% CI = 164-170]). Seventy nine % of supermarket snacks exceeded energy recommendations for children and 32% for adults. In coffee shops, 91% exceeded recommendations for children and 73% for adults. Forty one % of snacks were high in fat, 42% were high in saturated fat, 39% were high in sugar and 7% were high in salt. Cheaper snack products were more likely to be of lower nutritional quality. CONCLUSIONS: The high proportion of snack products that do not meet public health recommendations for energy content may contribute to the association between snacking and increased energy intake. Public health measures to increase the availability and reduce the price of snack products that meet public health energy content recommendations may reduce population-level obesity.

Food waste concerns, eating behaviour and body weight.

Consumer food waste is now a significant social issue. However, given that the modern day food environment has become characterised by larger portion sizes of more energy-dense foods, personal concerns about wasting food may result in eating behaviours that promote excess energy intake and weight gain. Across 3 studies, we developed a brief (5-item) measure to quantify concerns about food waste and examined the relationships between food waste concerns, eating behaviour and body weight. In Study 1, we showed that our 5-item measure of food waste concerns has acceptable convergent and divergent validity, and test-retest reliability. We also found that concerns about wasting food were predictive of greater behavioural intentions to avoid food waste (e.g. eating leftovers). In Study 2, greater food waste concerns were associated with an increased tendency to plate-clear when eating (self-reported), but not with objectively measured body weight or likelihood of having overweight or obesity. In Study 3, we examined how much food participants consumed when served a large portion size of a lunchtime meal and found that food waste concerns did not directly or indirectly predict how much participants ate. Overall, we found evidence that concerns about food waste are related to self-reported intentions to minimize food waste and plate-clearing tendencies, but no evidence that food waste concerns are related to objectively measured energy intake in the laboratory or body weight.

Plate-clearing tendencies and portion size are independently associated with main meal food intake in women: A laboratory study.

BACKGROUND: Larger portion sizes of food promote increased food intake, although the mechanisms explaining the portion size effect are unclear. In the present study we examined whether the tendency to clear one's plate when eating is associated with greater food intake in response to larger portion size. METHOD: We recruited female participants who were either self-reported habitual plate clearers (N = 48) or non-plate clearers (N = 41) into a laboratory study. In a between-subjects design, participants were served either a 'normal' (500 g) or 'large' (1000 g) portion of pasta for lunch and ate as much as they desired. RESULTS: There was no significant interaction found between portion size and plate-clearing tendencies; portion size had a similar sized effect on food intake in both plate clearers and non-plate clearers. A significant main effect of portion size was found, whereby participants consumed significantly more when served the large versus the normal portion (100.55 g difference, p < .001, ηp2  = 0.16). There was also a significant main effect of plate clearing; participants with a tendency to clear their plate when eating consumed significantly more than non-plate clearers (68.21 g difference, p = .006, ηp2  = 0.08). CONCLUSIONS: The tendency to clear one's plate when eating was associated with increased food intake during a lunchtime meal. Increasing the portion size of the lunchtime meal increased food intake, although the tendency for a larger portion size to increase food intake was observed irrespective of participant plate-clearing tendencies.

Dishware size and snack food intake in a between-subjects laboratory experiment.

OBJECTIVE: The use of smaller dishware as a way of reducing food consumption has intuitive appeal and is recommended to the general public. Recent experimental studies have failed to find an effect of plate size on food intake, although the methods used across studies have varied. The aim of the present study was to examine the effect that bowl size had on snack food consumption in a 'typical' snacking context (snacking while watching television). DESIGN: Between-subjects. SETTING: Laboratory experiment. SUBJECTS: Sixty-one adult participants served themselves and ate popcorn while watching television. Participants were randomly assigned to serve themselves with and eat from either a small or a large bowl. RESULTS: The use of a smaller bowl size did not reduce food consumption. Unexpectedly, participants in the small bowl condition tended to consume more popcorn (34·0 g) than participants in the large bowl condition (24·9 g; 37 % increase, d=0·5), although the statistical significance of this difference depended on whether analyses were adjusted to account for participant characteristics (e.g. gender) associated with food intake (P=0·02) or not (P=0·07). CONCLUSIONS: Counter to widely held belief, the use of a smaller bowl did not reduce snack food intake. Public health recommendations advising the use of smaller dishware to reduce food consumption are premature, as this strategy may not be effective.

Potential impact of alcohol calorie labelling on the attitudes and drinking behaviour of hazardous and low-risk drinkers in England: a national survey.

OBJECTIVES: We investigated the hypothetical impact of mandatory alcohol calorie labelling, comparing non-drinkers, low-risk and hazardous drinkers in terms of attitudes, knowledge about calorie content and hypothetical behaviour changes should labelling be introduced. DESIGN: Cross-sectional national telephone survey. SETTING: Community-dwelling adults in England between November 2022 and January 2023. PARTICIPANTS: Data were collected from 4683 adults >18 years, of whom 24.7% were non-drinkers; 77.6% of alcohol drinkers were categorised as low-risk and 22.4% as hazardous drinkers according to the Alcohol Use Disorders Identification Test questionnaire. PRIMARY OUTCOME MEASURES: Attitudes to alcohol calorie labelling in shops and supermarkets and in hospitality venues, knowledge of the calorie content of alcoholic beverages (beer, wine, cider and spirits) and changes in drinking practices if calorie labelling was introduced. RESULTS: Comparisons were made between non-drinkers, low-risk drinkers and hazardous drinkers, with analyses adjusted for age, gender, ethnicity, socioeconomic status and education. Attitudes to calorie labelling were generally positive, but were less favourable among alcohol drinkers than non-drinkers. Hazardous drinkers were more accurate in their estimations of the calorie content of wine, cider and spirits than non-drinkers (p<0.0001). Overall, 46.4% of drinkers indicated that they would change their drinking patterns if calorie labelling was introduced, and this response was more common among hazardous than low-risk drinkers (OR=1.43, 95% CI 1.199 to 1.699), adjusting for age, gender, ethnicity, socioeconomic status and education. Compared with low-risk drinkers, hazardous drinkers stated that they would be more likely to drink fewer alcoholic beverages, to drink alcohol less often, to choose lower calorie drinks and to do more exercise (adjusted OR 1.27, 1.009 to 1.606). CONCLUSIONS: A sizeable proportion of hazardous drinkers indicated that they would change their consumption practices if mandatory calorie labelling was introduced. Promoting more positive attitudes to calorie labelling might lead to stronger intentions to reduce consumption. Mandatory calorie labelling of alcoholic beverages may make a modest contribution to energy intake and the maintenance of health weight, particularly among heavier drinkers.

Evaluating the Onset, Severity, and Recovery of Changes to Smell and Taste Associated With COVID-19 Infection in a Singaporean Population (the COVOSMIA-19 Trial): Protocol for a Prospective Case-Control Study.

BACKGROUND: Sudden loss of smell and/or taste has been suggested to be an early marker of COVID-19 infection, with most findings based on self-reporting of sensory changes at a single time point. OBJECTIVE: To understand the onset, severity, and recovery of sensory changes associated with COVID-19 infection, this study will longitudinally track changes in chemosensory acuity among people with suspected COVID-19 infection using standardized test stimuli that are self-administered over 28 days. METHODS: In a prospective, case-controlled observational study, volunteers will be recruited when they present for COVID-19 screening by respiratory tract polymerase chain reaction test ("swab test"). The volunteers will initially complete a series of questionnaires to record their recent changes in smell and taste ability, followed by a brief standardized smell and taste test. Participants will receive a home-use smell and taste test kit to prospectively complete daily self-assessments of their smell and taste acuity at their place of residence for up to 4 weeks, with all data submitted for collection through web-based software. RESULTS: This study has been approved by the Domain Specific Review Board of the National Healthcare Group, Singapore, and is funded by the Biomedical Research Council Singapore COVID-19 Research Fund. Recruitment began on July 23, 2020, and will continue through to March 31, 2021. As of October 2, 2020, 69 participants had been recruited. CONCLUSIONS: To our knowledge, this study will be the first to collect longitudinal data on changes to smell and taste sensitivity related to clinically diagnosed COVID-19 infection, confirmed by PCR swab test, in a population-based cohort. The findings will provide temporal insights on the onset, severity, and recovery of sensory changes with COVID-19 infection, the consistency of symptoms, and the frequency of full smell recovery among patients with COVID-19. This self-administered and cost-effective approach has many advantages over self-report questionnaire-based methods and provides a more objective measure of smell and taste changes associated with COVID-19 infection; this will encourage otherwise asymptomatic individuals who are potential spreaders of the virus to self-isolate and seek formal medical diagnosis if they experience a sudden change in sensory acuity. This broadened case finding can potentially help control the COVID-19 pandemic and reduce the emergence of clusters of infections. TRIAL REGISTRATION: ClinicalTrials.gov NCT04492904; https://clinicaltrials.gov/ct2/show/NCT04492904. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24797.

A bit or a lot on the side? Observational study of the energy content of starters, sides and desserts in major UK restaurant chains.

OBJECTIVES: Our objective was to examine the kilocalorie (kcal) content of starters, sides and desserts served in major UK restaurant chains, comparing the kcal content of these dishes in fast-food and full-service restaurants. DESIGN: Observational study. SETTING: Menu and nutritional information provided online by major UK restaurant chains. METHOD: During October to November 2018, we accessed websites of restaurant chains with 50 or more outlets in the UK. Menu items that constituted starters, sides or desserts were identified and their kcal content was extracted. Accompanying beverages were not included. We used multilevel modelling to examine whether mean kcal content of dishes differed in fast-food versus full-service restaurants. MAIN OUTCOME MEASURES: The mean kcal content of dishes and the proportion of dishes exceeding public health recommendations for energy content in a main meal (>600 kcal). RESULTS: A total of 1009 dishes (212 starters, 318 sides and 479 desserts) from 27 restaurant chains (21 full-service, 6 fast-food) were included. The mean kcal content of eligible dishes was 488.0 (SE=15.6) for starters, 397.5 (SE=14.9) for sides and 430.6 (SE=11.5) for desserts. The percentage of dishes exceeding 600 kcal was 26.4% for starters, 21.7% for sides and 20.5% for desserts. Compared with fast-food chains, desserts offered at full-service restaurants were on average more calorific and were significantly more likely to exceed 600 kcal. CONCLUSIONS: The average energy content of sides, starters and desserts sold in major UK restaurants is high. One in four starters and one in five sides and desserts in UK chain restaurants exceed the recommended energy intake for an entire meal.