Impact on sales of adding a smaller serving size of beer and cider in licensed premises: an A-B-A reversal design.

BACKGROUND: Smaller serving sizes of alcoholic drinks could reduce alcohol consumption across populations thereby lowering the risk of many diseases. The effect of modifying the available range of serving sizes of beer and cider in a real-world setting has yet to be studied. The current study assessed the impact on beer and cider sales of adding a serving size of draught beer and cider (2/3 pint) that was between the current smallest (1/2 pint) and largest (1 pint) standard serving sizes. METHODS: Twenty-two licensed premises in England consented to taking part in the study. The study used an ABA reversal design, set over three 4-weekly periods, with A representing the non-intervention periods, during which standard serving sizes were served and B the intervention period when a 2/3 pint serving size of draught beer and cider was added to the existing range, along with smaller 1/2 pint and larger 1 pint serving sizes. The primary outcome was the daily volume of beer and cider sold, extracted from sales data. RESULTS: Fourteen premises started the study, of which thirteen completed it. Twelve of those did so per protocol and were included in the primary analysis. After adjusting for pre-specified covariates, the intervention did not have a significant effect on the volume of beer and cider sold per day (3.14 ml; 95%CIs -2.29 to 8.58; p = 0.257). CONCLUSIONS: In licensed premises, there was no evidence that adding a smaller serving size for draught beer and cider (2/3 pint) when the smallest (1/2 pint) and largest (1 pint) sizes were still available, affected the volume of beer and cider sold. Studies are warranted to assess the impact of removing the largest serving size. TRIAL REGISTRATION: ISRCTN: https://doi.org/10.1186/ISRCTN33169631 (08/09/2021), OSF: https://osf.io/xkgdb/ (08/09/2021).

Structuring of a proposal for the nursing process theoretical and methodological basis: professors' motivations / Estructuración de una propuesta para las bases teóricas y metodológicas del proceso de enfermería: motivaciones docentes / Estruturação de uma proposta para o embasamento teórico metodológico do processo de enfermagem: motivações docentes

ABSTRACT Objective: to describe the motivations that mobilize professors-nurses in the construction of a proposal for the theoretical and methodological basis for the Nursing Process teaching. Method: a Convergent Assistential research, conducted with professors-nurses. Six convergence groups were developed, with triggering questions on the theme. The reports were audio-recorded, validated by the participants and analyzed in the light of the Convergent Assistance Research. Results: there are three thematic approaches: professors' perception of the nurses' professional practices; dissatisfaction with the current health model; and dissatisfaction with the current teaching model. The thematic approaches reveal the motivation to overcome biomedical/cartesian practices in teaching and nursing care, which converges to the development of a proposal with a philosophical, theoretical and methodological framework for the Nursing Process teaching, aligned with the assumptions of the Unified Health System and consistent with health expanded clinic. Conclusion: this study allowed for the expression of concerns and discomforts with the current model of education and health, triggering reflections on the paradigm that guides the field of health teaching and dominates our life in society. The results reveal what is desired in the health scenario, as educating individuals and society, enhancing the perspective of social changes in the health sector, acclaimed and desired politically and socially, basing the development of philosophical, theoretical and methodological proposals for nursing care, consistent with society's current demands.

RESUMEN Objetivo: describir las motivaciones que impulsan a los enfermeros profesores a elaborar una propuesta para definir las bases teórica y metodológica para la enseñanza del Proceso de Enfermería. Método: investigación Convergente Asistencial, realizada con profesores enfermeros. Se desarrollaron seis grupos de convergencia con preguntas desencadenantes sobre la temática. Los relatos se grabaron en audio, fueron validados por los participantes y analizados bajo la óptica de la Investigación Convergente Asistencial. Resultados: surgen tres enfoques temáticos: prácticas profesionales de los enfermeros en la percepción de los profesores; la insatisfacción con el modelo de salud vigente; y la insatisfacción con el modelo de enseñanza vigente. Los enfoques temáticos revelan la motivación para superar prácticas biomédicas/cartesianas en la enseñanza y en la atención de enfermería, lo que converge para desarrollar una propuesta de referencial filosófico, teórico y metodológico para la enseñanza del Proceso de Enfermería, alineado con las presunciones del Sistema Único de Salud y en coincidencia con una clínica ampliada en salud. Conclusión: este estudio permitió expresar inquietudes y malestares con el modelo vigente de enseñanza y de salud, iniciando reflexiones sobre el paradigma que orienta al campo de la enseñanza en salud y rige nuestra vida en sociedad. Los resultados revelan lo que se desea en el ámbito de la salud, como individuos formadores y sociedad, potenciando la perspectiva de cambios sociales en el sector de la salud, aclamados y deseados tanto política como socialmente, y sirviendo como base para desarrollar propuestas filosóficas, teóricas y metodológicas para el cuidado de enfermería, en coincidencia con las demandas actuales de la sociedad.

RESUMO Objetivo: descrever as motivações que mobilizam enfermeiros professores na construção de uma proposta para o embasamento teórico e metodológico para o ensino do Processo de Enfermagem. Método: pesquisa Convergente Assistencial, com professores enfermeiros. Desenvolveram-se seis grupos de convergência com questões deflagradoras sobre a temática. Os relatos foram audiogravados, validados pelos participantes e analisados à luz da Pesquisa Convergente Assistencial. Resultados: surgem três enfoques temáticos: práticas profissionais dos enfermeiros na percepção dos professores; a insatisfação com o modelo de saúde vigente; e a insatisfação com o modelo de ensino vigente. Os enfoques temáticos revelam a motivação para superar práticas biomédicas/cartesianas no ensino e na assistência de enfermagem, o que converge para o desenvolvimento de uma proposta de referencial filosófico, teórico e metodológico para o ensino do Processo de Enfermagem, alinhado com os pressupostos do Sistema Único de Saúde e condizente com uma clínica ampliada em saúde. Conclusão: este estudo permitiu a expressão de inquietações e desconfortos com o modelo vigente de ensino e de saúde, disparando reflexões sobre o paradigma que orienta o campo do ensino na saúde e domina a nossa vida em sociedade. Os resultados revelam o que se almeja no cenário da saúde, como indivíduos formadores e sociedade, potencializando a perspectiva de mudanças sociais no setor da saúde, aclamadas e desejadas política e socialmente, alicerçando o desenvolvimento de propostas filosóficas, teóricas e metodológicas para o cuidado em enfermagem, condizentes com as demandas atuais da sociedade.

Consumption of Meat and Dairy Products Is Not Associated with the Risk for Rheumatoid Arthritis among Women: A Population-Based Cohort Study.

Diet has gained attention as a risk factor for the development of rheumatoid arthritis (RA), especially with regards to food of animal origin, such as meat and dairy products. By using data from national patient registers and dietary data from a large prospective population cohort, the Swedish Mammography Cohort, we aimed to investigate whether the consumption of meat and dairy products had any impact on the risk of subsequent development of RA. During 12 years of follow-up (January 2003-December 2014; 381, 456 person-years), 368 patients with a new diagnosis of RA were identified. No associations between the development of RA and the consumption of meat and meat products (hazard ratio [HR] for the fully adjusted model: 1.08 [95% CI: 0.77-1.53]) or the total consumption of milk and dairy products (HR for the fully adjusted model: 1.09 [95% CI: 0.76-1.55]) were observed. In conclusion, in this large prospective cohort of women, no associations were observed between dietary intake of meat and dairy products and the risk of RA development.

Commercially produced complementary foods in Bandung City, Indonesia, are often reported to be iron fortified but with less than recommended amounts or suboptimal forms of iron.

Commercially produced complementary foods (CPCF) that are iron fortified can help improve iron status of young children. We conducted a review of 217 CPCF sold in 42 stores in Bandung, Indonesia, in 2017. There were 95 (44%) infant cereals, 71 (33%) snacks or finger foods (biscuits or cookies, puffs, and noodles or crackers), 35 (16%) purees, and 16 (7%) other foods for which we obtained label information. Nearly 70% of CPCF reported iron content on their labels, but only 58% of products were reported to be fortified with iron according to ingredient lists. Among iron-fortified products, only one fifth indicated a specific type of iron used as the fortificant, but all of these were recommended by the World Health Organization for fortifying complementary foods. Infant cereal was more likely to contain added iron (81%) compared with snacks or finger food (58%) and purees (14%) and had higher iron content per median serving size (cereal = 3.8 mg, snacks or finger food = 1.3 mg, mixed meals = 2.7 mg, and purees = 0.9 mg). Infant cereal was most likely to meet the recommended daily intakes for iron (41% for infants 6-12 months of age and 66% for children 12-36 months) compared with snacks or finger food (infants = 14%, children = 22%), mixed meals (infants = 28%, children = 46%), or purees (infants = 9%, children = 15%). Regulations on fortification of complementary foods need to specify minimum levels and forms of iron and require reporting in relation to requirements by child age and serving size. Monitoring and enforcement of regulations will be essential to ensure compliance.

Nutrient and Mineral Profile of Chosen Fresh and Smoked Fish.

In the present study, were determined the basic nutrients (dry matter, crude ash, crude protein, ether extract, and energy) and mineral elements content in chosen species of raw and smoked freshwater and sea fish. The content of dry matter, and basic nutrients and Na+, K+, Ca+2, Mg+2, P+2, Zn+2, and Cu+2 in the fish samples was determined. The dietary intake of several macro- and microconstituents per one serving (150 g fresh or smoked fish) was calculated. The fresh fish contained on average 220.2 to 283.7 g·kg-1 of dry matter, 12.4 to 10.7 g·kg-1 of crude ash, 176.2 to 173.5 g·kg-1 of crude protein, 32.6 to 78.6 g·kg-1 of ether extract, and 104.6 to 119.1 kcal (freshwater and sea fish, respectively). Thermal treatment reduces the water and fat content in fish meat. Reduction of the K, Ca, Mg, P, Zn, and Cu levels was observed most frequently. The one serving of fish covers approximately 23% and 12% of the recommended dietary amount of K, 7.5-5.0% of Ca, ~12% of Mg, 6.8 to 12.5% of Zn, and about covered 6.7% of Cu. The smoking process increased the concentration of some basic nutrients and reduced the fat and mineral content. Whitefish, trout, halibut, mackerel, and herring had the highest levels of the analyzed minerals.

Mediterranean Diet Pyramid: A Proposal for Italian People. A Systematic Review of Prospective Studies to Derive Serving Sizes.

In the last decade, a number of meta-analyses of mostly observational studies evaluated the relation between the intake of food groups and the risk of noncommunicable diseases (NCDs). In this study, we systematically reviewed dose-response meta-analyses of prospective studies with the aim to derive the quantities of food to consume to attain a protective (Mediterranean food) or a non-adverse (non-Mediterranean food) effect toward selected NCDs such as cardiovascular disease (CVD) including coronary heart disease (CHD) and stroke, type 2 diabetes (T2DM), colorectal (CRC) and breast cancer. These derived quantities, wherever possible, were suggested for a quantification of food servings of the Mediterranean Diet Pyramid proposed for Italian People (MDPPI). This pyramid came from the Modern Mediterranean Diet Pyramid developed in 2009 for Italian people. A weekly menu plan was built on the advice about frequency of intakes and serving sizes of such pyramid and the nutritional composition of this diet was compared with the Reference Italian Mediterranean Diet followed in 1960 in Nicotera. The diet built according the advice of MDPPI was very similar to that of Nicotera in the late 1950s that has been chosen as Italian Reference Mediterranean Diet with the exception of percentage of energy provided by cereals that was lower and of fruits and vegetables that was higher. Saturated fatty acids were only the 6% of daily energy intake. Also the Mediterranean Adequacy Index (MAI) was very similar to that of the aforementioned diet.

Use of Nutrition Information and Understanding of "Percent Daily Value" on Nutrition Facts Tables: Evaluating the Impact of a National Public Education Campaign among Youth and Young Adults in Canada.

Purpose: In 2010, Health Canada implemented a national campaign to improve understanding of "percent daily value" (%DV) in Nutrition Facts Tables (NFTs). This study examined sources of nutrition information and knowledge of %DV information communicated in the campaign. Methods: Respondents aged 16-30 years completed the Canada Food Study in 2016 (n = 2665). Measures included sources of nutrition information, NFT use, and %DV knowledge based on the campaign message ("5% DV or less is a little; 15% DV or more is a lot"). A logistic regression examined correlates of providing "correct" responses to %DV questions related to the campaign messaging. Results: Overall, 7.2% (n = 191) respondents correctly indicated that 5% is "a little", and 4.3% (n = 115) correctly indicated 15% DV was "a lot". Only 4.0% (n = 107) correctly answered both. Correct recall of %DV amounts was not associated with number of information sources reported, but was greater among those who were female, were younger, and reported greater NFT understanding and serving size information use (P < 0.05 for all). Conclusions: Results show low awareness of messaging from the Nutrition Facts Education Campaign among young Canadians. Such a mass media campaign may be insufficient on its own to enhance population-level understanding of %DV.

Validation of a short questionnaire to record adherence to the Mediterranean diet: An Italian experience.

BACKGROUND AND AIMS: A greater adherence to the Mediterranean diet has been associated with a reduced risk of major chronic diseases and cancer. The aim of the study was to assess the validity of a new short self-administered 15-item questionnaire (QueMD) to measure adherence to the Mediterranean diet in Italy. METHODS AND RESULTS: Four-hundred and eighty three participants to cancer-screening programmes at the European Institute of Oncology, Milan (Italy) were invited to join this study. Those interested compiled the QueMD and a validated Food Frequency Questionnaire (FFQ) reporting their usual food consumption during the previous six months. We derived the alternate Mediterranean score (aMED) from both questionnaires with values ranging from 0 (minimal adherence) to 9 (maximal adherence). Complete dietary data were available for 343 individuals (participation rates 71.0%). Spearman correlation coefficient between the responses to the 15 questions of the QueMD and corresponding food intake derived from the FFQ ranged from 0.15 to 0.84. A moderate correlation was found between the aMED scores calculated from the QueMD and the FFQ (intraclass correlation coefficient 0.50; 95% CI, 0.42-0.58), while agreement between the two instruments was only poor to fair for 7 of the 9 single items composing the aMED score, with values ranging from 53.0% for wholegrain products to 79.5% for fruits. CONCLUSION: This new self-administered 15-item questionnaire could be a useful tool to assess adherence to the Mediterranean diet in the Italian population.

An overture to overeating: The cross-modal effects of acoustic pitch on food preferences and serving behavior.

Billions of dollars are spent annually with the aim of enticing consumers to purchase food. Yet despite the prevalence of such advertising, little is known about how the actual sensation of this advertising media affects consumer behavior, including consequential choices regarding food. This paper explores the effect of acoustic pitch in food advertising, demonstrating in two studies, including a field study in a live retail environment, how the perception of pitch in advertising can impact food desirability and decisions regarding serving size. In study 1, a field study, pitch affects actual serving sizes and purchase behavior in a live, self-serve retail setting, with low pitch leading to larger serving sizes. Study 2 demonstrates how low pitch increases desire for a food product among hungry consumers, and that this effect is mediated by perceptions of size and how filling consumers believe the product will be. We discuss these results in the context of cross-modal correspondence and mental imagery.

Prospective Study of Nut Consumption and Incidence of Metabolic Syndrome: Tehran Lipid and Glucose Study.

This study aimed to assess the association of various types of nut per se, and total nut consumption with the incidence of metabolic syndrome (MetS). A 6.2 ± 0.7-year population-based prospective study was conducted among 1265 adults, aged 19-74 years, participants of the Tehran Lipid and Glucose Study. A 168-item semi-quantitative food frequency questionnaire was used to collect information on nut consumption. MetS was defined according to the Joint Interim Statement guidelines and 276 new cases of MetS were identified. Median ± interquartile range of nut consumption was 2.08 (0.88-5.68) servings/week. After adjusting for family history of diabetes, age, gender, smoking, physical activity, fasting serum glucose at baseline, serum high density lipoprotein cholesterol (HDL-C) at baseline, energy intake, fiber, macronutrients, cholesterol intake, fruit, vegetables, dairy products and body mass index (BMI), a statistically significant decrease was observed in MetS in the third (≥5 servings/week) tertile of nuts (odds ratio: 0.68, 95% CI: 0.44-0.91, p trend: 0.03) compared with the lowest (≤1 serving/week). Walnut consumption showed a significant, inverse association with MetS risk; associations for other nut varieties were not significant. For each additional serving/week of walnuts consumed, incidence of MetS decreased by 3% (ORs: 0.97 CI: 0.93-0.99), after adjusting for confounding factors. Total nut consumption, especially walnuts, reduces the risk of MetS.

Age differences in the use of serving size information on food labels: numeracy or attention?

OBJECTIVE: The ability to use serving size information on food labels is important for managing age-related chronic conditions such as diabetes, obesity and cancer. Past research suggests that older adults are at risk for failing to accurately use this portion of the food label due to numeracy skills. However, the extent to which older adults pay attention to serving size information on packages is unclear. We compared the effects of numeracy and attention on age differences in accurate use of serving size information while individuals evaluated product healthfulness. DESIGN: Accuracy and attention were assessed across two tasks in which participants compared nutrition labels of two products to determine which was more healthful if they were to consume the entire package. Participants' eye movements were monitored as a measure of attention while they compared two products presented side-by-side on a computer screen. Numeracy as well as food label habits and nutrition knowledge were assessed using questionnaires. SETTING: Sacramento area, California, USA, 2013-2014. SUBJECTS: Stratified sample of 358 adults, aged 20-78 years. RESULTS: Accuracy declined with age among those older adults who paid less attention to serving size information. Although numeracy, nutrition knowledge and self-reported food label use supported accuracy, these factors did not influence age differences in accuracy. CONCLUSIONS: The data suggest that older adults are less accurate than younger adults in their use of serving size information. Age differences appear to be more related to lack of attention to serving size information than to numeracy skills.

Tablas auxiliares para la formulación y evaluación de regímenes alimentarios / Auxiliary tables for the formulation and evaluation of diets

La segunda edición contiene tres módulos: I. Tabla de valor nutricional de alimentos según unidad de consumo y porcentaje de parte comestible, presenta un total de 1027 datos de medidas caseras de alimentos en peso bruto y neto, porcentaje de parte comestible, información nutricional del peso neto en energía (kcal) y macronutrientes (proteínas, grasas y carbohidratos), fibra dietaria y micronutrientes como vitamina A, vitamina C, calcio, hierro y zinc, de aquellos alimentos considerados de mayor consumo; II. Tabla de factores de conversión de peso de alimentos cocidos a crudos, presenta un total de 228 datos, contiene información de factores de conversión de nueve grupos de alimentos, especificando el tipo de cocción correspondiente; y III. Guía visual de las dimensiones de las unidades de consumo, presenta un total de 557 datos, así como información visual de algunos tipos de peso (bruto y neto), obtenido en diferentes circunstancias, las características de las vajillas, cubiertos, entre otros utilizados como medidas caseras y las dimensiones y alturas obtenidas como promedio en cada uno de los procedimientos a nivel de laboratorio.

Weak Satiety Responsiveness Is a Reliable Trait Associated with Hedonic Risk Factors for Overeating among Women.

Some individuals exhibit a weak satiety response to food and may be susceptible to overconsumption. The current study identified women showing consistently low or high satiety responses to standardised servings of food across four separate days and compared them on behavioural, psychological and physiological risk factors for overeating and future weight gain. In a crossover design, 30 female participants (age: 28.0 ± 10.6; body mass index (BMI): 23.1 ± 3.0) recorded sensations of hunger in the post-prandial period following four graded energy level breakfasts. Satiety quotients were calculated to compare individuals on satiety responsiveness across conditions. Body composition, resting metabolic rate (RMR), energy intake, food reward and craving, and eating behaviour traits were assessed under controlled laboratory conditions. A distinct low satiety phenotype (LSP) was identified with good consistency across separate study days. These individuals had a higher RMR, greater levels of disinhibition and reported feeling lower control over food cravings. Further, they consumed more energy and exhibited greater wanting for high-fat food. The inverse pattern of characteristics was observed in those exhibiting a consistently high satiety phenotype (HSP). Weak satiety responsiveness is a reliable trait identifiable using the satiety quotient. The LSP was characterised by distinct behavioural and psychological characteristics indicating a risk for overeating, compared to HSP.

Paternal dietary folate, B6 and B12 intake, and the risk of childhood brain tumors.

It is biologically plausible that a paternal preconception diet low in nutrients related to DNA integrity could affect sperm DNA and subsequently risk of cancer in the offspring. The aim of this analysis was to investigate whether paternal preconception dietary folate, B6, or B12 intake was associated with the risk of childhood brain tumors (CBT) in an Australian case-control study. Cases <15 years of age were recruited from 10 Australian pediatric oncology centers between 2005 and 2010, and controls from random-digit dialing, frequency-matched to cases on age, sex, and state of residence. Paternal dietary information was obtained by food-frequency questionnaires. Nutrient values were energy adjusted and divided into tertiles for analysis by unconditional logistic regression. In fathers with relevant data (237 cases and 629 controls), no association with dietary folate and B6 and risk of CBT was seen; high B12 intake was associated with an increased risk of CBT (odds ratio highest vs. lowest tertile: 1.74, 95% confidence interval: 1.14, 2.66) without an increasing trend. These results do not support the hypothesis that paternal dietary folate intake influences the risk of CBT. The increased OR observed between dietary B12 intake and risk of CBT is without any certain explanation.

Preventing the pack size effect: exploring the effectiveness of pictorial and non-pictorial serving size recommendations.

People eat more from large than from small packs, which is known as the pack size effect. We hypothesized that providing a serving size recommendation would reduce the influence of the pack size on consumption and would thus diminish the pack size effect. Moreover, we hypothesized that a pictorial serving size recommendation, displaying food amounts visually, would be more effective than a non-pictorial recommendation that communicates the recommended amount in grams only. We tested these hypotheses in two online experiments (N = 317 and N = 324) and in one lab experiment (N = 89). In the online experiments, participants were shown a small or a large pack of unhealthy snacks, with or without a serving size recommendation. The main outcome measure was expected consumption. Replicating the pack size effect in an online setting, we found that participants expected to consume more food from large than from small packs. Furthermore, the pack size effect was considerably stronger for men than for women. Importantly, when including portion size preferences as a covariate, the pictorial serving size recommendation significantly reduced expected consumption, especially when placed on a large pack, as hypothesized. The non-pictorial serving size recommendation had no effect. In the lab experiment, students received a large bag of M&M's which did or did not contain the pictorial serving size recommendation. We again included general portion size preferences as a covariate. The serving size recommendation significantly lowered the amount of M&M's that participants served themselves, but only when participants reported to have noticed the serving size recommendation. We conclude that providing a pictorial serving size recommendation can be an effective intervention strategy to reduce the pack size effect, if it attracts sufficient attention.

Increased exposure to community-based education and 'below the line' social marketing results in increased fruit and vegetable consumption.

OBJECTIVE: To determine if localised programmes that are successful in engaging the community can add value to larger fruit and vegetable mass-media campaigns by evaluating the results of the Eat It To Beat It programme. DESIGN: The Eat It To Beat It programme is a multi-strategy intervention that uses community-based education and 'below the line' social marketing to increase fruit and vegetable consumption in parents. This programme was evaluated by a controlled before-and-after study with repeat cross-sectional data collected via computer-assisted telephone interviews with 1403 parents before the intervention (2008) and 1401 following intervention delivery (2011). SETTING: The intervention area was the Hunter region and the control area was the New England region of New South Wales, Australia. SUBJECTS: Parents of primary school-aged children (Kindergarten to Year 6). RESULTS: The programme achieved improvements in knowledge of recommended intakes for fruit and vegetables and some positive changes in knowledge of serving size for vegetables. Exposure to the programme resulted in a net increase of 0.5 servings of fruit and vegetables daily for those who recalled the programme compared with those who did not (P = 0.004). Increased intake of fruit and vegetables was significantly associated with increasing exposure to programme strategies. CONCLUSIONS: The Eat It To Beat It programme demonstrates that an increase in consumption of fruit and vegetables can be achieved by programmes that build on the successes of larger mass-media and social-marketing campaigns.This suggests that funding for localised, community-based programmes should be increased.