OBJECTIVE: To evaluate the effects of the specially designed nudging tableware, including a plate and bowl, on individual food choices in normal-weight young adults and preliminarily explore its mechanisms. We hypothesized that the toolset could increase the choice of vegetables and decrease that of rice.
METHODS: A randomized, single-blind, two-period crossover trial was carried out among 40 normal-weight university students in China. All subjects completed two buffets separated by an interval of one week, wearing the eye tracker. Vegetable choice, evaluated through the proportion of vegetables, was the primary outcome, and the weight of vegetables and rice were the secondary outcomes. The mechanisms of the decision-making process were preliminarily explored through eye tracking.
RESULTS: The usage of the nudging tableware significantly increased the proportion of vegetables and decreased the amount of rice taken (P<0.05), while insignificantly increased the weight of vegetables (P = 0.079). Eye tracking shows that the nudging plate significantly prolonged the food-choosing process and fixation duration on vegetables (P<0.05), and the latter was positively correlated to the increased quantity of vegetables while using the nudging plate (r = 0.493, P<0.01).
CONCLUSIONS: The specially designed nudging tableware might be an effective and practical tool to promote the choice of less rice and more vegetables. Mechanisms behind this change might include automatic and unconscious processes with the inconspicuously smaller capacity of the bowl and larger portion size of the vegetable segment, and increased attention triggered by the vegetable patterns and larger green underpainting.

Previous research has shown that being observed can influence people\'s behaviors, including their eating habits. In this study, we predicted that men and women would exhibit different reactions to the perception of portion size of meat when being observed. By utilizing a camera to create a sense of being observed during the act of eating meat, we revealed that men in the observed condition reported perceiving the portion size of the meat they ate to be smaller and the eating amount to be less than was reported by those in the non-observed condition. However, women did not show any differences in their perceptions of the portion size of the meat they ate. These findings demonstrate that gender identity plays a role in how people perceive the meat they eat when they are aware of being observed. The discussion highlights the effect of being observed on meat consumption and illustrates the influence of masculine identity.

Evidence confirms that parents know that they should limit non-core foods for their children since these tend to be high in energy density (HED), fat, salt and sugar. However, it is unclear how knowledge of portion size limits, such as the 100 kcal guide from Public Health England are applied in practice. To observe in real-time children\'s home food environment related to portion control and to explore with parents their reported portion size strategies, a mixed methods study was designed. Families with children aged 1-5 years were recruited (n = 21) to a three-part study: (1) to complete questionnaires and interviews on household food intake and portion control; (2) to report daily food intake for 4 days (n = 13) for one parent and their child(ren); (3) to observe home-based food provisioning via videorecording during dinner, breakfast and snack time (n = 6). Although the problem of large portion sizes of HED foods was recognised by mothers, strategies to downsize portions were not necessarily applied at home, as revealed in home observations and diaries. A mismatch between what was observed at home, what was reported in food diaries and what was said in interviews became apparent for some families. Mothers reported the need for greater support and guidance to downsize HED foods since they relied on pre-packaging as a guide to intake. Education and engagement were identified as important parameters for downsizing by mothers. One strategy which could be explored and applied by manufacturers is packaging design to faciliate the 100 kcal guidance using physical and engaging ways to assist parents in downsizing HED foods for their children. To facilitate effective government communication, innovative packaging design can be used to convey clear guidance and to tailor portion size messages for children. Packaging design, alongside government recommendations, can support parents\' goals to achieve healthy eating and can reinforce guidance for portion norms through innovation involving learning, playful engagement, and interaction.

Accurate estimation of food portion sizes remains an important challenge in dietary data collection. The present study aimed to develop a food atlas with adequate visual reference to improve the accuracy of dietary surveys in China.
A food atlas for dietary surveys in China was developed using three visual reference systems, namely, regularly placed food portions, the two-dimensional background coordinates and common objects known in daily life. The atlas was validated by estimating a meal before and after using the food atlas, and differences in weight estimation were compared using a paired t-test. In total, 50 college students participated in the study.
After determination of food varieties; design of the food display; purchase, processing, cooking and weighing of food; photographing food; post-image processing and data processing, a total of 799 pictures of 303 types of food and two types of tableware were produced. The mean value of food weight estimated with the atlas was closer to the actual weight, and the variation range of these values was smaller and more stable than that estimated without the atlas. The differences estimated before and after using the atlas for all foods were significant (P < 0.05). Comparing the differences in weight before using the atlas, the error ranges of food samples were reduced.
A food atlas has been developed for a retrospective dietary survey in China, which can be used to enable a better understanding of nutritional adequacy in the Chinese population.

This study aimed to develop a Chinese Healthy Eating Index for School-age Children (CHEI-SC), apply it in the 2011 China Health and Nutrition Survey (CHNS) to assess dietary quality, and compared it with our former developed index named CHEI. Data of 3-day 24-hour diet recalls and household food inventory survey from 1600 school-age children in CHNS-2011 were used to develop the CHEI-SC, using the methods of standard portion size, energy-density-based approach, and least restrictive approach. The CHEI-SC included 19 components with a total score (T-score) ranging from 0 to 100. The investigated children had a median score of 49.6. Children with a higher T-score were more likely to have higher social economic status (SES), higher level of urbanisation, fewer family size, and regularly attending school. The CHEI-SC was able to assess dietary quality of Chinese school-age children, was sensitive to demographics, and more comprehensive and accurate than the CHEI.

This paper reports a detailed epidemiological investigation of a large Haff disease outbreak in Nanjing, China, including laboratory analysis of water, river sediment, and fish.
Structured questionnaires were administered to all case-patients. An unmatched case-control study was conducted to identify the factors affecting the incidence of Haff disease. Thirteen samples of crayfish, together with four samples of water and four samples of sediment were collected and sent for laboratory analysis.
The disease onset of 494 patients occurred between 2 am on 30 June 2016 and 3 am on 29 August 2016. The median incubation time for onset of symptoms after crayfish ingestion was 7.1 hours (range: 1-20 hours). All patients presented with or developed local or diffuse myalgia. However, no kidney injury was observed. Serum creatinine kinase was elevated in all patients (mean: 4614 U/L, median: 2000 U/L, range: 81-55200 U/L). The average number of crayfish consumed by patients on the day of illness was 20 (2-80). The case-control study revealed that eating a large quantity of crayfish, drinking alcohol, and eating the crayfish head and/or intestines were associated with an increased risk of disease. Chemical analysis of crayfish, river water and sediment did not identify known or novel toxins including anticoccidiosis drugs, niclosamide, organophosphorus pesticides, and microcystins.
An outbreak of Haff Disease was associated with consumption of crayfish from the Yangtze River and its surrounding water system. Eating a large quantity of crayfish, eating the head and/or intestines, and consuming alcohol with the crayfish were associated with the development of Haff Disease.

The consumption of carbonated sugar-sweetened beverages (CSSBs) is associated with a range of health problems, but little is known about the sugar and energy content of CSSBs in China. The study aimed to investigate the sugar and energy content of CSSBs in Beijing, China.
We carried out a cross-sectional survey in 15 different supermarkets from July to October 2017 in Haidian District, Beijing.
The product packaging and nutrient labels of CSSBs were recorded by a snapshot in time to obtain company name, product name, serving size, and nutrient content, that is, carbohydrate, sugar and energy. For CSSB labels not showing sugar content, we used carbohydrate content as substitute. The sugar and energy content of CSSBs within each type of flavour were compared using Kruskal-Wallis test. The sugar content within the recommended levels was described using frequency. We also compared the sugar and energy content of top 5 CSSBs in terms of sales among three countries (China, UK and USA).
A total of 93 CSSB products were found. The median sugar content was 9.3 (IQR: 5.7-11.2) g/100 mL, and the energy content was 38 (IQR: 23-46) kcal/100 mL. There were 79 products labelled \'Red\' (high) per serving based on the criteria set in the UK (>11.25 g/100 mL). We found 62.4% of CSSBs had sugar content per serving that exceeds the daily free sugar intake for adults (25 g) recommended by the WHO. Some of the branded products sold in China had higher sugar content when they were compared with those in Western countries.
CSSBs in Beijing, China have high sugar and energy content. Reduction in sugar content and serving size of CSSBs and taxation policy on beverages will be beneficial in reducing sugar intake in China.

Current approaches to food volume estimation require the person to carry a fiducial marker (e.g. a checkerboard card), to be placed next to the food before taking a picture. This procedure is inconvenient and post-processing of the food picture is time-consuming and sometimes inaccurate. These problems keep people from using the smartphone for self-administered dietary assessment. The current bioengineering study presents a novel smartphone-based imaging approach to table-side estimation of food volume which overcomes current limitations.
We present a new method for food volume estimation without a fiducial marker. Our mathematical model indicates that, using a special picture-taking strategy, the smartphone-based imaging system can be calibrated adequately if the physical length of the smartphone and the output of the motion sensor within the device are known. We also present and test a new virtual reality method for food volume estimation using the International Food Unit™ and a training process for error control.
Our pilot study, with sixty-nine participants and fifteen foods, indicates that the fiducial-marker-free approach is valid and that the training improves estimation accuracy significantly (P0·05).
Elimination of a fiducial marker and application of virtual reality, the International Food Unit™ and an automated training allowed quick food volume estimation and control of the estimation error. The estimated volume could be used to search a nutrient database and determine energy and nutrients in the diet.

The objective of this study was to develop a Chinese Healthy Eating Index (CHEI) based on the updated Dietary Guidelines for Chinese (DGC-2016) and to apply it in the 2011 China Health and Nutrition Survey (CHNS-2011) to assess diet quality and its association with typical sociodemographic/economic factors. Data from 14,584 participants (≥2 years) from the CHNS-2011, including three 24-h dietary recalls and additional variables, were used to develop the CHEI. The standard portion size was applied to quantify food consumption. The CHEI was designed as a continuous scoring system, comprising 17 components; the maximum total score is 100. The mean, 1st and 99th percentiles of the CHEI score were 52.4, 27.6 and 78.3, respectively. Young and middle-aged adults scored better than the elderly. Diet insufficiency was chiefly manifested in fruits, dairy, whole grains and poultry; diet excess was mainly reflected in red meat, cooking oils and sodium. The CHEI was positively associated with education and urbanization levels; current smokers and unmarried people obtained relative low CHEI scores. Occupation and body mass index (BMI) were also related to the CHEI. Our findings indicate that the CHEI is capable of recognizing differences in diet quality among the Chinese, and it is sensitive to typical sociodemographic/economic factors.

Previous research has suggested that manipulations of plate size can have a direct impact on perception of food intake, measured by estimated fullness and intake. The present study, involving 570 individuals across Canada, China, Korea, and New Zealand, is the first empirical study to investigate cultural influences on perception of food portion as a function of plate size. The respondents viewed photographs of ten culturally diverse dishes presented on large (27 cm) and small (23 cm) plates, and then rated their estimated usual intake and expected fullness after consuming the dish, using 100-point visual analog scales. The data were analysed with a mixed-model ANCOVA controlling for individual BMI, liking and familiarity of the presented food. The results showed clear cultural differences: (1) manipulations of the plate size had no effect on the expected fullness or the estimated intake of the Chinese and Korean respondents, as opposed to significant effects in Canadians and New Zealanders (p < 0.05); (2) Canadian (88.91 ± 0.42) and New Zealanders (90.37 ± 0.41) reported significantly higher estimated intake ratings than Chinese (80.80 ± 0.38) or Korean (81.69 ± 0.44; p < 0.05), notwithstanding the estimated fullness ratings from the Western respondents were comparable or even higher than those from the Asian respondents. Overall, these findings, from a cultural perspective, support the notion that estimation of fullness and intake are learned through dining experiences, and highlight the importance of considering eating environments and contexts when assessing individual behaviours relating to food intake.