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Is there an association between food portion size and BMI among British adolescents?

  • Salwa A. Albar (a1) (a2), Nisreen A. Alwan (a1), Charlotte E. L. Evans (a1) and Janet E. Cade (a1)


The prevalence of obesity has increased simultaneously with the increase in the consumption of large food portion sizes (FPS). Studies investigating this association among adolescents are limited; fewer have addressed energy-dense foods as a potential risk factor. In the present study, the association between the portion size of the most energy-dense foods and BMI was investigated. A representative sample of 636 British adolescents (11–18 years) was used from the 2008–2011 UK National Diet and Nutrition Survey. FPS were estimated for the most energy-dense foods (those containing above 10·5 kJ/g (2·5 kcal/g)). Regression models with BMI as the outcome variable were adjusted for age, sex and misreporting energy intake (EI). A positive association was observed between total EI and BMI. For each 418 kJ (100 kcal) increase in EI, BMI increased by 0·19 kg/m2 (95 % CI 0·10, 0·28; P< 0·001) for the whole sample. This association remained significant after stratifying the sample by misreporting. The portion sizes of a limited number of high-energy-dense foods (high-fibre breakfast cereals, cream and high-energy soft drinks (carbonated)) were found to be positively associated with a higher BMI among all adolescents after adjusting for misreporting. When eliminating the effect of under-reporting, larger portion sizes of a number of high-energy-dense foods (biscuits, cheese, cream and cakes) were found to be positively associated with BMI among normal reporters. The portion sizes of only high-fibre breakfast cereals and high-energy soft drinks (carbonated) were found to be positively associated with BMI among under-reporters. These findings emphasise the importance of considering under-reporting when analysing adolescents' dietary intake data. Also, there is a need to address adolescents' awareness of portion sizes of energy-dense foods to improve their food choice and future health outcomes.

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* Corresponding author: S. A. Albar, fax +44 113 343 2982, email:;


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1 Health and Social Care Information Centre (Lifestyles Statistics) (2013) Statistics on Obesity, Physical Activity and Diet: England. London: The Health and Social Care Information Centre.
2 Reilly, J (2006) Obesity in childhood and adolescence: evidence based clinical and public health perspectives. Postgrad Med J 82, 429437.
3 Frank, BH (2008) Obesity Epidemiology. New York, NY: Oxford University Press.
4 Cutler, D, Glaeser, E & Shapiro, J (2003) Why Have Americans Become More Obese?. Cambridge, MA: National Bureau of Economic Research.
5 Huang, TTK & McCrory, MA (2005) Dairy intake, obesity, and metabolic health in children and adolescents: knowledge and gaps. Nutr Rev 63, 7180.
6 Rennie, KL, Johnson, L & Jebb, SA (2005) Behavioural determinants of obesity. Best Pract Res Clin Endocrinol Metab 19, 343358.
7 Nicklas, TA, Yang, S-J, Baranowski, T, et al. (2003) Eating patterns and obesity in children: The Bogalusa Heart Study. Am J Prev Med 25, 916.
8 Nielsen, S & Popkin, BM (2003) Patterns and trends in food portion sizes, 1977–1998. JAMA 289, 450453.
9 Steenhuis, IH, Leeuwis, FH & Vermeer, WM (2010) Small, medium, large or supersize: trends in food portion sizes in The Netherlands. Public Health Nutr 13, 852857.
10 Church, S (2008) Trends in Portion Sizes in the UK – A Preliminary Review of Published Information. London: Food Standards Agency.
11 Benson, C (2009) Increasing portion size in Britain. Soc Biol Hum Aff 74, 420.
12 Lioret, S, Volatier, J, Lafay, L, et al. (2007) Is food portion size a risk factor of childhood overweight? Eur J Clin Nutr 63, 382391.
13 Bandini, LG, Vu, D, Must, A, et al. (1999) Comparison of high-calorie, low-nutrient-dense food consumption among obese and non-obese adolescents. Obes Res 7, 438443.
14 Rodríguez, G & Moreno, LA (2006) Is dietary intake able to explain differences in body fatness in children and adolescents? Nutr Metab Cardiovasc Dis 16, 294301.
15 Westerterp-Plantenga, M (2001) Analysis of energy density of food in relation to energy intake regulation in human subjects. Br J Nutr 85, 351361.
16 World Cancer Research Fund (WCRF UK) (2007) Energy density: finding the balance for cancer prevention. (accessed 13 February 2014).
17 Ello-Martin, JA, Ledikwe, JH & Rolls, BJ (2005) The influence of food portion size and energy density on energy intake: implications for weight management. Am J Clin Nutr 82, Suppl. 1, 236S241S.
18 Kral, TVE & Rolls, BJ (2004) Energy density and portion size: their independent and combined effects on energy intake. Physiol Behav 82, 131138.
19 Rolls, BJ, Morris, EL & Roe, LS (2002) Portion size of food affects energy intake in normal-weight and overweight men and women. Am J Clin Nutr 76, 12071213.
20 Ledikwe, JH, Ello-Martin, JA & Rolls, BJ (2005) Portion sizes and the obesity epidemic. J Nutr 135, 905909.
21 Kerr, MA, Rennie, KL, McCaffrey, TA, et al. (2009) Snacking patterns among adolescents: a comparison of type, frequency and portion size between Britain in 1997 and Northern Ireland in 2005. Br J Nutr 101, 122131.
22 Forshee, RA, Anderson, PA & Storey, ML (2008) Sugar-sweetened beverages and body mass index in children and adolescents: a meta-analysis. Am J Clin Nutr 87, 16621671.
23 Gibson, S & Neate, D (2007) Sugar intake, soft drink consumption and body weight among British children: further analysis of National Diet and Nutrition Survey data with adjustment for under-reporting and physical activity. Int J Food Sci Nutr 58, 445460.
24 Wrieden, W, Gregor, A & Barton, K (2008) Have food portion sizes increased in the UK over the last 20 years? Proc Nutr Soc 67, E211.
25 UK Data Service Discover (2012) National Diet and Nutrition Survey, 2008–2011. Funded by the Department of Health (DH) in England and the UK Food Standards Agency (FSA) .
26 Bates, B, Lennox, A & Olson, A, et al. (2012) National Diet and Nutrition Survey: headline results from year 1, 2 and 3 (combined) of the rolling programme (2008/2009–2010/11). (accessed accessed February 2012).
27 Foster, E, Matthews, JN, Lloyd, J, et al. (2008) Children's estimates of food portion size: the development and evaluation of three portion size assessment tools for use with children. Br J Nutr 99, 175184.
28 Foster, E, Adamson, AJ, Anderson, AS, et al. (2009) Estimation of portion size in children's dietary assessment: lessons learnt. Eur J Clin Nutr 63, Suppl. 1, S45S49.
29 Food Standards Agency (2011) Appendix P: main and subsidiary food groups. (accessed 21 January 2012).
30 Food Standards Agency (2002) McCance and Widdowson's The Composition of Food, 6th ed. Cambridge, UK: Royal Society of Chemistry.
31 Wrieden, WL, Longbottom, PJ, Adamson, AJ, et al. (2008) Estimation of typical food portion sizes for children of different ages in Great Britain. Br J Nutr 99, 13441353.
32 Rolls, BJ, Drewnowski, A & Ledikwe, JH (2005) Changing the energy density of the diet as a strategy for weight management. J Am Diet Assoc 105, 98103.
33 Cole, TJ, Freeman, JV & Preece, MA (1995) Body mass index reference curves for the UK, 1990. Arch Dis Child 73, 2529.
34 Schofield, WN (1985) Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr 39, Suppl. 1, 541.
35 Torun, B, Davies, P, Livingstone, M, et al. (1996) Energy requirements and dietary energy recommendations for children and adolescents 1 to 18 years old. Eur J Clin Nutr 50, S37S81.
36 Berkey, CS, Rockett, HR, Field, AE, et al. (2000) Activity, dietary intake, and weight changes in a longitudinal study of preadolescent and adolescent boys and girls. Pediatrics 105, E56.
37 Rangan, AM, Flood, VM & Gill, TP (2011) Misreporting of energy intake in the 2007 Australian Children's Survey: identification, characteristics and impact of misreporters. Nutrients 3, 186199.
38 Hillier, FC (2010) The development and evaluation of a novel online tool for assessing dietary intake and physical activity levels for use in adult populations. PhD Thesis, Durham University.
39 Elliott, S, Truby, H, Lee, A, et al. (2011) Associations of body mass index and waist circumference with: energy intake and percentage energy from macronutrients, in a cohort of Australian children. Nutr J 10, 58.
40 Scientific Advisory Committee on Nutrition (SACN) (2012) Dietary Reference Values for Energy. London: The Stationery Office.
41 Gillis, L, Kennedy, L, Gillis, A, et al. (2002) Relationship between juvenile obesity, dietary energy and fat intake and physical activity. Int J Obes Relat Metab Disord 26, 458463.
42 Maffeis, C, Provera, S, Filippi, L, et al. (2000) Distribution of food intake as a risk factor for childhood obesity. Int J Obes Relat Metab Disord 24, 7580.
43 Magarey, A, Daniels, L, Boulton, T, et al. (2001) Does fat intake predict adiposity in healthy children and adolescents aged 2–15 y? A longitudinal analysis. Eur J Clin Nutr 55, 471481.
44 Alexy, U, Sichert-Hellert, W, Kersting, M, et al. (2004) Pattern of long-term fat intake and BMI during childhood and adolescence – results of the DONALD Study. Int J Obes Relat Metab Disord 28, 12031209.
45 Alexy, U, Sichert-Hellert, W & Kersting, M (2002) Fifteen-year time trends in energy and macronutrient intake in German children and adolescents: results of the DONALD study. Br J Nutr 87, 595604.
46 Young, LR & Nestle, M (2002) The contribution of expanding portion sizes to the US obesity epidemic. Am J Public Health 92, 246249.
47 Loaloraber, H & Nielsen, J (2013) Teenage usability: designing teen-targeted websites. (accessed 14 January 2014).
48 Albertson, AM, Anderson, GH, Crockett, SJ, et al. (2003) Ready-to-eat cereal consumption: its relationship with BMI and nutrient intake of children aged 4 to 12 years. J Am Diet Assoc 103, 16131619.
49 Albertson, A, Goebel, M, Kolberg, L, et al. (2001) Breakfast and ready-to-eat cereal consumption habits of adult women in the US population and the relationship with energy intake and body mass index. Obes Res 9, Suppl. 3, 183S.
50 Livingstone, MBE, Robson, PJ & Wallace, JMW (2004) Issues in dietary intake assessment of children and adolescents. Br J Nutr 92, Suppl. 2, S213S222.
51 Bachman, CM, Baranowski, T & Nicklas, TA (2006) Is there an association between sweetened beverages and adiposity? Nutr Rev 64, 153174.
52 Malik, VS, Schulze, MB & Hu, FB (2006) Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 84, 274288.
53 Pereira, MA (2006) The possible role of sugar-sweetened beverages in obesity etiology: a review of the evidence. Int J Obes 30, S28S36.
54 Harris, JE, Gleason, PM, Sheean, PM, et al. (2009) An introduction to qualitative research for food and nutrition professionals. J Am Diet Assoc 109, 8090.
55 Berkey, CS, Rockett, HR, Field, AE, et al. (2004) Sugar-added beverages and adolescent weight change. Obes Res 12, 778788.
56 Gillis, LJ & Bar-Or, O (2003) Food away from home, sugar-sweetened drink consumption and juvenile obesity. J Am Coll Nutr 22, 539545.
57 Troiano, RP, Briefel, RR, Carroll, MD, et al. (2000) Energy and fat intakes of children and adolescents in the United States: data from the National Health and Nutrition Examination Surveys. Am J Clin Nutr 72, Suppl. 5, 1343S1353S.
58 Mrdjenovic, G & Levitsky, DA (2003) Nutritional and energetic consequences of sweetened drink consumption in 6- to 13-year-old children. J Pediatr 142, 604610.
59 Ludwig, DS, Peterson, KE & Gortmaker, SL (2001) Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 357, 505508.
60 Phillips, SM, Bandini, LG, Naumova, EN, et al. (2004) Energy-dense snack food intake in adolescence: longitudinal relationship to weight and fatness. Obes Res 12, 461472.
61 Welsh, JA, Cogswell, ME, Rogers, S, et al. (2005) Overweight among low-income preschool children associated with the consumption of sweet drinks: Missouri, 1999–2002. Pediatrics 115, e223e229.
62 Glickman, D, Parker, L, Sim, L, et al. (2012) Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: National Academies Press.
63 Pan, A & Hu, FB (2011) Effects of carbohydrates on satiety: differences between liquid and solid food. Curr Opin Clin Nutr Metab Care 14, 385390.
64 DiMeglio, DP & Mattes, RD (2000) Liquid versus solid carbohydrate: effects on food intake and body weight. Int J Obes Relat Metab Disord 24, 794800.
65 Berkey, C, Rockett, HH, Willett, WC, et al. (2005) Milk, dairy fat, dietary calcium, and weight gain: a longitudinal study of adolescents. Arch Pediatr Adolesc Med 159, 543550.
66 Zemel, M (2003) Role of dietary calcium and dairy products in modulating adiposity. Lipids 38, 139146.
67 Livingstone, M & Robson, P (2000) Measurement of dietary intake in children. Proc Nutr Soc 59, 279293.
68 Livingstone, MB, Prentice, AM, Coward, WA, et al. (1992) Validation of estimates of energy intake by weighed dietary record and diet history in children and adolescents. Am J Clin Nutr 56, 2935.
69 Lafay, L, Mennen, L, Basdevant, A, et al. (2000) Does energy intake underreporting involve all kinds of food or only specific food items? Results from the Fleurbaix Laventie Ville Santé (FLVS) study. Int J Obes Relat Metab Disord 24, 15001506.
70 Rennie, KL, Jebb, SA, Wright, A, et al. (2007) Secular trends in under-reporting in young people. Br J Nutr 93, 241247.
71 Goodwin, RA, BrulÉ, D, Junkins, EA, et al. (2001) Development of a food and activity record and a portion-size model booklet for use by 6- to 17-year olds: a review of focus-group testing. J Am Diet Assoc 101, 926928.
72 Boushey, C, Kerr, D, Wright, J, et al. (2009) Use of technology in children's dietary assessment. Eur J Clin Nutr 63, S50S57.
73 British Nutrition Foundation (2009) What is energy density? = component&print = 1&page = (accessed accessed December 2012).


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Is there an association between food portion size and BMI among British adolescents?

  • Salwa A. Albar (a1) (a2), Nisreen A. Alwan (a1), Charlotte E. L. Evans (a1) and Janet E. Cade (a1)


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