{"doi":"10.52570/nesr.dgac2025.sr17","title":"Portion Size and Growth, Body Composition, and Risk of Obesity: A Systematic Review","abstract":"BackgroundThis systematic review was conducted by the 2025 Dietary Guidelines Advisory Committee as part of the process to develop the Dietary Guidelines for Americans, 2025-2030.The U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) appointed the 2025 Dietary Guidelines Advisory Committee (Committee) in January 2023 to review evidence on high priority scientific questions related to diet and health.Their review forms the basis of their independent, science-based advice and recommendations to HHS and USDA, which is considered as the Departments develop the next edition of the Dietary Guidelines.As part of that process, the Committee conducted a systematic review with support from USDA's Nutrition Evidence Systematic Review (NESR) team to answer the following question: What is the relationship between portion size and growth, body composition, and risk of obesity? MethodsThe Committee conducted a systematic review using the methodology of the USDA NESR team.The Committee first developed a protocol.The intervention/exposure was a food-based strategy targeting food and/or beverage portion size and pre-portioned foods that considers energy density, nutrient density and/or the quality or type of food served or consumed by young children, children, adolescents, adults, older adults, individuals during pregnancy and postpartum, the comparator was a different portion size served or consumed, and the outcomes were measures of growth (in young children, children, and adolescents) including: height, length/staturefor-age, weight, weight-for-age, stunting, failure to thrive, wasting, BMI-for-age, weight-for-length/stature, body circumferences (arm, neck, thigh), head circumference; body composition (in young children, children, adolescents, adults, and older adults) including: skinfold thickness, fat mass, ectopic fat, fat-free mass or lean mass, waist circumference, waist-to-hip-ratio; risk of obesity (in children, adolescents, adults, and older adults) including: BMI, underweight, normal weight, overweight and/or obesity, weight loss and maintenance (in adults and older adults); pregnancy and postpartum-related weight change (in individuals during pregnancy or postpartum) including: gestational weight gain and postpartum weight change.Additional inclusion criteria were established for the following study characteristics: a) use randomized or non-randomized controlled trial, prospective or retrospective cohort, or nested case-control study designs, b) be published in English in peer-reviewed journals, c) be from countries classified as high or very high on the Human Development Index, and d) enroll participants with a range of health statuses.The review excluded studies with infants (birth up to 12 months), studies that exclusively enrolled participants diagnosed with a disease, studies that examined portion size using liquid meal replacements, and studies with an intervention length less than 12 weeks.NESR librarians conducted a literature search in PubMed, Embase, CINAHL, and Cochrane to identify articles published between January 2000 and January 2024.Two NESR analysts independently screened all electronic results and the reference lists of included articles based on the pre-determined criteria.NESR analysts extracted data, from each included article, with a second analyst verifying accuracy of the extraction.Two NESR analysts independently conducted a formal risk of bias assessment, by study design, for each included article, then reconciled any differences in the assessment.The Committee qualitatively synthesized the evidence, according to the synthesis plan, with attention given to the overarching themes or key concepts from the findings, similarities and differences between studies, and factors that may have affected the results.The Committee developed conclusion statements and graded the strength of evidence based on its consistency, precision, risk of bias, directness and generalizability. 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