Young adults and eating away from home: associations with dietary intake patterns and weight status differ by choice of restaurant

Adolescents' awareness and use of menu labels in eating establishments: results from a focus group study

OBJECTIVE

Menu labelling has been identified as a potential strategy to help individuals make healthier choices when eating out. Although adolescents eat out often, little research involving menu labelling has been conducted with this population. The objectives of the present study were to: (i) gather qualitative information from adolescents regarding use of menu labels when eating out; (ii) gather adolescents' suggestions for optimal ways to design menu labels; and (iii) examine differences between adolescents living in communities of different socio-economic status.

DESIGN

Qualitative. Five focus groups of five to ten participants.

SETTING

Austin, TX, USA, 2012.

SUBJECTS

Forty-one adolescents living in diverse communities recruited using a snowballing technique at public and private recreation centres (twenty-four females; twenty-two African American).

RESULTS

Participants reported that menu labelling, in general, does not influence food selections when eating out. Among participants living in low-income communities, food purchases were based on price, taste and familiarity. Among participants living in high-income areas, food purchases were based on quality and ability to satiate (among boys). According to participants, effective ways to present menu labels are by matching calorie levels with physical activity equivalents or through simple graphics.

CONCLUSIONS

For adolescents, providing menu labels in their current format may not be an effective strategy to increase healthy food selection. Given that the current menu label format has been set by federal policy in the USA cannot be easily changed, research to determine how this format can be best presented or enhanced so that it can have an impact on all US sub-populations is warranted.

Living in a 'fat swamp': exposure to multiple sources of accessible, cheap, energy-dense fast foods in a deprived community

This study assesses the levels of fats, including trans-fatty acids, and salt in common takeaway fast foods in a deprived urban municipality in the West Midlands, England, and implications in the context of the spatial distribution of fast food takeaways. The results of the compositional analysis of over 250 take-out foods were compared with established and derived standards. About 70% of products exceeded the recommendation that a meal should contain less than 30% of a Guideline Daily Amount (GDA). More than half of them exceeded 50% GDA for at least one metric, including 81% of all analyses for SFA. And 17% of samples exceeded the GDA for SFA, including each of two meals that contained about twice the GDA. Over 30% samples exceeded the children's GDA for total fat or SFA. 27% of salt analyses exceeded the GDA. People in Sandwell are exposed to large portion sizes and high levels of fats and salt in takeaway foods, with levels in some foods having increased since 2010. Given this population's limited options to break out of a highly compromising environment of living simultaneously in a 'swamp' of unhealthy, readily accessible and cheap takeaways, and a 'desert' of healthy options, an immediate and innovative package of interventions is required.

Weight control behaviors among emerging adults with type 1 diabetes

PURPOSE

The purpose of this study was to examine the association of weight control behaviors (WCBs) with living and educational situations among emerging adults with type 1 diabetes during the first year after high school graduation.

METHODS

Among 184 emerging adults with type 1 diabetes, data were collected every 3 months for 12 months on WCBs, body mass index (BMI), living and educational situations; at baseline and 12 months, on impulse control; and at baseline, on sex, depressive symptoms, and glycemic control. Generalized linear models incorporated repeated measures (0, 3, 6, 9, and 12 months).

RESULTS

No significant associations existed between WCBs and living or educational situations, when controlling for covariates. More depressive symptoms and higher BMIs were associated with a greater likelihood of involvement in unhealthy WCBs, whereas more depressive symptoms-not higher BMI-were associated with higher odds for involvement in very unhealthy WCBs. Although healthy WCBs were also associated with more depressive symptoms and higher BMIs, they were also associated with greater impulse control.

CONCLUSIONS

Health care professionals should assess emerging adults with type 1 diabetes for WCBs along with BMI, depressive symptoms, and impulse control.

Impact of dining out on nutritional intake and metabolic syndrome risk factors: data from the 2011 Korean National Health and Nutrition Examination Survey

The frequency of dining out has rapidly increased; however, the independent associations between dining out, metabolic syndrome risk factors and nutritional status have not been well characterised. The aim of the present study was to investigate the associations between dining out, nutritional intakes and metabolic syndrome risk factors among Korean adults, using data from the 2011 Korean National Health and Nutrition Examination Survey. Frequency of dining out was significantly associated with intake of nutrients such as energy, water, protein, fat, carbohydrate, Ca, Na, vitamin A and carotene. Especially, the result revealed that Korean adults had insufficient Ca intake compared with the Korean reference intake (700 mg). As the frequency of dining out increased, so did energy intake. In addition, individuals who dined out seven or more times per week experienced a 64 % higher likelihood of blood pressure abnormalities, an 88 % higher likelihood of waist circumference abnormalities, and a 32 % higher likelihood of low HDL-cholesterol levels than those who dined out less than once per week. BMI was not associated with the frequency of dining out. Our findings suggest that strategies to modify dining-out behaviour could reduce metabolic syndrome risk factors via improved nutrition.

Sociodemographic disparities among fast-food restaurant customers who notice and use calorie menu labels

BACKGROUND

As part of the recently passed Patient Protection and Affordable Care Act, chain restaurants with 20 or more locations nationwide will soon be required to post calorie information on menus with the aim of helping customers make healthier food choices. To be effective, this policy must affect all customers, especially those most at risk for poor health and diet outcomes.

OBJECTIVE

To determine whether noticing or using calorie menu labels was associated with demographic characteristics of customers at a national fast-food chain currently implementing calorie menu labeling.

DESIGN

Cross-sectional analysis.

PARTICIPANTS/SETTING

Customer receipts and survey data were collected from 329 participants using street-intercept survey methodology at 29 McDonald's restaurant locations in low- and high-income neighborhoods throughout the Phoenix, AZ, metropolitan area.

OUTCOME MEASURES

Calorie menu labeling awareness and use were assessed. The total number of calories purchased was evaluated using participants' itemized receipts.

STATISTICAL ANALYSES

Multivariate logistic regression analyses were used to calculate the odds of customers noticing or using calorie menu labels.

RESULTS

Approximately 60% of participants noticed calorie menu labels, whereas only 16% reported using the information for food or beverage purchases. Higher-income individuals had twice the odds of noticing calorie labels (P=0.029) and three times the odds of using them (P=0.004). Significant positive associations were found between individuals with a bachelor's degree or higher and use of calorie menu labels (odds ratio 3.25; P=0.023). Noticing calorie menu labels was not associated with purchasing fewer calories; however, those who reported using calorie information purchased 146 fewer calories than those who did not (P=0.001).

CONCLUSIONS

Using calorie menu labels is associated with purchasing fewer calories. However, there are significant socioeconomic disparities among customers who notice and use calorie menu labels. Targeted education campaigns are needed to improve the use of menu labeling across all sociodemographic groups.

Motives for eating tasty foods associated with binge-eating. Results from a student and a weight-loss seeking population

The aim of this study was to use the Palatable Eating Motives Scale (PEMS) to determine if and what motives for eating tasty foods (e.g., junk food, fast food, and desserts) are associated with binge-eating in two diverse populations. BMI and scores on the PEMS, Yale Food Addiction Scale (YFAS), and Binge-eating Scale (BES) were obtained from 247 undergraduates at the University of Alabama at Birmingham (UAB) and 249 weight-loss seeking patients at the UAB EatRight program. Regression analyses revealed that eating tasty foods to forget worries and problems and help alleviate negative feelings (i.e., the 4-item Coping motive) was associated with binge-eating independently of any variance in BES scores due to sex, age, ethnicity, BMI, other PEMS motives, and YFAS scores in both students (R² = .57) and patients (R² = .55). Coping also was associated with higher BMI in students (p < 0.01), and in patients despite their truncated BMI range (p < 0.05). Among students, the motives Conformity and Reward Enhancement were also independently associated with binge-eating. For this younger sample with a greater range of BES scores, eating for these motives, but not for Social ones, may indicate early maladaptive eating habits that could later develop into disorders characterized by binge-eating if predisposing factors are present. Thus, identifying one's tasty food motive or motives can potentially be used to thwart the development of BED and obesity, especially if the motive is Coping. Identifying one's PEMS motives should also help personalize conventional treatments for binge-eating and obesity toward improved outcomes.

Trends in nutrient intakes and consumption while eating-out among Korean adults based on Korea National Health and Nutrition Examination Survey (1998-2012) data

BACKGROUND/OBJECTIVES

Eating-out among Korean people has become an important part of modern lifestyle due to tremendous growth of the food service industry and various social and economic changes. This study examined trends in meal patterns and meal sources while eating-out among Korean adults aged 19 years and older.

SUBJECTS/METHODS

Data were from the 1998-2012 KNHNES (Korea National Health and Nutrition Examination Survey) by the 24-hour dietary recall method. This study included 55,718 adults aged 19 years and older. For analysis of eating-out frequency, data were categorized by source of meals and serving place.

RESULTS

Average frequency of meals consumed away from home increased from 1998 to 2012, although it remained lower than that of meals at home. In addition, male, unmarried, employed, higher educated, and high income individuals more frequently consumed meals away from home. Moreover, sodium intake while eating-out significantly increased from 2,370 mg in 1998 to 2,935 mg in 2012. Lastly, percentage contributions of daily total protein intake, fat intake, and sodium intake from eating-out increased to more than half (53-55%) in 2012 compared with 47-48% in 1998.

CONCLUSIONS

As eating-out has grown in popularity, greater recognition of public health and nutritional education aimed at promoting healthy food choices is needed. In addition to developing consumer education for overall healthier eating patterns, individuals who are younger, unmarried, higher educated, and males are especially at risk and require attention.

The impact of restaurant consumption among US adults: effects on energy and nutrient intakes

OBJECTIVE

To examine the effect of fast-food and full-service restaurant consumption on adults' energy intake and dietary indicators.

DESIGN

Individual-level fixed-effects regression model estimation based on two different days of dietary intake data was used.

SETTING

Parallel to the rising obesity epidemic in the USA, there has been a marked upward trend in total energy intake derived from food away from home.

SUBJECTS

The full sample included 12 528 respondents aged 20-64 years who completed 24 h dietary recall interviews for both day 1 and day 2 in the National Health and Nutrition Examination Survey (NHANES) 2003-2004, 2005-2006, 2007-2008 and 2009-2010.

RESULTS

Fast-food and full-service restaurant consumption, respectively, was associated with an increase in daily total energy intake of 813·75 kJ (194·49 kcal) and 858·04 kJ (205·21 kcal) and with higher intakes of saturated fat (3·48 g and 2·52 g) and Na (296·38 mg and 451·06 mg). Individual characteristics moderated the impacts of restaurant food consumption with adverse impacts on net energy intake being larger for black adults compared with their white and Hispanic counterparts and greater for middle-income v. high-income adults.

CONCLUSIONS

Adults' fast-food and full-service restaurant consumption was associated with higher daily total energy intake and poorer dietary indicators.

Parent and child perspectives on family out-of-home eating: a qualitative analysis

OBJECTIVE

To (i) explore the factors influencing family out-of-home (OH) eating events and (ii) identify possible opportunities for food businesses to support families in making healthier OH choices.

DESIGN

Focus group discussions were conducted with parents (six to eight participants per group) and friendship pair discussions (informal interviews with two children who are friends) were conducted with children (5-12 years) throughout the island of Ireland. Both discussions were audio-recorded and analysed using a thematic content analysis.

SETTING

Eight focus groups and sixteen friendship pairs were conducted in Northern Ireland and sixteen focus groups and thirty-two friendship pairs were conducted in the Republic of Ireland.

SUBJECTS

Purposive sampling was used to recruit a sample of non-related parents and children that represented equal numbers of gender, age, socio-economic status and demographic backgrounds.

RESULTS

The main, overarching theme was that families perceived OH eating to be a treat, while health was not currently a key priority for many parents and children. Children were reported to have most responsibility for their own food choice decisions in this environment, with taste and food neophobia having the greatest influences. Parents believed that if food businesses could meet parent and child priorities in addition to health influences, e.g. change cooking methods, and increase flexibility, then families would be more likely to patronise these establishments.

CONCLUSIONS

The entire family OH eating experience needs to be considered when developing public health interventions and this research has highlighted key opportunities that caterers could employ to support healthier family OH food choices.

Diet quality in young adults and its association with food-related behaviours

OBJECTIVE

To determine the diet quality of a group of young adults and explore its associations with two food-related behaviours (involvement in meal preparation and consumption of commercially prepared meals).

DESIGN

Cross-sectional study of young adults. Sample characteristics, food-related behaviours and dietary intake were assessed using a self-administered questionnaire including an FFQ. Diet quality was measured using the fifteen-item Dietary Guideline Index (DGI) designed to assess adherence to Australian dietary guidelines. One-way ANOVA, t tests and multiple linear regression analyses were used to explore the relationships between DGI scores, sample characteristics and food-related behaviours.

SETTING

University students enrolled in an undergraduate nutrition class, Melbourne, Australia.

SUBJECTS

Students (n 309) aged 18-36 years.

RESULTS

The DGI score was normally distributed, with a mean score of 93·4 (sd 17·1) points (range 51·9-127·4 points), out of a possible score of 150 points. In multivariate analyses adjusted for age, sex, nationality, BMI and maternal education, cooking meals for oneself was positively associated with DGI score (β = 0·15; 95 % CI 1·15, 10·03; P = 0·01); frequency of takeaway and frequency of convenience meal consumption were inversely associated with DGI score (β = -0·21; 95 % CI -9·96, -2·32; P = 0·002 and β = -0·16; 95 % CI -7·40, -0·97; P < 0·01, respectively).

CONCLUSIONS

Cooking meals for oneself was linked to higher diet quality among young adults, while consumption of commercially prepared meals was associated with poorer diet quality. Maintaining education programmes that promote cooking skills within young adults has the potential to improve DGI scores.

Away-from-home eating: nutritional status and dietary intake among Brazilian adults

Objective

To evaluate the association between eating away from home and BMI and to examine whether dietary intake differs based on the consumption of away-from-home food (AFHF).

Design

Data were obtained from the first Brazilian National Dietary Survey, using food records. The association between the percentage of energy provided by foods consumed away from home and BMI status was tested using logistic regression models. The mean percentages of energy provided by protein, fat, saturated fat and free sugars were calculated based on the consumption of foods away from home among AFHF consumers.

Setting

Urban areas of Brazil.

Subjects

Adults (n13 736) between 25 and 65 years old.

Results

AFHF was not associated with BMI status. Individuals who consumed AFHF had higher intakes of free sugars away from home than at home and had higher intakes of energy-dense foods than AFHF non-consumers.

Conclusion

Although AFHF consumption was not related to overweight or obesity status, individuals who consumed foods away from home had higher intakes of energy-dense foods. Public health policies should be implemented to help people make healthier food choices away from home.

Risk factors of coronary heart disease among medical students in King Abdulaziz University, Jeddah, Saudi Arabia

BACKGROUND

Nowadays, Cardiovascular Diseases (CVDs) represents an escalating worldwide public health problem. Providing consistent data on the magnitude and risk factors of CVDs among young population will help in controlling the risks and avoiding their consequences.

OBJECTIVE

The objective was to estimate the prevalence of risk factors of Coronary Heart Disease (CHD) among medical students during their clinical clerkship (4th - 6th years).

METHODS

A cross-sectional study was done during the educational year 2012-2013 at King Abdulaziz University (KAU), Jeddah. Ethical standards were followed and a multistage stratified random sample method was used for selection of 214 medical students. Data was collected through an interviewing questionnaire, measurements and laboratory investigations. Both descriptive and analytical statistics were done by SPSS version 21. CHD risk percent in thirty years was calculated using Framingham algorithm for each student, then the risk among all students was determined.

RESULTS

The commonest risk factors of CHDs were daily intake of high fat diet (73.4%), physical inactivity (57.9%), overweight/or obesity (31.2%) and daily consumption of fast food (13.1%). Hyper-cholesterolemia (17.2%) and hypertension (9.3%) were also prevalent risk factors. Smoking prevalence was low (2.8%). Males had significantly higher mean scores for most of CHD risk factors compared to females (p < 0.05). Systolic Blood pressure was higher among males (119.47 ± 11.17) compared to females (112.26 ± 9.06). A highly statistical significant difference was present (Students't test = 4.74, p < 0.001). Framingham Risk Score revealed that CHD risk percent in thirty-years among all students was 10.7%, 2.3% and 0.5% for mild, moderate and severe risk, respectively.

CONCLUSION

An alarmingly high prevalence of CHD risk factors was prevailed among medical students, especially among males. However, a low prevalence of smoking may indicate the success of "Smoke-free Campus" program. Screening risk factors of CHD among medical students and implementation of intervention programs are recommended. Programs to raise awareness about CHD risk factors, encourage young adult students to adopt a healthy dietary behavior and promote physical exercise should be initiated.

Is density of neighbourhood restaurants associated with BMI in rural Chinese adults? A longitudinal study from the China Health and Nutrition Survey

OBJECTIVES

The neighbourhood availability of restaurants has been linked to the weight status. However, little is known regarding the relation between access to restaurant and obesity among the Chinese population. This study aims to explore the relationship between neighbourhood restaurant density and body mass index (BMI) in rural China.

DESIGN

A longitudinal study using data from the China Health and Nutrition Survey (CHNS) was conducted. Participants aged 18 and older from the 2004, 2006, 2009 and 2011 CHNS were recruited Separate sex-stratified random intercept-slope growth models of repeated BMI observations were estimated in the study.

SETTING

The data were derived from rural communities in nine provinces in China.

PARTICIPANTS

There were 11 835 male and 12 561 female person-years assessed in this study.

OUTCOMES

The primary outcome of this study was weight status. It is defined as a BMI value, a continuous variable which is calculated by dividing weight (kg) by the square of height (m(2)).

RESULTS

The study indicated that among men an increase of one indoor restaurant in the neighbourhood was associated with a 0.01 kg/m(2) increase in BMI, and an increase of one fixed outdoor food stall was associated with a 0.01 kg/m(2) decrease in BMI, whereas among women, an increase of one indoor restaurant in the neighbourhood was associated with a 0.005 kg/m(2) increase in BMI, and an increase of one fast-food restaurant and one fixed outdoor food stall was associated with a 0.02 and 0.004 kg/m(2) decline in BMI, respectively.

CONCLUSIONS

The density of neighbourhood restaurants was found to be significantly related to BMI in rural China. The results indicated that providing healthy food choices and developing related public health policies are necessary to tackle obesity among rural Chinese adults.

Eating location is associated with the nutritional quality of the diet in Norwegian adults

OBJECTIVE

To study the association between dinner eating location and the nutritional quality of the specific dinner meal and the whole-day dietary intake and to compare the diets of those consuming ≥25% of energy out of home and at school/work (SOH; substantial out-of-home eaters) with those consuming <25% of energy out (NSOH; non-substantial out-of-home eaters).

DESIGN

Cross-sectional dietary survey using two non-consecutive 24 h recalls. Recorded eating locations were at home, other private households, work/school, restaurant/cafeteria/fast-food outlet and travel/meeting.

SETTING

Nationwide, Norway (2010-2011).

SUBJECTS

Adults aged 18-70 years (n 1746).

RESULTS

Dinners at restaurants and other private households were higher in energy than home dinners (P < 0.01). Restaurant dinners contained less fibre (g/MJ; P < 0.01) and had a higher percentage of alcohol consumers (P < 0.05), while dinners at other private households had a higher percentage of energy from sugar (P < 0.001) and a higher percentage of consumers of sugar-sweetened beverages (P < 0.05) than home dinners. Most differences between dinners consumed at different eating locations were also observed in dietary intakes for the whole day. SOH-eaters had a higher energy intake (P < 0.01), a higher percentage of energy from sugar (P < 0.01) and a lower fibre intake (P < 0.01) than NSOH-eaters. The percentages of consumers of alcohol and sugar-sweetened beverages were higher (P < 0.01) among SOH-eaters.

CONCLUSIONS

Dinner eating location was significantly associated with the nutritional quality of the diet, both for the specific dinner meal and for whole-day intake. Our data generally point to healthier dinners being consumed at home. SOH-eaters had a less favourable dietary intake than NSOH-eaters.

Energy intake and diet selection during buffet consumption in women classified by the 6-n-propylthiouracil bitter taste phenotype

BACKGROUND

Exposure to a variety of energy-dense foods promotes increased energy intake and adiposity. Taste blindness to the bitterness of 6-n-propylthiouracil (PROP) has been associated with increased adiposity in women and might be linked to an increased energy intake and greater selection of dietary fat.

OBJECTIVE

We investigated whether PROP nontaster (NT) women would consume more fat and energy in a buffet setting than medium taster (MT) or supertaster (ST) women.

DESIGN

Seventy-five non-diet-restrained, lean, young women [mean ± SEM BMI (in kg/m²): 21.5 ± 0.6; age: 26.1 ± 1.3 y) ate lunch and dinner in the laboratory for 3 consecutive days under the following 2 conditions: ad libitum control meals (CONTs) or high-variety buffet meals (BUFFs). A standard breakfast was consumed each day of the study (4 - d washout between conditions).

RESULTS

NTs and MTs consumed more energy and fat (as the percentage of energy) from BUFFs than did STs (P < 0.01), which contributed to higher daily energy intakes in these 2 groups of women during BUFFs (2149 ± 49 kcal/d for NTs and 2209 ± 48 kcal/d for MTs compared with 1933 ± 50 kcal/d for STs; P < 0.01). Together, NTs and MTs consumed an extra 246 kcal/d during BUFFs than during CONTs. In addition, compared with STs, NTs and MTs consumed more added fats and sweets (servings/d; P < 0.003) and more energy from snacks (P < 0.01) across all study days.

CONCLUSIONS

NT and MT women consume more daily energy than do ST women when eating in a buffet setting, which is a common type of dietary exposure. This increase in energy intake over time could contribute to a positive energy balance and increased adiposity previously reported in these women.

Receptivity to television fast-food restaurant marketing and obesity among U.S. youth

BACKGROUND

Advertisement of fast food on TV may contribute to youth obesity.

PURPOSE

The goal of the study was to use cued recall to determine whether TV fast-food advertising is associated with youth obesity.

METHODS

A national sample of 2541 U.S. youth, aged 15-23 years, were surveyed in 2010-2011; data were analyzed in 2012. Respondents viewed a random subset of 20 advertisement frames (with brand names removed) selected from national TV fast-food restaurant advertisements (n=535) aired in the previous year. Respondents were asked if they had seen the advertisement, if they liked it, and if they could name the brand. A TV fast-food advertising receptivity score (a measure of exposure and response) was assigned; a 1-point increase was equivalent to affirmative responses to all three queries for two separate advertisements. Adjusted odds of obesity (based on self-reported height and weight), given higher TV fast-food advertising receptivity, are reported.

RESULTS

The prevalence of overweight and obesity, weighted to the U.S. population, was 20% and 16%, respectively. Obesity, sugar-sweetened beverage consumption, fast-food restaurant visit frequency, weekday TV time, and TV alcohol advertising receptivity were associated with higher TV fast-food advertising receptivity (median=3.3 [interquartile range: 2.2-4.2]). Only household income, TV time, and TV fast-food advertising receptivity retained multivariate associations with obesity. For every 1-point increase in TV fast-food advertising receptivity score, the odds of obesity increased by 19% (OR=1.19, 95% CI=1.01, 1.40). There was no association between receptivity to televised alcohol advertisements or fast-food restaurant visit frequency and obesity.

CONCLUSIONS

Using a cued-recall assessment, TV fast-food advertising receptivity was found to be associated with youth obesity.

Calorie labeling, fast food purchasing and restaurant visits

OBJECTIVE

Obesity is a pressing public health problem without proven population-wide solutions. Researchers sought to determine whether a city-mandated policy requiring calorie labeling at fast food restaurants was associated with consumer awareness of labels, calories purchased and fast food restaurant visits.

DESIGN AND METHODS

Difference-in-differences design, with data collected from consumers outside fast food restaurants and via a random digit dial telephone survey, before (December 2009) and after (June 2010) labeling in Philadelphia (which implemented mandatory labeling) and Baltimore (matched comparison city). Measures included: self-reported use of calorie information, calories purchased determined via fast food receipts, and self-reported weekly fast-food visits.

RESULTS

The consumer sample was predominantly Black (71%), and high school educated (62%). Postlabeling, 38% of Philadelphia consumers noticed the calorie labels for a 33% point (P < 0.001) increase relative to Baltimore. Calories purchased and number of fast food visits did not change in either city over time.

CONCLUSIONS

While some consumers report noticing and using calorie information, no population level changes were noted in calories purchased or fast food visits. Other controlled studies are needed to examine the longer term impact of labeling as it becomes national law.

Campus food and beverage purchases are associated with indicators of diet quality in college students living off campus

PURPOSE

To examine the association between college students' dietary patterns and frequency of purchasing food/beverages from campus area venues, purchasing fast food, and bringing food from home.

DESIGN

Cross-sectional Student Health and Wellness Study.

SETTING

One community college and one public university in the Twin Cities, Minnesota.

SUBJECTS

Diverse college students living off campus (n = 1059; 59% nonwhite; mean [SD] age, 22 [5] years).

MEASURES

Participants self-reported sociodemographic characteristics and frequency of purchasing food/beverages around campus, purchasing fast food, and bringing food from home. Campus area purchases included à la carte facilities, vending machines, beverages, and nearby restaurants/stores. Dietary outcomes included breakfast and evening meal consumption (d/wk) and summary variables of fruit and vegetable, dairy, calcium, fiber, added sugar, and fat intake calculated from food frequency screeners.

ANALYSIS

The associations between each purchasing behavior and dietary outcomes were examined using t-tests and linear regression.

RESULTS

Approximately 45% of students purchased food/beverages from at least one campus area venue ≥3 times per week. Frequent food/beverage purchasing around campus was associated with less frequent breakfast consumption and higher fat and added sugar intake, similar to fast-food purchasing. Bringing food from home was associated with healthier dietary patterns.

CONCLUSION

Increasing the healthfulness of campus food environments and promoting healthy food and beverage purchasing around campuses may be an important target for nutrition promotion among college students.

Adolescent dietary patterns in Fiji and their relationships with standardized body mass index

Background

Obesity has been increasing in adolescents in Fiji and obesogenic dietary patterns need to be assessed to inform health promotion. The objective of this study was to identify the dietary patterns of adolescents in peri-urban Fiji and determine their relationships with standardized body mass index (BMI-z).

Methods

This study analysed baseline measurements from the Pacific Obesity Prevention In Communities (OPIC) Project. The sample comprised 6,871 adolescents aged 13–18 years from 18 secondary schools on the main island of Viti Levu, Fiji. Adolescents completed a questionnaire that included diet-related variables; height and weight were measured. Descriptive statistics and regression analyses were conducted to examine the associations between dietary patterns and BMI-z, while controlling for confounders and cluster effect by school.

Results

Of the total sample, 24% of adolescents were overweight or obese, with a higher prevalence among Indigenous Fijians and females. Almost all adolescents reported frequent consumption of sugar sweetened beverages (SSB) (90%) and low intake of fruit and vegetables (74%). Over 25% of participants were frequent consumers of takeaways for dinner, and either high fat/salt snacks, or confectionery after school. Nearly one quarter reported irregular breakfast (24%) and lunch (24%) consumption on school days, while fewer adolescents (13%) ate fried foods after school. IndoFijians were more likely than Indigenous Fijians to regularly consume breakfast, but had a high unhealthy SSB and snack consumption.

Regular breakfast (p<0.05), morning snack (p<0.05) and lunch (p<0.05) consumption were significantly associated with lower BMI-z. Consumption of high fat/salt snacks, fried foods and confectionery was lower among participants with higher BMI-z.

Conclusions

This study provides important information about Fijian adolescents’ dietary patterns and associations with BMI-z. Health promotion should target reducing SSB, increasing fruit and vegetables consumption, and increasing regularity of meals among adolescents. Future research is needed to investigate moderator(s) of inverse associations found between BMI-z and consumption of snacks, fried foods and confectionery to assess for potential reverse causality.

'TXT2BFiT' a mobile phone-based healthy lifestyle program for preventing unhealthy weight gain in young adults: study protocol for a randomized controlled trial

BACKGROUND

Despite international efforts to arrest increasing rates of overweight and obesity, many population strategies have neglected young adults as a target group. Young adults are at high risk for unhealthy weight gain which tends to persist throughout adulthood with associated chronic disease health risks.

METHODS/DESIGN

TXT2BFiT is a nine month two-arm parallel-group randomized controlled trial aimed at improving weight management and weight-related dietary and physical activity behaviors among young adults. Participants are recruited via general practice (primary medical care) clinics in Sydney, New South Wales, Australia. All participants receive a mailed resource outlining national physical activity and dietary guidelines and access to the study website. Additional resources accessible to the intervention arm via the study website include Smartphone mobile applications, printable handouts, an interactive healthy weight tracker chart, and a community blog. The study consists of two phases: (1) Intensive phase (weeks 1 to 12): the control arm receives four short message service (SMS) text messages; the intervention arm receives eight SMS messages/week tailored to their baseline stage-of-change, one Email/week, and personalized coaching calls during weeks 0, 2, 5, 8, and 11; and (2) Maintenance phase (weeks 14 to 36): the intervention arm receives one SMS message/month, one Email/month and booster coaching calls during months 5 and 8. A sample of N = 354 (177 per arm) is required to detect differences in primary outcomes: body weight (kg) and body mass index (kg/m2), and secondary outcomes: physical activity, sitting time, intake of specific foods, beverages and nutrients, stage-of-change, self-efficacy and participant well-being, at three and nine months. Program reach, costs, implementation and participant engagement will also be assessed.

DISCUSSION

This mobile phone based program addresses an important gap in obesity prevention efforts to date. The method of intervention delivery is via platforms that are highly accessible and appropriate for this population group. If effective, further translational research will be required to assess how this program might operate in the broader community.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612000924853.

Neighborhood food environment role in modifying psychosocial stress-diet relationships

Exposure to highly palatable foods may increase eating in response to stress, but this behavioral response has not been examined in relation to the neighborhood food environment. This study examined whether the neighborhood food environment modified relationships between psychosocial stress and dietary behaviors. Probability-sample survey (n=460) and in-person food environment audit data were used. Dietary behaviors were measured using 17 snack food items and a single eating-out-of-home item. Chronic stress was derived from five subscales; major life events was a count of nine items. The neighborhood food environment was measured as availability of large grocery stores, small grocery stores, and convenience stores, as well as proportion of restaurants that were fast food. Two-level hierarchical regression models were estimated. Snack food intake was positively associated with convenience store availability and negatively associated with large grocery store availability. The measures of chronic stress and major life events were generally not associated with either dietary behavior overall, although Latinos were less likely to eat out at high levels of major life events than African Americans. Stress-neighborhood food environment interactions were not statistically significant. Important questions remain regarding the role of the neighborhood food environment in the stress-diet relationship that warrant further investigation.

Restaurant foods, sugar-sweetened soft drinks, and obesity risk among young African American women

BACKGROUND

The prevalence of obesity is disproportionately high in African American women, and consumption of fast foods and sugar-sweetened soft drinks is also especially high among African Americans.

OBJECTIVE

We investigated the relation of intakes of sugar-sweetened soft drinks and specific types of restaurant foods to obesity in the Black Women's Health Study.

DESIGN

In this prospective cohort study, 19,479 non-obese women aged 21-39 years at baseline were followed for 14 years (1995-2009). Dietary intake was assessed by validated food frequency questionnaire in 1995 and 2001.

MAIN OUTCOME MEASURES

Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of intakes of restaurant foods and sugar-sweetened soft drinks with incident obesity.

RESULTS

Higher intakes of burgers from restaurants and sugar-sweetened soft drinks were associated with greater risk of becoming obese. The associations were present in models that included both factors and adjusted for overall dietary pattern. The HR of obesity in relation to restaurant burger consumption of > or = 2 times/week compared with < 5 times/year was 1.26 (95% CI: 1.14-1.40; P-trend<.001). For sugar-sweetened soft drink intake, the HR was 1.10 (95% CI: .99-1.23; P-trend = .14) for > or = 2 drinks/day compared with < 1 drink/month. The associations were stronger among women younger than age 30 with normal weight at baseline.

CONCLUSIONS

Frequent consumption of burgers from restaurants and sugar-sweetened soft drinks contribute to obesity among young African American women.

Delay discounting and intake of ready-to-eat and away-from-home foods in overweight and obese women

A shift from home-prepared to away-from-home and ready-to-eat foods has occurred in recent decades, which has implications for obesity and health. This study tested whether delay discounting, a facet of impulsivity reflecting sensitivity to immediate reward, is associated with the frequency of consumption and typical amount consumed of home-prepared, away-from-home, and ready-to-eat foods among overweight and obese women. Seventy-eight participants completed a binary choice task assessing discounting of delayed monetary rewards. Nutrient analysis of weighed food records characterized dietary intake over seven consecutive days. Foods were categorized as home-prepared, away-from-home, or ready-to-eat by a registered dietitian from information provided by participants. Delay discounting was not associated with the frequency of consuming home-prepared, away-from-home, and ready-to-eat foods as reflected in the percentages of recorded foods or total energy intake from each category. However, once consuming away-from-home and ready-to-eat foods (but not home-prepared foods), impulsive women consumed more energy than less impulsive women. Exploratory analyses indicated that more impulsive women chose away-from-home foods with a higher energy density (kcal/g). Impulsivity was associated with the quantity of away-from-home and ready-to-eat foods consumed, but not the frequency of their consumption. Home food preparation may be critical to weight control for impulsive individuals.

Availability of limited service food outlets surrounding schools in British Columbia

OBJECTIVE

The purpose of this study was to provide a descriptive profile of the availability of limited service food outlets surrounding public schools in British Columbia, Canada.

METHODS

Data from the 2010 Canadian Business Data Files were used to identify limited service food outlets including fast food outlets, beverage and snack food stores, delis and convenience stores. The number of food outlets within 800 metres of 1,392 public schools and the distance from schools to the nearest food outlets were assessed. Multivariate regression models examined the associations between food outlet availability and school-level characteristics.

RESULTS

In 2010, over half of the public schools in BC (54%) were located within a 10-12 minute walk from at least one limited service food outlet. The median closest distance to a food outlet was just over 1 km (1016 m). Schools comprised of students living in densely populated urban neighbourhoods and neighbourhoods characterized by lower socio-economic status were more likely to have access to limited service food outlets within walking distance. After adjusting for school-level median family income and population density, larger schools had higher odds of exposure to food vendors compared to schools with fewer students.

CONCLUSION

The availability of and proximity to limited service food outlets vary widely across schools in British Columbia and school-level characteristics are significantly associated with food outlet availability. Additional research is needed to understand how food environment exposures inside and surrounding schools impact students' attitudes, food choices and dietary quality.

Sleep duration and BMI in a sample of young adults

We examined the association between sleep duration and BMI in young adults, and, specifically, in possible gender differences. The population-based sample included 955 young men and 1051 young women (mean age = 25.3 years, s.d. = 1.7) who participated in Project EAT-III (Eating and Activity in Teens and Young Adults)-III. In 2008-2009, study participants completed a survey, on which they reported their weight, height, and typical bed and awakening times. Gender-specific regression models estimated cross-sectional associations between sleep duration and weight status, adjusting for age, race, SES, family structure, depressive symptoms, physical activity, and sedentary and dietary behaviors. In multivariable-adjusted linear regression models, an hour increase in sleep was associated with a -0.38 (-0.70, -0.048) BMI in men. Men who slept <7 h had a 1.4 unit higher mean BMI (27.9; 95% confidence interval (CI): 26.9, 28.9) than men who slept 7-9 h/day (26.5; 95% CI: 26.1, 27.0). Prevalence estimates of overweight (BMI ≥ 25) and obesity (BMI ≥ 30) were also inversely associated with sleep duration among men. Sleep duration was not associated with BMI, overweight, or obesity in women. Among women, but not men, there was a statistically significant positive association between trouble falling or staying asleep and mean BMI. Sleep may be an important modifiable risk factor for obesity, particularly in young adult men.

Contingent choice. Exploring the relationship between sweetened beverages and vegetable consumption

Adults and children are repeatedly exposed to the pairing of food and drink as found in meal deals and "combos". There may arise from this indoctrination, a contingent relationship between drink context and food preference. Our multi-method research examines food and drink combining. A survey-based study examines the food and drink pairing preferences of adults (N=60), while a laboratory study with young children (N=75, aged three to five) examines the role of drink context on vegetable consumption. The adult survey finds strong food and drink combining preferences. The pairing of soft drinks with calorie dense foods is regarded favorably, while the pairing of soft drinks with vegetables is not. In child food trials, vegetable consumption is not influenced by the child's fussiness but is influenced by the drink accompaniment. In limited contexts, these findings demonstrate the contingent relationship between drink context and food consumption. Both palate preference and associative learning may be mechanisms driving the effects of drink context on food consumption. The findings suggest simple consumer strategies that might be employed to change dietary patterns (e.g., drink water with meals), and hold straightforward policy implications (e.g., increase water as the default option in meal deals).