Determinants of takeaway and fast food consumption: a narrative review

Serial mediation effect of physical activity and sleep quality between dietary behaviour and depression symptoms: A nationwide cross-sectional survey

Background

Substantial studies have revealed the potential mechanisms underlying the link between dietary behaviour and depression symptoms. This study investigated the relationship between depression symptoms and dietary behaviour, physical activity, and sleep quality in a nationwide sample of Chinese residents.

Methods

A total of 18 819 Chinese Residents completed the dietary behaviour, patient health questionnaire, international physical activity questionnaire, and Pittsburgh sleep quality index. We used the Hayes' serial mediation model to investigate the correlation between the variables.

Results

Among the participants, 85.5% were aged between 18 and 59, 41.2% were male, and 73.8% were urban residents. There is a negative correlation between dietary behaviour and physical activity (r = -0.038, P < 0.001), while there is a positive correlation with depression symptoms (r = 0.238, P < 0.001) and sleep quality (r = 0.115, P < 0.001). Additionally, depression shows a positive correlation with physical activity (r = 0.024, P < 0.001) and sleep quality (r = 0.298, P < 0.001), while there is a negative correlation between physical activity and sleep quality (r = -0.035, P < 0.001). Dietary behaviour was found to be connected with depression symptoms via three mediation pathways: (1) physical activity (B = -0.003, 95% confidence interval (CI) = -0.016, -0.007), (2) sleep quality (B = 0.034, 95% CI = 0.126, 0.164), and (3) physical activity and sleep quality (B = 0.001, 95% CI = 0.001, 0.003).

Conclusions

These findings highlight the significance of psychological and physical factors in exploring the mechanisms through which dietary behaviour is related to depression symptoms. Overall, this study showed the important role of lifestyle factors in depression symptoms, suggesting that appropriate dietary behaviours, appropriate physical activity, and good sleep quality are necessary for the avoidance or improvement of depression symptoms.

Ready-to-Eat Food Environments and Risk of Incident Heart Failure: A Prospective Cohort Study

BACKGROUND

Food environments have been linked to cardiovascular diseases; however, few studies have assessed the relationship between food environments and the risk of heart failure (HF). We aimed to evaluate the association between ready-to-eat food environments and incident HF at an individual level in a large prospective cohort.

METHODS

Exposure to ready-to-eat food environments, comprising pubs or bars, restaurants or cafeterias, and fast-food outlets, were individually measured as both proximity and density metrics. We also developed a composite ready-to-eat food environment density score by summing the densities of 3 types of food environments. Cox proportional analyses were applied to assess the associations of each single type and the composite food environments with HF risk.

RESULTS

Closer proximity to and greater density of ready-to-eat food environments, particularly for pubs and bars and fast-food outlets (P<0.05 for both proximity and density metric) were associated with an elevated risk of incident HF. Compared with those with no exposure to composite ready-to-eat food environments, participants in the highest density score category had a 16% (8%-25%; P<0.0001) higher risk of HF. In addition, we found significant interactions of food environments with education, urbanicity, and density of physical activity facilities on HF risk (all Pinteraction<0.05); the ready-to-eat food environments-associated risk of HF was stronger among participants who were poorly educated, living in urban areas, and without physical activity facilities.

CONCLUSIONS

Exposure to ready-to-eat food environments is associated with a higher risk of incident HF, suggesting the potential importance of minimizing unfavorable food environments in the prevention of HF.

Editorial: nutrition at key stages of the lifecycle

Nutritional requirements of individuals vary across the lifecycle, according to activity, age and gender. To optimize human health, consideration of nutritional priorities at each stage is needed. This conference brought together multidisciplinary experts in maternal and child nutrition and health, cardiometabolic and plant-based nutrition and dietitians involved in the care of vulnerable populations, plus nutritional metabolism, health and ageing. The presentations highlighted the most important nutrition research in these areas, updating knowledge and suggesting how dietary advice and policy could be adapted to incorporate research findings. With the global increase in non-communicable disease (NCD) and nutrition being considered as a key modifiable risk factor for the prevention and management of NCD, this conference was much needed.

Identifying an avid eating profile in childhood: Associations with temperament, feeding practices and food insecurity

This study aimed to identify distinct eating behaviour profiles in young children and examine how other key predictors of children's eating behaviour, including child temperament, the experience of food insecurity, or parental feeding practices, may vary by identified profiles. An online survey was conducted with 995 parents/carers living in England and Wales (N = 995, Mage = 35.4 years, 80% female, 88% White). Participants reported on their child's eating behaviour using the Child Eating Behaviour Questionnaire and completed measures of child temperament, household food security and parental feeding practices. Latent Profile Analysis (LPA) was carried out to identify distinct eating profiles amongst the children (36-72 months, Mage = 48.8 months, 52% female). Four eating profiles emerged from the sample of children: (a) avid eating, (b) avoidant eating, (c) happy eating, and (d) typical eating. Avid eating (21.9% of children) was characterised by higher levels of food responsiveness, enjoyment of food, and emotional over-eating in combination with lower satiety responsiveness, slowness in eating and food fussiness. Children with an avid eating profile were reported to be more surgent and experienced greater food insecurity than all other eating profiles. Parents of children belonging to the avid eating profile showed significantly greater use of food for emotional regulation, varied and balanced food provision, restriction of food for health, and restriction of food for weight feeding practices than the three other eating profiles.

Influence of lifestyle on suboptimal health: Insights from a national cross-sectional survey in China

Background

Suboptimal health status (SHS) is a non-clinical or pre-disease state between optimal/ideal health and disease. While its etiology remains unclear, lifestyle is considered one of the most important risk factors. We aimed to examine the effects of lifestyles on SHS through a nationwide survey in China.

Methods

We conducted a cross-sectional survey in 148 cities across China between 20 June and 31 August 2022, on 30 505 participants from rural and urban communities gathered through stratified quota sampling. We measured SHS with the Short-Form Suboptimal Health Status Questionnaire (SHSQ-SF). We gathered information on participants' lifestyles (ie, smoking, alcohol consumption, breakfast habits, weekly food delivery frequency, intermittent fasting, sleep duration and physical activities) through face-to-face interview. We determined the relationship between lifestyle and SHS logistic regression analysis by based on odds ratios (ORs) and 95% confidence intervals (CIs).

Results

We included 22 897 participants (female: 13 056, male: 9841), 12 108 (52.88%) of whom reported exposure to SHS. After adjusting for demographic characteristics, individuals who currently smoked (OR = 1.165; 95% CI = 1.058-1.283) and those who drank alcohol (OR = 1.483; 95% CI = 1.377.1.596) were at a higher risk of SHS than those who have never done either. In a dose-response way, takeaway food consumption was associated with a higher risk of SHS, while increased frequency of breakfast and mild-intensity exercise conversely reduced said risk. Individuals with shorter sleep duration had a higher risk of SHS when compared to those who slept for more than seven hours per day.

Conclusions

We observed a relatively high prevalence of SHS across China, highlighting the importance of lifestyle in health promotion. Specifically, adopting healthy dietary habits, engaging in regular physical activity, and ensuring high-quality sleep are key in preventing SHS.

Registration

Chinese Clinical Trial Registry (ChiCTR2200061046).

A review on takeaway packaging waste: Types, ecological impact, and disposal route

Rapid economic growth and urbanization have led to significant changes in the world's consumption patterns. Accelerated urbanization, the spread of the mobile Internet, and the increasing pace of work globally have all contributed to the demand for the food takeaway industry. The rapid development of the takeaway industry inevitably brings convenience to life, and with it comes great environmental pressure from waste packaging materials. While maintaining the convenience of people's lives, further reducing the environmental pollution caused by takeaway packaging materials and promoting the recycling and reuse of takeaway packaging waste need to attract the attention and concern of the whole society. This review systematically and comprehensively introduces common takeaway food types and commonly used packaging materials, analyzes the impacts of discarded takeaway packaging materials on human health and the ecological environment, summarizes the formulation and implementation of relevant policies and regulations, proposes treatment methods and resourceful reuse pathways for discarded takeaway packaging, and also provides an outlook on the development of green takeaway packaging. Currently, only 20% of waste packaging materials are recycled worldwide, and there is still a need to develop more green takeaway packaging materials and continuously improve relevant policies and regulations to promote the sustainable development of the takeaway industry. The review is conducive to further optimizing the takeaway packaging management system, alleviating the environmental pollution problem, and providing feasible solutions and technical guidance for further optimizing takeaway food packaging materials and comprehensive utilization of resources.

Digital Marketing and Fast-Food Intake in the UAE: The Role of Firm-Generated Content among Adult Consumers

In the contemporary digital marketing context, this study aimed to investigate the influence of firm-generated content and social media advertising on fast-food consumption patterns among the adult population. Utilizing a questionnaire distributed to customers of a restaurant in Fujairah, United Arab Emirates, convenience sampling was employed. The findings underscored a significant positive relationship between firm-generated content and social media engagement, as well as between the latter and online shopping behavior. However, it was determined that word of mouth did not significantly moderate the relationship between attitudes towards social media advertisements and fast-food consumption patterns. From a theoretical perspective, these results enrich the understanding of how digital dynamics shape consumer behavior in specific contexts. Practically speaking, they prompt a critical reflection on the ethics of marketing in promoting products potentially detrimental to health, urging both companies and policymakers to reconsider their strategies and regulations, respectively.

Effects of glyphosate exposure on western diet-induced non-alcoholic fatty liver disease in mice

We evaluated whether glyphosate promotes western diet (WD)-induced non-alcoholic fatty liver disease (NAFLD). Male C57BL/6J mice were fed WD and received intragastrical glyphosate (0.05, 5 or 50 mg/kg) for 6 months. Glyphosate did not promote WD-induced obesity, hypercholesterolemia, glucose intolerance, hepatic steatosis, and fibrosis. Nonetheless, the higher dose (50 mg) enhanced hepatic CD68+ macrophage density, p65, TNF-α, and IL-6 protein levels. Furthermore, this dose decreased hepatic Nrf2 levels, while enhancing lipid peroxidation in the liver and adipose tissue. Hepatic transcriptome revealed that glyphosate at 50 mg upregulated 212 genes and downregulated 731 genes. Genes associated with oxidative stress and inflammation were upregulated, while key cell cycle-related genes were downregulated. Our results indicate that glyphosate exposure - in a dose within the toxicological limits - impairs hepatic inflammation/redox dynamics in a NAFLD microenvironment.

Habitual Diets Are More Expensive than Recommended Healthy Diets

Understanding food prices and affordability is crucial for promoting healthy dietary habits and informing policy actions. We assessed changes in the cost and affordability of habitual and recommended healthy diets in Northwest Tasmania from 2021 to 2023. The recommended diet was 16-22% less expensive than the habitual diet during the period. Notably, 60% of the total cost of the habitual diet was spent on discretionary items. The cost of the habitual diet increased by 9% in this period, whereas the cost of the recommended diet increased by only 2%. The habitual diet was unaffordable for households with median gross, minimum wage disposable or welfare-dependent incomes. The recommended diet, however, was affordable for some groups but posed a risk of food stress for those with median gross and minimum wage disposable income and remained unaffordable for those who were welfare dependent. Our findings reveal that adhering to a healthy Australian Dietary Guidelines-recommended diet can be more cost-effective than following a habitual unhealthy diet. However, adopting a healthy diet can be challenging for low-income families. Interventions such as financial support, nutrition education, community gardens and food hubs, as well as price regulation and subsidies for farmers, can help address food insecurity in Northwest Tasmania.

2,4-dichlorophenoxyacetic acid (2,4-D) exposure during postnatal development alters the effects of western diet on mouse prostate

Western diet (WD), abundant in saturated fats and simple carbohydrates, has been associated with the development of prostate diseases. In addition, 2,4-dichlorophenoxyacetic acid (2,4-D), an herbicide used in agricultural and non-agricultural settings, may interfere with the endocrine system impacting reproductive health. The association of both factors is something common in everyday life, however, there are no relevant studies associating them as possible modulators of prostatic diseases. This study evaluated the action of the herbicide 2,4-D on the postnatal development of the prostate in mice fed with WD. Male C57Bl/6J mice received simultaneously a WD and 2,4-D at doses of 0.02, 2.0, or 20.0 mg/kg b.w./day for 6 months. The prolongated WD intake induced obesity and glucose intolerance, increasing body weight and fat. WD induced morphological changes and increased PCNA-positive epithelial cells in prostate. Additionally, the WD increased gene expression of AR, antioxidant targets, inflammation-related cytokines, cell repair and turnover, and targets related to methylation and miRNAs biosynthesis compared to the counterpart (basal diet). 2,4-D (0.02 and 2.0) changed prostate morphology and gene expression evoked by WD. In contrast, the WD group exposed to 20 mg/kg of 2,4-D reduced feed intake and body weight, and increased expression of androgen receptor and genes related to cell repair and DNA methylation compared to the negative control. Our results showed that 2,4-D was able to modulate the effects caused by WD, mainly at lower doses. However, further studies are needed to elucidate the mechanisms of 2,4-D on the obesogenic environment caused by the WD.

Can mindful eating buffer against the influence of neighbourhood fast food exposure on unhealthy food intake?

A food-abundant environment is associated with unhealthy food intake, but not everyone is affected to the same degree. Mindful eating, which is eating with attention and awareness, has been associated with less external eating and less food cravings, and could act as a protective factor against influences from the food environment. The current study aimed to investigate whether the association between exposure to fast-food around the home and unhealthy food intake was moderated by mindful eating. The study was conducted in 1086 Dutch adults of 55 years and older of the Longitudinal Aging Study Amsterdam study. The mindful eating domains (Mindful Eating Behavior Scale) were tested as moderating variables in the linear regression models with absolute and relative density of fast-food outlets in the neighbourhood (400, 800 and 1600m) as independent variables and unhealthy food intake (snacks (g/d)) and saturated fat as a percentage of total energy intake (en%)) as dependent variable. Bootstrapping with 5000 samples using the pick-a-point approach showed that after adjustments, only two out of 48 interactions terms were statistically significant: Eating with Awareness (EwA) and Eating without Distraction (EwD) moderated the positive association between the relative density of fast-food outlets and saturated fat (en%) respectively in a buffer of 800m (interaction EwA: B = -0.84, 95% CI [-1.46; -0.22]) and in a buffer of 1600m (interaction EwD: B = -0.82, 95% CI [-1.61; -0.04]). The results of the current study indicate that mindful eating cannot buffer against the influence of the fast-food abundant environment on unhealthy food intake. Future research is needed to confirm these findings, for example in younger populations.

Global burden of non-communicable chronic diseases associated with a diet low in fruits from 1990 to 2019

Background

The aim of this study was to assess the global burden of disease from non-communicable chronic diseases (NCD) due to diet low in fruits from 1990 to 2019.

Methods

Based on data from the Global Burden of Disease (GBD) 2019, the global burden of disease due to diet low in fruits was analyzed for each country or region, disaggregated by disease type, age, sex, and year. The number of deaths and disability-adjusted life years (DALYs), population attributable fraction (PAF), age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were calculated, and the average annual percentage change (AAPC) was calculated to describe trends in ASMR and ASDR from 1990 to 2019.

Results

From 1990 to 2019, the number of deaths and DALYs due to diet low in fruits increased by 31.5 and 27.4%, respectively. Among the tertiary diseases, ischemic heart disease, stroke, and diabetes and kidney disease were the top three contributors to the global increase in deaths and DALYs. However, both ASMR and ASDR showed a decreasing trend. The fastest decline in ASMR and ASDR was in stroke, with AAPC of -2.13 (95% CI: -2.22, -2.05, p < 0.05) and -0.56 (95% CI: -0.62, -0.51, p < 0.05), respectively. For GBD regions, high PAF occurred mainly in South Asia, Oceania, and sub-Saharan Africa. Age-specific PAF for stroke and ischemic heart disease death attributable to diet low in fruits was significantly negatively associated with age. Diet low in fruits related ASMR and ASDR showed an M-shaped relationship with the socio-demographic index (SDI), but with an overall decreasing trend.

Conclusion

The number of deaths and DALYs due to diet low in fruits continues to increase. Therefore, early nutritional interventions should be implemented by the relevant authorities to reduce the burden of diseases caused by diet low in fruits.

The relationship between family diet consumption, family environment, parent anxiety and nutrition status children during the COVID-19 pandemic: a longitudinal study

Background

The COVID-19 pandemic has exacerbated the trends of childhood overweight, obesity, and malnutrition, as well as increased psychological stress and family conflicts among family members. It is important to explore the relationship between changes in the family environment during the COVID-19 on child nutrition.

Objective

This study aims to analyze the nutritional status of Chinese children during the COVID-19 pandemic and its relationship with family diet, family environment, and parental anxiety, in order to provide evidence for further interventions in children's nutritional status.

Method

This study included 7,645 primary and secondary school students and their parents from five schools in Chengdu, China. Chi-square tests were used to analyze the categorical variables of children's malnutrition, overweight, obesity, and parental anxiety. T-tests were used to assess changes in the continuous variable of family environment between two rounds of follow-up surveys. Multiple logistic regression analysis was employed to examine the impact of changes in family diet during the COVID-19 pandemic on children's nutritional status. Generalized estimating equations were used to analyze the effects of family environment and parental anxiety on childhood obesity.

Result

The prevalence of malnutrition and obesity decreased from 11.64% and 11.60% in wave 1 to 4.96% and 10.50% in wave 2, and the rate of overweight increased from 13.11% in wave 1 to 13.73% in wave 2. Children whose families reduced consumption of staple foods during the COVID-19 were more likely to be frail, and families increased consumption of sugary drinks, take-out or meal delivery services, living in towns, family environmental barriers, and parental anxiety were risk factors for overweight obesity. Mother's education level in middle and high school and low age were protective factors for overweight obesity.

Conclusion

The physical environment of the family, the emotions of family members, and children's perceptions of the family's soft environment can influence children's eating behaviors, children's nutritional intake, and malnutrition and obesity in children under public health emergencies, and family-based dietary interventions may be effective. Parents can increase consumption of healthy foods and improve the family environment, which improve their growth.

TFOS Lifestyle: Impact of nutrition on the ocular surface

Nutrients, required by human bodies to perform life-sustaining functions, are obtained from the diet. They are broadly classified into macronutrients (carbohydrates, lipids, and proteins), micronutrients (vitamins and minerals) and water. All nutrients serve as a source of energy, provide structural support to the body and/or regulate the chemical processes of the body. Food and drinks also consist of non-nutrients that may be beneficial (e.g., antioxidants) or harmful (e.g., dyes or preservatives added to processed foods) to the body and the ocular surface. There is also a complex interplay between systemic disorders and an individual's nutritional status. Changes in the gut microbiome may lead to alterations at the ocular surface. Poor nutrition may exacerbate select systemic conditions. Similarly, certain systemic conditions may affect the uptake, processing and distribution of nutrients by the body. These disorders may lead to deficiencies in micro- and macro-nutrients that are important in maintaining ocular surface health. Medications used to treat these conditions may also cause ocular surface changes. The prevalence of nutrition-related chronic diseases is climbing worldwide. This report sought to review the evidence supporting the impact of nutrition on the ocular surface, either directly or as a consequence of the chronic diseases that result. To address a key question, a systematic review investigated the effects of intentional food restriction on ocular surface health; of the 25 included studies, most investigated Ramadan fasting (56%), followed by bariatric surgery (16%), anorexia nervosa (16%), but none were judged to be of high quality, with no randomized-controlled trials.

High nutrition literacy linked with low frequency of take-out food consumption in chinese college students

BACKGROUND

The excessive consumption of take-out food has increased the risk of nutrition-related chronic diseases. Nutrition literacy (NL) is an important influencing factor of food choice. This study aimed to explore the relationship between nutrition literacy and take-out food consumption.

METHODS

A cross-sectional study was conducted on 2130 college students in Bengbu, China. A self-reported questionnaire that included demographic information, lifestyle behavior, take-out food consumption, and nutrition literacy scale was used. Ordinal logistic regression models were used to analyze the association between nutrition literacy and take-out food consumption.

RESULTS

Of the students surveyed, 61.5% consumed take-out food at least once a week. NL was significantly associated with the frequency of take-out food consumption ≥ 4 times/week (OR = 0.995, 95% CI = 0.990-1.000); the difference specifically was discovered for applying skills, interactive skills, and critical skills. Moreover, students with high level NL ate less (Spicy) hot pot (OR = 0.996, 95% CI = 0.992-1.000), but more vegetable and fruit salad (OR = 1.009, 95% CI = 1.002-1.015).

CONCLUSIONS

NL, especially in applying skills, interactive skills, and critical skills, is not only associated with consumption frequency of take-out food among college students, but also links with types of take-out food consumption. Our findings emphasize that targeted interventions on nutritional skills literacy should be needed to improve dietary behaviors for student's good health.

Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022)

Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.

Using the theory of planned behavior to predict factors influencing fast-food consumption among college students

PURPOSE

The purpose of this research is to examine the behavioral factors that impact fast food consumption (FFC) among college students in Pakistan by applying the theory of planned behavior (TPB).

METHODS

Cross-sectional survey was distributed to college students in Pakistan. The questionnaire examines the factors associated with six categories: demographics, FFC pattern, intention for FFC, attitudes toward FFC, Subjective Norms (SN), and Perceived Behavioral Control (PBC). Data analysis was conducted using SPSS and SPSS AMOS software using descriptive statistics, inferential statistics (chi-square, t-test, Pearson correlation, and multiple regression analysis), and structural equation modeling (SEM) Analysis.

RESULTS

A total of 220 questionnaires were completed (97 males and 123 females). There were significant differences in FFC association with gender. Among the constructs of TPB, behavioral intention (BI) and SN are the strongest predictors of the FFC (p < .05). TPB has significantly predicted FFC behavior with a variance of R² 0.603. The SEM analysis shows that the data collected were incompatible with the theoretical TPB model, making it unfeasible to test our five hypotheses or interpret the results due to the poor fit of the model with the data.

CONCLUSIONS

To ensure a good fit of the data with the specified TPB model in SEM analysis, the number of indicators should be limited (≤ 30), or the sample size should be greater (N ≥ 500). Pakistani college students' FFC is mainly influenced by friends and the increased popularity of fast food, despite their knowledge of its negative health effects. Educational programs should target specific harmful effects of fast food, and SN and BI are the strongest predictors of FFC among TPB constructs. These findings can be useful for developing targeted interventional health strategies and future research.

Heavy metal risk of disposable food containers on human health

The consumption of disposable materials is booming with the rapid development of urbanization and industrialization, which may inevitably cause the release of toxic and harmful substances during use of them in daily life. This study was to estimate element levels such as Beryllium (Be), Vanadium (V), Zinc (Zn), Manganese (Mn), Cadmium (Cd), Chromium (Cr), Nickel (Ni), Cobalt (Co), Antimony (Sb), Barium (Ba), Lead (Pb), Iron (Fe), Copper (Cu), and Selenium (Se) in leachate and subsequently assess the health risk of exposure to those disposable products such as paper and plastic food containers. We found that a large amount of metals was released from disposable food containers in hot water, and the order of metal concentration is Zn > Ba > Fe > Mn > Ni > Cu > Sb > Cr > Se > Be > Pb > Co > V > Cd. Additionally, the hazard quotient (HQ) of metals in young adults were less than 1, and were decreased in the order of Sb > Fe > Cu > Be > Ni > Cr > Pb > Zn > Se > Cd > Ba > Mn > V > Co. Furthermore, the excess lifetime cancer risk (ELCR) results of Ni and Be indicated that chronic exposure to Ni and Be may have a non-negligible carcinogenic risk. These findings suggest that potential health risk of metals may exist for the individuals to use disposable food containers under high temperature environment.

Prevalence of fast-food intake among a multi-ethnic population of middle-aged men and connection with sociodemographic factors and obesity

Adults are increasingly eating fast-food, which is connected to adverse health outcomes such as obesity and chronic diseases. This work was carried out to study the prevalence of fast-food intake among a multi-ethnic population of middle-aged men and its connection with sociodemographic factors and obesity. This cross-sectional study enrolled 1800 middle-aged men from Riyadh, Kingdom of Saudi Arabia. A valid and reliable questionnaire was used to assess participants fast-food intake frequency. Fast-food was consumed weekly by 87.8% of participants and daily by 45.6% of participants. The nationality of participants was determined as a predictor of fast-food intake. The highest and lowest prevalence of weekly fast-food intake was reported among Turkish (99.6%) and Sudanese (48.3%) participants. The highest and lowest daily intake rates were reported among participants from the Philippines (85.9%) and Bangladesh (10.0%). Another factor predicting fast-food intake was obesity. Obese participants had a significantly higher odds ratio (OR) of weekly (OR = 5.83, P <.001) and daily (OR = 1.93, P <.001) fast-food intake than non-overweight/nonobese participants. Fast-food intake was prevalent among middle-aged men who reside in Kingdom of Saudi Arabia. Results connect fast-food intake with nationality and obesity.

Frequency of Convenience Cooking Product Use Is Associated with Cooking Confidence, Creativity, and Markers of Vegetable Intake

Low levels of cooking skills, confidence and home cooking are related to poorer dietary outcomes and are a common barrier to adequate vegetable consumption. Convenience cooking products may play a role in lowering the levels of confidence and creativity required to prepare home-cooked meals. It has previously been reported that those who use convenience cooking products have lower levels of cooking confidence and creativity and lower vegetable intakes compared to those who do not use these products. However, the relationship between these outcomes and the frequency of use of convenience cooking products has not been assessed. Therefore, a balanced demographic panel of Australian adults (n = 1034) was surveyed on the frequency of convenience cooking product use, vegetable intake and variety, and opinions and habits regarding vegetable intake. Those who used the products more regularly had higher cooking confidence and creativity, and higher vegetable variety scores, compared to less regular users (p < 0.05). However, the frequency of use of convenience cooking products was not associated with higher vegetable intake and did not influence views around the ease of eating vegetables. Therefore, these products may be a tool for assisting those with lower levels of cooking skills in accessing a higher variety of vegetables, but vegetable quantity in these products may need to be revised to assist consumers in better meeting intake recommendations.

Fast food consumption in adults living in Canada: alternative measurement methods, consumption choices, and correlates

Global industries and technological advancements have contributed to the proliferation of fast food (FF) establishments and ultraprocessed food, associated with poorer diet quality and health outcomes. To investigate FF as an indicator, we compared alternative methods to capture self-reported FF consumption and examined associated socio-demographic factors. We conducted a secondary analysis of the 2014-2015 Foodbook study, a cross-sectional survey on foods consumed by Canadians during the previous week. An embedded randomized design compared alternative FF intake questions of varying details. A total of 6062 participants aged 18+ were included, representing 24.7 million Canadian adults. Approximately 48% consumed FF in the past week, and of FF consumers, average frequency was twice. Asking broadly about FF intake without examples resulted in significantly lower reported FF intake compared with the two more detailed questions; the latter two were not significantly different. Burgers, pizza, and submarines/sandwiches were most commonly consumed. Men, younger age, higher BMI, women in central Canada (versus territorial regions), and men with income $30 000-$80 000 (versus >$80 000) were associated with higher FF consumption. Consumption of FF is common among Canadians; some associated factors are gender-specific. Further research examining FF as an indicator, and individual and societal implications of FF consumption, is recommended to inform programs and policies.

A narrative review of online food delivery in Australia: challenges and opportunities for public health nutrition policy

OBJECTIVE

Online food delivery (OFD) platforms offer consumers a convenient and fast delivery service of foods and drinks sourced from foodservice partners (e.g. restaurants, quick service restaurants). There is a need to assess the impact of this emergent segment of the foodservice sector on diet and diet-related health. The aim of this narrative review was to describe the OFD sector in Australia, its use and identify potential ways to include OFD platforms in existing public health nutrition policy.

DESIGN

A search was conducted in peer-reviewed and grey literature. Sources were analysed and synthesised to report the characteristics of OFD platforms, delivery process, users and potential drivers of usage. The aim and scope of public health nutrition policies were analysed to identify ways of including OFD platforms.

SETTING

Australia.

PARTICIPANTS

General population.

RESULTS

There are three main operators with 9000-16 000 foodservice partners based predominantly in the main cities of Australia. OFD revenue has grown by 72 % in the last 5 years and is predicted to increase driven by usage by working adults with high disposable income who demand convenience. Current policies and initiatives aimed at manufacturers, retailers and foodservice outlets do not specifically regulate OFD platforms, although there is scope for these to be extended to such platforms.

CONCLUSIONS

OFD platforms are disruptors of the foodservice sector. Innovative and consistent health policy options that target the unique challenges and opportunities posed by OFD platforms are required to limit the potentially negative impact of OFD platforms on diet and diet-related health.

Status of nutrition labeling knowledge, attitude, and practice (KAP) of residents in the community and structural equation modeling analysis

Objective

Unhealthy foods were a major contributor to the occurrence of chronic non-communicable diseases. The promotion of nutrition labeling in the community can effectively help residents to choose healthy foods, which plays an important role in the prevention of chronic diseases. However, the public awareness of this measure is not clear. Our study used a structural equation model based on the KAP theory to analyze the interaction mechanisms among knowledge, attitude, and practice and aimed to evaluate the relationships among nutrition knowledge, attitude, and practice of residents, which can provide the basis of policy formulation for nutrition education and behavior intervention.

Methods

We carried out a cross-sectional study from May 2022 to July 2022 in the "Community Health Service Center", and each "Community Service Station" in Yinchuan use a self-designed questionnaire and convenience sampling to evaluate resident nutrition labeling KAP status. This study adopted the structural equation modeling approach to analyze a survey of Chinese individuals through the cognitive processing model, interrelated nutrition knowledge, nutrition label knowledge, attitude, and practice.

Results

According to the principle of sample size estimation, a total of 636 individuals were investigated, with the ratio of male to female being 1:1.2. The average score of community residents' nutrition knowledge was 7.48 ± 3.24, and the passing rate was 19.4%. Most residents had a positive attitude toward nutrition labeling, but the awareness rate was only 32.7% and the utilization rate was 38.5%. Univariate analysis showed that women had higher knowledge scores than men (p < 0.05), and young people had higher scores than older adults (p < 0.05), and the difference was significant. Based on the KAP structural equation model (SEM), residents' nutrition knowledge will directly affect their attitude toward nutrition labeling. Attitude played a greater role as an indirect effect between knowledge and behavior, while trust limits residents' practice of nutrition labeling and then affects their practice. It could be explained that nutrition knowledge was the prerequisite for label reading behavior, and attitude was the intermediary effect.

Conclusion

The nutrition knowledge and nutrition labeling knowledge of respondents hardly directly support the practice of nutrition labeling, but it can influence the use behavior by forming a positive attitude. The KAP model is suitable for explaining residents' use of nutrition labeling in the region. Future research should focus on better understanding the motivations of residents to use nutrition labeling and the opportunity to use nutrition labeling in real-life shopping settings.

Multilevel correlates of abdominal obesity in adolescents and youth living with HIV in peri-urban Cape Town, South Africa

BACKGROUND

Chronic non-communicable disease comorbidities are a major problem faced by people living with HIV (PLHIV). Obesity is an important factor contributing to such comorbidities and PLHIV face an elevated risk of obesity. However, there is data paucity on the intersection of obesity and HIV in adolescents and youth living with HIV (AYLHIV) in sub-Saharan Africa. We therefore aimed to investigate the prevalence of abdominal obesity and associated multilevel factors in AYLHIV in peri-urban Cape Town, South Africa.

METHODS

We conducted a cross-sectional study enrolling AYLHIV aged 15-24 years attending primary healthcare facilities in peri-urban Cape Town in 2019. All measures, except for physical examination measures, were obtained via self-report using a self-administered electronic form. Our outcome of interest was abdominal obesity (waist-to-height ratio ≥ 0.5). We collected individual-level data and data on community, built and food environment factors. Data was summarized using descriptive statistics, stratified by obesity status. Multilevel logistic regression was conducted to investigate factors associated with abdominal obesity, adjusted for sex and age.

FINDINGS

A total of 87 participants were interviewed, 76% were female and the median age was 20.7 (IQR 18.9-23.0) years. More than two fifths had abdominal obesity (41%; 95% CI: 31.0-51.7%), compared to published rates for young people in the general population (13.7-22.1%). In multilevel models, skipping breakfast (aOR = 5.42; 95% CI: 1.32-22.25) was associated with higher odds of abdominal obesity, while daily wholegrain consumption (aOR = 0.20; 95% CI: 0.05-0.71) and weekly physical activity (aOR = 0.24; 95% CI: 0.06-0.92) were associated with lower odds of abdominal obesity. Higher anticipated stigma was associated with reduced odds of obesity (aOR = 0.58; 95% CI: 0.33-1.00). Land-use mix diversity (aOR = 0.52; 95% CI: 0.27-0.97), access to recreational places (aOR = 0.37; 95% CI: 0.18-0.74), higher perceived pedestrian and traffic safety (aOR = 0.20; 95% CI: 0.05-0.80) and having a non-fast-food restaurant within walking distance (aOR = 0.30; 95% CI: 0.10-0.93) were associated with reduced odds of abdominal obesity. The main limitations of the study were low statistical power and possible reporting bias from self-report measures.

CONCLUSIONS

Our findings demonstrate a high prevalence of abdominal obesity and highlight multilevel correlates of obesity in AYLHIV in South Africa. An intersectoral approach to obesity prevention, intervening at multiple levels is necessary to intervene at this critical life stage.

Fast-Food Optimal Defaults Reduce Calories Ordered, as Well as Dietary Autonomy: A Scenario-Based Experiment

BACKGROUND

Low-calorie menu items as optimal defaults may encourage healthier choices when people eat out. Limited research has studied default effects from the restauranteurs' perspective, as well as the public health perspective.

OBJECTIVE

To examine the effects of optimal defaults on calories ordered, dietary autonomy, and visit intention in the context of a fast-food drive-through.

DESIGN

Between-subjects randomized scenario-based experiment.

PARTICIPANTS/SETTING

In all, 377 adults who lived in the United States were recruited through a crowdsourcing platform in July 2020.

INTERVENTION

Participants were asked to visualize ordering a combo meal in a fast-food drive-through. They were randomly assigned to order from 1 of 3 menu boards: (1) menu items available for combos by customer choice, (2) combos that included traditional high-calorie default items, or (3) combos that included low-calorie optimal defaults.

MAIN OUTCOME MEASURES

Differences in calories ordered among groups, dietary autonomy, and restaurant visit intention.

ANALYSIS

Statistical tests included multiple regression, Kruskal-Wallis, χ², and 1-way analysis of variance. Covariates such as education and sex were tested in regression models as potential confounders.

RESULTS

Compared with the choice combo meals, optimal combo meals reduced calories ordered by consumers (-337 kcal, standard error = 19, P < .001), while traditional combos increased them (+132 kcal, standard error = 20, P < .001). No significant difference was found in visit intention. Dietary autonomy was affected by the optimal defaults (P = .025), even in participants with high health concern. Conversely, the traditional combo's effect on dietary autonomy was moderated by health concern (B = -0.26, P = .023), with only individuals with very high levels of health concern perceiving less autonomy.

CONCLUSIONS

Optimal defaults provided a robust reduction in calories ordered but had implications for dietary autonomy.

Visual Cues and Optimal Defaults in Fast-Food Combo Meals Benefit Health-Concerned Consumers-A Randomized Scenario-Based Experiment

BACKGROUND

The use of low-calorie menu items as optimal defaults and visual cues may nudge consumers to healthier choices at restaurants. However, little is known regarding their effects on emotions and behavioral intentions, particularly among people with different levels of health concern.

OBJECTIVE

Evaluate optimal defaults and visual cues' effect on anticipated pleasure and order intention depending upon consumers' health concern level.

DESIGN

Between-subjects randomized scenario-based experiment.

PARTICIPANTS/SETTING

In all, 636 US adults recruited through an online crowdsourcing platform in July 2020.

INTERVENTION

Participants saw 1 of 6 menu boards in a fast-food drive-through simulation. Half the menu boards included meal photos with (1) menu items to be arranged as a combo by choice (ie, create-your-own combo); (2) traditional combos that included high-calorie default items; or (3) optimal combos that included low-calorie default items. The remaining 3 boards were identical without photos.

MAIN OUTCOME MEASURES

Anticipated pleasure, order intention, and health concern were evaluated with 7-point Likert scales.

ANALYSIS

Statistical tests included multiple regression, Kruskal-Wallis, χ², and analysis of variance. Education and sex were tested as potential confounders.

RESULTS

Optimal combos negatively affected anticipated pleasure (P = .003) and order intention (P < .001) compared with choice combos. Order intention reduction was the same for traditional and optimal combos (P = .128). The presence of photos changed order intention for optimal combos but varied by consumer's health concern level. When health concern was lower, photos decreased the likelihood of ordering the optimal combos (B = -3.06, P = .001), but when health concern was higher, photos enhanced ordering intention compared with the choice group (B = 0.60, P = .001). The photos did not affect anticipated pleasure for any level of health concern.

CONCLUSIONS

The adverse effect of optimal defaults and how visual cues may reduce their negative effect should be considered in menu design.

Nutritional quality and consumer health perception of online delivery food in the context of China

Background

Today, the popularization of mobile internet technology has enabled the public’s need for food convenience and diversity arising from modern fast-paced lifestyles to be met at a relatively low cost. The digital age of the restaurant industry has arrived. Online food delivery (OFD) is rapidly developing globally. However, the public’s awareness of the nutritional quality of food through OFD and their knowledge of dietary nutrition remain to be investigated.

Methods

In the context of China, this study attempts to evaluate the nutritional quality of best-selling OFD set meals (i.e., meal combos) based on the current official Chinese dietary guidelines 2022. It accomplishes this by collecting data on popular OFD restaurants among consumers in 115 Chinese universities from the restaurants’ delivery addresses. Moreover, 20,430 valid questionnaires were collected online from undergraduates, graduate students, and other young groups aged 18–30 throughout China for descriptive analysis to investigate consumers’ perceptions of the nutritional quality of food through OFD and its health impact.

Results

The results of the nutritional quality evaluation of the OFD set meals ranged widely from 15 to 85, with a mean of 36.57 out of a possible maximum score of 100; and 89.56% scored less than 50. The nutritional quality of OFD foods was thus generally low. The nutritional quality of foods was negatively correlated with their popularity among consumers.

Conclusions

Young OFD consumers generally paid low attention to dietary nutrition knowledge and seldom paid attention to nutritional quality when choosing OFD foods while the nutritional quality of OFD foods was generally low. Respondents subjectively reported that long-term consumption of OFD food caused weight gain, increased blood lipids, and gastrointestinal discomfort. They thought that the reason might be excessive oil, salt, and sugar in the food, while ignoring the balance between different types of food.

Prevalence of Fast Food Intake among a Multi-Ethnic Population of Young Men and Its Connection with Sociodemographic Determinants and Obesity

Fast food is commonly consumed by young adults. Eating fast food is connected with the risk of obesity and other related diseases. The present study examines the prevalence of fast food intake in a diverse sample of young men. This cross-sectional study included 3600 young men (20-35 years) who resided in Riyadh, KSA. The frequency of fast food intake was assessed using a valid and reliable questionnaire. Weekly and daily intake of fast food were the two outcome variables adopted to assess the intake frequency. Weight and height were measured. Fast food was eaten by 88.8% and 50.1% of participants weekly and daily, respectively. Fast food intake was predicted by the nationality of participants. The highest prevalence of weekly fast food intake (99.7%) was observed among Saudi, Egyptian, and Indian participants, while the lowest rate was observed among Sudanese participants (48.6%). The highest and lowest rates of daily intake were seen among Filipino (83.4%) and Bangladeshi (6.3%) participants. Obesity was another predictor of fast food intake. Obese participants had a significantly higher odds ratio of weekly (OR = 2.89, p = 0.006) and daily (OR = 1.39, p = 0.021) fast food intake than non-overweight/non-obese participants. In conclusion, fast food is frequently consumed by young men in KSA. Our findings link the likelihood of fast food intake to sociodemographic determinants and obesity.

Unhealthy Food at Your Fingertips: Cross-Sectional Analysis of the Nutritional Quality of Restaurants and Takeaway Outlets on an Online Food Delivery Platform in New Zealand

Online food delivery (OFD) platforms have become increasingly popular due to advanced technology, which is changing the way consumers purchase food prepared outside of the home. There is limited research investigating the healthiness of the digital food environment and its influence on consumer choice and dietary behaviours. This study is the first to examine the nutritional quality and marketing attributes of menu items from popular independent and franchise restaurants and takeaway outlets on New Zealand’s market leading OFD platform (UberEATS®). A total of 374 popular independent and franchise restaurants and takeaway outlets were identified to form a database of complete menus and marketing attributes. All 25,877 menu items were classified into 38 food and beverage categories based on the Australian Dietary Guidelines. Of complete menus, 73.3% (18,955/25,877) were discretionary. Thirty-six percent (9419/25,877) were discretionary cereal-based mixed meals, the largest of the 38 categories. Discretionary menu items were more likely to be categorized as most popular (OR: 2.0, 95% CI 1.7−2.2), accompanied by a photo (OR: 1.7, 95% CI 1.6−1.8), and offered as a value bundle (OR: 4.6, 95% CI 3.2−6.8). Two of the three discretionary mixed meal categories were significantly less expensive than their healthier counterparts (p < 0.001). The overwhelming availability and promotion of discretionary choices offered by restaurants and takeaway outlets on OFD platforms have implications for public health policy. Further research to explore direct associations between nutritional quality and consumers’ dietary choices is required.

Psychiatric Symptoms and Frequency of Eating out among Commuters in Beijing: A Bidirectional Association?

Background: Mental illness places as a distant first in global burdens, exceeding both cardiovascular and circulatory diseases, in terms of the years lived with the disability. The emergence of the new and burgeoning area of “Nutrition Psychiatry” offers promise in improving mental health with diet. Mental health and well-being are critical to commuters but rarely recieve the attention they need. This study aimed to examine the bidirectional relationship between the frequency of eating out and depression, anxiety, and stress symptoms in a sample of Beijing commuters. Methods: A total of 3337 commuters (mean (SD) age, 38.78 (10.41); 74.74% males) from the cohort study CHCN-BTH were included. The psychiatric symptoms were evaluated using a 21-item self-reported depression–anxiety–stress scale (DASS-21). A Cochran–Armitage trend chi-square test, restricted cubic spline, multiple logistic regression, multinomial logit models, and E-values were performed to estimate the associations between eating out and psychiatric symptoms in both directions. Results: A daily rate of eating out more than 50% had a higher risk for depression (OR, 95% CI: 1.68, 1.184–2.393), anxiety (1.73, 1.259–2.369), and stress (1.99, 1.191–3.329) than the individuals eating at home. A higher frequency of eating out for lunch was significantly associated with an increased risk of depression (1.78, 1.28–2.46), anxiety (1.67, 1.26–2.23), and stress (2.05, 1.31–3.22). Similar results were found when eating out for dinner with increased risks for depression 2.20 (1.59, 3.06), anxiety 1.91 (1.42, 2.59), and stress 2.61 (1.68, 4.05). There is limited evidence supporting the effects of psychiatric symptoms on the frequency of eating out in the reverse analyses. Conclusions: The frequency of eating out is positively associated with an increased risk of psychiatric symptoms, especially when eating out for lunch and dinner. People eating at home have the lowest risk of suffering psychiatric symptoms, followed by those eating in the workplace canteen. Eating at home should be considered for future recommendations for the prevention of psychiatric symptoms.

Facilitators and barriers influencing weight management behaviours during pregnancy: a meta-synthesis of qualitative research

BACKGROUND

Obesity and overweight are considered risk factors for a range of adverse outcomes, including stillbirth. This study aims to identify factors reported by women influencing weight management behaviours during pregnancy.

METHODS

A systematic search was conducted in five databases from inception to 2019 and updated in 2021. Qualitative studies involving pregnant or post-partum women, from high-income countries, examining women's experiences of weight management during pregnancy were included. Meta-ethnography was used to facilitate the meta-synthesis of 17 studies.

RESULTS

Three themes were identified during the analysis: (1) Awareness and beliefs about weight gain and weight management, which included level of awareness and knowledge about dietary and exercise recommendations, risk perception and decision balance, perceived control over health and weight gain and personal insecurities. (2) Antenatal healthcare, women's experiences of their interactions with healthcare professionals during the antenatal period and the quality of the education received had an effect on women's behaviour. Further, our findings highlight the need for clear and direct information, and improved interactions with healthcare professionals, to better support women's weight management behaviours. (3) Social and environmental influence, the social judgement and stigmatization associated with overweight and obesity also acted as a negative influence in womens' engagement in weight management behaviours.

CONCLUSION

Interventions developed to promote and maintain weight management behaviours during pregnancy should consider all levels of influence over women's behaviours, including women's level of awareness and beliefs, experiences in antenatal care, education provision and social influence.

Neighbourhood walkability and dietary attributes: effect modification by area-level socio-economic status

OBJECTIVE

Higher neighbourhood walkability would be expected to contribute to better health, but the relevant evidence is inconsistent. This may be because residents' dietary attributes, which vary with socio-economic status (SES) and influence their health, can be related to walkability. We examined associations of walkability with dietary attributes and potential effect modification by area-level SES.

DESIGN

The exposure variable of this cross-sectional study was neighbourhood walkability, calculated using residential density, intersection density and destination density within 1-km street-network buffer around each participant's residence. The outcome variables were dietary patterns (Western, prudent and mixed) and total dietary energy intake, derived from a FFQ. Main and interaction effects with area-level SES were estimated using two-level linear regression models.

SETTING

Participants were from all states and territories in Australia.

PARTICIPANTS

The analytical sample included 3590 participants (54 % women, age range 34 to 86).

RESULTS

Walkability was not associated with dietary attributes in the whole sample. However, we found interaction effects of walkability and area-level SES on Western diet scores (P < 0·001) and total energy intake (P = 0·012). In low SES areas, higher walkability was associated with higher Western dietary patterns (P = 0·062) and higher total energy intake (P = 0·066). In high SES areas, higher walkability was associated with lower Western diet scores (P = 0·021) and lower total energy intake (P = 0·058).

CONCLUSIONS

Higher walkability may not be necessarily conducive to better health in socio-economically disadvantaged areas. Public health initiatives to enhance neighbourhood walkability need to consider food environments and socio-economic contexts.

Association between patterns of eating habits and mental health problems in Chinese adolescents: A latent class analysis

Objective

We aimed to investigate the association between different eating habit patterns and mental health problems among Chinese middle and high school students, and further to estimate the interaction effect of different grouping variables on eating habits.

Methods

One thousand three hundred and forty-eight adolescents from Jilin Province in China were involved in this cross-sectional study. Mental health and eating habits were assessed using General Health Questionnaire and questions on Nutrition Knowledge, Attitude and Practice, respectively. Latent class analysis (LCA) was performed to identify eating habit patterns. Binary logistic regression and generalized linear models were used to explore the association between eating habit patterns, energy-adjusted nutrient intakes and mental health problems. Interaction analysis was performed to analyze the association between eating habits and mental health in different groups.

Results

Based on the LCA results, a 3-class parallel model was identified: 648 adolescents (48.1%) were classified in class-1 “Healthy Eating Behavior/Eating at Home,” 452 adolescents (33.5%) in class-2 “Healthy Eating Behavior/Eating at School” and 248 adolescents (18.4%) in class-3 “Unhealthy Eating Behavior/Random Place.” Compared with class-1, participants in class-2 and class-3 were at higher risk of mental health problems, especially for class-3 (p < 0.05). The energy and nutrient intakes by different latent classes showed that adolescents who ate unhealthy had lower daily intake of energy, protein, carbohydrate, fiber, Vitamins and minerals (p < 0.05). The interaction between age, sleep duration and different eating habits was statistically significant (p for interaction < 0.1).

Conclusion

“Unhealthy eating behavior/random place pattern” was positively correlated with mental health problems of adolescents. The adolescents with health diet were accompanied by fewer mental health problems, especially for that eating at home. And there were interactions between eating habits and age, sleep duration on the mental health problems.

Estimating the Impact of COVID-19 Pandemic on Customers’ Dining-Out Activities in South Korea

This study classified the types of dining-out activities into three categories: visiting restaurants, using delivery services, and using take-out services to understand how customers’ various dining-out activities were carried out during the COVID-19 pandemic. The study used the Theory of Planed Behavior (TPB) model to analyze the structural relationship between the main factors and three dining-out activities. An online survey method was used to distribute and collect survey link addresses through respondents’ SNS and e-mail and a data analysis was performed on the final 429(85.8%) effective samples. A paired t-test and structural equation modeling (SEM) were used to investigate customers’ dining-out activities. This study is of significant contribution in that it compared and analyzed customers’ various dining-out activities using the TPB model, laid the theoretical foundation for related research, and suggested ways to help related industry workers establish marketing strategies under the pandemic.

The association between fast-food consumption and job-related factors among Russian adults

Time constraints contribute to individuals' dietary choices along with incomes, prices, and preferences. As fast food is prepared and served quickly, it is often preferred to other food options, especially when individuals are under time pressure. This paper focuses on a set of job-related characteristics that could potentially contribute to fast-food consumption choice, and controls for standard socio-demographic, economic, and lifestyle factors. This study uses data from a quantitative household survey on health behavior and medicine of Russian adults conducted in 2017 (n = 4006). The study applies simple probit, ordered probit, and zero-inflated ordered probit models to examine how job-related characteristics are connected to the probability and frequency of fast-food consumption among Russian adults. The results shows that employment is positively associated with both probability and frequency of fast-food consumption. However, for working adults, the decisions to eat fast food, and how frequently it is eaten, are affected by different factors. For example, working part time decreases the probability of fast-food consumption; having more than one job increases the frequency of its intake for fast-food consumers; having canteens with hot meals at work decreases the frequency of fast-food intake. Although job-related factors are significant in all models, marginal effects show that living in large cities, especially Moscow and Saint Petersburg, plays a larger role in the probability and frequency of fast-food consumption because access to various fast-food outlets increases in relation to the size of the settlement.

Street Food and Takeaway Food Purchasing Patterns in Bosnia and Herzegovina

This study aimed to describe street food and takeaway food purchasing patterns in Sarajevo and Banja Luka, throughout the day and by city location. A cross-sectional evaluation of street food and takeaway food customers was conducted in 2017. All eligible vending sites (n = 348) in the vicinity of selected markets and bus stops were included. Data on the food items purchased, and time and geographic location of the purchases were collected. A total of 755 customers purchased 929 food items. Takeaway venues showed higher customer influx (5.0 vs. 2.0 customers observed per 10 min of observation, p < 0.001) and buying rates (6.7 vs. 2.0 items bought per 10 min of observation, p < 0.001; 1.5 vs. 1.0 items bought per customer, p < 0.001) than street food sites. These rates were higher in city peripheries for street food venues, and in city centres for takeaway establishments. The purchase of industrial food products prevailed throughout the day in street food venues, whereas most takeaway purchases comprised homemade foods, with or without industrial beverages. The proportion of customers buying foods and beverages together was higher in takeaway venues (15.3% vs. 6.0%, p < 0.001), especially during lunchtime and in city centres. In street food vending sites, sweet and savoury snacks seemed to be preferred in the afternoon, whereas in takeaway food establishments, savoury pastries and main dishes were mostly purchased at breakfast or lunch, and bread during the morning. Soft drinks and industrial juices were frequently purchased in both types of vending site and at all hours of the day, particularly in the afternoon. Our findings provide an overview of street food and takeaway food buying habits and consumer demands in these cities, reflecting local food culture and dietary behaviours. The identification of the meal contexts and city sub-regions in which specific purchasing practices emerge point to potential priority targets. These insights can be useful when designing interventions adapted to the specificities of these food environments and the food habits of customers.

Investigating experiences of frequent online food delivery service use: a qualitative study in UK adults

BACKGROUND

Food prepared out-of-home is typically energy-dense and nutrient-poor. This food can be purchased from multiple types of retailer, including restaurants and takeaway food outlets. Using online food delivery services to purchase food prepared out-of-home is increasing in popularity. This may lead to more frequent unhealthy food consumption, which is positively associated with poor diet and living with obesity. Understanding possible reasons for using online food delivery services might contribute to the development of future public health interventions, if deemed necessary. This knowledge would be best obtained by engaging with individuals who use online food delivery services as part of established routines. Therefore, we aimed to investigate customer experiences of using online food delivery services to understand their reasons for using them, including any advantages and drawbacks.

METHODS AND RESULTS

In 2020, we conducted telephone interviews with 22 adults living in the UK who had used online food delivery services on at least a monthly basis over the previous year. Through codebook thematic analysis, we generated five themes: 'The importance of takeaway food', 'Less effort for more convenience', 'Saving money and reallocating time', 'Online food delivery service normalisation' and 'Maintained home food practices'. Two concepts were overarching throughout: 'Place. Time. Situation.' and 'Perceived advantages outweigh recognised drawbacks'. After considering each of the accessible food purchasing options within the context of their location and the time of day, participants typically selected online food delivery services. Participants reported that they did not use online food delivery services to purchase healthy food. Participants considered online food delivery service use to be a normal practice that involves little effort due to optimised purchasing processes. As a result, these services were seen to offer convenient access to food aligned with sociocultural expectations. Participants reported that this convenience was often an advantage but could be a drawback. Although participants were price-sensitive, they were willing to pay delivery fees for the opportunity to complete tasks whilst waiting for delivery. Furthermore, participants valued price-promotions and concluded that receiving them justified their online food delivery service use. Despite takeaway food consumption, participants considered home cooking to be irreplaceable.

CONCLUSIONS

Future public health interventions might seek to increase the healthiness of food available online whilst maintaining sociocultural values. Extending restrictions adopted in other food environments to online food delivery services could also be explored.

Behavior of Polish Consumers in Relation to Meals Ordered in Food Service Establishments in the Context of Plate Waste

In the food service industry, food is wasted at every stage of the process. A significant part of food wastage is the so-called plate waste, i.e., food left by the consumer on the plate. The purpose of this research was to analyze the behavior of Polish consumers in relation to meals ordered in food establishments. The following issues were taken into account: leaving an unfinished meal on a plate and reasons for it, taking an unfinished meal home, and ordering half portions. The study was conducted on a representative group of 1115 adult Polish citizens using the CAPI method. Segmentation (cluster analysis) of respondents differing in their behavior in relation to ordered meals was carried out. It turned out that about 53% of Polish citizens do not use food services at all. Men with secondary and higher levels of education and other sources of income (cluster C) less frequently declared leaving unfinished meals on a plate and taking an unfinished meal home, especially in canteens, compared to other clusters. Few respondents declared buying half portions. Excessively large portions and inadequate taste of dishes were indicated by almost 50% of respondents as the main reasons for the generation of plate waste. Measures should be promoted to encourage consumers and food service providers to reduce the generation of plate waste.

The Intersection of Neighborhood Environment and Adverse Childhood Experiences: Methods for Creation of a Neighborhood ACEs Index

This study evaluated methods for creating a neighborhood adverse childhood experiences (ACEs) index, a composite measure that captures the association between neighborhood environment characteristics (e.g., crime, healthcare access) and individual-level ACEs exposure, for a particular population. A neighborhood ACEs index can help understand and address neighborhood-level influences on health among individuals affected by ACEs. Methods entailed cross-sectional secondary analysis connecting individual-level ACEs data from the Philadelphia ACE Survey (n = 1677) with 25 spatial datasets capturing neighborhood characteristics. Four methods were tested for index creation (three methods of principal components analysis, Bayesian index regression). Resulting indexes were compared using Akaike Information Criteria for accuracy in explaining ACEs exposure. Exploratory linear regression analyses were conducted to examine associations between ACEs, the neighborhood ACEs index, and a health outcome—in this case body mass index (BMI). Results demonstrated that Bayesian index regression was the best method for index creation. The neighborhood ACEs index was associated with higher BMI, both independently and after controlling for ACEs exposure. The neighborhood ACEs index attenuated the association between BMI and ACEs. Future research can employ a neighborhood ACEs index to inform upstream, place-based interventions and policies to promote health among individuals affected by ACEs.

Patterns of Street Food Purchase in Cities From Central Asia

Street food makes a significant contribution to the diet of many dwellers in low- and middle-income countries and its trade is a well-developed activity in the central Asian region. However, data on its purchase and nutritional value is still scarce. This study aimed to describe street food purchasing patterns in central Asia, according to time and place of purchase. A multicentre cross-sectional study was conducted in 2016/2017 in the main urban areas of four central Asian countries: Dushanbe (Tajikistan), Bishkek (Kyrgyzstan), Ashgabat (Turkmenistan) and Almaty (Kazakhstan). Street food markets (n = 34) and vending sites (n = 390) were selected by random and systematic sampling procedures. Data on the purchased foods and beverages were collected by direct observation. Time and geographic location of the purchases was registered, and their nutritional composition was estimated. A total of 714 customers, who bought 852 foods, were observed. Customers' influx, buying rate and purchase of industrial food were higher in city centers compared to the outskirts (median: 4.0 vs. 2.0 customers/10 min, p < 0.001; 5.0 vs. 2.0 food items/10 min, p < 0.001; 36.2 vs. 28.7%, p = 0.004). Tea, coffee, bread and savory pastries were most frequently purchased in the early morning, bread, main dishes and savory pastries during lunchtime, and industrial products in the mid-morning and mid-afternoon periods. Energy and macronutrient density was highest at 11:00–12:00 and lowest at 09:00–10:00. Purchases were smaller but more energy-dense in city centers, and higher in saturated and trans-fat in the peripheries. This work provides an overview of the street food buying habits in these cities, which in turn reflect local food culture. These findings from the main urban areas of four low- and middle-income countries which are currently under nutrition transition can be useful when designing public health interventions customized to the specificities of these food environments and their customers.

Reimagining Food: Readdressing and Respecting Values

The values associated with food are framed and constructed by market-based systems that assign attributes to different foods across the marketplace. The aim of the paper was to conceptualize the range of non-financial aspects associated with food in the literature examined and a typology was introduced to position a new set of non-financial food values, the alter-values, which support the creation of a more holistic approach to visualize and reimagine a more sustainable, resilient food system that readdresses and respects such values. The four alter-values of interest, intrinsic, production-related, supply chain related, and emotio-cultural values, were discussed in the context of changing food environments, and a visualization of the typology was presented to explain them. By focusing especially on intrinsic and emotio-cultural values, an adaptation of the current food environment beyond pecuniary-based emphasis was possible. Such an approach helps to challenge the structure of the conventional food system towards a more citizen-driven sustainable model, altering priorities, with a drive towards embedding values and going beyond perceiving food only in terms of exchange value, to considering food as a vital aspect of life.

Consumption Frequency and Purchase Locations of Foods Prepared Outside the Home in Australia: 2018 International Food Policy Study

BACKGROUND

Foods prepared outside the home (e.g., fast-food chains, restaurants) represent increasing proportions of diets worldwide, and have been associated with higher energy intakes and BMIs. To improve the healthiness of population diets, it is important to understand patterns of consumption of these foods, and whether related policy measures are effective.

OBJECTIVES

This study aimed to identify the frequency and sources of consumption of foods prepared outside the home in Australia, and to understand the impact of nutrition information in restaurants on related food choices.

METHODS

Data were from a web-based survey (the International Food Policy Study) completed in 2018 by Australian adults aged ≥18 years (n = 4103). The number of meals prepared outside the home, their purchase locations, and the extent to which nutrition information was noticed and influenced purchasing decisions were each analyzed by sociodemographic characteristics and BMI, with linear models also adjusted for sex, age group, education, ethnicity, and BMI.

RESULTS

An average of 2.73 (95% CI, 2.61-2.86) meals per week were prepared outside the home, with higher frequencies among men, younger ages, and more highly educated participants. A wide variety of sources for these foods was observed, with fast-food outlets being most common. Around one-quarter of all foods prepared outside the home were delivered. A small percentage (14.9%; 95% CI, 13.3%-16.7%) of participants reported noticing nutrition information, but among those who did, around half reported that it influenced their behavior.

CONCLUSIONS

Foods prepared outside the home are commonly purchased in Australia, particularly by young adults, from a variety of outlet types. While current menu energy labeling regulations may provide some population health benefit, a broader policy focus on foods prepared outside the home is needed as part of efforts to improve population diets.

Differences in Overweight or Obesity, Changes in Dietary Habits after Studying Abroad and Sleep Quality by Acculturative Degree among Asian Foreign Students: A Cross Sectional Pilot Study

The number of foreign students is increasing worldwide, and they suffer from acculturation to different environments or cultures. This pilot study examined the difference in overweight or obesity, changes in dietary habits after studying abroad and sleep quality according to acculturative degree among 225 Asian foreign students in South Korea. Most subjects (61.8%) experienced a low acculturative degree. The change in dietary habits after studying abroad showed a significant difference according to the acculturative degree (p < 0.001); however, there were no differences observed in sleep quality (p = 0.090) and prevalence of overweight or obesity according to acculturative degree (p = 0.101). Interestingly, a difference in the risk for being overweight or obese by sleep quality after being stratified into groups according to acculturative degree was observed. Among the groups with a low acculturative degree, subjects reporting poor sleep quality had a 2.875-fold (95% CI = 1.167−7.080) higher risk of being overweight or obese than those reporting good sleep quality. However, the risk of being overweight or obese was not different among the high acculturative group regardless of their sleep quality. The results showed that the degree of acculturation could influence the risk of being overweight or obese according to sleep quality among Asian foreign students.

Psychological Health and Sleep Quality of Medical Graduates During the Second Wave of COVID-19 Pandemic in Post-epidemic Era

Recently, a COVID-19 virus variant spread rapidly in Guangzhou, China, causing public panic. This study aimed to understand the psychological and sleep-related consequences of the secondary outbreak of the pandemic on medical students. In this cross-sectional survey-based study, participants anonymously completed structured questionnaires online from June 8–22, 2021. We collected participants' demographic and general information. Anxiety, depression, and sleep quality were measured using the Zung Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI), respectively. Protective factors were assessed using the Coping Style Questionnaire (CSQ). Uni- and multivariate logistic regression analyses were performed examining factors associated with mental health and sleep quality problems. During the second wave of the pandemic in local outbreak areas in Guangzhou, China, more than one-third of medical students' mental health and sleep quality were affected. The prevalence of anxiety, depression, and poor sleep quality were 27.54%, 27.58%, and 18.19%, respectively. Students belonging to the Class of 2019, aged over 29 years, those with siblings, and those whose hometowns were in other provinces were more prone to the three health problems. Factors associated with an increased risk of mental health problems were vaccination status (adjusted odds ratio 1.603–1.839) and diet status (adjusted odds ratio 1.62–1.929). Positive coping styles served as protective factors (p < 0.05). We discovered that completed vaccination status, good diet, and positive coping styles were related to good mental health and sleep quality.

Young Adults’ Use of Mobile Food Delivery Applications and the Potential Impacts on Diets during COVID-19 Pandemic in Singapore: A Mixed Methods Study (Preprint)

BACKGROUND

Poor diet contributes significantly to the development of non-communicable diseases (NCDs). In Singapore, it is recommended to consume at least two servings of fruits and vegetables (FV) daily to reduce the risk of developing NCDs. However, the adherence rate among young adults is low. The COVID-19 pandemic has led to frequent users of Mobile Food Delivery Applications (MFDAs) adopting unhealthy eating habits including high consumption of sugar-sweetened beverages (SSBs), making it crucial to gain a deeper understanding of the underlying factors driving their usage patterns.

OBJECTIVE

This study aimed to examine the usage patterns of MFDAs among young adults during the COVID-19 pandemic; investigate the association between MFDA usage and socio-demographic factors, dietary factors, and body mass index (BMI); identify the underlying reasons for the observed usage patterns of MFDAs among users; compare the influences of MFDA usage between frequent and infrequent users.

METHODS

A sequential mixed methods design was used, involving an online survey and in-depth interviews with a subset of questionnaire respondents. Poisson regression and thematic analysis were employed to analyze the quantitative and the qualitative data respectively.

RESULTS

The quantitative results revealed that 41.7% (150/360) of the participants reported using MFDAs frequently, defined as at least once-a-week use. Although not significant, the study found that frequent users were less likely to consume two servings of vegetables per day and more likely to drink SSBs. Nineteen individuals who had participated in the quantitative component were selected for and completed the interviews. Qualitative analysis identified four primary themes: deliberations about other sources of meals versus meals purchased via MFDAs, convenience is vital, preference for unhealthy meals ordered from MFDAs most of the time, and cost is king. Before making any purchase, MFDA users consider all these themes at the same time, with the cost being the most significant influential factor. A conceptual framework based on these themes is presented. Lack of culinary skills and COVID-19 restrictions were also found to influence frequent usage.

CONCLUSIONS

The study suggests that interventions should focus on promoting healthy dietary patterns among young adults who frequently use MFDAs. Teaching cooking skills, especially among young males, and time management skills could be useful to reduce reliance on MFDAs. The study highlights the need for public health policies that make healthy food options more affordable and accessible. Given the unintended changes in behavior during the pandemic such as reduced physical activity or sedentary behavior and altered eating pattern, it is essential to consider behavior change in interventions aimed at promoting healthy lifestyles among young adults who frequently use MFDAs. Further research is needed to evaluate the effectiveness of interventions during COVID-19 restrictions and to assess the impact of the "new normal" post-COVID on dietary patterns and physical activity levels.

Cardiovascular disease burden attributable to dietary risk factors from 1990 to 2019: A systematic analysis of the Global Burden of Disease study

BACKGROUND AND AIMS

Dietary risks have always been a major risk factor for cardiovascular diseases (CVDs), especially in young people. This article aimed to provide an updated and comprehensive view of the spatial, temporal and sexual heterogeneity in diet-attributable CVD burdens from 1990 to 2019.

METHODS AND RESULTS

Data on diet-attributable CVD burdens were extracted from the Global Burden of Disease (GBD) Study 2019. Numbers and age-standardized rates (ASRs) of deaths, disability-adjusted life years (DALYs) and corresponding estimated annual percentage change (EAPC) were determined. Globally, the number of diet-attributable CVD deaths and DALYs in 2019 were 6.9 million and 153.2 million, marking 43.8% and 34.3% increases since 1990, respectively. However, ASRs of death and DALYs have declined over time. The regions with the highest ASRs of diet-related CVD deaths and DALYs were in Central Asia, whereas the lowest ASRs of CVD deaths and DALYs were observed in the high-income Asia Pacific region. Globally, men suffered higher death and DALY burdens than women. Ischemic heart disease and stroke were the leading causes of CVD deaths and DALYs, globally. Regarding the specific diet group, diets low in whole grains, high in sodium, low in fruits, low in nuts and seeds, low in vegetables and low in seafood omega-3 fatty acids contributed to CVD deaths and DALYs the most. Dietary risks accounted for a higher proportion in people aged less than 65 years old.

CONCLUSIONS

Diet-attributable CVDs threaten public health, particularly in low SDI countries and younger generations. As diet-related CVDs are nation-specific, the prioritization of public health interventions should be evidence-based.

Eating out of Home: Influence on Nutrition, Health, and Policies: A Scoping Review

Eating out of home (EOH) is a common practice worldwide but research gaps have been identified. The aims of this review were (a) to find a common definition for EOH, (b) to determine the nutritional contribution of EOH, and (c) to analyze the relationship of EOH with health parameters in adults. Fifty-seven articles were finally selected. The definition of EOH was not harmonized between researchers and the comparison between studies was quite difficult. Restaurant and fast food were the terms most used, followed by chain restaurant, à la carte, sit-down restaurant, eating at table, full service, ready to eat, takeaway, buffet and buffet by weight, bar, cafes, and cafeterias, either alone or attached to at least one of the above. The profile of the main EOH participant was a highly educated, high-income, and unmarried young man. EOH was related to a body mass index (BMI) or being overweight in a different way depending on age, sex, or EOH frequency. A high rate of EOH led to poorer diet quality, characterized by higher intakes of energy, total and saturated fats, sugar, and sodium, as well as lower intakes of fiber, dairy, fruit, vegetables, and micronutrients. Regarding beverages, a higher intake of soft drinks, sugar-sweetened beverages, fruit juices, beer, and other alcohol was observed when EOH. There is a need for a methodological consensus for analyzing the impact of EOH on dietary intake and health to avoid bias. Additionally, measures and policies should be utilized to help consumers to make healthier choices when EOH is compatible with business regarding those running EOH establishments.

Healthy eating in the wild: An experience-sampling study of how food environments and situational factors shape out-of-home dietary success

Across many parts of the world, people increasingly eat out-of-home. Simultaneously, many people strive to eat a healthier diet, but it remains unclear to what extent and how eating out helps or hinders people in achieving their dietary goals. The present study investigated how characteristics of the physical micro-environment in out-of-home food outlets (e.g., cafeterias, supermarkets, and restaurants) influence the healthiness of food choices among a sample of German adults with a goal to eat healthier. We used an experience sampling method to obtain detailed information about people's motivation for selecting a specific food outlet and the outlet's micro-environment. We further asked for people's mood, visceral state, and thoughts during their food choice and obtained evaluations of food choices reported near their occurrence and in externally valid conditions. The data was collected via a mobile app over a period of six to eleven days between November and December of 2018 in Germany with a sample of 409 participants (n_obs = 6447). We find that even health-conscious people select food outlets and their respective micro-environments based on short-term goals, such as ease, taste, and speed of a consumption episode rather than long-term health outcomes. Using multiple regression, we show that micro-environments that promote healthy food, make such food more appealing and easier to select facilitate healthy food choices. We further identify some of the psychological mechanisms through which the micro-environment can affect food choices, as well as how individual characteristics moderate the relationship between specific micro-environmental factors and goal success. Taken together, our findings suggest the opportunity for, and arguably also necessity of, reshaping food environments to better facilitate healthier choices and support public health in the face of increasing out-of-home food consumption and the adverse consequences of unhealthy diets.

Beyond emotion: online takeaway food consumption is associated with emotional overeating among Chinese college students

BACKGROUND

Online takeaway food has become very popular in China. However, the potential effects of online takeaway food consumption on eating behaviours among individuals during the transition stage from adolescence to young adulthood have not yet been assessed.

OBJECTIVE

This study aimed to examine the effects of takeaway food consumption on emotional overeating behaviour among college students.

METHODS

Data were collected from 1450 college students from six universities in Anhui, China. The frequency of emotional overeating during the past 4 weeks was assessed by the emotional overeating questionnaire (EOQ). Data on the frequency of online takeaway food consumption and other potential risk factors at the individual, interpersonal, physical environment, and macro-system levels were assessed by questionnaire. Multilevel linear regression analyses were employed to explore the association between takeaway food consumption and emotional overeating behaviour.

RESULTS

Compared to those who consumed online takeaway food less than 1 day per week, participants who consumed this food 4-5 days per week and participants who consumed this food 6-7 days per week had significantly higher EOQ scores (β = 0.14, p < 0.05 and β = 0.67, p < 0.001, respectively). More frequent consumption was associated with higher EOQ scores (p for trend < 0.001).

CONCLUSION

A higher frequency of takeaway food consumption was associated with an elevated risk of emotional overeating among college students independent of personal emotional status and other potential confounders at the interpersonal, physical environmental and macro-system levels.

LEVEL OF EVIDENCE

Level V; cross-sectional descriptive study.