Fast-food consumers in Singapore: demographic profile, diet quality and weight status

Consumption Patterns of Processed Foods in Singapore-A Cross-Sectional Study

The consumption of processed foods is increasingly widespread and could have an impact on diet quality and health. Understanding the factors influencing people's eating habits is useful for assessing such impact. There are limited data on the consumption patterns of processed foods and associated factors influencing the dietary patterns in Singapore. This cross-sectional study based on a food frequency questionnaire aimed to examine how the consumption of processed foods among 2079 Singapore residents aged 18 to 89 years varies with sociodemographic factors. The analysis of the consumption by processed food groups showed that the studied factors, i.e., age, gender, ethnicity, housing and health status, all contributed to differences in processed food consumption to varying extents, with ethnicity being the key factor driving the variation. Such differences were also confirmed to a limited degree by determining another measure of consumption, i.e., a processed food variety score. The findings in this study could inform further work in relation to dietary risks.

Dietary patterns of persons with chronic conditions within a multi-ethnic population: results from the nationwide Knowledge, Attitudes and Practices survey on diabetes in Singapore

BACKGROUND

Chronic conditions are a leading cause of death and disability worldwide and respective data on dietary patterns remain scant. The present study aimed to investigate dietary patterns and identify sociodemographic factors associated with Dietary Approaches to Stop Hypertension (DASH) scores within a multi-ethnic population with various chronic conditions.

METHODS

The present study utilised data from the 2019-2020 Knowledge, Attitudes, and Practices study on diabetes in Singapore - a nationwide survey conducted to track the knowledge, attitudes, and practices pertaining to diabetes. The study analysed data collected from a sample of 2,895 Singapore residents, with information from the sociodemographic section, DASH diet screener, and the modified version of the World Mental Health Composite International Diagnostic Interview (CIDI) version 3.0 checklist of chronic physical conditions.

RESULTS

Respondents with no chronic condition had a mean DASH score of 18.5 (±4.6), those with one chronic condition had a mean DASH score of 19.2 (±4.8), and those with two or more chronic conditions had a mean DASH score of 19.8 (±5.2). Overall, the older age groups [35- 49 years (B = 1.78, 95% CI: 1.23 - 2.33, p <0.001), 50-64 years (B = 2.86, 95% CI: 22.24 - 3.47, p <0.001) and 65 years and above (B = 3.45, 95% CI: 2.73 - 4.17, p <0.001)], Indians (B = 2.54, 95% CI: 2.09 - 2.98, p <0.001) reported better diet quality, while males (B = -1.50, 95% CI: -1.87 - -1.14, p <0.001) reported poorer diet quality versus females.

CONCLUSION

Overall, respondents with two or more chronic conditions reported better quality of diet while the sociodemographic factors of age, gender and ethnicity demonstrated a consistent pattern in correlating with diet quality, consistent with the extant literature. Results provide further insights for policymakers to refine ongoing efforts in relation to healthy dietary practices for Singapore.

Diet quality of frequent fast-food consumers on non-fast food intake day is similar to a day with fast food. What We Eat in America, NHANES 2013-2016

BACKGROUND

Frequent fast food (FF) consumers may make more healthful food choices at eating occasions without FF. However, it is not clear if poor diet quality of frequent FF consumers is a function of FF consumption or less healthful food choices overall.

OBJECTIVE

The objective of this study was to compare diet quality, energy, and nutrient intakes of infrequent FF consumers (INFREQ) with that of frequent FF consumers on an intake day with FF (FREQ-FF) or without FF (FREQ_NO FF).

DESIGN

This study is a cross-sectional analysis of one day dietary intake data from What We Eat in America, NHANES 2013-2016, the dietary intake component of NHANES.

PARTICIPANTS/SETTING

Participants included adults 20+ years (N=4012), who, in the previous seven days, reported no consumption of FF or pizza (N=2142; INFREQ) or reported FF or pizza three or more times and either had FF/pizza (N=1455; FREQ_FF) or did not have FF/pizza (N=415; FREQ_NO FF) on the intake day.

MAIN OUTCOME MEASURES

Main outcomes were energy, nutrient density (nutrient intake/1000 kcal), and diet quality evaluated using Healthy Eating Index (HEI)-2015 STATISTICAL ANALYSES PERFORMED: Group comparisons were made using t-tests. Differences were considered significant at P<0.001.

RESULTS

Compared to INFREQ, FREQ_FF had higher intakes of energy and fat/1000 kcal, lower scores for total HEI and most components, and lower nutrient densities of most micronutrients (P<0.001). HEI component scores of INFREQ for vegetables, fruit, whole grains and added sugars were higher than FREQ_FF (P<0.001). Energy intake, most nutrient densities, and total HEI and component scores of FREQ_NO FF were not significantly different from FREQ_FF with the exception of fruit but were different from INFREQ for some nutrients and HEI components."

CONCLUSIONS

Results suggest diet quality and nutrient intake of frequent FF consumers on a non-FF intake day is not markedly different from a day with FF.

Development and Validation of a Lifestyle Behavior Tool in Overweight and Obese Women through Qualitative and Quantitative Approaches

There is a paucity of effective intervention tools for overweight/obese women to assess, guide and monitor their eating behavior. This study aimed to develop a lifestyle intervention tool, assess its acceptability and usefulness, and verify its construct validity in overweight/obese women. The 6P tool (Portion, Proportion, Pleasure, Phase, Physicality, Psychology) was developed and 15 women with a body mass index (BMI) ≥ 25 kg/m2 were interviewed to assess its perceived acceptability and usefulness. Subsequently, the revised 6P tool was tested in 46 women with a BMI ≥ 25 kg/m2. The Three-Factor Eating Questionnaire (TFEQ), International Physical Activity Questionnaire-Short (IPAQ), and weight were measured at baseline and one-month. Most participants were satisfied with the presentation of the 6P tool (86.8%), and agreed it was useful in guiding healthy eating (81.6%) and raising awareness of eating behavior (97.4%). There were significant improvements in cognitive restraint (p = 0.010) and disinhibition (p = 0.030) (TFEQ), portion size (P1), pleasure behaviors (P3), and total composite 6P score (p < 0.001). However, there was no significant reduction in weight or increase in physical activity. The 6P tool is acceptable and presents with good validity for assessing lifestyle behaviors.

Healthy Eating Index (HEI-2015) of Female College Students According to Obesity and Exercise Participation

BACKGROUND

Individuals participating in exercise are more likely to lead a healthy lifestyle to achieve their exercise-related goals. This study aimed to examine the differences in dietary quality of female university students by exercise involvement and body mass index (BMI).

METHODS

This study was conducted with 360 female university students in Turkey. Students were asked to complete a questionnaire containing general characteristics and food consumption records. The "Healthy Eating Index (HEI-2015)" score was calculated using the results of food consumption records.

RESULTS

The findings showed that the ratio of individuals who exercised regularly was 34.2%. The ratio (44.2%) of regularly exercising participants with moderate/good diet quality was greater than that of regularly exercising participants with poor diet quality (30.6%) (P=0.016). There was no significant difference between the scores of overall diet quality according to BMI classification (P>0.05). The score (45.3±13.4) for overall diet quality of those participating in exercise in the group with normal body weight was higher than the score (41.5±12.1) for overall diet quality of those not participating in exercise (P=0.026). Those participating in exercise in the group with normal body weight consumed more greens and beans, whole grains, dairy products, seafood/vegetable proteins, and refined grains than those not participating in exercise (P<0.05).

CONCLUSION

The rate of overall participation in physical activity was low. However, students participating in physical activity and with a normal body weight had a better diet quality. Creating an ideal environment that encourages students to participate in physical activity at universities can be an effective method for improving their diet quality.

Is fast-food consumption a problem among adolescents in Malaysia? An analysis of the National School-Based Nutrition Survey, 2012

BACKGROUND

Fast-food consumption is an unhealthy dietary behaviour because it increases the risk of diet-related chronic diseases. We aimed to investigate factors associated with fast-food consumption, namely sociodemographic characteristics, body mass index-for-age, meal away from home habit, and intake of various food groups among adolescents in Malaysia.

METHODS

We analysed data from the National School-Based Nutrition Survey (NSNS). The NSNS was a nationwide, cross-sectional survey. Multiple-stage stratified cluster random sampling method was applied to obtain a representative sample of adolescents' population. This study recruited adolescents aged 10-18 years who were attending schools. Pre-tested self-administered questionnaires in Malay language were used to obtain relevant information. Frequency of fast-food consumption per week was classified into three groups: "consumed fast-food four to seven days", "consumed fast-food one to three days", and "did not consume fast-food". Intake of food groups was assessed by self-administered food frequency questionnaire. Descriptive and complex sample multinomial logistic regression analyses were performed in data analysis.

RESULTS

A total of 26,383 from 40,012 selected adolescents completed all the relevant questions for this study. Of those surveyed, 13.5% of the respondents consumed fast-food 4 to 7 days, 69.3% of the respondents consumed fast food 1 to 3 days, and 17.2% of them did not consume fast-food in a typical week. Frequency of fast-food consumptions (4 to 7 days and 1 to 3 days per week) was significantly associated with age; sex; ethnicity; locality of schools; frequency of eating out; and not consuming recommended intake of cereals or grains, vegetables, and meat or poultry or eggs.

CONCLUSION

In conclusion, age; sex; ethnicity; locality of schools; frequency of eating out per week; imbalanced intake of cereals or grains, meat, or poultry or eggs; and inadequate vegetable intake were significantly associated with fast-food consumption among adolescents in Malaysia. The findings of this study will be useful for policy makers in promoting healthy food choices among adolescents in Malaysia.

The Role of Social Health and Demographic Factors in Bread Quality: An Ecological Study in Isfahan, Iran

Social health has been defined as participation in and responsibility for social processes. Because bread is considered an essential staple food in Iran, several social policies have been implemented to improve the quality of bread, regardless of social aspects. The current study aims to investigate the relationship between bread quality, bakers’ social health, and demographic factors. This was a cross-sectional ecological study conducted in Isfahan, Iran. Stratified sampling was used to select 171 traditional bakeries from Isfahan’s 15 municipality districts. The Adult Social Health Questionnaire was used to collect data. A laboratory test was employed to obtain data on bread quality. The Spearman correlation test, bivariate logistic regression, and multiple logistic regression were applied to analyze the data. The results showed that 36.26% of bakeries had pH ≤ 6 (high-quality bread) and 63.74% of them had pH > 6 (bread quality was low). The use of baking soda had a negative relationship with bakers’ social health ( $P$ value = 0.029). According to the findings, low social health increased the likelihood of producing low-quality bread by 53% when compared to high social health. Education, specifically illiteracy and semiliteracy, increased the risk of low-quality bread production by 35% and 27%, respectively. Through responsibility, consciousness, and empathy, social health is linked to bread quality. This implies that health policies could be tailored to address the social health of bakeries in order to improve bread quality.

Dietary intake of persons with depressive and psychotic disorders in Singapore

INTRODUCTION

Nutritional psychiatry is an emerging field of study that investigates the role of diet and nutrition in mental health. Studies conducted in the general population have linked depressive symptoms with poor dietary patterns. The aim of this study was to characterise the dietary intake and analyse the dietary pattern using the Dietary Approach to Stop Hypertension (DASH) in a sample of psychiatric patients in a multiethnic Asian nation.

METHODS

Participants were recruited from an outpatient clinic and an inpatient unit at the Institute of Mental Health in Singapore. Self-reported dietary habits of a sample of psychiatric patients (N=380) were analysed using DASH. To examine the variables associated with DASH scores, a linear regression was conducted with the full sample and sociodemographic variables.

RESULTS

Persons with depressive disorders had a mean DASH score of 21.3 (±4.2), while persons with psychotic disorders had a mean DASH score of 21.2 (±4.9). Respondents who were older (B=1.94, 95% confidence interval [CI] 0.91-2.96, P<0.001), female (B=1.09, 95% CI 0.07-2.11, P=0.04) and economically inactive (B=1.98, 95% CI 0.006-3.96, P=0.049) were more likely to report a higher diet quality compared with their respective counterparts, while smokers (B= -1.39, 95% CI -2.45 to -0.34, P=0.009) tended to report a lower diet quality compared with their non-smoking counterparts.

CONCLUSION

Dietary patterns of persons with mental disorders were characterised. A host of sociodemographic factors, and not diagnosis of mental disorders, influenced the dietary quality of people with depressive and psychotic disorders. Clinicians treating psychiatric patients need to be aware of the nuanced reasons behind poor dietary choices and provide targeted psychoeducation to specific subgroups within the patient population.

Determinants of Junk Food Consumption Among Adolescents in Pokhara Valley, Nepal

Background: Junk food consumption and its consequences has become a major public health concern globally because of its deteriorating health consequences and surging prevalence. Though its adverse health consequences are widely prevalent in all age groups, children and adolescents are more at risk. It may lead to obesity and act as a risk factor for different non-communicable diseases (NCD's) like heart diseases, cardiovascular disease, cancer, hypertension, diabetes, etc. This study was carried out to explore the junk food consumption and its associated factors among adolescent students. Methods: A cross-sectional study was conducted among 538 adolescent students of Kaski district, Nepal. We used a stratified proportionate sampling technique to recruit the participants. A self-administered questionnaire was used for data collection. Descriptive and bivariate statistical analysis was performed. The odds ratio was computed to test the association. Results: The study found that more than half of the participants (60.30%) consumed junk foods over the last 30 days, more prevalent among public school participants (65.1%) followed by participants of private school (56.3%). More than half of the participants consumed salty snacks (58.7%) followed by sweets (57.5%). The time of consumption was found to be higher together with friends (83.9%). Similarly, it was consumed more while the participants were on a trip (70.1%). Consumption of junk foods was significantly associated with public school (OR: 1.44, CI = 1.01-2.06), single family (OR: 1.46, CI = 1.01-2.10), living with parents (OR: 1.64, CI = 1.03-2.63), while on travel (OR: 1.99, CI = 1.33-2.98), while reading (OR: 2.01, CI = 1.16-3.47), at home (OR: 2.20, CI = 1.53-3.16), at school (OR: 2.86, CI = 1.98-4.12), friends' influence (OR: 2.01, CI = 1.37-2.94), and junk food availability at home (OR: 1.92, CI = 1.33-2.76). Conclusion: Consumption of junk foods among adolescent students was remarkably high in both public school and private school adolescents. Regardless of adequate knowledge on harmful consequences of junk foods, school-going adolescents are consuming junk foods due to its easy availability and ready-to-use packaging. The government of Nepal should strictly standardize and regulate advertising policies and extravagant health claims advertised by junk food manufacturers. An appropriate intervention targeted to adolescents to improve food behaviors is recommended.

Development of Fatty Acid Reference Ranges and Relationship with Lipid Biomarkers in Middle-Aged Healthy Singaporean Men and Women

Dietary fatty acids (FA) are essential for overall human health, yet individual FA reference ranges have yet to be established. Developing individual FA reference ranges can provide context to reported concentrations and whether an individual displays deficient, or excess amounts of FA. Reference ranges of sixty-seven individual FA (μmol/L) were profiled and analyzed using gas chromatography with a flame ionization detector from serum samples collected from 476 middle-aged Singaporean males (BMI:23.3 ± 2.9) and females (BMI:21.8 ± 3.6). Measures of triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol (TC) (mmol/L) were also collected. The mean FA concentration seen in this cohort (11,458 ± 2478 was similar to that of overweight North American cohorts assessed in past studies. Ten biologically relevant FA were compared between sexes, with females exhibiting significantly higher concentrations in four FA (p < 0.05). A multiple regression model revealed the ten FA contributed significantly to nearly all lipid biomarkers (p < 0.05). A majority of participants who had FA concentrations in the ≥95th percentile also exhibited TG, HDL, LDL, and TC levels in the “high” risk classification of developing cardiovascular disease. Future studies profiling individual FA reference ranges in many unique, global cohorts are necessary to develop cut-off values of individual FA concentrations highly related to disease-risk.

Fast food consumption among young adolescents aged 12-15 years in 54 low- and middle-income countries

BACKGROUND

Most countries worldwide, especially low- and middle-income countries (LMICs), are facing an increasing prevalence of fast-food consumption and multiple burdens of malnutrition among young adolescents.

OBJECTIVE

To compare the prevalence of fast-food consumption among young adolescents in LMICs.

METHODS

We used data from the most recent Global School-Based Student Health Survey (2009-2015), which had been collected using a standardized questionnaire. The weighted prevalence and 95% confidential intervals of fast-food consumption were calculated overall and in subgroups stratified by age, sex, and nutritional status. The pooled overall and regional estimates were obtained using a random-effects model. Heterogeneity was assessed using the I2 statistic. The associated risk factors for fast-food consumption were explored using logistic regression analysis.

RESULTS

Our study comprised 153,496 young adolescents (46.90% boys) from 54 LMICs. Overall, approximately 55.2% (51.3-59.1%) of the adolescents consumed fast food at least 1 day per week, and 10.3% (8.3-12.4%) did so 4-7 days per week. The prevalence of fast-food consumption 4-7 days per week was lowest in the Americas (8.3%; 6.7-9.9%) and highest in Southeast Asia (17.7%; 2.3-33.2%). At a country level, the prevalence was lowest in Pakistan (1.5%; 1.0-2.0%) and highest in Thailand (43.3%; 40.4-46.1%). Furthermore, in subgroups stratified by nutritional status, the prevalence was lowest in the obesity group (6.6%; 4.5-8.7%). Factors such as age, sex, BMI, food insecurity, fruit consumption, vegetable consumption, soft-drink consumption, smoking, physical activity level, and sedentary behavior level were found to be correlated with fast-food consumption.

CONCLUSIONS

The identified high prevalence of fast-food consumption among young adolescents in LMICs indicates the urgent need to prioritize the implementation of healthy-diet promotion programs to improve adolescent health in these countries.

Current Developments in Digital Quantitative Volume Estimation for the Optimisation of Dietary Assessment

Obesity is a global health problem with wide-reaching economic and social implications. Nutrition surveillance systems are essential to understanding and addressing poor dietary practices. However, diets are incredibly diverse across populations and an accurate diagnosis of individualized nutritional issues is challenging. Current tools used in dietary assessment are cumbersome for users, and are only able to provide approximations of dietary information. Given the need for technological innovation, this paper reviews various novel digital methods for food volume estimation and explores the potential for adopting such technology in the Southeast Asian context. We discuss the current approaches to dietary assessment, as well as the potential opportunities that digital health can offer to the field. Recent advances in optics, computer vision and deep learning show promise in advancing the field of quantitative dietary assessment. The ease of access to the internet and the availability of smartphones with integrated cameras have expanded the toolsets available, and there is potential for automated food volume estimation to be developed and integrated as part of a digital dietary assessment tool. Such a tool may enable public health institutions to be able to gather an effective nutritional insight and combat the rising rates of obesity in the region.

Trends in health screening participation and lifestyle behaviours after participation in a free, access-enhanced screening intervention in a low-income Singaporean rental-flat community

Our objective was to evaluate the impact of an access-enhanced health screening intervention on screening adherence in a rental-flat community. In Singapore, public rental flats provide heavily subsidised rentals for the needy who cannot afford to own their own homes; with a majority of Singaporeans (≥85%) staying in owner-occupied public housing. We observed trends in health screening adherence and health behaviours among residents of a multi-ethnic public rental-flat community in Singapore from 2013 to 2017, after participation in a free, access-enhanced multi-modality screening programme in 2011. Residents staying in neighbouring owner-occupied housing who participated in the same screening programme served as a basis of comparison. A total of 478 rental-flat residents and 505 owner-occupied flat residents participated. In the rental-flat community, hypertension screening rates improved from 18.3% (24/131) in 2013, to 61.2% (52/85) in 2015 and 44.2% (34/77) in 2017 (p < .001). For diabetes, rates improved from 26.2% (43/164) → 47.0% (54/115) → 49.5% (45/91; p < .001). For dyslipidaemia screening, rates improved from 18.2% (31/170) → 39.6% (38/96) → 47.5% (38/80; p < .001). In the owner-occupied community (n = 505), screening rates largely remained stagnant (hypertension: 52.2% → 75.0% → 54.5%, p = .059; diabetes: 66.0% → 56.5% → 66.7%, p = .434; dyslipidaemia: 53.1% → 50.0% → 57.1%, p = .818). In the rental-flat community, unhealthy behaviours increased from 2013 to 2017, with higher proportions of overweight (30.4% → 24.8% → 52.1%, p < .001), higher smoking (11.7% → 36.9% → 32.5%, p < .001) and higher drinking rates (1.4% → 0.7% → 8.1%, p < .001). This shift was also reflected in the owner-occupied community, with higher percentages of overweight and higher drinking rates (p < .001).

Are Asian foods as "fattening" as western-styled fast foods?

In Asia, the consumption of western-styled fast foods is widely perceived as the cause of the rise in obesity and chronic disease. Twenty-five of the most popular local Asian foods were compared for energy, total fat, saturated fat, sodium, and cholesterol with twenty-nine western-styled fast foods. The comparative analysis showed no significant difference in energy (p = 0.150) and total fat (p = 0.346) between the two food categories. These findings suggest that many local Asian foods contribute as much energy and total fat in a single meal as western-styled fast foods. Local Asian foods had greater amounts of sodium (p < 0.001), saturated fat (p = 0.007), and cholesterol (p = 0.009) than western-styled fast foods. The persistent presumption that the consumption of western-styled fast foods is the cause of obesity in Asia needs to be challenged. This observation that local Asian foods are as energy dense as western-styled fast foods, will enable us to redress the necessary strategies to address the Asian diet-health debate.

Dietary Patterns in Primary School are of Prospective Relevance for the Development of Body Composition in Two German Pediatric Populations

This study performed comparative analyses in two pediatric cohorts to identify dietary patterns during primary school years and examined their relevance to body composition development. Nutritional and anthropometric data at the beginning of primary school and two or four years later were available from 298 and 372 participants of IDEFICS-Germany (Identification and prevention of Dietary-induced and lifestyle-induced health Effects In Children and infants Study) and the KOPS (Kiel Obesity Prevention Study) cohort, respectively. Principal component analyses (PCA) and reduced rank regression (RRR) were used to identify dietary patterns at baseline and patterns of change in food group intake during primary school years. RRR extracted patterns explaining variations in changes in body mass index (BMI), fat mass index (FMI), and waist-to-height-ratio (WtHR). Associations between pattern adherence and excess gain in BMI, FMI, or WtHR (>75th percentile) during primary school years were examined using logistic regression. Among PCA patterns, only a change towards a more Mediterranean food choice during primary school years were associated with a favorable body composition development in IDEFICS-Germany (p < 0.05). In KOPS, RRR patterns characterized by a frequent consumption of fast foods or starchy carbohydrate foods were consistently associated with an excess gain in BMI and WtHR (all p < 0.005). In IDEFICS-Germany, excess gain in BMI, FMI, and WtHR were predicted by a frequent consumption of nuts, meat, and pizza at baseline and a decrease in the consumption frequency of protein sources and snack carbohydrates during primary school years (all p < 0.01). The study confirms an adverse impact of fast food consumption on body composition during primary school years. Combinations of protein and carbohydrate sources deserve further investigation.

An Overview of Whole Grain Regulations, Recommendations and Research across Southeast Asia

The Association of Southeast Asian Nations (ASEAN) is a diverse region that is experiencing economic growth and increased non-communicable disease burden. This paper aims to evaluate the current regulations, dietary recommendations and research related to whole grains in this region. To do this, a systematic literature review was carried out and information was collected on regulations and dietary recommendations from each member state. The majority of publications on whole grains from the region (99 of 147) were in the area of food science and technology, with few observational studies (n = 13) and human intervention studies (n = 10) related to whole grains being apparent. Information from six countries (Indonesia, Malaysia, The Philippines, Singapore, Thailand and Vietnam) was available. Wholegrain food-labelling regulations were only noted in Malaysia and Singapore. Public health recommendation related to whole grains were apparent in four countries (Indonesia, Malaysia, The Philippines, Singapore), while recent intake data from whole grains was only apparent from Malaysia, The Philippines and Singapore. In all cases, consumption of whole grains appeared to be very low. These findings highlight a need for further monitoring of dietary intake in the region and further strategies targeted at increasing the intake of whole grains.

Determinants of eating at local and western fast-food venues in an urban Asian population: a mixed methods approach

BACKGROUND

Like several Southeast Asian countries, Singapore has a complex eating-out environment and a rising eating-out prevalence. However the determinants and drivers of eating-out in urban Asian environments are poorly understood.

METHODS

We examined the socio-demographic characteristics of persons who frequently ate away from home in local eateries called hawker centres and Western fast-food restaurants, using data from 1647 Singaporean adults participating in the National Nutrition Survey (NNS) 2010. We also assessed the underlying drivers of eating out and evaluated if these were different for eating at local eateries compared to Western fast-food restaurants using 18 focus group discussions of women (130 women).

RESULTS

Participants reported a high eating-out frequency with 77.3% usually eating either breakfast, lunch or dinner at eateries. Main venues for eating-out included hawker centres (61.1% usually ate at least 1 of 3 daily meals at this venue) and school/workplace canteens (20.4%). A minority of participants (1.9%) reported usually eating at Western fast-food restaurants. Younger participants and those of Chinese and Malay ethnicity compared to Indians were more likely to eat at Western fast-food restaurants. Chinese and employed persons were more likely to eat at hawker centres. The ready availability of a large variety of affordable and appealing foods appeared to be a primary driver of eating out, particularly at hawker centres.

CONCLUSIONS

Our findings highlight the growing importance of eating-out in an urban Asian population where local eating venues play a more dominant role compared with Western fast-food chains. Interventions focusing on improving the food quality at venues for eating out are important to improve the diet of urban Asian populations.

Socio-Demographic Determinants of Diet Quality in Australian Adults Using the Validated Healthy Eating Index for Australian Adults (HEIFA-2013)

Diet quality indices have been shown to predict cardiovascular disease, cancer, Type 2 Diabetes, obesity and all-cause mortality. This study aimed to determine the socio-demographics of Australian adults with poor diet quality. Diet quality was assessed for participants of the 2011-2012 National Nutrition and Physical Activity Survey aged 18 years or above (n = 9435), with the validated 11-component Healthy Eating Index for Australians (HEIFA-2013), based on the 2013 Australian Dietary Guidelines. Differences in scores by demographics (ANOVA) and regression models for associations between the HEIFA-2013 score and demographic characteristics were conducted. The mean (SD) HEIFA-2013 score was 45.5 (14.7) out of 100 due to poor intakes of vegetables, fruit, grains, dairy and fat and high intakes of added sugar, sodium and discretionary foods. Lower mean HEIFA-2013 scores (SD) were found for males 43.3 (14.7), young-adults 41.6 (14.2) obese 44.1 (14.3), smokers 40.0 (14.2), low socio-economic status 43.7 (14.9) and Australian country-of-birth 44.2 (14.6) (p < 0.05). The overall diet quality of the Australian population is poor and targeted interventions for young-adults, males, obese and those with lower socio-economic status are recommended.

Analysis of the barriers and enablers to implementing lifestyle management practices for women with PCOS in Singapore

BACKGROUND

Polycystic ovary syndrome (PCOS) is a condition that affects women of reproductive age and manifests with adverse reproductive, metabolic and psychological consequences. Evidence-based PCOS guidelines recommend lifestyle management first line for infertility. In Singapore women with PCOS can attend the PCOS Clinic at the Kandang Kerbau Women and Children's Hospital for infertility treatment. However lifestyle integration into infertility management is currently limited and barriers and enablers to progress remain unclear.

METHODS

All PCOS clinic staff undertook semi-structured interviews to investigate perceived barriers for staff and consumers for the integration of lifestyle into infertility management. This study utilised various tools including an 8P Ishikawa diagram model to identify and categorise barriers. A modified Hanlon method was then used to prioritise barriers within the Singaporean context considering organisational, cultural and financial constraints. Propriety, economics, acceptability, resources and legality (PEARL) criteria were also incorporated into this decision-making tool.

RESULTS

In the 8P model, there were five factors contributing to the 'procedure (consultations and referral processes)' barrier, one 'policy (government and hospitals)' factor, five 'place' factors, two 'product (lifestyle management programme)' barriers, two 'people (programme capacity)' factors, four 'process (integration)' factors, three 'promotion' barriers and three 'price' factors. Of the prioritised barriers, two were identified across each of 'procedures', 'place', 'product' and 'people' and four related to 'processes'. There were no barriers identified that for 'policies', 'promotion' and 'price' that can be addressed.

CONCLUSIONS

There is a clear need to integrate lifestyle into infertility management in PCOS, in line with current national and international evidence-based guidelines. The highest priority identified improvement opportunity was to develop a collaborative lifestyle management programme across hospital services. Reductions in variation of delivery and strengthening support within the lifestyle programme are other identified priorities. The strength of this study is that this is the first study to utilise a pragmatic quality improvement method for barriers identification and prioritisation in the area of lifestyle management for women with PCOS. This project identified factors that may provide easy improvements, but also identified some local factors that may be very difficult to change. The major limitation of this study is that it is only looking at the Singapore setting, so may have limited applicability to other countries. However, results from quality improvement projects are meant to be context specific.

Weight-Related Dietary Behaviors in Young Adults

The origins of the obesogenic environment date back to the early 1980s. This means that young adults i.e., those aged 18 to 35 years, have only ever experienced a food milieu that promotes obesity. Indeed, younger generations are becoming heavier sooner than their parents in developed countries, such as the USA. Young adults demonstrate food consumption patterns and dietary behaviors implicated in an excessive gain of body fat. They are the highest consumers of fast food and sugar-sweetened beverages among adult age groups and the lowest consumers of fruit and vegetables. Younger adults are meal skippers but may consume more energy from snacks than older adults. So that the gains made in stemming obesity in childhood are not undone during young adulthood, prevention programs are needed. This review highlights areas for consideration in planning such programs.

Fast Food Pattern and Cardiometabolic Disorders: A Review of Current Studies

Background: There are growing concern globally regarding the alarming trend of fast food consumption and its related cardiometabolic outcomes including overweight and obesity. This study aimed to review the current evidences available in relation to adverse effects of fast food pattern on cardiometa­bolic risk factors.

Methods: Relevant articles including epidemiological and clinical studies with appropriate design and good quality were obtained through searches of the Medline, PubMed, Scopus databases and Google scholar with related key words including "fast foods", "processed foods", "obesity", "overweight", "insulin resistance", "diabetes", "cardiovascular disease", "metabolic syndrome", "dyslipidemia" and "hypertension".

Results: Fast food consumption and out-of-home eating behavior is a main risk factor for lower diet quality, higher calorie and fat intake and lower micronutrients density of diet. Frequent consumption of fast foods was accompanied with overweight and abdominal fat gain, impaired insulin and glucose homeostasis, lipid and lipoprotein disorders, induction of systemic inflammation and oxidative stress. Higher fast food consumption also increases the risk of developmental diabetes, metabolic syndrome and cardiovascular disease.

Conclusion: This review provides further evidence warning us against the irreparable effects of fast food consumption on public health especially the increasing global burden of obesity and cardiovascu­lar diseases.