What factors are associated with frequent unhealthy snack-food consumption among Australian secondary-school students?

Convenience as a dimension of food environments: A systematic scoping review of its definition and measurement

Convenience is a major driver of food choice throughout the world, yet it is often inconsistently conceptualised, defined and measured. This limits the scope for food systems policy and interventions to leverage convenience to improve diet and nutrition outcomes. We conducted a systematic literature review to determine how convenience is both defined and measured in food environment and nutrition research. Six databases were systematically searched and studies were screened by two independent reviewers based on pre-defined eligibility criteria, yielding 243 studies for inclusion in the final review. 77% of studies did not explicitly define convenience. Among those that did, the dimensions and components within definitions varied. 83% of studies used perceived measures of convenience rather than objective measures. Convenience was most commonly measured in high income countries (64%) and in relation to the home food environment (53%), followed by formal retail (40%). Very few studies measured convenience in relation to the informal retail or cultivated food environments, and no studies considered convenience in relation to wild food environments. The vast majority of studies did not consider the validity or reliability of the measures of convenience. Based on our findings we propose a definition of convenience as a characteristic that results in reduced requirement for resources including time, physical effort, mental effort and skills by the consumer in relation to the planning, acquisition, preparation, storage, transport, consumption or clean-up of food. This definition can be used to help guide the development of measurement tools that can be used to assess convenience across different dimensions and contexts in a more comprehensive way. We also propose a framework for considering convenience as an entry point in food systems to improve diets and nutrition outcomes.

Association between body weight misperception and snacking patterns among adolescents: a population-based cross-sectional study

BACKGROUND

Unhealthy snacking behaviors and body weight misperception are both significant concerns in adolescent health. Weight misperception are common among youth and may influence their motivation to engage in health-related behaviors, however, the effect on snacking patterns choice remains unclear. Our study aimed to examine the relationship between body weight misperception and snacking pattern choice among school adolescents.

METHODS

A cross-sectional study was conducted using an online survey platform. Body weight misperception was defined based on perceived body weight and true weight. Snack intake was measured using a qualitative food-frequency questionnaire. Factor analysis was used to identify snacking patterns, and multiple linear regression was employed to examine the association between body weight misperception and snacking patterns.

RESULTS

190,296 students with the average age of 13.3 ± 1.0 years was included, and 44.5% of students misperceived their weight. Overestimation was more prevalent than underestimation. Two snacking patterns, namely a high-calorie snacking pattern and a healthy snacking pattern, were identified with eigenvalues > 1. Weight underestimation was positively linked to high-calorie snacking pattern scores for both normal weight students (β: 0.16, 95% CI: 0.11, 0.21) and students with overweight/obesity (β: 0.44, 95% CI: 0.35, 0.52), and to healthy snacking scores for students with overweight/obesity (β: 0.28, 95% CI: 0.22, 0.33), but negatively linked to healthy snacking pattern scores for normal weight students (β: -0.12, 95% CI: -0.15, -0.09). Conversely, weight overestimation was negatively linked to both high-calorie and healthy snacking pattern scores for normal weight students (β: -0.07, 95% CI: -0.11, -0.04 and β: -0.13, 95% CI: -0.15, -0.10), but positively linked to healthy snacking scores for underweight students (β: 0.15, 95% CI: 0.08, 0.21). Interactions were found between sex, grade, accommodation, only child, primary guardians, parental education level and weight misperception to snacking patterns.

CONCLUSIONS

Adolescents with normal weight and overweight/obesity who misperceived their weight exhibited less healthy snacking patterns, whereas underweight students who misperceived their weight displayed healthier snacking patterns. Comprehensive programs are crucial to educate and guide adolescents in understanding their weight status and making healthier snack choices, involving families, schools, and society.

How (Un-)Healthy are Austrian school food environments? Evidence from focus groups and citizen science

BACKGROUND

Adolescents face high-choice school food environments that offer plenty of highly processed foods. Processed food producers target young people in their marketing, but there is limited data on the actual food supply inside and in the vicinity of Austrian schools and its impact on adolescent food choices. This study employs an innovative mixed-methods approach to explore adolescents' food choices.

METHODS

In Study 1, we conducted a citizen science study, with students as volunteer scientists. The students examined the food supply in and around their schools according to the Austrian food pyramid and categorized 953 food items in 144 food suppliers using photographs and descriptions. In Study 2, we explored students' food preferences in focus groups. We conducted four focus groups at four different schools in Tyrol, with 25 students (11 male, 14 female) between the ages of 12 and 15. We then linked the findings on individual preferences with the documented supply.

RESULTS

Study 1 found that the food supply in the investigated schools was predominantly categorized as unhealthy. The students categorized 46% as "unhealthy", 32% as "intermediate", and only 22% as "healthy". Study 2 identified three influential factors in students' food choices: 1) individual factors (such as taste and preferences), 2) social factors (such as mingling with peers), and 3) structural factors (such as physical environment and accessibility).

CONCLUSION

The study shows that unhealthy products cater to unhealthy preferences among adolescents and dominate current school food environments. Policies need to address unhealthy school food environments to address this issue. For instance, food supplies should be presented in an attractive ways, in fun places where students can mingle and express their identities.

Changes in Student's Breakfast and Snack Consumption during the Second COVID-19 Lockdown in Portugal: A Five-Wave Study

The circumstances of the COVID-19 lockdown affected many students' life spheres, including their feeding patterns and snack intake. The main goals of the present study were to: (a) analyze the changes in students' breakfast and snacking consumption during lockdown, and (b) analyze changes in the content of the students' snacks using the Healthy Eating Index. This study analyzed data from a sample of 726 students from 36 classes from the late elementary (i.e., fifth grade) through high school (i.e., twelfth grade) from two public schools in the north of Portugal. Data were collected in five moments during the 2020/2021 school year, pre-, during, and post-second lockdown moments. Throughout the five moments, almost 90% of the students ate breakfast, and the majority brought snacks from home to eat in school. Surprisingly, there was an increase in the quality of the snacks consumed during lockdown compared to the pre-lockdown moments (e.g., consumption of more whole and total fruits and less consumption of food with added sugar, saturated fats, refined grains, and fatty acids). Suggestions for healthy behavior promotion will be discussed, such as improving the school food environment and teaching children to prepare healthy lunch boxes.

'I Knew I Should Stop, but I Couldn't Control Myself': a qualitative study to explore the factors influencing adolescents' consumption of sugar-sweetened beverages and sugary snacks from a socio-ecological perspective

OBJECTIVE

To explore the factors influencing Taiwanese adolescents' consumption of sugar-sweetened beverages (SSB) and sugary snacks from a socio-ecological perspective.

DESIGN

This study adopted a qualitative design by using face-to-face, in-depth interviews guided by a semistructured questionnaire.

SETTING

Eight junior high schools in New Taipei City and Changhua County, Taiwan, September to November 2018.

PARTICIPANTS

Fifty-nine participants aged 12-14 years participated in this study.

RESULTS

Reflexive thematic analysis was used to analyse the data. This study identified four themes to address the multifaceted factors that influence adolescents' consumption of SSB and sugary snacks. At the intrapersonal level, physiological factors, psychological factors, individual economic factors and taste preferences were mentioned in connection with people's consumption of SSB and sugary snacks. Positive or negative influences of parents, siblings, peers and teachers on SSB and sugary snack intake were identified at the interpersonal level. The availability of SSB and sugary snacks at home, their availability in vending machines or in school stores in the school environment and participants' access to convenience stores and hand-shaken drink shops in the broader community influenced SSB and sugary snack consumption. Additionally, food culture and food advertising were identified as influencing societal factors.

CONCLUSIONS

Overall, this qualitative study determined not only that the consumption of SSB and sugary snacks is influenced by intrapersonal factors but also that interpersonal, environmental and societal factors affect adolescents' increased sugar intake. The findings are helpful to broaden the options for designing and developing interventions to decrease SSB and sugary snack consumption by adolescents.

Energy drink consumption among Australian adolescents associated with a cluster of unhealthy dietary behaviours and short sleep duration

BACKGROUND

Non-alcoholic energy drinks ('energy drinks') are high in sugar, as well as caffeine, leading to concerns regarding their suitability for children and adolescents. Despite this, marketing of energy drinks is often directed at adolescents, and there are no age restrictions on the sale of these products in Australia. The current study aimed to examine patterns in consumption of energy drinks among Australian secondary school students and identify sociodemographic and behavioural correlates associated with regular consumption.

METHODS

Participants were 8942 students in Years 8 to 11 (aged 12 to 17 years) who participated in the 2018 National Secondary Students' Diet and Activity (NaSSDA) cross-sectional survey. A multistage stratified random sampling procedure was used. Within the school setting, students self-completed an online questionnaire assessing their dietary, physical activity and sedentary behaviours. A multilevel logistic regression model was used to examine associations between energy drink consumption and sociodemographic and behavioural factors.

RESULTS

Overall, 8% of students reported consuming energy drinks on a weekly basis ('regular consumers'). A further 16% indicated they consume less than one cup per week of these types of drinks, while around three-quarters (76%) reported they do not consume energy drinks. Regular consumption of energy drinks was independently associated with being male, having greater weekly spending money, high intakes of snack foods, fast food, other sugar-sweetened beverages and fruit juice, as well as short sleep duration. There was no independent association with other sociodemographic characteristics (i.e., year level, level of disadvantage, geographic location), consumption of vegetables and fruit, physical activity level, or sedentary recreational screen time.

CONCLUSIONS

While most Australian adolescents do not consume energy drinks, regular consumption is more prevalent among males, and consumption appears to cluster with other unhealthy dietary behaviours and short sleep duration. Findings support the need for policies that will reach identified at-risk groups (e.g., increased regulation of the marketing and sale of energy drinks), as well as suggest opportunities for interventions targeting energy drink consumption alongside other unhealthy dietary behaviours.

The socio-ecological model as a framework for understanding junk food consumption among schoolchildren in Nepal

BACKGROUND

The consumption of industrially processed food, popularly known as junk food, is a growing public health concern worldwide, including in Nepal. Schoolchildren are a vulnerable group and they consume junk food at school.

AIM

The aim of this study was to examine multi-level determinants of junk food consumption among basic schoolchildren using the socio-ecological model as a framework.

METHODS

A cross-sectional study was conducted among students (n = 404), and a self-reported questionnaire was used to collect the data. The chi-square test and logistic regression were applied to analyse the results using SPSS version 26.

RESULTS

Nearly half (47%) of the students reported that they consumed junk foods at snack time. Important variables for explaining junk food consumption were knowledge of food and nutrition-a micro-level determinant; sharing knowledge of food and nutrition with classmates at school-a meso-level determinant; grade of student-an exo-level determinant; and occupation of parents-a macro-level determinant. However, multivariate analysis found that knowledge of food and nutrition (p < 0.05), and sharing knowledge of food and nutrition with classmates at school (p < 0.05) were the significant predictors of junk food consumption.

CONCLUSIONS

Junk food consumption is common among basic-level students in the study schools. Multi-level determinants explain the factors associated with this behaviour, extending from micro to macro as the socio-ecological model asserts. This study points to the need for comprehensive school-based nutrition education that targets multiple levels of influence, focusing on active learning approaches to promote healthy dietary behaviour in students.

A Cross-Sectional Survey of Salty Snack Consumption among Serbian Urban-Living Students and Their Contribution to Salt Intake

This study investigated the behavior of urban-living students related to the salty snacks consumption, and their contribution to salt daily intake. A cross-sectional survey on 1313 urban-living students (16–25 years, 61.4% university students and 38.6% high school students) used a pre-verified questionnaire created specifically for the study. The logistic regression analysis was performed to investigate the factors influencing snack consumption. The results of salt content and the snack consumption frequency were used to evaluate snack contribution to salt intake. All subjects consumed salty snacks, on average several times per week, more often at home and slightly more during periods of intensive studying, with 42% of the participants reporting to consume two or more packages per snacking occasion. Most of the participants consumed such products between main meals, but 10% of them took snacks immediately after the main meal. More high-school students than university students were in the “high snack group” (p < 0.05). The most frequently consumed salty snacks were those with the highest content of salt. Salt intake from snack products for a majority of participants ranged between 0.4 and 1 g/day. The research revealed younger age, home environment and significant contribution to salt intake as critical points in salty snack consumption among urban-living students important for the better understanding of their dietary habits.

Adolescents' views on high school food environments

ISSUE ADDRESSED

This study explored adolescents' views on high school food environments and potential strategies to help them to make informed food choices.

METHODS

Fifteen focus groups were conducted with 131 adolescents aged 12-17 years from three high schools in South East Queensland, Australia. Adolescents were asked how their school food environment (dis)encouraged them to eat healthy and what schools could do to help them eat healthier. All focus groups were audio recorded. Data were analysed using content and thematic data analysis methods.

RESULTS

Four major themes emerged: food availability and affordability; food related policy and regulations; nutrition education; and attitudes, preferences and practices. Adolescents stated that nutrition education within the school curriculum and positive role modelling by peers and school staff in healthy eating were the major factors in helping them to make informed food choices. In contrast, high availability, affordability, fundraising, peer pressure, positive attitudes and negative role modelling towards unhealthy foods impacted unhealthy dietary behaviours.

CONCLUSIONS

Emerging results indicate that adolescents do not perceive the current high school food environments as helping them to make healthy food choices. Adolescents suggested limiting unhealthy foods in high schools by implementing strict food and beverage policies, compulsory nutrition education classes and changing attitudes towards healthy foods as strategies to improve high school food environments. SO WHAT?: This study highlights the importance of high school food environments in impacting adolescents' food choices. Strategies identified by adolescents inform public health practitioners and school authorities on how high school food environments could be tailored to help them in making better food choices.

The Response of More Health Focused and Less Health Focused People to a Physical Activity Calorie Equivalent Label on Discretionary Snack Foods

A Physical Activity Calorie Equivalent (PACE) label shows the minutes of physical activity required to burn off the caloric content of a particular food. This study investigated the influence of PACE labelling on liking and consumption of discretionary snack foods in a group of more health focused and less health focused consumers. Participants (n = 97) tasted and rated (i.e., liking, prospective consumption) a range of snack foods with or without a PACE label. Total sampling consumption was also measured. Participants completed a shortened version of the International Physical Activity Questionnaire and the General Health Interest Scale questionnaire. Paired samples t-test, independent samples t-tests, a General Linear Model and Chi-Square tests were used to check for statistical significance. For more health focused participants (n = 57), the PACE label decreased only liking (p = 0.02). The PACE label was not effective in reducing liking (p = 0.49), prospective consumption (defined as the amount of the sample participants thought that they could consume) (p = 0.10) or consumption (p = 0.41) of energy-dense discretionary snack foods for less health focused individuals (n = 40). The level of participants’ physical activity did not facilitate the influence of PACE labelling on liking, consumption or prospective consumption. The PACE label was found to not be effective among less health focused individuals or the overall sample population. Therefore, the PACE label may not be an effective labelling strategy to reduce the liking or consumption of discretionary snack foods.

Snacking Behaviour and Its Determinants among College-Going Students in Coastal South India

BACKGROUND

Consumption of snacks in between the regular meals is a poor snacking behaviour. It is an established risk factor for several lifestyle-related disorders and has long-term effects among the younger individuals.

OBJECTIVES

To study the snacking behaviour and to assess their determinants among college-going students.

METHODS

This cross-sectional study was conducted among 865 college-going students in Mangaluru. Data were collected using a pretested pro forma that was coded and analyzed using Statistical Package for Social Sciences (SPSS) version 11.5. The chi-square test and random-effect logistic regression analyses were used.

RESULTS

Overall, there were 52.4% females and 47.6% males, and 76.8% of them were aged <20 years. More than half of the participants (54.3%) had the habit of snacking in between regular meals. Among them, a large proportion (78.7%) did not have any specific timings for snacking. Also, 51.1% of the students were snacking while watching TV, and 31.9% of them snacked while studying. Breakfast was the most commonly skipped meal (26.2%); of those missing the breakfast regularly, 123 (71.9%) had poor snacking behaviour. A significantly larger proportion of males had a higher frequency of snacking per day (69.3% versus 57.2%, p < 0.0001) and consumed aerated drinks more frequently (22.6% versus 15.8%, p=0.011), skipped meals more often (58.6% versus 50.6%, p=0.022), and preferred adding fruits in snacks (78.1% versus 69.4%, p=0.005). Snacking frequency was proportionately higher among students of private colleges (73.6%) than that in the government colleges (55.1%). Participants from nonscience stream, nonvegetarians, and those with a tendency to skip the regular meals had significantly higher levels of poor snacking behaviour.

CONCLUSIONS

The study population had a high level of poor snacking behaviour. Appropriate measures are needed among younger people to follow fixed eating patterns and avoid skipping of regular meals.

Socio-economic and demographic factors associated with snacking behavior in a large sample of French adults

Background

Few studies have specifically focused on demographic and socio-economic characteristics associated with snacking in adults, whereas their identification could be useful for defining effective public health measures. The aim of our study was to assess the associations of these factors with daily snacking behavior and its dietary quality.

Methods

This cross-sectional study included 84,692 women and 23,491 men from the NutriNet-Santé cohort study. Occurrence of snacking, energy intake from snacks, snack nutrient, and energy densities were assessed using 24-h dietary records of weekdays at baseline. Associations between socio-economic and demographic factors (age, presence of children in the household, education, income, occupation), and snacking behavior were examined using multivariable logistic regression and analysis of covariance, stratified by sex and adjusted for total daily energy intake.

Results

Older individuals were more likely to snack during the day in both sexes while individuals with primary education (OR = 0.79 (0.71;0.87) in women; OR = 0.71 (0.60;0.83) in men), female employees (OR = 0.94 (0.89;0.99), and self-employed women were less likely to snack during the day. Older individuals, in particular middle-aged subjects, had higher snack nutrient density, and lower energy intake and density from snacks compared with younger adults. Presence of a child in the household was associated with higher energy density, lower nutrient density (in women), and lower energy intake from snacks (in men), compared with those who lived without a child in household. In low income individuals and manual workers, snacks had lower nutrient density and higher energy content than in higher socioeconomic categories. At last, energy intake from daily snacking occasions was higher in women with low education level.

Conclusions

Although snacking was less prevalent in low socioeconomic categories and young adults, their snacks had higher energy content and were of poorer nutrient density. Such findings provide useful information on mechanisms of social disparities in dietary behavior.

Trial registration

This study was conducted according to the guidelines laid down in the Declaration of Helsinki. All procedures were approved by the Institutional Review Board of the French Institute for Health and Medical Research (IRB Inserm No0000388FWA00005831) and the French Data Protection Authority (Commission Nationale Informatique et Libertés No.908450 and No.909216). Clinical Trial no. NCT03335644

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0655-7) contains supplementary material, which is available to authorized users.

Physical activity-equivalent label reduces consumption of discretionary snack foods

OBJECTIVE

The present research aimed to investigate the impact of the physical activity calorie equivalent (PACE) front-of-pack label on consumption, prospective consumption and liking of familiar and unfamiliar discretionary snack foods.

DESIGN

In a within-subject randomised design, participants tasted and rated liking (9-point hedonic scale) and prospective consumption (9-point category scale) of four different snack foods with four different labels (i.e. blank, fake, PACE, PACE doubled) and four control snack foods. The twenty snack foods were presented during two 45 min sessions (i.e. ten snack foods per session) which were separated by one week. The amount participants sampled of each snack food was measured.

SETTING

The study was conducted in the Centre for Advanced Sensory Sciences laboratory at Deakin University, Australia.

SUBJECTS

The participants were 153 university students (126 females, twenty-seven males, mean age 24·3 (sd 4·9) years) currently enrolled in an undergraduate nutrition degree at Deakin University.

RESULTS

When the PACE label was present on familiar snack foods, participants sampled 9·9 % (22·8 (sem 1·4) v. 25·3 (sem 1·5) g, P=0·03) less than when such label was not present. This was in line with a decreased prospective snack food consumption of 9·1 % (3·0 (sem 0·2) v. 3·3 (sem 0·2) servings, P=0·03). Such pattern was not seen in unfamiliar snacks.

CONCLUSIONS

The PACE label appears to be a promising way to decrease familiar discretionary snack food consumption in young, health-minded participants.

Direct Effects of the Home, School, and Consumer Food Environments on the Association between Food Purchasing Patterns and Dietary Intake among Rural Adolescents in Kentucky and North Carolina, 2017

Background: Obesity rates are higher among rural versus urban adolescents. To examine possible mechanisms for the rural-urban adolescent obesity disparity, we examined the direct and indirect effects of food purchasing patterns, and the home, school, and consumer food environments on dietary intake among rural adolescents. Methods: A baseline survey was conducted among adolescents in eight rural high schools (four in Eastern Kentucky, and four in Eastern North Carolina). Participants answered questions about food purchasing patterns, dietary intake, home food availability, and demographics. The school and consumer food environments were assessed using validated measures from the School Meals Cost Study (United States Department of Agriculture-Mathematica) and the Nutrition Environment Measurement Survey for Stores, Restaurants, and Corner Stores. Results: Of 432 adolescents, 55% were normal weight, 24% were overweight, and 21% were obese. There was a direct association between unhealthy food purchasing patterns (shopping frequently at gas stations, fast food, and dollar stores) and consuming more added sugars, when compared to those with a healthy shopping pattern (shopping less frequently at gas stations, fast food, and dollar stores) [Odds Ratio = 2.41 (95% CI (confidence interval) 0.99, 3.82)]. Those who reported always having fruits and vegetables in the home consumed more servings of fruits and vegetables [OR = 0.31 cups (95% CI 0.22, 0.44)] compared to those who reported never having fruits and vegetables in the home. Adolescents attending a school with a low healthy food availability score consumed fewer servings of fruits and vegetables [−0.001 (95% CI −0.001, 0.0001)] compared to those attending a school with a high healthy food availability score. Conclusions: There are direct associations between food purchasing patterns, the home and school food environments, and dietary intake among rural adolescents. These cross-sectional results informed the development of the “Go Big and Bring it Home” program, a text messaging intervention to improve adolescents’ fruit, vegetable, and healthy beverage intake.

Factors associated with high consumption of soft drinks among Australian secondary-school students

Objective

To examine demographic and behavioural correlates of high consumption of soft drinks (non-alcoholic sugar-sweetened carbonated drinks excluding energy drinks) among Australian adolescents and to explore the associations between high consumption and soft drink perceptions and accessibility.

Design

Cross-sectional self-completion survey and height and weight measurements.

Setting

Australian secondary schools.

Subjects

Students aged 12–17 years participating in the 2012–13 National Secondary Students’ Diet and Activity (NaSSDA) survey (n 7835).

Results

Overall, 14 % of students reported consuming four or more cups (≥1 litres) of soft drinks each week (‘high soft drink consumers’). Demographic factors associated with high soft drink consumption were being male and having at least $AU 40 in weekly spending money. Behavioural factors associated with high soft drink consumption were low fruit intake, consuming energy drinks on a weekly basis, eating fast foods at least once weekly, eating snack foods ≥14 times/week, watching television for >2 h/d and sleeping for <8 h/school night. Students who perceived soft drinks to be usually available in their home, convenient to buy and good value for money were more likely to be high soft drink consumers, as were students who reported usually buying these drinks when making a beverage purchase from the school canteen/vending machine.

Conclusions

High soft drink consumption clusters with other unhealthy lifestyle behaviours among Australian secondary-school students. Interventions focused on reducing the availability of soft drinks (e.g. increased taxes, restricting their sale in schools) as well as improved education on their harms are needed to lower adolescents’ soft drink intake.

Mediating effects of dietary intake on associations of TV viewing, body mass index and metabolic syndrome in adolescents

Objective

Evidence suggests that TV viewing is associated with body mass index (BMI) and metabolic syndrome (MetS) in adolescents. However, it is unclear whether dietary intake mediates these relationships.

Methods

A cross‐sectional analysis was conducted in adolescents (12–19 years) participating in the 2003–2006 United States National Health and Nutrition Examination Survey. BMI z scores (zBMI) (n = 3,161) and MetS (n = 1,379) were calculated using age‐ and sex‐specific criteria for adolescents. TV viewing (h/day) was measured via a self‐reported questionnaire, and dietary intake was assessed using two 24‐h recalls. Using the MacKinnon method, a series of mediation analyses were conducted examining five dietary mediators (total energy intake, fruit and vegetable intake, discretionary snacks, sugar‐sweetened beverages and diet quality) of the relationships between TV viewing and zBMI and MetS.

Results

Small positive relationships were observed between TV viewing and zBMI (β = 0.99, p < 0.001) and TV viewing and MetS (OR = 1.18, p = 0.046). No dietary element appeared to mediate the relationship between TV viewing and zBMI. However, sugar‐sweetened beverage consumption and fruit and vegetable intake partially mediated the relationship between TV viewing and MetS, explaining 8.7% and 4.1% of the relationship, respectively.

Conclusions

These findings highlight the complexity of the relationships between TV viewing, dietary intake and cardiometabolic health outcomes, and that TV viewing should remain a target for interventions.