Takeaway food consumption and cardio-metabolic risk factors in young adults

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).

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.

Pooled prevalence of food away from home (FAFH) and associated non-communicable disease (NCD) markers: a systematic review and meta-analysis

BACKGROUND

Food away from home (FAFH) is an 'eating behavior' widely practiced across nations, more common in developed nations. Likewise, in developing countries an increase of close to 50% indicates an upsurge in FAFH consumption. While various indices and tools are used to assess diet quality, diversity, or healthy eating, FAFH is less utilized to study dietary behaviors and the associated disease risk.

OBJECTIVE

To calculate the pooled estimate of FAFH and identify the associated non-communicable disease (NCD) markers.

DESIGN

Systematic review and meta-analysis.

METHODS

Independent electronic searches were conducted across 6 databases: Medline, Web of Science, Scopus, Cochrane library, Ingenta, and CAB direct. Observational studies investigating the association between FAFH and NCD markers published between the year 2011 and 2021 were eligible for inclusion. Studies that included overweight or obese participants, pregnant women, or those under institutional care at baseline were excluded. The guidelines for reporting meta-analysis of observational studies in epidemiology were adhered to in the preparation of this systematic review.

RESULTS

The random effects combined estimate for the overall prevalence of FAFH was 39.96% (95% CI 29.97-53.29). High heterogeneity (τ² = 0.63, I² = 100%) and high risk of bias were observed among the selected studies. The test for overall effect was observed to be z = 25.11 (p < 0.001). Eleven out of fourteen studies showed a positive association between FAFH and anthropometric changes. Twelve out of seventeen studies showed a positive association between FAFH and cardiovascular disease (CVD) biomarkers.

CONCLUSION

Our work confirms FAFH as an evolving dietary behavior in both developing and developed countries, emphasizing the lack of representation from low-income countries. The association of FAFH with obesity and non-communicable disease risk is reinforced by our analyses. These findings should enable policy decisions to meet the rising demand of FAFH with healthier options to prevent the risk of NCD.

Understanding the Online Environment for the Delivery of Food, Alcohol and Tobacco: An Exploratory Analysis of 'Dark Kitchens' and Rapid Grocery Delivery Services

Online spaces are increasingly important in the sale of food, alcohol and tobacco. This analysis focuses on two developments in online food delivery: delivery-only 'dark kitchens' and rapid grocery delivery services (RGDS), with the aim to understand and assess the availability of health harming and health promoting products through these services. Data was collected for one metropolitan local authority in London, UK, using publicly available online sources. Being explorative in nature, the analysis includes descriptive statistics and qualitative assessment. Three dark kitchens (renting kitchens to 116 food businesses), three grocery delivery apps, and 76 grocery businesses available through online delivery platforms were identified. Most businesses renting dark kitchen space were 'virtual restaurants' (52%) selling fast food (47%) or dessert (21%) through online delivery platforms. RGDS sold a variety of items, with a focus on pre-packaged foods high in fat, salt and sugar, alcoholic beverages and tobacco. These items were also most likely to be promoted through offers and promotional language. Fruits and vegetables were less commonly available and mainly on grocery delivery apps. Online delivery services increase the temporal and geographic availability and promotion of many unhealthy products. Research expanding on the geographic area of interest is needed.

Impacts of COVID-19 Lockdown on Food Ordering Patterns among Youths in China: The COVID-19 Impact on Lifestyle Change Survey

INTRODUCTION

Limited studies have focused on how the COVID-19 outbreak and thereby lockdown had affected the youth's food ordering patterns, which was associated with their dietary behaviors and could have longer term impacts on their later-life health status if the trend persists. This study aimed to evaluate changes in food ordering patterns among youths in China after the COVID-19 outbreak.

METHODS

The data were obtained from a national retrospective survey (COINLICS) conducted in early May 2020 via social media platforms in China among more than 10,000 youth participants at 3 educational levels. Participants reported their basic sociodemographic characteristics, weight status, and lifestyles including food ordering patterns. We described and compared their weight status and food ordering patterns before COVID-19 (January) and under lockdown (February).

RESULTS

We observed significant changes in youths' weight status and food ordering patterns under lockdown. A significant increase was observed in the prevalence of overweight/obesity (13.5%-17.0%) and obesity (8.7-10.8%), which varied by sex and educational level. Overall, the average weekly frequency of food ordering among the Chinese students had declined, with the largest decrease seen among graduate students, followed by undergraduate and high/vocational school students. Regardless of types of food, the percentage of participating youths who started ordering under lockdown was all lower than that of youths who stopped ordering. Among those who had still ordered foods under lockdown, a larger percentage of female than male high/vocational school students ordered barbecue/grill and cakes/pastries; no significant differences were found across the educational levels.

CONCLUSION

The participating youths' food ordering patterns had significantly changed during the COVID-19 lockdown, with heterogeneities observed to different extents between sexes and across educational levels. Our findings would inform policy makers and health professionals of these changes in time, for better policy making and public health practice.

Living Environment Considerations on Obesity Prevention Behaviors and Self-Efficacy among Chinese Americans

The aim of this study is to ascertain if the living environment (type of residential neighborhood and number of household members) will elucidate differences in obesity risk reduction behaviors and self-efficacy in Chinese Americans. A cross-sectional survey design was used to recruit participants from Los Angeles County and New York City metropolitan areas. A total of 650 adults were recruited from diverse socioeconomic backgrounds. Descriptive statistics were measured for 19 behaviors reflecting food intake and portion size control and items measuring self-efficacy and attitudes. T-tests were applied for the two categories of living environment. The mean age of the sample was 36.3 years. The 'high income' neighborhood group indicated a greater frequency of behaviors, including choosing steamed over fried foods (p < 0.01) and using small amounts of oil (p < 0.05). In general, this group exhibited more favorable attitudes and stronger self-efficacy to perform health behaviors. Multiple regression analyses point to the impact of self-efficacy in predicting behaviors. Nutrition professionals must assess client's living environments in the adoption of obesity prevention behaviors and the fostering of behavioral confidence.

The Contribution of Foods Prepared Outside the Home to the Diets of 18- to 30-Year-Old Australians: The MYMeals Study

Young adults are the highest consumers of food prepared outside home (FOH) and gain most weight among Australian adults. One strategy to address the obesogenic food environment is menu labelling legislation whereby outlets with >20 stores in one state and >50 Australia-wide must display energy content in kJ. The aim of this study was to assess the contribution of FOH to the energy and macronutrients, saturated fat, total sugars and sodium intakes of young Australians. One thousand and one 18 to 30-year-olds (57% female) residing in Australia’s most populous state recorded all foods and beverages consumed and the location of preparation for three consecutive days using a purpose-designed smartphone application. Group means for the daily consumption of energy, percentage energy (%E) for protein, carbohydrate, total sugars, total and saturated fats, and sodium density (mg/1000 kJ) and proportions of nutrients from FOH from menu labelling and independent outlets were compared. Overall, participants consumed 42.4% of their energy intake from FOH with other nutrients ranging from 39.8% (sugars) to 47.3% (sodium). Independent outlets not required to label menus, contributed a greater percentage of energy (23.6%) than menu labelling outlets (18.7%, p < 0.001). Public health policy responses such as public education campaigns, extended menu labelling, more detailed nutrition information and reformulation targets are suggested to facilitate healthier choices.

[Eating away from home and biomarkers for chronic noncommunicable diseases in Brazilian adolescents]

The study aimed to assess the relationship between food consumption away from home and alterations in biomarkers for chronic noncommunicable diseases in Brazilian adolescents. This cross-sectional study used data from the Study of Cardiovascular Risk Factors in Adolescents (ERICA), conducted in 36,956 adolescents in 2013/2014. The relationship between food consumption away from home and each target outcome (hypertriglyceridemia, hypercholesterolemia, hyperglycemia, high glycated hemoglobin, and hyperinsulinemia) was tested with logistic regression models adjusted for age, school system (public versus private), physical activity, and screen time. Data on food consumption were obtained with a 24-hour diet recall (24HR), analyzing consumption of energy, added sugar, sodium, potassium, fiber, fruits, vegetables, rice, beans, sandwiches, cakes, dessert, chocolates, and sodas. The results showed that 53.2% of adolescents consumed foods away from home. Eating away from home showed an inverse relationship with hyperinsulinemia (OR = 0.65; 95%CI: 0.46-0.92) and hyperglycemia (OR = 0.46; 95%CI: 0.30-0.71) in boys and hypertension (OR = 0.71; 95%CI: 0.55-0.92) and hyperglycemia (OR = 0.57; 95%CI: 0.34-0.96) in girls. However, the consumption of calories, added sugar, sandwiches, desserts, and sodas was higher in adolescents that consumed foods away from home. The protective role of eating away from home, as measured by biochemical indicators in adolescents, may be a function of higher consumption of school meals, which was more frequent among adolescents that consumed food away from home, thus highlighting the importance of encouraging consumption of school meals.

A qualitative study of the drivers of socioeconomic inequalities in men's eating behaviours

Background

Men of low socioeconomic position (SEP) are less likely than those of higher SEP to consume fruits and vegetables, and more likely to eat processed discretionary foods. Education level is a widely used marker of SEP. Few studies have explored determinants of socioeconomic inequalities in men’s eating behaviours. The present study aimed to explore intrapersonal, social and environmental factors potentially contributing to educational inequalities in men’s eating behaviour.

Methods

Thirty Australian men aged 18–60 years (15 each with tertiary or non-tertiary education) from two large metropolitan sites (Melbourne, Victoria; and Newcastle, New South Wales) participated in qualitative, semi-structured, one-on-one telephone interviews about their perceptions of influences on their and other men’s eating behaviours. The social ecological model informed interview question development, and data were examined using abductive thematic analysis.

Results

Themes equally salient across tertiary and non-tertiary educated groups included attitudes about masculinity; nutrition knowledge and awareness; ‘moralising’ consumption of certain foods; the influence of children on eating; availability of healthy foods; convenience; and the interplay between cost, convenience, taste and healthfulness when choosing foods. More prominent influences among tertiary educated men included using advanced cooking skills but having relatively infrequent involvement in other food-related tasks; the influence of partner/spouse support on eating; access to healthy food; and cost. More predominant influences among non-tertiary educated men included having fewer cooking skills but frequent involvement in food-related tasks; identifying that ‘no-one’ influenced their diet; having mobile worksites; and adhering to food budgets.

Conclusions

This study identified key similarities and differences in perceived influences on eating behaviours among men with lower and higher education levels. Further research is needed to determine the extent to which such influences explain socioeconomic variations in men’s dietary intakes, and to identify feasible strategies that might support healthy eating among men in different socioeconomic groups.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6162-6) contains supplementary material, which is available to authorized users.

Cross-Sectional Associations between Dietary Fat-Related Behaviors and Continuous Metabolic Syndrome Score among Young Australian Adults

Dietary guidelines recommend removing visible fat from meat, choosing low-fat options and cooking with oil instead of butter. This study examined cross-sectional associations between fat-related eating behaviors and a continuous metabolic syndrome (cMetSyn) score among young adults. During 2004–2006, 2071 participants aged 26–36 years reported how often they trimmed fat from meat, consumed low-fat dairy products and used different types of fat for cooking. A fasting blood sample was collected. Blood pressure, weight and height were measured. To create the cMetSyn score, sex-specific principal component analysis was applied to normalized risk factors of the harmonized definition of metabolic syndrome. Higher score indicates higher risk. For each behavior, differences in mean cMetSyn score were calculated using linear regression adjusted for confounders. Analyses were stratified by weight status (Body mass index (BMI) < 25 kg/m² or ≥ 25 kg/m²). Mean cMetSyn score was positively associated with consumption of low-fat oily dressing (P_Trend = 0.013) among participants who were healthy weight and frequency of using canola/sunflower oil for cooking (P_Trend = 0.008) among participants who were overweight/obese. Trimming fat from meat, cooking with olive oil, cooking with butter, and consuming low-fat dairy products were not associated with cMetSyn score. Among young adults, following fat-related dietary recommendations tended to not be associated with metabolic risk.

Examining the interaction of fast-food outlet exposure and income on diet and obesity: evidence from 51,361 UK Biobank participants

BACKGROUND

Household income (as a marker of socioeconomic position) and neighbourhood fast-food outlet exposure may be related to diet and body weight, which are key risk factors for non-communicable diseases. However, the research evidence is equivocal. Moreover, understanding the double burden of these factors is a matter of public health importance. The purpose of this study was to test associations of neighbourhood fast-food outlet exposure and household income, in relation to frequency of consumption of processed meat and multiple measures of adiposity, and to examine possible interactions.

METHODS

We employed an observational, cross-sectional study design. In a cohort of 51,361 adults aged 38-72 years in Greater London, UK, we jointly classified participants based on household income (£/year, four groups) and GIS-derived neighbourhood fast-food outlet proportion (counts of fast-food outlets as a percentage of all food outlets, quartiles). Multivariable regression models estimated main effects and interactions (additive and multiplicative) of household income and fast-food outlet proportion on odds of self-reported frequent processed meat consumption (> 1/week), measured BMI (kg/m2), body fat (%), and odds of obesity (BMI ≥ 30).

RESULTS

Income and fast-food proportion were independently, systematically associated with BMI, body fat, obesity and frequent processed meat consumption. Odds of obesity were greater for lowest income participants compared to highest (OR = 1.54, 95% CI: 1.41, 1.69) and for those most-exposed to fast-food outlets compared to least-exposed (OR = 1.51, 95% CI: 1.40, 1.64). In jointly classified models, lowest income and highest fast-food outlet proportion in combination were associated with greater odds of obesity (OR = 2.43, 95% CI: 2.09, 2.84), with relative excess risk due to interaction (RERI = 0.03). Results were similar for frequent processed meat consumption models. There was no evidence of interaction on a multiplicative scale between fast-food outlet proportion and household income on each of BMI (P = 0.230), obesity (P = 0.054) and frequent processed meat consumption (P = 0.725).

CONCLUSIONS

Our study demonstrated independent associations of neighbourhood fast-food outlet exposure and household income, in relation to diet and multiple objective measures of adiposity, in a large sample of UK adults. Moreover, we provide evidence of the double burden of low income and an unhealthy neighbourhood food environment, furthering our understanding of how these factors contribute jointly to social inequalities in health.

Takeaway meal consumption and risk markers for coronary heart disease, type 2 diabetes and obesity in children aged 9-10 years: a cross-sectional study

OBJECTIVE

To investigate associations between takeaway meal consumption and risk markers for coronary heart disease, type 2 diabetes and obesity risk markers in children.

DESIGN

A cross-sectional, school-based observational study.

SETTING

85 primary schools across London, Birmingham and Leicester.

PARTICIPANTS

1948 UK primary school children in year 5, aged 9-10 years.

MAIN OUTCOME MEASURES

Children reported their frequency of takeaway meal consumption, completed a 24-hour dietary recall, had physical measurements and provided a fasting blood sample.

RESULTS

Among 1948 participants with complete data, 499 (26%) never/hardly ever consumed a takeaway meal, 894 (46%) did so <1/week and 555 (28%) did ≥1/week. In models adjusted for age, sex, month, school, ethnicity and socioeconomic status, more frequent takeaway meal consumption was associated with higher dietary intakes of energy, fat % energy and saturated fat % energy and higher energy density (all P trend <0.001) and lower starch, protein and micronutrient intakes (all P trend <0.05). A higher frequency of takeaway meal consumption was associated with higher serum total cholesterol and low-density lipoprotein (LDL) cholesterol (P trend=0.04, 0.01, respectively); children eating a takeaway meal ≥1/week had total cholesterol and LDL cholesterol 0.09 mmol/L (95% CI 0.01 to 0.18) and 0.10 mmol/L (95% CI 0.02 to 0.18) higher respectively than children never/hardly ever eating a takeaway meal; their fat mass index was also higher.

CONCLUSIONS

More frequent takeaway meal consumption in children was associated with unhealthy dietary nutrient intake patterns and potentially with adverse longer term consequences for obesity and coronary heart disease risk.

Association between diet quality, dietary patterns and cardiometabolic health in Australian adults: a cross-sectional study

BACKGROUND

Diet quality indices score dietary intakes against recommendations, whereas dietary patterns consider the pattern and combination of dietary intakes. Studies evaluating both methodologies in relation to cardiometabolic health in a nationally representative sample are limited. The aim of the present study was to investigate the relationship between diet quality, dietary patterns and markers of cardiometabolic health in Australian adults.

METHODS

Dietary data, using two 24-h dietary recalls, were collected from adults in the cross-sectional Australian Health Survey 2011-2013 (n = 2121; 46.4 (SE 0.48) years). Diet quality was estimated using the Dietary Guideline Index (DGI). Dietary patterns (DPs), derived using reduced rank regression, were estimated using fiber density, SFA: PUFA and total sugars intake as intermediate markers. Multi-variable adjusted linear regression analyses were used to examine associations between diet quality and DPs and blood biomarkers, body mass index, waist circumference, diastolic and systolic blood pressure and an overall cardiometabolic risk score.

RESULTS

DGI was associated with lower glucose (coef - 0.009, SE 0.004; P-trend = 0.033), body mass index (coef - 0.017, SE 0.007; P-trend = 0.019) and waist circumference (coef - 0.014, SE 0.005; P-trend = 0.008). Two dietary patterns were derived: dietary pattern-1 was characterized by higher intakes of pome fruit and wholegrain bread, while dietary pattern-2 was characterized by higher intakes of added sugars and tropical fruit. Dietary pattern-1 was associated with lower body mass index (coef - 0.028, SE 0.007; P-trend< 0.001) and waist circumference (coef - 0.017, SE 0.005; P-trend = 0.001). There was a trend towards lower cardiometabolic risk score. Dietary pattern-2 was associated with lower HDL-cholesterol (coef - 0.026, SE 0.012; P-trend = 0.028). There was a trend towards lower diastolic blood pressure. No associations with other markers were observed.

CONCLUSIONS

Better diet quality and healthier dietary patterns were primarily associated with favorable anthropometric markers of cardiometabolic health. Findings support the need for comparison of whole-diet based methodologies that take into consideration the interactions between foods and nutrients. Longitudinal studies are warranted to better understand causal relationships between diet and cardiometabolic health.

A prospective study of frequency of eating restaurant prepared meals and subsequent 9-year risk of all-cause and cardiometabolic mortality in US adults

Restaurant prepared foods are known to be energy-dense and high in fat and sodium, but lower in protective nutrients. There is evidence of higher risk of adiposity, type II diabetes, and heart disease in frequent consumers of restaurant meals. However, the risk of mortality as a long-term health consequence of frequent consumption of restaurant meals has not been examined. We examined the prospective risk of all-cause and coronary heart disease, cerebrovascular disease and diabetes (cardiometabolic) mortality in relation to frequency of eating restaurant prepared meals in a national cohort. We used frequency of eating restaurant prepared meals information collected in the National Health and Nutrition Examination Surveys, conducted from 1999-2004, with mortality follow-up completed through Dec. 31, 2011 (baseline age ≥ 40y; n = 9107). We estimated the relative hazard of all-cause and cardiometabolic mortality associated with weekly frequency of eating restaurant meals using Cox-proportional hazards regression methods to adjust for multiple covariates. All analyses accounted for complex survey design and included sample weights. Over 33% of all respondents reported eating ≥3 restaurant prepared meals/week. In this cohort, 2200 deaths due to all causes and 665 cardiometabolic deaths occurred over a median follow-up of 9 years. The covariate-adjusted hazard ratio of all cause or cardiometabolic mortality in men and women reporters of <1 or 1-2 restaurant prepared meals did not differ from those reporting ≥3 meals/week (P>0.05). The results were robust to effect modification by baseline BMI, years of education, and baseline morbidity. Expectedly, the 24-h dietary intakes of whole grains, fruits, dietary fiber, folate, vitamin C, potassium and magnesium at baseline were lower, but energy, energy density, and energy from fat were higher in more frequent restaurant meal reporters (P<0.05). Baseline serum HDL cholesterol, folate, and some carotenoids were inversely associated with the frequency of eating restaurant prepared meals (P<0.05); however, serum concentrations of total cholesterol, triglycerides, fasting glucose, insulin, glycated hemoglobin, and c-reactive protein were unrelated (P<0.05). The weekly frequency of eating restaurant prepared meals and prospective risk of mortality after 9 years were not related in this cohort.

Determinants of takeaway and fast food consumption: a narrative review

Out-of-home foods (takeaway, take-out and fast foods) have become increasingly popular in recent decades and are thought to be a key driver in increasing levels of overweight and obesity due to their unfavourable nutritional content. Individual food choices and eating behaviours are influenced by many interrelated factors which affect the results of nutrition-related public health interventions. While the majority of research based on out-of-home foods comes from Australia, the UK and USA, the same issues (poor dietary habits and increased prevalence of non-communicable disease) are of equal concern for urban centres in developing economies undergoing ‘nutrition transition’ at a global scale. The present narrative review documents key facets, which may influence out-of-home food consumption, drawn from biological, societal, environmental, demographic and psychological spheres. Literature searches were performed and references from relevant papers were used to find supplementary studies. Findings suggest that the strongest determinants of out-of-home food availability are density of food outlets and deprivation within the built environment; however, the association between socio-economic status and out-of-home food consumption has been challenged. In addition, the biological and psychological drives combined with a culture where overweight and obesity are becoming the norm makes it ‘fashionable’ to consume out-of-home food. Other factors, including age group, ethnicity and gender demonstrate contrasting effects and a lack of consensus. It is concluded that further consideration of the determinants of out-of-home food consumption within specific populations is crucial to inform the development of targeted interventions to reduce the impact of out-of-home foods on public health.

Fast Food Intake in Relation to Employment Status, Stress, Depression, and Dietary Behaviors in Low-Income Overweight and Obese Pregnant Women

Objective This study explored fast food intake as a potential mediator of the relationships among employment status; stress; depression; and fruit, vegetable, and fat intakes by race (African American vs. Non-Hispanic White) and body mass index (BMI category: overweight vs. obesity). Methods Low-income overweight and obese pregnant women (N = 332) were recruited from the Special Supplemental Nutrition Program for Women, Infants and Children in Michigan. Path analysis was performed to explore mediation effects by race and BMI category. Results Fast food intake mediated the relationship between employment status and fat intake (p = 0.02) in Non-Hispanic White women, but no mediation effect was detected in African American women. For overweight women, fast food intake mediated the relationship between employment status and fat intake (p = 0.04) and the relationship between depression and vegetable intake (p = 0.01). Also, fast food intake partially mediated the relationship between depression and fat intake (p = 0.003). For obese women, fast food intake mediated the relationship between employment status and fat intake (p = 0.04). Conclusion Fast food is an important topic for nutrition education for overweight and obese pregnant women. Future interventions may be more successful if they address issues associated with employment status (e.g., lack of time to plan and cook healthy meals) and depressive mood (e.g., inability to plan meals or shop for groceries when coping with negative emotions).

A Mobile Health Lifestyle Program for Prevention of Weight Gain in Young Adults (TXT2BFiT): Nine-Month Outcomes of a Randomized Controlled Trial

Background

The unprecedented rise in obesity among young adults, who have limited interaction with health services, has not been successfully abated.

Objective

The objective of this study was to assess the maintenance outcomes of a 12-week mHealth intervention on prevention of weight gain in young adults and lifestyle behaviors at 9 months from baseline.

Methods

A two-arm, parallel, randomized controlled trial (RCT) with subjects allocated to intervention or control 1:1 was conducted in a community setting in Greater Sydney, Australia. From November 2012 to July 2014, 18- to 35-year-old overweight individuals with a body mass index (BMI) of 25-31.99 kg/m2 and those with a BMI ≥ 23 kg/m2 and a self-reported weight gain of ≥ 2 kg in the past 12 months were recruited. A 12-week mHealth program “TXT2BFiT” was administered to the intervention arm. This included 5 coaching calls, 96 text messages, 12 emails, apps, and downloadable resources from the study website. Lifestyle behaviors addressed were intake of fruits, vegetables, sugar-sweetened beverages (SSBs), take-out meals, and physical activity. The control group received 1 phone call to introduce them to study procedures and 4 text messages over 12 weeks. After 12 weeks, the intervention arm received 2 further coaching calls, 6 text messages, and 6 emails with continued access to the study website during 6-month follow-up. Control arm received no further contact. The primary outcome was weight change (kg) with weight measured at baseline and at 12 weeks and self-report at baseline, 12 weeks, and 9 months. Secondary outcomes were change in physical activity (metabolic equivalent of task, MET-mins) and categories of intake for fruits, vegetables, SSBs, and take-out meals. These were assessed via Web-based surveys.

Results

Two hundred and fifty young adults enrolled in the RCT. Intervention participants weighed less at 12 weeks compared with controls (model β=−3.7, 95% CI −6.1 to −1.3) and after 9 months (model β=− 4.3, 95% CI − 6.9 to − 1.8). No differences in physical activity were found but all diet behaviors showed that the intervention group, compared with controls at 9 months, had greater odds of meeting recommendations for fruits (OR 3.83, 95% CI 2.10-6.99); for vegetables (OR 2.42, 95% CI 1.32-4.44); for SSB (OR 3.11, 95% CI 1.47-6.59); and for take-out meals (OR 1.88, 95% CI 1.07-3.30).

Conclusions

Delivery of an mHealth intervention for prevention of weight gain resulted in modest weight loss at 12 weeks with further loss at 9 months in 18- to 35-year-olds. Although there was no evidence of change in physical activity, improvements in dietary behaviors occurred, and were maintained at 9 months. Owing to its scalable potential for widespread adoption, replication trials should be conducted in diverse populations of overweight young adults.

Trial Registration

Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000924853; (Archived by WebCite at http://www.webcitation.org/6i6iRag55)

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.

Saturated and trans-fatty acids in UK takeaway food

The aim of the study was to analyze the saturated fatty acid (SFA) and trans-fatty acid (TFA) contents of popular takeaway foods in the UK (including English, pizza, Chinese, Indian and kebab cuisine). Samples of meals were analyzed by an accredited public analyst laboratory for SFA and TFA. The meals were highly variable for SFA and TFA. English and Pizza meals had the highest median amount of SFA with 35.7 g/meal; Kebab meals were high in TFA with up to 5.2 g/meal. When compared to UK dietary reference values, some meals exceeded SFA and TFA recommendations from just one meal. Takeaway food would be an obvious target to reduce SFA and TFA contents and increase the potential of meeting UK recommendations. Strategies such as reformulation and smaller takeaway portion sizes warrant investigation.

Consumption Frequency of Foods Away from Home Linked with Higher Body Mass Index and Lower Fruit and Vegetable Intake among Adults: A Cross-Sectional Study

INTRODUCTION

Consumption of foods prepared away from home (FAFH) has grown steadily since the 1970s. We examined the relationship between FAFH and body mass index (BMI) and fruit and vegetable (FV) consumption.

METHODS

Frequency of FAFH, daily FV intake, height and weight, and sociodemographic data were collected using a telephone survey in 2008-2009. Participants included a representative sample of 2,001 adult men and women (mean age 54 ± 15 years) residing in King County, WA, with an analytical sample of 1,570. Frequency of FAFH was categorized as 0-1, 2-4, or 5+ times per week. BMI was calculated from self-reported height and weight. We examined the relationship between FAFH with FV consumption and BMI using multivariate models.

RESULTS

Higher frequency of FAFH was associated with higher BMI, after adjusting for age, income, education, race, smoking, marital status, and physical activity (women: p = 0.001; men: p = 0.003). There was a negative association between frequency of FAFH and FV consumption. FAFH frequency was significantly (p < 0.001) higher among males than females (43.1% versus 54.0% eating out 0-1 meal per week, resp.). Females reported eating significantly (p < 0.001) more FV than males.

CONCLUSION

Among adults, higher frequency of FAFH was related to higher BMI and less FV consumption.

Nutrition Promotion to Prevent Obesity in Young Adults

Young adulthood is a vulnerable period for weight gain and the health consequences of becoming obese during this life-stage of serious concern. Some unhealthy dietary habits are typical of young adults in many developed nations encountering the obesity epidemic. These include high sugar-sweetened beverage consumption, lower vegetable intake and greater consumption of foods prepared outside the home including fast foods. Each of these dietary behaviours may place young adults at increased risk for overweight and obesity. Evidence suggests many young adults with unhealthy nutrition behaviours are not considering nor preparing to make changes. To improve their nutrition and health as they progress through the lifecycle requires approaches specifically targeted to this age group. Strategies and programs should include both individual level and population approaches. The evidence base for prevention of weight gain and halting overweight and obesity in young adulthood is currently small with few studies of high quality. Studies modifying food environments in colleges and universities are also of limited quality, but sufficiently promising to conduct further research employing better, more sophisticated, study designs and additionally to include health outcome measures. More research into programs tailored to the needs of young adults is warranted with several studies already underway.

The availability and accessibility of nutrition information in fast food outlets in five states post-menu labelling legislation in New South Wales

OBJECTIVES

1) Explore the availability and accessibility of fast food energy and nutrient information post-NSW menu labelling legislation in states with and without menu labelling legislation. 2) Determine whether availability and accessibility differed compared with pre-menu labelling legislation in NSW.

METHODS

We visited 210 outlets of the five largest fast food chains in five Australian states to observe the availability and accessibility of energy and nutrient information. Results were compared with 197 outlets surveyed pre-menu labelling.

RESULTS

Most outlets (95%) provided energy values, half provided nutrient values and 3% provided information for all menu items. The total amount of information available increased post-NSW menu labelling implementation (473 versus 178 pre-implementation, p<0.001); however, fewer outlets provided nutrient values (26% versus 97% pre-implementation, p<0.001).

CONCLUSIONS

Fast food chains surveyed had voluntarily introduced menu labelling nationally. However, more nutrient information was available in-store in 2010, showing that fast food chains are able to provide comprehensive nutrition information, yet they have stopped doing so.

IMPLICATIONS

Menu labelling legislation should compel fast food chains to provide accessible nutrition information including nutrient values in addition to energy for all menu items in-store. Additionally, public education campaigns are needed to ensure customers can use menu labelling.

Away from home meals: associations with biomarkers of chronic disease and dietary intake in American adults, NHANES 2005-2010

Background

Away from home (AFH) meals are known to be energy-dense and of poor diet quality. Both direct and indirect exposure (e.g., neighborhood restaurant density) to AFH meals have been implicated as contributors to higher body weight and adverse health outcomes.

Objective

To examine the association of frequency of eating AFH and fast-food meals with biomarkers of chronic disease and dietary intake.

Design

This cross-sectional study used frequency of AFH and fast-food meal and biomarker data from the NHANES 2005-2010. Information on weekly frequency of AFH and fast-food meals was collected via questionnaire during the household interview. The metabolic biomarkers examined included BMI, serum cholesterol (total, HDL, and LDL), triglycerides, glycohemoglobin, and fasting glucose (n=8314, age ≥20, NHANES 2007-2010). Biomarkers of dietary exposure included serum concentrations of vitamins A, D, E, C, B-6, B-12, folate, and carotenoids (n=4162; 2005-2006). Multiple linear and logistic regression methods adjusted for complex survey methodology and covariates.

Results

American adults reported a mean of 3.9 (95% CI 3.7, 4.0) AFH and 1.8 (1.6, 1.9) fast-food meals/week. Over 50% of adults reported ≥3 AFH and >35% reported ≥2 fast-food meals/week. Mean BMI of more frequent AFH or fast-food meal reporters was higher (P_trend≤0.0004). Serum concentrations of total, LDL, and HDL cholesterol were related inversely with frequency of AFH meals (P<0.05). Frequency of fast-food meals and serum HDL-cholesterol were also related inversely (P=0.0001). Serum concentrations of all examined micronutrients (except vitamin A and lycopene) declined with increasing frequency of AFH meals (P<0.05); women and ≥50 y olds were at higher risk.

Conclusions

Reporters of frequent AFH and fast-food meals had higher BMI and lower concentrations of HDL cholesterol; but profiles of other biomarkers did not indicate higher metabolic risk. However, the serum concentrations of nutrients with mostly plant foods as sources declined with increasing AFH meal frequency.

Blackham T, Long R, Taylor C, Ashton M, Stevenson L, Glynn Davies I. Nutritional composition of takeaway food in the UK

Purpose

– This paper aims to determine the nutritional profile of popular takeaway meals in the UK. Fast food has a poor nutritional profile; research has focused on the major catering chains, with limited data on takeaway food from independent establishments.

Design/methodology/approach

– Random samples of takeaway meals were purchased from small, independent takeaway establishments. Multiple samples of 27 different takeaway meals, from Indian, Chinese, kebab, pizza and English-style establishments (n = 489), were analysed for portion size, energy, protein, carbohydrate, total fat, salt and total sugars.

Findings

– Takeaway meals were inconsistent with UK dietary recommendations; pizzas revealed the highest energy content, and Chinese meals were lowest in total fat. However, there was a high degree of variability between and within categories, but the majority of meals were excessive for portion size, energy, macronutrients and salt.

Research limitations/implications

– The present study focused on energy, macronutrients, salt and total sugars. Future research should analyse the quality of fat and carbohydrates and micronutrients to provide a more detailed nutritional profile of takeaway food.

Practical implications

– The nutritional variability between establishments suggests that recipe reformulation should be explored in an attempt to improve the nutritional quality of takeaway foods. In addition, portion size reduction could favour both the consumer and the industry.

Social implications

– Takeaway outlets do not provide nutritional information; due to the excessive nutritional profiles, regular intake may increase the risk of non-communicable disease. Therefore, there is a pressing need for this provision to help consumers make conscious food choices.

Originality/value

– This is the first study to analyse energy and macronutrient content of independent takeaway meals in the UK.

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

OBJECTIVE

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

DESIGN

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

SETTING

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

SUBJECTS

Students (n 309) aged 18-36 years.

RESULTS

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

CONCLUSIONS

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

Frequency of consumption at fast-food restaurants is associated with dietary intake in overweight and obese women recruited from financially disadvantaged neighborhoods

Fast-food restaurants are more prevalent in lower-income and predominately African American neighborhoods, where consumption of fast food is also higher. In general populations, fast-food consumption is related to less healthy dietary intake. This cross-sectional study examined the hypotheses that greater fast-food consumption is associated with less healthy dietary intake and poorer diet quality in overweight and obese women (n = 196, 25-51 years, 87% African American) recruited from financially disadvantaged Census tracts. Dietary intake and diet quality (Alternate Healthy Eating Index) were assessed via three 24-hour dietary recalls. Linear regression models tested the association between fast-food consumption and each outcome (model 1). Model 2 added sociodemographics and physical activity. Model 3 added total caloric intake. Fast-food consumption was significantly associated with total caloric intake; total intake of meat, grains, sweetened beverages, dairy, fiber, cholesterol, sodium, and added sugar; and percent of calories from total fat, saturated fat, and trans-fatty acids. Statistically significant associations remained in model 2, but most were not significant in model 3. Fast-food consumption was not associated with diet quality (Alternate Healthy Eating Index) in any model. In this at-risk sample, fast-food consumption was associated with more negative dietary practices. Significant associations generally disappeared when controlling for total caloric intake, suggesting that women who eat more fast food have higher total caloric intakes as a result of increased consumption of unhealthy rather than healthy foods.