Americans' Perceptions about Fast Food and How They Associate with Its Consumption and Obesity Risk

Factors associated with adherence to the Mediterranean diet among medical students at a private university in Lima, Peru

<b>Introduction:</b> The Mediterranean diet (MedD)is a characteristic eating pattern of the countries of the Mediterranean region. Nonetheless, is unknown its adherence in medical students. We aimed to determine the prevalence of adherence to the Mediterranean diet (AMedD) and associated factors in medical students from Peru.<br /> <b>Material and methods</b>: Analytical cross-sectional study carried out by means of a virtual survey. PREDIMED scale was used to evaluate AMedD. The factors assessed were age, sex, academic year, body mass index (BMI), place of lunch consumption, cigarette smoking, and physical activity. Poisson regression with robust variance was used to present it in crude and adjusted prevalence ratios (PRa).<br /> <b>Results:</b> High AMedD was present in 38.50%. Statistically significant association was found for sex (PRa: 0.623; 95%CI 0.488-0.796); for overweight (PRa: 0.417; 95%CI 0.270-0.644), obesity (PRa: 0.591; 95%CI 0.400-0.874) versus normopese; cigarette smoking (PRa: 0.450; 95%CI 0.263-0.773); and high physical activity (PRa: 1.652; 95%CI 1.233-2.215).<br /> <b>Conclusions</b>: AMedD was low. The related factors were sex, BMI, consumption of lunch outside the home, cigarette smoking, and a high level of physical activity. If this is confirmed in future studies, it would be necessary to consider these elements to encourage greater consumption of MedD components by students, which would help to improve their long-term health.

Food and Physical Activity Environment in the US-Affiliated Pacific Region: The Children's Healthy Living Program

OBJECTIVE

To describe the quality of food and physical activity (PA) environments by World Bank Income level in jurisdictions from the Children's Healthy Living Program.

DESIGN

Baseline cross-sectional community data were analyzed from 11 jurisdictions categorized by World Bank Income levels to describe exposure to different food and PA outlets. The Children's Healthy Living Program was a multilevel, multijurisdictional prevalence study and community intervention trial that reduced child obesity in the US-Affiliated Pacific region.

SETTING

US-Affiliated Pacific region.

PARTICIPANTS

Food (n = 426) and PA (n = 552) Outlets.

MAIN OUTCOME MEASURES

Physical activity and food scores that reflect the quality of the outlets that support being physically active and healthy eating options, respectively.

ANALYSIS

Descriptive statistics are presented as means ± SD or percentages.

RESULTS

High-income-income level jurisdictions had higher food and PA scores than middle-income level jurisdictions.

CONCLUSIONS AND IMPLICATIONS

The US-Affiliated Pacific region has limited quality food and PA outlets in underserved communities at risk for obesity. The findings in this paper can be used to develop tools and design interventions to improve the food and PA environment to increase a healthier, active lifestyle.

Consumption of Foods Away from Home Is Associated with Lower Diet Quality Among Adults Living in Puerto Rico

BACKGROUND

Consuming foods away from home (FAFH) is ubiquitous, yet, it is unclear how it influences diet in diverse populations.

OBJECTIVE

The study aimed to evaluate the association between frequency and type of consumption of FAFH and diet quality.

DESIGN

The study had a cross-sectional design. Participants self-reported the frequency of consuming FAFH as "rarely" (≤1 time per week) vs "frequently" (≥2 times per week) at various commercial establishments or noncommercial FAFH (ie, friends' or relatives' homes).

PARTICIPANTS/SETTING

Participants were adults (aged 30 through 75 years) from the PRADLAD (Puerto Rico Assessment of Diet, Lifestyle, and Diseases) study conducted in San Juan, Puerto Rico metro area (n = 239) in 2015.

MAIN OUTCOME MEASURES

A validated food frequency questionnaire captured dietary intake. The Alternate Healthy Eating Index-2010 defined diet quality. Secondary outcomes included whether participants met 2015-2020 Dietary Guidelines for Americans recommendations for sodium, added sugars, saturated fat, dietary fiber, total energy, and alcohol.

STATISTICAL ANALYSES PERFORMED

Linear or logistic regression models adjusted for age, sex, employment, income, education, and food insufficiency tested differences in mean Alternate Healthy Eating Index-2010 scores or odds of meeting (vs not meeting) intake recommendations by FAFH type and frequency.

RESULTS

Overall, 54.4% and 37.2% of participants reported consuming commercial FAFH and noncommercial FAFH "frequently," respectively. Consuming FAFH "frequently" (vs "rarely") was associated with lower mean Alternate Healthy Eating Index-2010 scores for both commercial FAFH (57.92 vs 63.58; P = .001) and noncommercial FAFH (56.22 vs 62.32; P < .001). Consuming commercial FAFH "frequently" (vs "rarely") at any type of food establishment was associated with lower odds of meeting the dietary fiber Dietary Reference Intakes (odds ratio 0.43; 95% CI 0.23 to 0.81). Consuming noncommercial FAFH "frequently" was associated with lower odds of meeting recommendations for sodium (odds ratio 0.30; 95% CI 0.11 to 0.79) and added sugars (odds ratio 0.41; 95% CI 0.18 to 0.93).

CONCLUSIONS

Frequent consumption of FAFH is associated with lower diet quality and lower adherence to dietary recommendations in Puerto Rico. Future studies should explore whether diet quality can be improved by prioritizing healthy at-home meals and reformulating the quality of commercial FAFH.

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.

The ontology of fast food facts: conceptualization of nutritional fast food data for consumers and semantic web applications

Background

Fast food with its abundance and availability to consumers may have health consequences due to the high calorie intake which is a major contributor to life threatening diseases. Providing nutritional information has some impact on consumer decisions to self regulate and promote healthier diets, and thus, government regulations have mandated the publishing of nutritional content to assist consumers, including for fast food. However, fast food nutritional information is fragmented, and we realize a benefit to collate nutritional data to synthesize knowledge for individuals.

Methods

We developed the ontology of fast food facts as an opportunity to standardize knowledge of fast food and link nutritional data that could be analyzed and aggregated for the information needs of consumers and experts. The ontology is based on metadata from 21 fast food establishment nutritional resources and authored in OWL2 using Protégé.

Results

Three evaluators reviewed the logical structure of the ontology through natural language translation of the axioms. While there is majority agreement (76.1% pairwise agreement) of the veracity of the ontology, we identified 103 out of the 430 statements that were erroneous. We revised the ontology and publicably published the initial release of the ontology. The ontology has 413 classes, 21 object properties, 13 data properties, and 494 logical axioms.

Conclusion

With the initial release of the ontology of fast food facts we discuss some future visions with the continued evolution of this knowledge base, and the challenges we plan to address, like the management and publication of voluminous amount of semantically linked fast food nutritional data.

Differences in the sugar content of fast-food products across three countries

OBJECTIVE

To compare the sugar content of items at four multinational fast-food chains, across three countries.

DESIGN

Total sugar (g)/per serving was extracted from online nutrition information, and sugar/100 g serving was calculated. Foods were categorised as: breakfast sandwiches, burgers, sandwiches, desserts and condiments. Beverages were categorised as fountain, frozen or pre-packaged. Sugar (g) was compared across countries using linear mixed-effects models. Pairwise comparisons were performed with Tukey-Kramer adjustments.

SETTING

USA, Germany and Australia.

PARTICIPANTS

Burger King™ (Hungry Jack's™), Kentucky Fried Chicken™, McDonald's™ and Subway™.

RESULTS

Differences in total sugar/100 g or ml were observed across countries for burgers (n 104), desserts (n 110), sandwiches (n 178), pre-packaged beverages (n 36) and frozen beverages (n 72). Comparing identical items across countries (e.g. BigMacTM from McDonalds in USA, Germany and Australia), burgers (n 10 available in all three countries) had lower sugar content in Australia (3·4 g/100 g) compared with the USA (4·7 g/100 g, P = 0·02) or Germany (4·6 g/100 g, P = 0·04), yet no differences were observed in other food categories. Comparing the same beverages across countries (e.g. chocolate shake from Burger King), frozen beverages (n 4 available in all three countries) had lower sugar content in Australia (14·2 g/100 ml), compared with the USA (20·3 g/100 ml, P = 0·0005) or Germany (17·8 g/100 ml, P = 0·0148), yet no differences were observed in other beverage categories.

CONCLUSIONS

Heterogeneity in fast-food sugar content across countries suggests that reductions are possible and should be implemented to reduce health risks associated with excess added sugar intake.

Association of neighborhood-level social determinants and food environments with pediatric hypertension care

Despite the apparent relationship between neighborhood characteristics and health, few studies of child health address neighborhood-level barriers, which may contribute to clinic no-show rates and difficulties following treatment plans in children and youth. We used longitudinal data from an outpatient hypertension clinic to examine neighborhood social disorganization, built environments, and their associations with patients' clinic attendance and the risk of obesity/hypertension using mixed-effects regression models. Patients from disorganized neighborhoods were less likely to attend a baseline visit, and more likely to develop overweight/obesity and hypertension during follow-up. High-level fast-food expenditures in the neighborhood were associated with higher BMI percentiles and SBP during follow-up.

Impact of a Behavioral Intervention on Diet, Eating Patterns, Self-Efficacy, and Social Support

OBJECTIVE

To examine the effectiveness of a structured multimodal behavioral intervention to change dietary behaviors, as well as self-efficacy and social support for engaging in healthier diets.

METHODS

A quasi-experimental design was used to assign sites into intervention and comparison groups. Data were collected at baseline, 3 months, and 6 months. The intervention group participated in Texercise Select, a 12-week lifestyle enhancement program. Multiple mixed-effects models were used to examine nutrition-related changes over time.

RESULTS

For the intervention group, significant improvements were observed for fast food consumption (P = .011), fruit/vegetable consumption (P = .008), water consumption (P = .009), and social support (P < .001) from baseline to 3 months. The magnitude of these improvements was significantly greater than changes in the comparison group.

CONCLUSIONS AND IMPLICATIONS

Findings suggest the intervention's ability to improve diet-related outcomes among older adults; however, additional efforts are needed to maintain changes over longer periods.

Consumers' Perceptions and Sensory Properties of Beef Patty Analogues

The present study was carried out to gain consumer insights on the use of tempeh (a fermented soy bean product) to improve the healthiness of beef patties and to determine the acceptable level of tempeh (10%, 20%, or 30%) in the patty. The study consisted of conducting two focus groups (n = 15), a pilot sensory evaluation, and a full consumer sensory study. The focus groups were asked about their consumption of beef patties, attitudes towards processed meat, attitudes towards negative aspects of red meat consumption, and attitudes towards tempeh consumption, as well as sensory perceptions of the cooked patties and their visual acceptance of raw patties. Focus group discussions suggested that there was a market for the product if consumers were informed of tempeh health benefits. Participants seemed more willing to choose how to balance their diet with an antioxidant source than buy a beef patty with added antioxidants. The focus group participants rated the visual attributes of raw patties from all treatments and it was found that the 20% tempeh and 30% tempeh patties were ranked lower (p < 0.05) than the others. Overall, the sensory experiments showed that the inclusion of 10% tempeh was the most acceptable level of addition. There were no significant (p > 0.05) differences between the control and 10% tempeh patties for overall acceptability or acceptance of flavor. However, 10% tempeh patties were found to be more tender and juicier than the control (p < 0.05). A proper knowledge and awareness of consumers about the benefits of tempeh could allow the development of beef containing tempeh products.

Children's Intake of Food from Non-Fast-Food Outlets and Child-Specific Menus: A Survey of Parents

Eating out-of-home is associated with higher energy intakes in children. The continued high prevalence of childhood obesity requires a greater understanding of child menu options and eating out frequency to inform appropriate regulatory initiatives. The majority of studies to date have focused on menus from fast-food outlets with few focused on non-fast-food outlets. This study aimed to describe parents’ reports of their child(ren)’s (aged up to 6 years) frequency of consuming foods at non-fast-food outlets, observations of child menus at these outlets, and their purchasing behaviours and future preferences regarding these menus; and if their responses were influenced by sociodemographic characteristics. Ninety-five parents completed a 15-item cross-sectional survey. Overall, children from 54% of families consumed food from non-fast-food outlets at least monthly. Of the 87 parents who reported that their child eats at a non-fast-food restaurant, 71 had children who ordered from child menus every time (7%, n = 5), often (29%, n = 22), sometimes (42%, n = 32) or rarely (16%, n = 12), with a further 7% (n = 5) never ordering from these menus. All parents indicated that they would like to see a higher proportion of healthy child menu items than is currently offered. Parents’ responses were not influenced by sociodemographic characteristics. Parents’ views support implementation of initiatives to increase availability of healthy options on child menus at non-fast-food outlets.

High consumption of energy-dense nutrient-poor foods among low-income groups in the Mississippi Delta and Alabama

OBJECTIVE

To assess the consumption of sugar-sweetened beverages (SSB) and other energy-dense nutrient-poor (EDNP) foods in two Southern low-income communities targeted by the Balance Calories Initiative, a campaign by the top-three American beverage companies intended to reduce the consumption of sugary beverages by 20 % over 10 years.

DESIGN

We conducted self-administered intercept surveys in front of food retail outlets between August and November 2016. We recruited adults with children <18 years living at home and adolescents aged 10-17 years with parental consent.

SETTING

Retail food outlets in Mississippi and Alabama, USA.

PARTICIPANTS

Adults (n 11 311) and adolescents (n 3460).

RESULTS

The percentage of high SSB consumers (≥4 servings/d) was 40·9 % among adult males, 32·3 % among adult females, 43·0 % among adolescent males and 34·4 % among adolescent females (male - female difference, P < 0·0001). In aggregate, respondents also reported consuming a mean of 3 servings of salty snacks, cookies and/or candy in the past 24 h, with adolescent males reporting 4 servings.

CONCLUSIONS

SSB should be a primary target of future interventions to improve dietary intake, but EDNP foods likely contribute as many daily kilojoules as SSB among this population. Future campaigns should aim to limit the consumption of all EDNP foods.