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

Eating behaviors and dietary intake 2 to 4 years following sleeve gastrectomy: Are there any associations?

OBJECTIVES

A lack of research exists on associations between eating behaviors and dietary intake among patients undergoing bariatric surgery. This study aimed to ascertain the association between eating behaviors and dietary quantity and quality at mid-term postsleeve gastrectomy (SG).

METHODS

This cross-sectional study included 146 adults within 2 to 4 years post-SG. Dietary intake and eating behaviors were assessed using a food frequency questionnaire and the Dutch Eating Behavior Questionnaire, respectively. Energy and the proportion of macronutrients were determined. Carbohydrate quality index (CQI), fat quality index (FQI), healthy plate protein quality index (HPPQI), macronutrient quality index (MQI), and Healthy Eating Index (HEI)-2015 were computed to evaluate diet quality. Participants were categorized into high and low groups based on median scores for each eating behavior scale. Least-squared (geometric) means and 95% confidence intervals were determined for each group using the analysis of covariance, adjusted for age and sex.

RESULTS

The mean time since surgery for participants was 30.8 ± 6.5 months, and 77.4% were female. Participants with high emotional eating had higher energy and HPPQI. Individuals with high external eating had higher energy and percentages of fat and lower FQI and HEI scores. Individuals with high restrained eating scores demonstrated lower energy intake but a higher percentage of protein intake and higher CQI, FQI, MQI, and HEI scores.

CONCLUSIONS

External eating showed the most unfavorable associations, while restrained eating showed the most favorable associations with quantity and quality of diet 2 to 4 years after SG. Emotional eating was minimally related to dietary characteristics.

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

Background

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

Methods

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

Results

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

Conclusions

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

Does Awareness of Malaysian Healthy Plate Associate with Adequate Fruit and Vegetable Intake among Malaysian Adults with Non-Communicable Diseases?

The healthy eating plate concept has been introduced in many countries, including Malaysia, as a visual guide for the public to eat healthily. The relationship between Malaysian Healthy Plate (MHP) and adequate fruit and vegetable (FV) intake among morbid Malaysian adults is unknown. Hence, we investigated the relationship between awareness of the MHP and FV intake among morbid Malaysian adults. National survey data on 9760 morbid Malaysian adults aged 18 years and above were analyzed. The relationship between awareness of MHP and FV intake among Malaysian adults with obesity, diabetes mellitus, hypertension, and hypercholesterolemia were determined using multivariable logistic regression controlling for sociodemographic characteristics and lifestyle risk factors. Our data demonstrated that MHP awareness is associated with adequate FV intake among the Malaysian adults with abdominal obesity (adjusted odds ratio (aOR): 1.86, 95% confidence interval (CI): 1.05-3.29), diabetes mellitus (aOR: 4.88, 95% CI: 2.13-22.18), hypertension (aOR: 4.39, 95% CI: 1.96-9.83), and hypercholesterolemia (aOR: 4.16, 95% CI: 1.48-11.72). Our findings indicated the necessity for ongoing efforts by policymakers, healthcare professionals, and nutrition educators to promote the concept of MHP and ensure that morbid Malaysian adults consume a sufficient intake of FV or adopt a healthy eating pattern to achieve and maintain optimal health.

Feasibility pilot study of a Japanese teaching kitchen program

Background

This pilot study examined the feasibility of a new lifestyle modification program involving a "Teaching Kitchen" in Japan. Our goal was to explore (1) feasibility of the program; (2) acceptability for class frequency (weekly vs. bi-weekly); and (3) changes in biometrics, dietary intakes, and lifestyle factors.

Methods

A total of 24 employees with obesity in a Japanese company were recruited. Participants were randomly divided into two groups (weekly or bi-weekly group), each attending the program consisting of four two-hour classes (lectures on nutrition, exercise, mindfulness, and culinary instructions). Participants were observed for changes in dietary intakes, biometrics, and health related quality of life over the subsequent 3 months. We tested the between-group differences in changes using linear mixed-effect models.

Results

The program completion rates were 83.3% in total (91.7% for weekly group and 75.0% for bi-weekly group). From baseline to post-intervention, significant decreases were observed in weight (p < 0.001), body mass index (p < 0.001), diastolic blood pressure (p = 0.03), body fat mass (p < 0.001), and dietary intakes in total fat (p = 0.03) and sodium (p = 0.008) among 17 participants who were available for measurements. Improvements in biometrics remained significant 1 month after the intervention (all p ≤ 0.03 in 14 participants). Participants' health related quality of life was significantly improved in bodily pain, general health, vitality, and mental component score (all p ≤ 0.047).

Conclusions

The new Japanese Teaching Kitchen program is feasible with high program completion rates in Japanese office workers with obesity. While this was a small feasibility study, significant multiple improvements in dietary intakes, biometrics, and health related quality of life suggest that this line of inquiry warrants further exploration to address obesity and obesity-related diseases in Japan.

Oil/Salt Use Assessment of Chinese-Style Canteens Based on Consumers' Perception of the Nutrition Environment

Excess cooking oil and salt use in catering services contributes to obesity and cardiovascular disease, but the assessment of oil/salt use has been a challenge in nutrition environment measurement. We conducted a knowledge, attitude, and practice survey on 250 respondents in five university canteens at China Agricultural University, Beijing, China. Using on-site tools including a newly developed Likert scale and the previously tested Oil-Salt Visual Analogue Scale (OS-VAS), the respondents were asked to evaluate their personal taste, their impression of the oil/salt status of canteen dishes, and their attitude toward oil/salt reduction. Data analysis showed that gender and self-image of body shape had a significant impact on KAP scores and the impression of the oil/salt environment. The respondents' taste preferences correlated with their perception of oil and salt, but knowledge and attitude were not directly related to scores on oil and salt, while weight status was related to oil and salt scores. The Likert scale-based assessment could work but was not as effective as the OS-VAS in distinguishing the differences among the selected canteens. These results indicate that the quality of the nutrition environment in catering services needs to be comprehensively evaluated with an objective evaluation of raters and a subjective evaluation of consumers.

Using Crowdsourced Food Image Data for Assessing Restaurant Nutrition Environment: A Validation Study

Crowdsourced online food images, when combined with food image recognition technologies, have the potential to offer a cost-effective and scalable solution for the assessment of the restaurant nutrition environment. While previous research has explored this approach and validated the accuracy of food image recognition technologies, much remains unknown about the validity of crowdsourced food images as the primary data source for large-scale assessments. In this paper, we collect data from multiple sources and comprehensively examine the validity of using crowdsourced food images for assessing the restaurant nutrition environment in the Greater Hartford region. Our results indicate that while crowdsourced food images are useful in terms of the initial assessment of restaurant nutrition quality and the identification of popular food items, they are subject to selection bias on multiple levels and do not fully represent the restaurant nutrition quality or customers' dietary behaviors. If employed, the food image data must be supplemented with alternative data sources, such as field surveys, store audits, and commercial data, to offer a more representative assessment of the restaurant nutrition environment.

The Effects of Ontario Menu Labelling Regulations on Nutritional Quality of Chain Restaurant Menu Items-Cross-Sectional Examination

Restaurant foods are associated with excessive energy intake and poor nutritional quality. In 2017, the Healthy Menu Choices Act mandated food service establishments with ≥20 outlets in Ontario to display the energy content on menus. To examine the potential impact of menu labelling, nutrition information for 18,760 menu items were collected from 88 regulated and 53 unregulated restaurants. Descriptive statistics were calculated for serving size, energy, saturated fat, sodium and total sugars. Quantile regression was used to determine the differences between regulated and unregulated restaurants. The energy content of menu items from regulated restaurants (median (95% CI): 320 kcal (310, 320)) was significantly lower than those from unregulated restaurants (470 kcal (460, 486), p < 0.001). Saturated fat, sodium and total sugars were significantly lower in regulated restaurants (4 g (4, 4), 480 mg (470, 490) and 7 g (6, 7), respectively) than in unregulated restaurants (6 g (6, 6), 830 mg (797, 862) and 8 g (8, 9), respectively, p < 0.001). This study showed that menu items from regulated restaurants had smaller serving size, lower levels of energy and nutrients of public health concern compared to those from the unregulated restaurants, suggesting potential downstream beneficial effects of menu labelling in lowering caloric content and nutrients of public health concern in foods.

How to enable healthier and more sustainable food practices in collective meal contexts: A scoping review

Collective meal contexts such as restaurants, cafeterias and canteens can help accelerate transitions to healthier and more sustainable diets. However, evidence from intervention studies on these contexts lacks integration. This scoping review aimed to map determinants of dietary change in collective meal contexts across multiple settings, interventions, target groups, and target behaviors. The review provided two main outcomes: (i) identifying intervention components to promote dietary change in collective meal contexts, based on the existing body of evidence; and (ii) classifying and integrating these intervention components into an overarching framework of behavior change (i.e., COM-B system). The review encompassed twenty-eight databases via two indexing services and extracted information from 232 primary sources (27,458 records selected for title and abstract screening, 574 articles selected for full-text screening). We identified a total of 653 intervention activities, which were classified into intervention components and grouped under three broad themes, namely contextual and environmental changes, social influence, and knowledge and behavioral regulation. Multi-component interventions tended to report overall positive outcomes. The review proposes several directions for future research, including: (i) moving toward more theory-based interventions in collective meal contexts; (ii) providing more detailed information about intervention settings, implementation, target groups, activities, and materials; and (iii) improving the use of open science practices in the field. Furthermore, the review offers a free, original, open-access list and synthesis of 277 intervention studies in collective meal contexts, which can help intervention planners and evaluators optimize their efforts to promote healthier and more sustainable food practices in these contexts.

Caregiver perceptions of snacks for young children: A thematic synthesis of qualitative research

Snacks are inconsistently defined in nutrition research and dietary guidelines for young children, challenging efforts to improve diet quality. Although some guidelines suggest that snacks include at least two food groups and fit into an overall health promoting dietary pattern, snacks high in added sugars and sodium are highly marketed and frequently consumed. Understanding how caregivers perceive "snacks" for young children may aid in development of effective nutrition communications and behaviourally-informed dietary interventions for obesity prevention. We aimed to synthesize caregivers' perceptions of snacks for young children across qualitative studies. Four databases were searched for peer-reviewed qualitative articles including caregiver perceptions of "snacks" for children ≤5 years. We conducted thematic synthesis of study findings, concluding with the development of analytical themes. Data synthesis of fifteen articles from ten studies, conducted in the U.S., Europe, and Australia, revealed six analytical themes that captured food type, hedonic value, purpose, location, portion size, and time. Caregivers perceived snacks as both "healthy" and "unhealthy" foods. Less healthy snacks were described as highly liked foods, which required restriction and were consumed outside the home. Caregivers used snacks to manage behavior and curb hunger. Snack portions were described as "small", although caregivers reported various methods to estimate child portion size. Caregivers' perceptions of snacks revealed opportunities for targeted nutrition messaging, especially supporting responsive feeding and nutrient-dense food choices. In high-income countries, expert recommendations should consider caregivers' perceptions of snacks, more clearly defining nutrient-dense snacks that are enjoyable, achieve dietary requirements, reduce hunger, and promote healthy weight.

Socioeconomic position and the effect of energy labelling on consumer behaviour: a systematic review and meta-analysis

BACKGROUND

There are well documented socioeconomic disparities in diet quality and obesity. Menu energy labelling is a public health policy designed to improve diet and reduce obesity. However, it is unclear whether the impact energy labelling has on consumer behaviour is socially equitable or differs based on socioeconomic position (SEP).

METHODS

Systematic review and meta-analysis of experimental (between-subjects) and pre-post implementation field studies examining the impact of menu energy labelling on energy content of food and/or drink selections in higher vs. lower SEP groups.

RESULTS

Seventeen studies were eligible for inclusion. Meta-analyses of 13 experimental studies that predominantly examined hypothetical food and drink choices showed that energy labelling tended to be associated with a small reduction in energy content of selections that did not differ based on participant SEP (X2(1) = 0.26, p = .610). Effect estimates for higher SEP SMD = 0.067 [95% CI: -0.092 to 0.226] and lower SEP SMD = 0.115 [95% CI: -0.006 to 0.237] were similar. A meta-analysis of 3 pre-post implementation studies of energy labelling in the real world showed that the effect energy labelling had on consumer behaviour did not significantly differ based on SEP (X2(1) = 0.22, p = .636). In higher SEP the effect was SMD = 0.032 [95% CI: -0.053 to 0.117] and in lower SEP the effect was SMD = -0.005 [95% CI: -0.051 to 0.041].

CONCLUSIONS

Overall there was no convincing evidence that the effect energy labelling has on consumer behaviour significantly differs based on SEP. Further research examining multiple indicators of SEP and quantifying the long-term effects of energy labelling on consumer behaviour in real-world settings is now required.

REVIEW REGISTRATION

Registered on PROSPERO (CRD42022312532) and OSF ( https://doi.org/10.17605/OSF.IO/W7RDB ).

Position of the Society for Nutrition Education and Behavior: Nutrition Educator Competencies for Promoting Healthy Individuals, Communities, and Food Systems: Rationale and Application

It is the position of the Society for Nutrition Education and Behavior that to improve the health of individuals, communities, and food systems, it is essential that nutrition educators meet each of 6 content competencies (basic food and nutrition knowledge, nutrition across the life cycle, food science, physical activity, food and nutrition policy, and agricultural production and food systems) and 4 process competencies (behavior and education theory; nutrition education program design, implementation and evaluation; written, oral, and social media communication; and nutrition education research methods). These competencies reflect the breadth of the nutrition education field and are grounded in peer-reviewed research. The rationale and evidence base for these competencies are presented. They are designed for educational institutions to plan curricula and programs; public, private, and nonprofit organizations for training; individuals for professional development; and policymakers and advocates to inform strong, comprehensive nutrition education policy.

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.

Impact of an Interactive Health Corner Using the Culinary Education Approach in Promoting Long-Term Dietary Changes among Patients Who Seek Public Primary Care Services

An unhealthy diet is a major risk factor for chronic diseases. Although nutrition education and cooking demonstrations have resulted in favourable dietary changes, it is unclear whether this is sustainable for longer periods. This study aims to evaluate the long-term impact of a nutrition-led cooking intervention using the culinary education approach on dietary patterns based on My Healthy Plate (MHP). This was a quasi-experimental study involving patients who sought public primary care services in two polyclinics (mean age 59.3 years old). A self-administered survey was done at baseline, 6 months, and 1 year for both the intervention and the comparison groups. Participants in the intervention group were exposed to the health corner, which provided nutrition education and cooking demonstrations using the culinary education approach. A total of 216 participants completed the study at 1 year with a follow-up rate of 86%. Adjusted risk ratios (aRR) were obtained from negative binomial regression. Compared with the comparison group, participants in the intervention group were more likely to report adhering to the requirements of MHP at 6 months (aRR 1.83, 95% CI 1.12-2.99) and 1 year (aRR 1.54, 95% CI 1.10-2.16). Participants in the intervention group were less likely to add salt or sauces to food at 6 months (aRR 0.29, 95% CI 0.12-0.75) and 1 year (aRR 0.21, 95% CI 0.07-0.61) and more likely to remove fat when eating meat at 1 year (aRR 0.30, 95% CI 0.13-0.67) than the comparison group. The interventions at the health corner had a positive impact in helping patients achieve MHP recommendations, not adding salt and sauces to their food, and removing animal fat before eating. There is potential for expanding this initiative to improve healthy eating practices in other polyclinics.

Poverty, Household Structure and Consumption of Foods Away from Home in Peru in 2019: A Cross-Sectional Study

The aim of this study was to evaluate the probability of buying food away from home according to the type of household using the logit model, as well as the sociodemographic characteristics of the heads of household, and how much income expenditure represents. A cross-sectional study was carried out using the National Household Survey (ENAHO) 2019 database. After joining the database, the household type variables were created. To calculate the probability with the “logit” model of purchase, the variables—family size, income, types of household, and total expenditure—were selected as a measure of the purchasing power of the family. A statistically significant association (p < 0.05) was found between the probability of consumption and the variables: age of household members, predominance, nuclear without children−married, nuclear with children−cohabitant, nuclear with children−widowed, nuclear with children−separated, extended, compounded, poor not extreme, and not poor. The bulk of families was represented by nuclear families (61.97%). The highest expenditure in the CFAH was for families defined as composite with a yearly average of USD 1652.89 (equivalent to PEN 5520.67). Observing the expenditure on food consumed outside the home through the composition of households can allow a better approach to offer educational measures. This information can be helpful to developers of educational issues.

Food Away from Home Frequency, Diet Quality, and Health: Cross-Sectional Analysis of NHANES Data 2011-2018

The consumption of meals prepared away from home (FAFH) in the U.S. has been commonly linked to overall poorer diet quality; however, less is known about the relationship with health parameters. The aim of this cross-sectional study was to assess the diet quality and health parameters of adults who reported the frequency of obtaining or eating FAFH using a combination of four 2-year cycles of National Health and Nutrition Examination Survey (NHANES, 2011−2018) data. Data from 14,999 adults aged 20 to 65 years were used to examine the associations between diet and health outcomes and the weekly frequency of FAFH. Multivariable regression models were used to compare Healthy Eating Index-2015 (HEI-2015) scores by FAFH frequency, adjusting for sociodemographic variables. Adults with more frequent FAFH meals were more likely to be younger, male, lower-income, and unmarried. Total HEI-2015 scores and component scores for greens and beans, total and whole fruits, whole grains, saturated fats, and added sugars were significantly lower in those consuming >2 FAFH meals/week vs. ≤2 FAFH meals/week. BMI and waist circumference tended to be higher for women having more frequent FAFH meals. More frequent FAFH meals among adults were associated with poorer diet quality and weight outcomes, building on results from earlier studies.

Potential for Front of Pack Labeling Exposure to Impact US Dietary Choices: A Population-Based Cross-Sectional Study Using NHANES 2017–2018

In recent years, front-of-pack nutrition labeling (FOPL) schemes have proliferated, but the components of the diet subject to FOPL have not been described. This study quantified the proportion and elements of the diet that would be subject to FOPL in the US. The 2017–2018 National Health and Nutrition Examination Survey (n = 7121; age ≥2 year) 24-h dietary recalls were used to identify foods/beverages subject to FOPL. The proportion of dietary energy and additional dietary constituents subject to FOPL was estimated. Overall, 57% of dietary energy would be subject to FOPL. Individuals consuming more away-from-home meals had lower exposure to FOPL. Adults with a healthy-weight and those consuming a more healthful diet had more exposure to FOPL. Protein, sodium, potassium, whole fruit, vegetables, and unprocessed meats were less subject to FOPL as compared to total sugars, added sugars, calcium, fruit juice, milk, yogurt, nuts/seeds and whole grains. Because less than 60% of the diet would be impacted by FOPL, implementation of such a policy may have limited reach for the US diet and demonstrates some inconsistencies with current dietary guidance regarding the under- and over-representation of key food groups and nutrients.

Association between Nutrition Behavior and Colorectal Cancer Diet Recommendation

The incidence of colorectal cancer has considerably increased worldwide, particularly among adults aged 50 and older. Despite numerous nutrition initiatives, colorectal cancer (CRC) remains a public health burden that affects younger adults in the United States. Understanding the potential factors contributing to non-adherence to nutrition recommendations can be helpful to develop effective nutrition initiatives to prevent CRC. This study aimed to determine differences in nutrition knowledge, attitudes, and beliefs (KAB); examine their associations on diet characteristics and weight status; and identify factors influencing eating patterns among ethnically diverse populations at risk for CRC and living in urban areas. The study used a quantitative descriptive and correlational research design in which data were collected through an online cross-sectional survey. A total of 377 participants responded to the survey. The study revealed a few significant differences in KAB levels between males and females. KAB levels were not associated with weight status but with meat recommendations among overweight or obese males. Ultimately, the study identified perceived barriers and facilitators as factors influencing participants’ diets. Differences in KAB among males and females were inconsistent with the diet characteristics and weight status variables. This study suggests acknowledging these differences and inconsistencies when designing nutrition initiatives focusing on colorectal cancer prevention.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Consumption of takeaway and delivery meals is associated with increased BMI and percent fat among UK Biobank participants

BACKGROUND

Consumption of meals bought from out-of-home sources is a suggested risk factor for obesity, but the supporting evidence is mixed.

OBJECTIVES

To investigate the association between consumption of different types of meals and BMI or percent body fat.

METHODS

Data were from the UK Biobank in response to a "Type of Meals Eaten" survey, which specified the sources of the meals consumed over the previous 24 h. Because direction of causality is unknown, the data were analyzed with meal choice as the dependent variable first and then BMI as the dependent variable second.

RESULTS

The total number of participants was 5197 (2841 women and 2356 men). Participants with higher BMI and percent body fat were more likely to report consuming takeaway and/or delivery meals, with prevalence ORs (95% CIs) of 2.12 (95% CI: 1.40, 3.22; Bonferroni P < 0.0001) for women's adjusted BMI, 1.95 (95% CI: 1.30, 2.93; Bonferroni P < 0.0001) for women's adjusted percent body fat, 1.65 (95% CI: 1.05, 2.59; Bonferroni P < 0.002) for men's adjusted BMI, and 1.41 (95% CI: 0.70, 2.84; Bonferroni P < 0.01) for men's adjusted percent body fat. As BMI and percent body fat increased, both men and women were increasingly less likely to report having consumed a home-cooked and prepared meal during the previous 24 h. Analyzing the data with BMI and percent body fat as the dependent variable showed that both unadjusted and adjusted BMI and percent body fat were higher in individuals reporting consumption of takeaway and delivery foods the previous day and lower in those consuming homecooked meals. The probability of having consumed a meal that was prepared and eaten at a restaurant and/or café was also associated with BMI and percent fat among men but not women.

CONCLUSIONS

Homecooked meals were more often consumed by those with low BMI and percent body fat, whereas delivery and takeaway meals were more often eaten by individuals with higher BMI. Consumption of fast-food/café meals was not consistently associated with BMI or percent body fat. The direction of causality in these associations cannot be inferred from this cross-sectional study.

Trans-Fatty Acids in Fast-Food and Intake Assessment for Yerevan’s Population, Armenia

There are stringent regulations applicable for trans-fatty acid (TFA) limitations from food supply across the world. However, in Armenia, there is a scarcity of data on TFA content in food products and their consumption levels. Considering that fast-food is among the major contributors to TFA intake, this study aims to assess the dietary exposure of TFAs through the consumption of fast-food in Yerevan, Armenia. Eleven types of fast-food were included in the study. The Food Frequency Questionnaire (FFQ) was used to evaluate daily fast-food consumption. TFA contents in samples were determined using gas chromatography-mass spectrometry. Mean daily fast-food consumption values ranged from 14.68 g/day to 76.09 g/day, with popcorn as the lowest and pastry as the highest consumed food. The study results indicate that the aggregate average daily intake (DI) of TFA is 0.303 g/day. Even though TFA DI values do not exceed the WHO limit of 1%, they substantially contribute to daily TFA intake and may exceed the limit when combined with other foods. Hence, it is recommended to carry out continuous monitoring of TFA content in the food supply to ensure consumer health protection.

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

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

Incremental Costs and Diners' Satisfaction Associated with Improvement in Nutritional Value of Catering Dishes

Eating in catering systems has been identified as a driver of poor diet quality. Interventions within catering systems increase the nutrient density of dishes. Little is known about the incremental costs associated with this strategy. One part of the NEKST (Nutrition Environmental Kibbutzim Study) intervention was nutritional improvement of recipes (decreasing the amount of energy, sodium, and saturated fat). We evaluated the nutritional content of dishes per 100 g and the incremental costs associated with these changes from the catering system’s perspective, as well as diners’ satisfaction with the catering system before and after the intervention. Our results revealed that as energy and saturated fat decreased, the associated incremental cost increased (rs = −0.593, p = 0.010 and rs = −0.748, p < 0.001, respectively). However, the decrease in sodium was not associated with increased costs (rs = 0.099, p = 0.696). While diners’ satisfaction decreased in the control group, it did not change in the intervention group following the intervention (p = 0.018). We concluded that recipe modification improved the nutritional value of dishes without increasing cost. This intervention was not associated with decreased diner satisfaction. This evidence encourages the implementation of policies to improve the nutritional quality of food served by caterers without jeopardizing sales and with the potential to improve public health.

Stressed females, rather than males, tend to eat away from home

OBJECTIVES

The aim of this study is to examine the association between perceived stress and multifarious eating away from home among Chinese adults in different genders.

METHODS

We examined cross-sectional data from the China Health and Nutrition Survey conducted in 2018 among Chinese adults aged 18-59 years. A self-reported questionnaire involving the perceived stress scale with 10 items (PSS-10), and the food frequency questionnaire about eating away from home were used. Adjusted two-level zero-inflated Poisson regression models were used to explore the association.

RESULTS

There were 3161 males and 3599 females in the study. The median PSS-10 score was 16.0 and the frequencies of eating 1) breakfast, 2) lunch or supper, and 3) three main meals away from home were 12, 10, and 49 times per year, respectively. In males, PSS-10 score was not associated with eating away from home. In females, PSS-10 score was significantly positively associated with eating 1) lunch or supper, 2) three main meals, 3) Chinese food away from home, and 4) eating at stalls/restaurants (β₁ = 0.016, P₁ = 0.006; β₂ = 0.014, P₂ = 0.002; β₃ = 0.015, P₃ = 0.013; β₄ = 0.014, P₄ = 0.015 respectively). But there was not association between PSS-10 score and the frequency of eating breakfast away from home in females (β = 0.006, P = 0.325).

CONCLUSIONS

Stressed females tend to eat away from home, but the effects are very small.

Eating away from home is associated with overweight and obesity among Ugandan adults: the 2014 Uganda non-communicable disease risk factor survey

BACKGROUND/OBJECTIVES

We investigated the associations between eating away from home (EAFH) and overweight and obesity among Ugandan adults using the 2014 Uganda non-communicable disease risk factor survey.

SUBJECTS/METHODS

In total, 3,025 participants aged 18–69 years were included in the analysis. The frequency of EAFH was assessed by asking participants the number of meals eaten per week that were not prepared at a home. EAFH frequency was categorized as; less than once/week, 1-2 times/week, or ≥ 3 times/week. Logistic regression was used to evaluate the associations between overweight, obesity, and EAFH. We also tested whether sex and age modified these associations.

RESULTS

Participants that ate away from home ≥ 3 times/week were 2.13 times more likely to be obese than those that ate away from home less than once/week (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.28–3.54). However, when the analysis was stratified by sex, women that ate away from home ≥ 3 times/week were 42% less likely to be overweight than those that ate away from home less than once/week (OR, 0.58; 95% CI, 0.36–0.94). Men that ate away from home ≥ 3 times a week were 3.89 times and 2.23 times more likely to be obese and overweight, respectively, than those that ate away from home less than once/week (obesity: OR, 3.89; 95% CI, 1.50–10.09; overweight: OR, 2.23; 95% CI, 1.42–3.51). Age-stratified analysis showed that among participants aged 31–50 years, those that ate away from home ≥ 3 times a week were 3.53 times more likely to be obese than those that ate away from home less than once/week (OR, 3.53; 95% CI, 1.69–7.37).

CONCLUSIONS

Frequent EAFH was positively associated with overweight and obesity among men, and obesity among young/middle-aged adults, but negatively associated with overweight in women. Nutritional interventions for obesity reduction in Uganda should include strategies aimed at reducing the frequency of eating meals prepared away from home, and specifically target men and young/middle-aged adults.

Obesity and food away from home: What drives the socioeconomic gradient in excess body weight?

Rising obesity rates are one of the most challenging public health issues in many emerging economies. To what extent food away from home (FAFH) and its nutritional components are behind this rise is not yet well understood. To address the issue, this paper combines a representative restaurant survey that includes detailed information on the diet quality of the most widely consumed meals and their nutritional components from 1605 restaurants and a representative household survey with anthropometric measures of adult women living in 40 neighborhoods in the Lima Metropolitan Area. One important advantage of the dataset is the fact that nutrition professionals observed the preparation of the meals and that they were subject to a detailed laboratory analysis. Exploiting this data, we examine the differences in nutritional quality of FAFH among 40 neighborhoods of various socioeconomic groups and explore whether these differences can explain part of the observed socioeconomic gradient in excess body weight. The findings indicate that less healthy food in restaurants located in the food environment of the households is significantly associated with higher rates of obesity and overweight. In particular, the high supply and intake of sodium potentially drives higher excess body weight. The study also finds that up to 15 percent of the socioeconomic gradient in obesity is attributable to the restaurant food quality in the food environment of the households.

Sex Difference in the Association Between Eating Away From Home and the Risk of High Serum Uric Acid in South China

Background: The prevalence of high serum uric acid is increasingly rising in recent years, and diet behavior is perceived to be associated with it. This study aimed to explore the relationship between eating away from home (EAFH) and the risk of high serum uric acid in adults in South China.

Methods: The data utilized in this study were from Guangdong Nutrition and Health Survey (NHS) 2015. Serum uric acid concentration was detected. EAFH in the past week was investigated. We defined EAFH as food consumption away from home. Dietary data were collected by 24-h recalls on 3 consecutive days. A generalized linear mixed-effects model was applied to compute the odds ratio (OR) and its corresponding 95% CI.

Results: A total of 3,489 individuals were included in this study. A 1.27-fold OR (95% CI: 1.05–1.52, P = 0.012) of high serum uric acid was identified in adults with EAFH in comparison with those without EAFH. With respect to men, a 1.66-fold OR (95% CI: 1.3–2.1, P < 0.001) of high serum uric acid was observed. We also observed that men with EAFH had higher intakes of red meat, poultry, vegetable, carbohydrate, protein, fat, and total energy, while a lower grain intake than those without EAFH. However, there was a lack of significant association between EAFH and the odds ratio of high serum uric acid in women. Women with EAFH did not have higher consumptions of red meat, vegetable, fish, fat, and water than those without EAFH.

Conclusions: This study found that EAFH was associated with an increased odds ratio of high serum uric acid in men, but not in women.

Secular Trends in Dietary Intake over a 20-Year Period in People with Type 2 Diabetes in Japan: A Comparative Study of Two Nationwide Registries; Japan Diabetes Complications Study (JDCS) and Japan Diabetes Clinical Data Management Study (JDDM)

Background: In order to provide effective dietary guidance, it is necessary to consider dietary intake, which can change over time. This study analyzed changes in the diet of Japanese patients with type 2 diabetes over a 20-year period. Methods: We compared the results of two dietary surveys that used the food frequency questionnaire format. The first was conducted in 1996 by the Japan Diabetes Complications Study (JDCS) (n = 1509; males 53.3%), and the second in 2014–2018 by the Japan Diabetes Clinical Data Management Study (JDDM) (n = 1145; males 65.6%). Both are nationwide representative registries of outpatients with type 2 diabetes in Japan. Results: Over a 20-year period, both men and women with type 2 diabetes had a significant increase in body mass index (BMI). Nonetheless, there was only a small change in energy intake. Conversely, there was a significant increase in fat intake and thus in the fat-to-energy ratio. With regard to food groups, there was a significant increase in meat intake and a decrease in the intake of fish, soybeans/soy products, vegetables, and fruits, with a particularly significant decrease in vegetables. Conclusions: Even in Japan, an industrialized country with a stable socioeconomic environment, there were many significant changes in the dietary intake of patients with type 2 diabetes over the 20-year period.

Twenty-year trends in vegetable consumption by preparation method and eating location for Korean population from 1998 to 2017

Vegetables are an important source for the essential vitamins and minerals that are necessary for optimal health. This research investigated changes in vegetable intake over time in the Korean population from 1998 to 2017, focusing on preparation methods of vegetables and location of consumption. This cross-sectional study is based on the Korea National Health and Nutrition Examination Survey (KNHANES) that was established in 1998 to assess the health and nutritional status of the South Korean population. This research utilised information from 1998 to 2017 which is the extent of all available KNHANES data. Vegetable consumption was grouped, according to preparation methods and common eating locations. Both crude and age-standardised means of vegetable intake were derived via a 24-h dietary recall. All participants who completed a 24-h dietary recall survey were selected for the analyses. This included 109 220 individuals (49 069 men and 60 151 women) over the course of 20 years of the KNHANES. Total vegetable intake decreased over time (Pfor trends < 0·001), specifically, steamed and salted vegetables (Pfor trends < 0·001). In contrast, Koreans consumed noticeably more raw vegetables from 1998 to 2017 (Pfor trends < 0·001). Vegetable intake at home significantly declined (Pfor trends < 0·001), while that eaten at restaurants or outside the home increased greatly (Pfor trends < 0·001). Over 20 years, Koreans have ingested decreasing amounts of vegetables, but the intake of raw vegetables has escalated. However, the location of vegetable consumption has changed, with an increase at both restaurants and outside the home (approximately 70·0 %).

Barriers, Enablers, and Perceptions on Dietary Salt Reduction in the Out-of-Home Sectors: A Scoping Review

In this review, we have investigated the perceptions, barriers, and enabling factors that were responsible for a dietary salt reduction in the out-of-home sectors. For this purpose, we examined different knowledge databases such as Google Scholar, Ebscohost, MEDLINE (PubMed), Ovid, and Cochrane Library for research articles from September to December 2020. The inclusion criteria for the research articles were that they had to be published in English and had to be a qualitative or quantitative study that was conducted after 2010. These studies also had to report the various enablers, barriers, and perceptions regarding salt reduction in the out-of-home sectors. After implementing the inclusion criteria, we successfully screened a total of 440 studies, out of which 65 articles fulfilled all the criteria. The perceived barriers that hindered salt reduction among the out-of-home sectors included lack of menu and food variabilities, loss of sales due to salt reduction, lack of technical skills for implementing the salt reduction processes for cooking or reformulation, and an absence of environmental and systemic support for reducing the salt concentration. Furthermore, the enablers for salt reduction included the intervention programs, easy accessibility to salt substitutes, salt intake measurement, educational availability, and a gradual reduction in the salt levels. With regards to the behavior or perceptions, the effect of organizational and individual characteristics on their salt intake were reported. The majority of the people were not aware of their salt intake or the effect of salt on their health. These people also believed that low salt food was recognized as tasteless. In conclusion, the enablers, barriers, and perceptions regarding salt reduction in the out-of-home sectors were multifaceted. Therefore, for the implementation of the strategies, policies, and initiatives for addressing the barriers, the policymakers need to encourage a multisectoral collaboration for reducing the salt intake in the population.

Fruit and Vegetable Intake and Barriers to Their Consumption among University Students in Kuwait: A Cross-Sectional Survey

Data on fruit and vegetable (F/V) consumption and barriers to their intake by Kuwait college students are needed for health promotional activities to curtail obesity and related comorbidities prevalent in Kuwait. This study employed a cross-sectional survey aimed at assessing the median F/V intake in a sample of Kuwait University students to determine its relationship with gender, body weight, college affiliation, and family monthly income and to explore perceived barriers to eating F/V. The median total F/V intake was 2.06, and the median intake of F/V without fries was even lower. Significant gender differences were found in intakes of fruit juice and the percentage of juice from fruit intake, with males consuming more servings per day compared to females. Male students were found to consume proportionately more fried potatoes of total vegetable intake when compared to females, whereas female students were found to consume more vegetables without fries than males. Taste, inconvenience, and lack of knowledge on F/V intake recommendations and preparation methods were among the main barriers to consuming more F/V. College students require encouragement to consume more F/V through targeted campaigns to increase awareness of recommendations, health benefits, and ways to incorporate F/V in their daily diet.

The association between frequency of eating out with overweight and obesity among children aged 6-17 in China: a National Cross-sectional Study

BACKGROUND

In parallel with the increased prevalence of childhood overweight and obesity, the proportion of eating out in China has increased dramatically in recent years. The purpose of the study was to explore the association between frequency of eating out with overweight and obesity among Chinese children.

METHODS

The representative sample was recruited from Chinese National Nutrition and Health Survey (CNNHS) in 2010-2012, which included Chinese children aged 6-17 years (7685 boys and 7576 girls). Frequency of eating out was collected by interview-administered questionnaire and categorized as: 0, 1-2 and ≥ 3 times per week. Height and weight were measured, consequently body mass index was calculated.

RESULTS

The prevalence of eating out among Chinese children aged 6-17 years old was 23.2%. Children who ate out 0, 1-2, ≥3 times per week were accounted for 76.8, 10.9 and 12.3% respectively. Findings revealed that eating out three times per week or more was statistically significant associated with higher prevalence of overweight and obesity among boys (OR = 1.20,95CI:1.04-1.38) compared with those ate out less than three times per week. However, no significantly association was observed among girls (OR = 0.91, 95CI:0.78-1.01). In additional, Younger children, rural children, children from low income family, those with leisure exercises (certain physical activities regularly carried out such as swimming, walking, running, equipment fitness), leisure time sedentary behaviors (LTSB)(> 2 h/d) were relatively more likely to eat out.

CONCLUSIONS

The results illustrated that eating out three times or more had a significantly positive effect on overweight and obesity among boys in China.

For whom and under what circumstances do nutrition-education cooking interventions work: a realist synthesis

OBJECTIVE

To explore for whom and under what circumstances nutrition-education cooking interventions affect nutrition outcomes in adults.

METHODS

A realist synthesis was undertaken. The CINAHL, Ovid Medline, Scopus, and Web of Science databases were searched for literature published between 1980 and 2019, using the terms "cook" and "intervention" and their synonyms; 5759 articles were identified. Grey literature was sourced for further additional program context. A total of 23 articles (n = 11 programs) met inclusion criteria for analysis. Program data were coded in duplicate for context, outcome, and mechanism configurations, and used to build a refined program theory.

RESULTS

Nutrition-education cooking interventions targeted at low-socioeconomic-status and marginalized populations produced a range of positive nutrition outcomes. Outcomes were observed when the program involved hands-on cooking and a skilled facilitator coupled with individual self-efficacy, knowledge gain, family support, and an expectation of positive health outcomes.

CONCLUSION

These findings highlight key program components to achieve improvements in nutrition and important recommendations for nutrition-education cooking interventions.

Consumption of meals prepared away from home is associated with inadequacy of dietary fiber, vitamin C and mineral intake among Japanese adults: analysis from the 2015 National Health and Nutrition Survey

Background

Consumption of home-prepared meals may lead to better nutritional intake. Few studies have examined the association between the frequency of consuming meals prepared away from home and the inadequacy of nutritional intake based on nutritional standards and food group intake. We therefore aimed to investigate this issue among Japanese adults.

Methods

This study was a secondary analysis of the 2015 National Health and Nutrition Survey in Japan, involving 921 men and 1300 women aged 18–64 years, conducted as a cross-sectional survey. The frequency of consuming meals prepared away from home was defined using two questions inquiring about the frequency of eating out and take-away meals. Data on dietary intake were collected using a one-day semi-weighed household dietary record. Participants were stratified into three groups based on the frequency of consuming meals prepared away from home (High, Moderate, Low). The inadequacy of each nutrient intake was assessed by comparing estimated average requirement (EAR) level for 14 nutrients and the range of the dietary goal (DG) for seven nutrients according to the 2015 version of the Dietary Reference Intakes for Japanese. Group differences in nutrients adequacy were assessed using the covariate and logistic regression analysis. Food intake was also compared across the groups by classifying each food item into 17 groups based on Standard Tables of Food Composition.

Results

The proportion of participants who consumed home-prepared meals almost every day were 34.9% among men and 46.8% among women, and the proportion of those consuming a higher frequency of meals prepared away from home were 14.7 and 6.3%, respectively. A higher frequency of consuming meals prepared away from home was associated with inadequacy of dietary fiber, vitamin C and minerals (iron, magnesium and potassium) intake, and with lower intake of vegetables and higher intake of fat and oils.

Conclusions

High frequency of consuming meals prepared away from home was associated with insufficient intake of dietary fiber, vitamin C and multiple minerals among Japanese adults. These nutrients may be the potential target of interventions aimed at improving nutrient intake in individuals who predominantly eat food prepared away from home.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00693-6.

Diabetes Self-Management Education Support Healthy Teaching Kitchen Cooking Classes Delivered Using a Telehealth Technology

PURPOSE

The purpose of the study was to evaluate the effectiveness of diabetes self-management education and support (DSMES) among veterans with diabetes using the Healthy Teaching Kitchen (HTK) by means of telehealth communication.

METHODS

A retrospective chart review collected data from veterans with type 2 diabetes (T2DM) that participated in the DSMES-HTK program at 2 Veterans Affairs Northeast Ohio Healthcare System facilities between February 2013 and December 2018. A factorial design was used to compare A1C data and use of clinical video telehealth from main hub to satellite site. Statistical analyses were performed using SPSS (Version 25). Repeated measures analysis of variance (RMANOVA) were performed to compare mean A1C in veterans that attended HTK at the main site versus a telehealth site. RMANOVA was also used to compare mean A1C in veterans that attended at least 1 hands-on class versus those that attended at least 1 demonstration class.

RESULTS

A1C values of all groups improved over time and were sustained regardless of DSMES-HTK delivery method or location.

CONCLUSIONS

Sustained improvement in A1C was observed in patients that participated in both DSMES-HTK in person and via clinical video telehealth classes conducted by hub site facilitator with RDN, CDCES credential. The use of a clinical video telehealth strategy for DSMES-HTK capitalizes on limited, highly skilled, credentialed instructional team members.

Factors associated with ordering food via online meal ordering services

OBJECTIVE

Online meal ordering services are increasing in popularity in Australia and globally. Meals ordered online for home delivery are typically less healthy than home-made meals, potentially contributing to weight gain. The aim of the present study was to identify the types of consumers who are most likely to engage in online meal ordering.

DESIGN

A cross-sectional survey including items relating to demographic and lifestyle factors was disseminated via a web panel provider.

SETTING

Australia.

PARTICIPANTS

A total of 2010 Australian adults aged 18+ years.

RESULTS

More than a quarter of respondents (28 %) engaged in online meal ordering at least once in the previous month. Younger respondents, those with a higher BMI, and those with higher education and income levels were more likely to have done so. Consuming higher levels of sugary drinks and fast-food restaurant patronage were significantly associated with ordering meals online for home delivery.

CONCLUSIONS

The outcomes of this study suggest that the use of online meal ordering services is becoming a common practice in Australia, and it is therefore important to implement evidence-based strategies and policies to encourage individuals to make healthy food choices when using these services.

Identification of Barriers to Adherence to a Weight Loss Diet in Women Using the Nominal Group Technique

Background: At any given time, a majority of women are engaged in some type of weight loss diet; however, these efforts are difficult to sustain for long-term weight control. Because women are more likely to develop obesity and suffer a greater severity of obesity-related health and economic consequences, we sought to identify the key factors that make adhering to a weight loss diet difficult for overweight/obese women. Methods: Ten nominal group technique (NGT) sessions aimed at identifying perceived barriers to adherence to a weight loss diet were conducted as part of a weight loss study for overweight/obese women (n = 33) during the controlled feeding weight loss phase. Results: Individual-level barriers to emerge from the sessions included knowing when to stop eating, being able to control cravings and emotional eating, and sustaining healthier dietary habits. Environmental-level barriers included family/social events that bring people together, especially those centered around food and drink, eating out, cost, and busy schedules. Conclusions: These findings offer a deeper understanding of barriers women find most salient to adhering to a weight loss diet, providing direction for the clinical application of weight loss programs.

Acceptability and feasibility of a café-based sustainable food intervention in the UK

Dietary change is needed to improve health and reduce the environmental burden of food production and consumption. Using an Intervention Mapping approach, this study aimed to explore the views caterers and customers held towards point-of-choice interventions that promote healthy and environmentally friendly (EF) food and beverage choices at the University of Sheffield. Intervention options proposed during focus groups were devised using the Nuffield Bioethics ladder of intervention. Ten focus groups were held involving caterers (n = 16) and customers (n = 45). Thematic analysis was conducted on the transcripts of caterer and customer focus groups seperately, and then comparisons were made to identify concerns about the acceptability and feasibility of intervention options. Attitudes towards intervention options varied considerably amongst stakeholders, with the greatest disparity of opinion in the acceptability of interventions that restrict or limit personal choice, particularly with regards to meat consumption. Information provision was favoured as an acceptable intervention by both customers and caterers. However, labelling products in terms of their environmental impact was considered practically unfeasible. Social norms around eating also emerged as influencing the acceptability and feasibility of interventions with concerns raised about: shaming customers who chose meat, the exclusivity of vegan choices and the limited availability and appeal of meatless café options. Financial considerations were the main priority of caterers when discussing point-of-choice interventions. An acceptable and feasible café-based intervention ought to increase awareness and understanding of healthy and EF food choices, protect customer choice and avoid additional costs.

Cooking as a Health Behavior: Examining the Role of Cooking Classes in a Weight Loss Intervention

Americans are cooking fewer meals at home and eating more convenience foods prepared elsewhere. Cooking at home is associated with higher quality diets, while a reduction in cooking may be associated with increases in obesity and risk factors for chronic disease. The aims of this study were to examine cooking as an intervention for weight control in overweight and obese adults, and whether such an intervention increases participants' food agency and diet quality. Overweight and obese adults were randomized into one of two intervention conditions: active or demonstration. Both conditions received the same 24-week behavioral weight loss intervention, and bi-weekly cooking classes. The active condition prepared a weekly meal during a hands-on lesson, while the demonstration condition observed a chef prepare the same meal. The active condition lost significantly more weight at six months compared with the demonstration condition (7.3% vs. 4.5%). Both conditions saw significant improvements in food agency scores and Healthy Eating Index scores, though no significant differences were noted between groups. The addition of active cooking to a weight management intervention may improve weight loss outcomes, though benefits in diet quality and cooking behaviors may also be seen with the addition of a demonstration-only cooking intervention.

Debunking the High Cost of Healthy Diets: Consumer Behavior Predicts Dietary Energy Density in a Nationally Representative Sample of US Adults

PURPOSE

Dietary energy density (ED; kcal/g) is an established marker for diet quality and a risk factor for obesity. Previous studies have suggested that low-ED diets cost more than high-ED diets, adding an economic contribution to the obesity epidemic. This study evaluated the relationship between consumer behavior (money spent on food) and dietary energy density in a nationally representative sample of US adults.

DESIGN, SETTING AND SUBJECTS

Data from 10,622 adult participants in the 2013-2016 NHANES were used for this study. The NHANES is a large cross-sectional survey conducted by the CDC and NCHS.

MEASURES

Consumer behavior was evaluated by examining total dollars spent on food, as well as dollars spent at various categories of food stores & restaurants. Dietary ED was calculated using multiple methods.

ANALYSIS

Multivariate regression models were then used to evaluate the relationship between consumer behavior, defined as money spent in four categories (groceries, take-out, dining out, other food purchases) and dietary energy density.

RESULTS

Low-ED diets did not cost more than high-ED diets overall, though low-ED diets contained more servings of fruits (1.6 vs 0.4), vegetables (2.2 vs 0.9) and fiber (21 vs 13g), and fewer added sugars (15 vs. 18 tsp), solid fats (28 vs 39g), all p's < 0.01. Differences in spending patterns were identified. A positive linear trend between money spent on fast food/takeout and dietary energy density (p < 0.001) was observed. Additionally, individuals in the lowest quartile of ED spent more at grocery stores per person than individuals in the highest quartile of ED ($182 vs. $150 p = 0.04).

CONCLUSION

Spending pattern and consumer choices are associated with dietary ED in this cross-sectional analysis of a nationally representative population sample. Identifying eating behaviors associated with diets high in energy density may inform future investigations that intervene on dietary habit for promotion of healthy eating and prevention of weight gain.

Teaching Kitchens in the Learning and Work Environments: The Future Is Now

The learning and working environments of today's hospitals and health systems are designed to predict, diagnose, treat, and manage disease. However, the food environments in these settings are often extraordinarily unappealing, unhealthy, and can adversely impact the well-being of health professionals. What if future health-care sites were designed as showrooms of the most appealing and nutritious foods? What if future cafeterias included ventilated "Teaching Kitchens" as extensions to the everyday "grab and go" check-out lines? What if health-care providers, trainees, staff, and community members had access to foods that were healthy, delicious, affordable, sustainable, and easy to prepare? Most importantly, what if health professionals learned to make these healthy, delicious recipes as part of their required training? "See one, do one, teach one" could become, "See one, taste one, make one, teach one". Teaching Kitchens could serve as both learning laboratories and clinical research centers, whereby teaching kitchen curricula could be tested, through sponsored research, for their impact on behaviors, clinical outcomes, and costs. What if spaces adjacent to Teaching Kitchens were designated "Mindful Eating Spaces," where self-selected patrons could enjoy a "Culinary Feast alongside a Technological Fast" in an effort to carve out a brief oasis of mindful, resilience-building reflection during any given day? This article describes the rationale for and necessary components of such a futurist "Teaching Kitchen" within future working and learning environments. Importantly, if and when Teaching Kitchens are built within health-care settings, they may serve as catalysts of personal and societal health enhancement for all.

Snacks and The City: Unexpected Low Sales of an Easy-Access, Tasty, and Healthy Snack at an Urban Snacking Hotspot

: While many people declare an intention to eat and snack more healthily, a large body of research has found that these intentions often do not translate into actual behavior. This failure to fulfil intentions is regularly attributed to the obesogenic environment, on which basis it is assumed that changing the food environment may lead to more healthy snacking behavior. To test this premise in real life practice, the present research project investigated whether making a healthy snack easy-to-access in an urban environment characterized by unhealthy snacking would support people in their intentions of purchasing more healthy snacks. The urban snack project consisted of three phases. In Phase 1, a hotspot location for unhealthy snacking was determined by using a Global Positioning System to track people's snacking locations anda survey to verify the location . In Phase 2, an attractive snack was developed that met consumers' criteria of what constituted a healthy and tasty snack, together with corresponding branding that also included a small food truck from which to sell the newly developed snacks. In Phase 3, the snack was sold from the food truck located at the previously determined unhealthy snacking hotspot. We counted the number of snacks sold and canvassed people's opinions about the snack and its branding, finding that in spite of people's appreciation for the snack, the food truck, and the branding, actual sales of the snack were very low. In the Discussion, we name predominant eating and purchasing habits as possible reasons for these low sales. Future research could focus on placing the healthy snack directly beside people's habitual snack purchase location to ensure that the new choice gets better recognized. Overall, the findings suggest that merely placing healthy snacks more prominently in people's food environment is not sufficient to lead people to snack more healthily.

Do Changes in the Local Food Environment Within New Residential Developments Influence the Diets of Residents? Longitudinal Results from RESIDE

Background: There is limited longitudinal evidence supporting a link between food outlet locations and dietary outcomes to inform policy and urban planning. This study examined how longitudinal changes in the local food environment within new residential developments influenced changes in adult dietary intake. Methods: Adult participant data (n = 3223 person-observations) were sourced from the RESIDential Environments (RESIDE) project across three time points between 2004 to 2012 in Perth, Western Australia. Fixed effects regression estimated the relationship between change in spatial exposure to the local food environment, individual behaviours and perceptions of the local food environment with dietary outcome variables (healthy diet score, unhealthy diet score, diet quality score and fruit/vegetable intake). Results: An increase over time in the percentage of healthy food outlets around the home was significantly (p ≤ 0.05) associated with an increase in healthy diet scores and an increase in the distance from home to the nearest café restaurant was significantly (p ≤ 0.05) associated with an increase in diet quality scores. Conclusions: Modifying the local food environment by increasing the relative proportion of healthy food outlets around the home may support healthier dietary intake.

Understanding food westernisation and other contemporary drivers of adult, adolescent and child nutrition quality in urban Vietnam

OBJECTIVE

To examine the association between consumption of western foods purchased and consumed away from home and measures of nutrition quality: average daily caloric intake and macronutrient (carbohydrates, fat and protein) shares, for urban consumers in Vietnam, a country undergoing economic transition.

DESIGN

Cross-sectional observational data were collected using household surveys and 24-h food diaries. Outcome variables were individual average daily caloric intake and shares of calories from macronutrients: carbohydrates, fat and protein. The key explanatory variable was individual daily share of calories from western food purchased and consumed away from home. Ordinary least squares and multivariate regression analyses were used to examine the association between the outcome variables: caloric intake and macronutrient shares and the share of calories from western food consumed away from home.

SETTING

Hanoi and Ho Chi Minh City in Vietnam.

PARTICIPANTS

In total, 1685 households and 4997 individuals, including adults (aged $$ \ge $$ 18 years), adolescents (aged 10-17 years) and children (aged 0-9 years).

RESULTS

The share of calories from western food away from home was significantly associated with higher caloric intake among male and female adults (P < 0·01), adolescents (P < 0·01) and male children (P < 0·10) and was associated with higher shares of fat for male and female adults (P < 0·01), adolescents (P < 0·01) and male children (P < 0·01).

CONCLUSIONS

Policymakers must be conscious of the numerous factors associated with poor nutrition quality, especially in younger Vietnamese individuals. Relevant interventions targeting at risk groups are required if nutrition improvement is a long-term goal.

The effect of time use and food cost on dietary quality

OBJECTIVE

To develop a questionnaire to measure food nutrition, food expenditures and time spent in food-related activities; and to assess the association between diet quality, time spent in food-related activities and food expenditures using data from a pilot study.

DESIGN

Cross-sectional study. Multiple linear regression models were used to analyse participants' survey response behaviours and the relationship between food nutritional quality and time and money expenditures.

SETTING

Online survey using Qualtrics software in a public university located in West Texas, USA.

PARTICIPANTS

Faculty and staff aged 18 years and older from a public university located in West Texas, USA.

RESULTS

Combining questions from three survey instruments that collect data on food nutrition, food expenditures and time spent in food-related activities resulted in a thirty-page survey instrument. The median completion time of the survey instrument was about 30 min. Preliminary results suggest that time and money expenditures are associated with food quality but that their role is small relative to sociodemographic characteristics such as race and gender.

CONCLUSIONS

Time and money expenditures are associated with food quality but their role is small relative to sociodemographic characteristics such as race and gender.

The Impact of Dietary Supplementation of Whole Foods and Polyphenols on Atherosclerosis

The purpose of this review is to highlight current research on the benefits of supplementation with foods with a diverse polyphenol composition, including fruits, vegetables, nuts, grains, oils, spices, and teas in blunting atherosclerosis. We searched PubMed for publications utilizing whole food or polyphenols prepared from whole foods in Apolipoprotein E (ApoE) or Low-Density Lipoprotein Receptor (LDLR) knockout mice, and identified 73 studies in which plaque was measured. The majority of the studies reported a reduction in plaque. Nine interventions showed no effect, while three using Agaricus blazei mushroom, HYJA-ri-4 rice variety, and safrole-2', 3'-oxide (SFO) increased plaque. The mechanisms by which atherosclerosis was reduced include improved lipid profile, antioxidant status, and cholesterol clearance, and reduced inflammation. Importantly, not all dietary interventions that reduce plaque showed an improvement in lipid profile. Additionally, we found that, out of 73 studies, only 9 used female mice and only 6 compared both sexes. Only one study compared the two models (LDLR vs. ApoE), showing that the treatment worked in one but not the other. Not all supplementations work in both male and female animals, suggesting that increasing the variety of foods with different polyphenol compositions may be more effective in mitigating atherosclerosis.

The Impact of Isolation Measures Due to COVID-19 on Energy Intake and Physical Activity Levels in Australian University Students

The coronavirus disease 2019 (COVID-19) pandemic resulted in physical isolation measures in many parts of the world. In Australia, nationwide restrictions included staying at home, unless seeking medical care, providing care, purchasing food, undertaking exercise, or attending work in an essential service. All undergraduate university classes transitioned to online, mostly home-based learning. We, therefore, examined the effect of isolation measures during the early phase of the COVID-19 pandemic in Australia (March/April) on diet (24-h recall) and physical activity (Active Australia Survey) patterns in third-year biomedical students. Findings were compared with students enrolled in the same course in the previous two years. In females, but not males, energy intake was ~20% greater during the pandemic, and snacking frequency and energy density of consumed snacks also increased compared with 2018 and 2019. Physical activity was impacted for both sexes during the pandemic with ~30% fewer students achieving “sufficient” levels of activity, defined by at least 150 min over at least five sessions, compared with the previous two years. In a follow-up study six to eight weeks later (14–18% response rate), during gradual easing of nationwide restrictions albeit continued gym closures and online learning, higher energy intake in females and reduced physical activity levels in both sexes persisted. These data demonstrate the health impacts of isolation measures, with the potential to affect long-term diet and activity behaviours.