Nutritional challenges and health implications of takeaway and
Agnieszka Jaworowska, Toni Blackham, Ian G Davies, and Leonard Stevenson
Consumption of takeaway and fast food continues to increase in Western societies
and is particularly widespread among adolescents. Since food is known to play an
and trans fatty acid content. It also reports on the association between the
consumption of such foods and health outcomes. While the available evidence
health are currently limited and, in recent years, changes have been taking place
that are designed to improve them. Therefore, more studies should be directed at
gaining a firmer understanding of the nutrition and health consequences of eating
takeaway and fast foods and determining the best strategy to reduce any negative
impact their consumption may have on public health.
© 2013 International Life Sciences Institute
Lifestyle changes that have taken place in many countries
worldwide over the last few decades have been shown to
impact food consumption patterns.1–4One of the most
prominent trends is the increasing frequency with which
meals are consumed outside of the home environment.4–6
In addition,even meals consumed at home are often pur-
chased from catering outlets that offer takeaway or home
delivery service.5,7The traditional family dinner is
increasingly being replaced by eating “on the run” at
various locations throughout the day.1As a result, less
and man in the United States spending 47 min and
19 min per day, respectively, carrying out food prepara-
tion and cleaning up. Moreover, among the 13,200 US
citizens in one study,59% of men and 32% of women did
not spend any time on daily food preparation.8
Food eaten outside of the home is becoming an
important and regular component of theWestern diet.9,10
A number of studies have shown increased frequency of
takeaway and fast food consumption worldwide, espe-
cially in Europe, the United States, and Australia.9–15A
governmental report in the United Kingdom indicated
about 22% of residents were found to purchase foods
from takeaway outlets at least once a week and 58% a few
times a month.11A similar frequency of consumption of
takeaway or fast food has also been observed in other
countries, with approximately 28% of Australians12con-
suming takeaway meals at least twice a week and 37% of
US residents13eating fast food at least once over two
nonconsecutive days. Fast food is particularly popular
among adolescents, with a report from 2001 indicating
that 75% of US teenagers between the ages of 11 and 18
years eat at fast-food outlets at least once a week14and a
2010 report indicating that 70% of Brazilian students
Affiliations: A Jaworowska, T Blackham, IG Davies, and L Stevenson are with the Faculty of Education, Community and Leisure, Centre for
Tourism, Events & Food Studies, Liverpool John Moores University, Liverpool, United Kingdom.
Correspondence: A Jaworowska, Faculty of Education, Community and Leisure, Centre forTourism, Events & Food Studies, Liverpool John
Moores University, I.M. Marsh Campus, Barkhill Road, L17 6BD Liverpool, United Kingdom. E-mail: I.Davies@ljmu.ac.uk;
email@example.com. Phone: +44-0151-231-5290.
Key words: chronic disease, dietary intake, fast food, takeaway food
Nutrition Science ↔ Policy
Nutrition Reviews® Vol. 71(5):310–318
(9–18 years old) consume fast food four times or more
per week.15Moreover, Guthrie et al.10reported that con-
2% of total energy in the 1970s to 10% of energy in the
1990s.10That observed trend is continuing among chil-
dren and adolescent populations, with data from the
2003–2006 National Health and Nutrition Examination
Surveys showing a further increase to 13% of total daily
It is well known that food plays an important role in
the development and prevention of many diseases.17
There is also no doubt that observed changes in dietary
patterns affect the quality of the diet as well as public
health. Consumption of takeaway and fast food has been
ity of studies on this subject have focused on the relation-
ship between fast food consumption and weight gain,18–20
more frequent consumption of meals prepared outside of
the home has also been observed to correspond with
increased risk of insulin resistance, type 2 diabetes,
elevated total cholesterol, and low-density lipoprotein
cholesterol (LDL-C) levels as well as decreased high-
density lipoprotein cholesterol (HDL-C) concentra-
Takeaway or fast food consumers are
characterized by higher intakes of energy, fat, saturated
fatty acids (SFAs), trans fatty acids (TFAs), added sugar
and sodium, and lower intakes of fiber, macronutrients,
and vitamins in comparison to those who do not eat food
and fast-food consumption has been linked to poor
dietary patterns including higher intakes of carbonated
soft drinks and sweets and lower consumption of fruits,
vegetables, whole grains, and dairy products.12,13,19,24
This review focuses on the energy and fat content in
takeaway and fast foods and their health implications.
However,it should be pointed out that other components
of takeaway and fast foods, such as salt and sugar, also
have important effects on health.
Literature searches were performed using the following
electronic databases: Medline, ScienceDirect, and Web of
Science. The following key words were used: fast food,
takeaway food, nutrient content, lifestyle, health, obesity,
cardiovascular disease, blood lipids, fat, saturated fatty
acids,trans fatty acids,energy density,food consumption
original and review article identified was searched for
additional references. Searches were restricted to manu-
scripts in the English-language literature and included all
available data until March 2011. Articles were limited to
human participants only.
ENERGY AND ENERGY DENSITY
Humans possess a weak initial ability to recognize the
energy density of consumed food and to appropriately
regulate the bulk of food eaten to maintain energy
balance; thus,people generally tend to consume a similar
amount of food every day regardless of variations in
energy density.25–27This tendency to consume a constant
amount of food was confirmed by Seagle et al.,28who
analyzed the 4-day food records of normal-weight adults.
Daily variations in the weight of consumed food were
energy or fat.28Similarly, a retrospective investigation of
three community studies from the United Kingdom (the
Cambridge Family Food Survey, n = 195); the MRC
National Survey of Health and Development [NSHD],
n = 343; and the Leeds Nutritional Survey, n = 2,086)
showed that the weight of food consumed remained rela-
with a low energy density is eaten, a greater amount of
food needs to be consumed for a given level of energy
intake in comparison to food with a high energy density.
Therefore, increasing the energy density of the diet may
result in a passive increase in energy intake, because
weight of food.
Bell et al.26conducted a study of normal-weight
women (n = 18) who consumed all of their meals in the
laboratory over three 2-day periods. During lunch,
dinner, and an evening snack, participants consumed ad
libitum main entrees, which were similar in macronutri-
ent composition but varying in energy density (low,
medium, or high). The women consumed similar
amountsof foodindependentof theenergydensityof the
meal served. Thus, energy intake was about 25% lower
with meals of low energy density in comparison with
those of high energy density. Results showed no differ-
ences across conditions in hunger or fullness before
meals, after meals, or over each 2-day period.26These
findings were confirmed by several other studies that
tested the effect of variations in the fat content of the diet
while maintaining a constant energy density.30,31Stubbs
et al.,30in a 14-day intervention study,reported that men
who were offered a diet varying in fat content (20,40,and
60% of total energy) but with a constant energy density,
ate a constant weight of food; therefore, they had similar
energy intakes despite different proportions of fat
content in the diet. Similarly, in a randomized crossover
study performed over an 11-day period, Saltzman et al.31
found that seven pairs of male twins who consumed, ad
libitum, a low- or a high-fat diet matched for energy
density (20% or 40% of total energy) had similar daily
energy intakes (10.3 and 10.7 MJ/d, respectively) regard-
less of the condition of the diet. These findings support
Nutrition Reviews® Vol. 71(5):310–318
the hypothesis that the energy density of consumed food
is a crucial determinant of energy intake. Therefore, the
density,may increase or decrease energy intake indepen-
dent of the macronutrient content of the diet.
RELATIONSHIP BETWEENTAKEAWAY AND
FAST FOODS AND OBESITY
The relationship between fast or takeaway food con-
sumption and increased body mass index (BMI) and
obesity has been reported in many epidemiological
studies.18–20–32Among a Spanish population (n = 3,054),
Schröder et al.33found that consumption of fast food
more frequently than once a week increased the risk of
findings of Kjøllesdal et al.,34who reported from a group
of working Oslo citizens (n = 8,943) that the likelihood of
being obese increased significantly with frequent eating
in staff canteens, after demographic and socioeconomic
variables were taken into account. Similar trends have
also been observed in developing countries; Rouhani
et al.35found that high intakes of fast foods were signifi-
cantly associated with increased incidences of overweight
and obesity among Isfahani (Iranian) girls aged 11–13
more per week has been independently associated with a
31% higher prevalence of moderate abdominal obesity in
men and a 25% higher prevalence in women.19According
to a theoretical model, an energy increase of 17 kcal/day
for men and 19 kcal/day for women would lead to a
weight increase of 1 kg per year independent of baseline
body weight.36On average, regular consumption of fast-
food meals was related to increases in energy intake of
56 kcal/day37and 187 kcal/day19among adults and chil-
dren, respectively. Thus, a higher frequency of fast-food
consumption was associated with a weight gain of 0.72 kg
over3years,37andof 4.5 kgovera15-yearperiod,18above
the average weight gain.Moreover,women who reported
eating takeaway food once a week were 15% less likely to
be weight maintainers than those who rarely (once a
month or less) or never ate takeaway food.38
ENERGY CONTENT AND INTAKE OFTAKEAWAY AND
It has been shown that a typical meal purchased from
fast-food restaurants tends to be energy dense and con-
tains approximately 236 kcal/100 g, which is twice the
recommended energy density of a healthy diet.39Consid-
ering the large portion sizes of meals eaten out of the
home, one meal can provide approximately 1,400 kcal.40
Bauer et al.41found that despite the increasing attention
to the role of fast food in the American diet, including
legislation and public health campaigns addressing the
healthfulness of fast food, the median energy content
across all menu items remained relatively stable over a
14-year study period (1997–2010).
Mancino et al.42based on the dietary recall data col-
lected over2 nonconsecutive days from the 2003–2004
National Health and Nutrition Examination Survey
(NHANES) and the 1994–1996 Continuing Survey of
Food Intakes by Individuals, and with the use of a first-
difference estimator, found that each meal eaten away
from home added, on average, 130 kcal to total daily
energy intake, with lunch and dinner having the greatest
effect on total daily energy. French et al.,14in a study
conducted among 11–18-year-old American teenagers
(n = 4,746), reported that energy intake was 40% higher
among male and 37% higher among female adolescents
who reported eating fast food three times or more during
the studied week in comparison with those who had not
eaten fast foods. Additionally, a dose-response pattern
was observed with energy intake directly increasing with
increased frequency of fast food consumption.14Simi-
larly, a follow-up study including African American
women aged 30–69 years (n = 44,072) indicated that,
compared to women who have never eaten Chinese food,
pizzas, fried fish, fried chicken, or burgers, women who
reported eating such foods at least once a week had sig-
nificantly higher daily energy intakes.21Furthermore, a
study by Bowman and Vinyard
adults aged 20 years and older showed a positive relation-
ship between the energy density of the diet and fast food
consumption. Their evaluation of the quality of the diet
of American adults showed increased dietary energy
density among men and women who reported eating fast
food (95 and 102 kcal/100 g, respectively) compared to
those who did not (89 and 98 kcal/100 g among men and
19that included 9,872
TOTAL FAT AND SATURATED FATTY ACIDS
The high levels of fat intake commonly associated with
takeaway or fast food consumption may be a factor
leading to obesity development that is independent of
total energy intake. Findings of a study carried out by
Alfieri et al.43among 150 adults in the United Kingdom
found a strong positive correlation between BMI and
total fat consumption but no association with energy
intake.These results were in line with findings of a cross-
sectional study of 15,266 men (55–79 years) performed
by Satia-Abouta et al.,44which showed that fat intake has
a higher adipogenic effect than total energy intake. In a
multivariate linear regression model after adjustment for
demographic and health-related characteristics, BMI
Nutrition Reviews® Vol. 71(5):310–318
increased by 0.14 and 0.53 kg/m2for every 500 kcal of
total energy intake and 500 kcal energy derived from fat,
respectively.Additionally,only energy provided from fat,
but not energy from other macronutrients (carbohydrate
and protein), increased linearly with increasing BMI. In
contrast, Larson et al.45suggested that dietary fat plays a
very minor role in increasing adiposity, and explained
obesity risk factors.
There are several possible explanations for why
A number of studies have shown that fat exerts a less
(173.4 g of carbohydrate, 11.2 g of fat, 12.7 g of protein,
and 803 kcal of total energy) suppressed intake of food
with the next meal, in contrast to the breakfast supple-
mented by fat (77.8 g of carbohydrate,50.9 g of fat,12.7 g
of protein,and 803 kcal total energy),which produced no
detectable effect on appetite expression. Furthermore, fat
is utilized with very high energy efficiency; thus,the diet-
induced thermogenesis following fat consumption is
much lower than after protein or carbohydrate intakes.
may, therefore, promote dietary fat accumulation in
50 g of fat to a standard breakfast (55% energy from car-
bohydrate, 30% from fat, and 15% from protein) did not
ing18 h.Similarly,Hortonet al.48foundthatinagroupof
ing (50% above energy recruitment) of fat and carbohy-
drate,overfeeding with fat did not produce an increase in
fat oxidation and total energy expenditure, and led to
storage of 90–95% of excess energy.In contrast,carbohy-
drate overfeeding was associated with increased carbohy-
in 75–85% of excess energy being stored.48Furthermore,
Raben et al.49in a study of 19 healthy participants who
were provided with meals similar in energy density but
rich in protein,fat,carbohydrate,or alcohol observed that
postprandial lipid oxidation was suppressed after
protein-, carbohydrate-, and alcohol-rich meals and was
almost unchanged after the fat-rich meal.Griffiths et al.50
reported that lipid oxidation was higher after a high-fat
meal(80 gofcarbohydrate,80 goffat,and18 gofprotein)
thanafteralow-fatmeal(80 gofcarbohydrate,0.8 goffat,
and 18 g of protein), but the difference in oxidation level
reached 10 g only (20.7 vs. 10.6 g, P < 0.01), despite the
high-fat meal providing 79.2 g more fat than the low-fat
meal. It should also be mentioned that fat is more
effectively absorbed from the gastrointestinal tract in
a high-fat diet produced significantly lower fecal loss of
energy than a high-carbohydrate diet. In addition, fat is
known to improve the taste and texture of many food
products, which may also promote active overconsump-
tion associated with enhanced appetite due to sensory
stimulation.52Increased food intake occurring with
increased food palatability has been observed in many
previous studies.53–56However, other studies that investi-
gated the sensory properties of food involved in sensory-
specific satiety found that increased sensory stimulation
may reduce food consumption.57
A diet high in fat, particularly one rich in SFAs, may
not only lead to a higher risk of obesity development, it
increase total and HDL-C levels, although not all SFAs
affect plasma lipid and lipoprotein concentrations in the
same manner.58For example, stearic acid, in comparison
with other SFAs,has little effect on plasma lipids; this has
been proposed to be a result of the rapid conversion of
stearic acid in the body to oleic acid.59On the other hand,
SFAs with 12–16 carbon atoms are considered to be
hypercholesterolemic, and lauric acid (C12:0) appears to
acids also increase the concentration of HDL-C; as a
result,they do not increase the ratio of total cholesterol to
HDL-C.60Whether a diet high in SFAs is associated with
an increased risk of coronary heart disease is still contro-
versial.60,61A number of epidemiological and dietary
intervention studies have found that a diet rich in SFAs is
associated with a higher risk of impaired glucose toler-
ance,insulin resistance,and type 2 diabetes,62–64but there
is no evidence of a direct causal relationship with CVD.65
participants with recently diagnosed and undiagnosed
healthy controls. These findings were similar to those of
Wang et al.64who, in a 9-year follow-up study of 2,909
American participants (45–64 years of age), showed a
positive association between diabetes incidence and the
proportion of total SFAs in plasma cholesterol esters and
phospholipids,which reflects dietary intake of fatty acids.
several cancers. Kurahashi et al.66in a 7.5-year follow-up
study among 43,435 Japanese men aged 45–74 years
found that myristic and palmitic acids increased the risk
of prostate cancer in a dose-dependent manner. Multi-
variable relative risk on comparison of the highest with
the lowest quartiles of myristic acid and palmitic acid
intake were 1.62 (1.15–2.29) and 1.53 (1.07–2.20),respec-
tively. There is also evidence suggesting a possible rela-
tionship between SFA intake and a modest increase in
breast cancer risk.67
Nutrition Reviews® Vol. 71(5):310–318
One of the main sources of SFAs in takeaway or fast
foods worldwide is palm oil, which is widely used as a
frying medium due to excellent frying performance
together with production of a highly desirable fried food
flavor; it is especially popular in Southeast Asian coun-
tries, as well as in small, independent takeaway outlets in
the United Kingdom.68,69Palm oil is suggested as an
acceptable alternative to PHVO in the deep fat frying
process, but unhydrogenated vegetable oils are recom-
mended as they produce a much more favorable plasma/
serum lipid profile than either palm oil or partially
hydrogenated oils.59,70In a dietary intervention study by
Vega-López et al.,7015 participants were provided for 5
weeks with food varying in the type of fat (partially
hydrogenated soybean oil,soybean oil,palm oil,or canola
oil;attwo-thirdsof totalfat,or20%of totalenergy).Itwas
oil resulted in higher LDL-C concentrations than other
investigated fats. No significant differences in the total
cholesterol to HDL-C ratio were observed among the
diets enriched with palm,canola,and soybean oils.Vessby
et al.,71in the KANWU study, included 162 healthy par-
ticipants who received an isoenergetic diet for 3 months
containing either a high proportion of saturated or
monounsaturated fatty acids,and found that replacement
of SFAs with monounsaturated fatty acids was associated
with improved insulin sensitivity.
On average,food eaten out of the home is character-
ized by a high total fat and SFA content. Stender et al.,72
after analyzing meals containing french fries and fried
chicken (nuggets or hot wings) purchased from
McDonald’s and KFC outlets in 35 countries worldwide,
found that the total fat content varied from 41 to 74 g
depending on the country. These results were supported
by later findings of Dunford et al.,73who reported that
food items (burgers, chicken products, sides, or pizzas)
purchased from fast-food chains contained between 10
and 13 g of total fat and between 3.9 and 4.9 g of SFAs per
The intake of fat and SFAs increases along with
higher frequency of out-of-home eating.13,19,21A study
involving a large sample (n = 44,072) of adult African
American women showed that total fat intake was signifi-
cantly higher among women who reported eating out of
the home at least once a week, regardless of the type of
meals consumed (burgers, fried chicken, fried fish,
Chinese food, pizzas, or Mexican food) when compared
to those who had never eaten food prepared outside the
home.21This is consistent with previous findings of Paer-
atakul et al.,13which indicated that, among 9,063 adults
and 8,307 children and adolescents,on the day when fast
food was eaten, the intake of total fat, SFAs, and percent-
age of energy provided by fat was higher compared to the
day without fast food consumption.
TRANS FATTY ACIDS
tion of unsaturated fatty acids from feed by hydrogen
similar species of TFA isomers, but in different amounts
ent biological effects.74The concentration of TFAs in par-
as 30–50%, compared with only around 5% in dairy and
ruminant meat products.74Ruminant and industrially
produced TFAs have been shown to have a detrimental
effect on blood lipids when consumed in high doses;
however, moderate intakes of ruminant TFAs, such as
effects on plasma lipids and other risk factors for cardio-
vascular disease.75Hulshof et al.76reported that TFA
total energy intake) in all Western European countries
investigated in the TRANSFAIR study, and the main
estimated that average US consumption of industrially
day (2003) to 1.3 g/per day (2010) as a result of food
labelling and legislation.77However, individuals with
certain dietary habits may still consume high levels of
industrially produced TFAs.77Indeed, very high TFA
intake levels (3.5–12.5% of total energy intake) have been
shown in males aged 12–19 years, and the types of foods
pastries.78In the United Kingdom, the National Diet
of TFA,79but this survey did not assess intake from take-
away food from independent outlets.
Trans fatty acids, due to their physiological effects,
are undesirable components of the diet.A growing body
of evidence has demonstrated numerous adverse effects
associated with consumption of TFAs,including systemic
inflammation, diabetes, insulin resistance, endothelial
dysfunction, obesity, decreased LDL particle size,
decreased HDL-C and apolipoproteinA1 concentrations,
and increased total cholesterol,lipoprotein (a) and apoli-
poprotein B levels.80,81A recent meta-analysis of the
effects of TFA consumption on blood lipids and lipopro-
teins showed that each 1% energy replacement of TFAs
with SFAs, monounsaturated fatty acids, or polyunsatu-
rated fatty acids,respectively,decreased total cholesterol/
HDL-C ratio by 0.31, 0.54, and 0.67; apolipoprotein
B/apolipoprotein A1 ratio by 0.007,0.010,and 0.011; and
Lp(a) concentration by 3.76, 1.39, and 1.11 mg/L.82
Esmaillzadeh et al.83in a cross-sectional study of 486
Nutrition Reviews® Vol. 71(5):310–318
apparently healthy women aged 40–60 years found that
greater consumption of PHVO was associated with
increased circulating concentrations of several markers
of endothelial dysfunction and systemic inflammation.
C-reactive protein, interleukin 6, and soluble tumor
necrosis factor 2 levels were, respectively, 73%, 17%, and
5% higher among women in the highest quintile of TFA
intake compared with the lowest quintile.84Many studies
that investigated an association between habitual intakes
of or exposure to TFAs, assessed using tissue biomarkers
(for example, erythrocyte membrane TFA concentra-
tions, serum phospholipids, and adipose tissue fatty acid
risk of coronary heart disease among individuals with
greater TFA consumption or exposure.85The majority of
these studies have focused on PHVO and, until recently,
no positive association between ruminant TFA consump-
tion and cardiovascular risk was found86; however, a
recent study by Laake et al.87found ruminant TFAs
increased this risk, including for coronary heart disease,
among women but not among men. Furthermore, TFA
consumption may be associated with weight gain and
visceral fat accumulation.A large prospective study con-
ducted among 16,587 men,after controlling for potential
confounders, found that substitution of each 2% of
fatty acids was independently associated with a 2.7 cm
increase in waist circumference over 9 years.88It should
also be mentioned that TFAs are transferred from the
mother to the fetus across the placenta and are present in
breast milk.80,89Because humans do not synthesize TFA
isomers, the concentration of these isomers in human
milk is directly related to the maternal diet. The content
of TFAs in human milk varies among countries, from
0.5% inAfrica,through 1.40–2.80% in Poland,to 6–7% of
total fatty acids in Canada.90A recent cross-sectional
study found that infants of mothers who consumed 4.5 g
or more of TFAs daily while breastfeeding were over two
times more likely to have body fat higher than 24% in
comparison to the offspring of mothers consuming less
Takeaway and fast food,particularly french fries and
deep-fried meats may contain a large amount of TFAs
from PHVO, which are used for deep frying. It has been
reported that a single meal of french fries (171 g) and
fried chicken (160 g) purchased from fast food outlets
provided from 0.3 to 24 g of TFAs.72Similarly, Wagner
et al.92found that the TFA content in burgers may vary
between 0.1 and 1.05 g per 100 g and in french fries
between 0.1 and 1.6 g per 100 g.This is in agreement with
Australian data reporting that the level of TFAs in take-
away meals may be between 0.1 and 1.4 g/100 g depend-
ing on the type of meal.93Also, recent data from the
United States showed that the content of TFAs in 32
representative fast-food samples ranged from 0.1 to 3.1 g
It has been assessed that individuals who frequently
consume fast-food meals could be receiving between 6
and 12% of their dietary energy from TFAs,95and a single
meal of fried chicken with chips may deliver four times
more TFAs than the daily recommended allowance in the
United Kingdom (i.e., no more than 2% of total recom-
mended daily energy intake).96
In New York City, legal requirements regarding the
use of PHVO in the preparation of foods sold by chain
and nonchain restaurants have been implemented.Phase
one of the initiative (2007) obligated all food outlets to
use oils,shortenings,and margarines containing less than
0.5 g of TFAs per serving. Phase two (2008) involved
reformulating all food items to contain less than 0.5 g of
TFAs per serving. These restrictions have resulted in sig-
nificant decreases in the TFA content of foods purchased,
and between 2007 and 2009, the mean TFA content per
purchase decreased by 2.4 g. However, the existing regu-
required to hold a permit from the NewYork City Health
Department97; thus, the level of TFAs in food products
from independent outlets may be higher.98
It should be pointed out that most of the accessible
studies regarding TFA levels in fast foods or other take-
away fried meal options did not distinguish between
naturally occurring TFAs in food products and TFAs
from PHVO, or they evaluated the levels of specific
species of TFA isomers.
In summary, a growing body of evidence suggests that,
even though positive changes are being made to improve
the nutrient profiles of takeaway and fast foods,77some of
these frequently consumed foods may contribute to a
variety of negative health outcomes,including cardiovas-
cular disease, insulin resistance, type 2 diabetes, and
obesity.12,18–22Simultaneously, food prepared outside of
the home is making up an increasing portion of the
Western diet and there is no expectation that this trend
will reverse or stop. However, most of the studies per-
formed to date have only investigated the nutritional
quality of food from fast-food restaurant chains, and
there is still a lack of data regarding the nutrient content
in takeaway meals from small independent outlets,
including those serving such foods as ethnic cuisines,deli
foods, fish and chips, and pizza. Furthermore, there is a
lack of good-quality data on the consumption of different
takeaway food options. To the best of our knowledge, no
studies published to date have differentiated between
consumption of fast foods and other types of takeaway
meals,and the majority of previous studies have concen-
Nutrition Reviews® Vol. 71(5):310–318
trated on foods from fast-food chain restaurants or have
investigated food prepared outside of the home without
considering the source,i.e.,fast-food chain restaurants or
independent takeaway outlets. However, recent work
indicates there are significant differences in the nutrient
composition of different types of takeaway meals (e.g.,
Indian, Chinese, English, pizzas, kebabs)99,100as well as
a similar type.101,102To date,only one study has examined
the relationship between the frequency of consumption
of specific types of meals eaten out of the home (i.e.,
Mexican food) and the incidence of type 2 diabetes, but
this study was limited to restaurant food only.21Further-
more, most studies have only investigated the frequency
of out-of-home eating and have not taken into account
the amount of food consumed, the overall diet quality,
and other lifestyle factors.Therefore,more studies should
be directed at furthering understanding of the nutrition
and health consequences of both takeaway and fast food
consumption and to finding the best strategies to reduce
any negative impact their consumption may have on
public health. Such strategies may require governmental
regulation. In Finland, for example, legislation on food
labelling, such as the mandatory warning of “high salt
product” on products in which the salt concentration
exceeds set limits, has been shown to be a useful tool to
reduce salt intake in the population.103Similarly, in
Denmark, the restriction of industrially produced TFA
levels of all food products to a maximum of 2% of the
total fat content showed it is possible to reduce or remove
TFAs from the content of food products.104
The cooperation of food technologists, nutritionists,
and chefs is needed in order to alter the food preparation
processes at fast-food and takeaway outlets with the goal
of improving the nutritional quality of prepared meals.
However, this may not be easy to achieve, as chefs and
especially due to concerns about adverse effects on palat-
ability, which can potentially affect profits. Furthermore,
voluntary guidelines do not always result in adequate
changes to the nutritional quality of takeaway foods;thus,
of effecting change.
Declaration of interest The authors have no relevant
interests to declare.
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