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Fast-Food Offerings in the United States in 1986, 1991, and 2016 Show Large Increases in Food Variety, Portion Size, Dietary Energy, and Selected Micronutrients
Abstract
Background:
US national survey data shows fast food accounted for 11% of daily caloric intake in 2007-2010.
Objective:
To provide a detailed assessment of changes over time in fast-food menu offerings over 30 years, including food variety (number of items as a proxy), portion size, energy, energy density, and selected micronutrients (sodium, calcium, and iron as percent daily value [%DV]), and to compare changes over time across menu categories (entrées, sides, and desserts).
Design:
Fast-food entrées, sides, and dessert menu item data for 1986, 1991, and 2016 were compiled from primary and secondary sources for 10 popular fast-food restaurants.
Statistical analysis:
Descriptive statistics were calculated. Linear mixed-effects analysis of variance was performed to examine changes over time by menu category.
Results:
From 1986 to 2016, the number of entrées, sides, and desserts for all restaurants combined increased by 226%. Portion sizes of entrées (13 g/decade) and desserts (24 g/decade), but not sides, increased significantly, and the energy (kilocalories) and sodium of items in all three menu categories increased significantly. Desserts showed the largest increase in energy (62 kcal/decade), and entrées had the largest increase in sodium (4.6% DV/decade). Calcium increased significantly in entrées (1.2%DV/decade) and to a greater extent in desserts (3.9% DV/decade), but not sides, and iron increased significantly only in desserts (1.4% DV/decade).
Conclusions:
These results demonstrate broadly detrimental changes in fast-food restaurant offerings over a 30-year span including increasing variety, portion size, energy, and sodium content. Research is needed to identify effective strategies that may help consumers reduce energy intake from fast-food restaurants as part of measures to improve dietary-related health issues in the United States.
... Thanks in part to globalisation, the so-called 'obesogenic' food environments have become more common worldwide and are even reaching remote communities who for centuries engaged with a healthy lifestyle and lived in harmony with the natural environment (16) . These obesogenic food environments are characterised by easy access to energy dense, highly palatable foods with poor nutritional value and increasing portion sizes of these foods (16)(17)(18)(19) . ...
... Ultra-processed foods, and fast foods, also often come in standardised portions (Table 1). These 'standardised' portion sizes of preprepared foods have been increasing in recent years and it is known that people eat more of the food provided to them as the portion size increases (19,49,50) . It is likely that increasing portion sizes of prepared, and particularly highly palatable ultra-processed food, has increased the risk of overeating and, therefore the risk of weight gain, more so for women than men. ...
... Increases in fast-food portion sizes Most research on serve size and portion size trends of common fast foods comes from high-income countries, particularly America. In the USA, a survey of fast-food menu items from 10 popular fast-food restaurants showed there was an increase in the variety of menu items, increases in portion sizes and increases in the Na content of items available, across three time points in a 30-year time period (1986-2016) (19) . Increase in portion sizes within and outside of the home ...
Obesity is a leading cause of death and disability globally. There is a higher proportion of women living with obesity than men, with differences in prevalence rates between women and men particularly staggering in low- and middle- income countries. The food environments that most people live in have been defined as “obesogenic”, characterised by easy access to energy dense, highly palatable foods with poor nutritional value. There is an established need to intervene to change food environments to prevent obesity. However, minimal successes are evident with no country set to meet the World Health Organization goal of reducing obesity prevalence to 2010 numbers by 2025. In this review, we provide a narrative around the sex (biological) and gender (socio-cultural) related considerations for the relationship between nutrition, interactions with the food environment, and obesity risk. We provide an argument that there are gendered responses to food environments that place women at a higher risk of obesity particularly in relation to food industry influences, due to gendered roles and responsibilities in relation to paid and unpaid labour, and due to specific food security threats. This review concludes with hypotheses for addressing the obesity burden in a gender responsive manner, with a call for gender equity to be a key component of the development, implementation and monitoring of obesity prevention focused policies going forward.
... 2,25 Adult Americans consume at least 11% of their total caloric intake by eating at snack bars or fast food restaurants. 26 Over the 20-year period from 1986 to 2016, restaurant entrée portion sizes increased by 26 g and desserts by 48 g, 26 with a 5-time increase in portion size of ultraprocessed foods since 2002. 27 This increase in portion size has been linked to peoples' underestimation of energy intake 28 and to increasing obesity in the United States. ...
... 2,25 Adult Americans consume at least 11% of their total caloric intake by eating at snack bars or fast food restaurants. 26 Over the 20-year period from 1986 to 2016, restaurant entrée portion sizes increased by 26 g and desserts by 48 g, 26 with a 5-time increase in portion size of ultraprocessed foods since 2002. 27 This increase in portion size has been linked to peoples' underestimation of energy intake 28 and to increasing obesity in the United States. ...
... 27 This increase in portion size has been linked to peoples' underestimation of energy intake 28 and to increasing obesity in the United States. 26,27 Portion control has been demonstrated to be a successful strategy for weight maintenance 29,30 ; however, some studies that used portion control for weight loss showed initial weight loss with portion control use declining over a year's time. 31 Studies have additionally found that a large portion at one meal did not decrease the size of subsequent meals. ...
Objective
Because eating, nutrition, and weight management patterns adopted during pregnancy may persist beyond the postpartum period, pregnancy provides an opportunity for health education that affects the future health of the pregnant person, the fetus, and the family. This systematic review aimed to find nutrition and weight management behaviors that could be used safely during pregnancy to optimize gestational weight gain.
Methods
PubMed, MEDLINE, and Web of Science were searched for research or systematic reviews published in English from 2018 to 2023 using terms including gestational weight gain maintenance, weight, management, pregnancy, behavior, strategy, and strategies. Excluded research used pediatric or adolescent populations, restrictive diets such as no carbohydrate or no fat diets, fasting, bariatric surgery, weight loss medications, private industry, or profit-earning programs using food brands or specific diet programs.
Results
The abstracts reviewed in these areas: excessive gestational weight gain (1019), low-glycemic index diet (640), Mediterranean diet (220), MyPlate diet (2), the Dietary Approaches to Stop Hypertension (DASH) diet (50), portion control (6), home meal preparation (6), mindful eating (13), intuitive eating (10), self-weighing (10), and motivational interviewing during pregnancy (107), were reduced to 102 studies. Studies in those 10 areas were reviewed for nutrition and eating behaviors that are safe to use during pregnancy and could be used along with motivational interviewing.
Conclusion
Clinicians can discuss these behaviors using motivational interviewing techniques to assist clients in optimizing gestational weight gain. Dialogue examples pairing these strategies with motivational interviewing principles are included.
... There is also some evidence to suggest that greater access to fast-food restaurants is associated with worse diets and higher prevalence of obesity [10,11], but, again, some studies report otherwise [12,13]. The hypothesized pathway is that those shopping at convenience stores and fast-food restaurants, where the availability of energy-dense, nutrient-poor food and beverage items is high [14][15][16], are likely to make less healthy food purchases. In contrast, supermarkets and waitservice restaurants sell a mix of healthy and less-healthy food and beverage items [17,18]. ...
... expenditures during this period [40]. Evidence also suggests that restaurants have shifted to selling less healthy food and beverage items over time [15,41]. ...
Objective
The aim of this study was to examine relationships between the food environment and obesity by community type.
Methods
Using electronic health record data from the US Veterans Administration Diabetes Risk (VADR) cohort, we examined associations between the percentage of supermarkets and fast‐food restaurants with obesity prevalence from 2008 to 2018. We constructed multivariable logistic regression models with random effects and interaction terms for year and food environment variables. We stratified models by community type.
Results
Mean age at baseline was 59.8 (SD = 16.1) years; 93.3% identified as men; and 2,102,542 (41.8%) were classified as having obesity. The association between the percentage of fast‐food restaurants and obesity was positive in high‐density urban areas (odds ratio [OR] = 1.033; 95% CI: 1.028–1.037), with no interaction by time (p = 0.83). The interaction with year was significant in other community types (p < 0.001), with increasing odds of obesity in each follow‐up year. The associations between the percentage of supermarkets and obesity were null in high‐density and low‐density urban areas and positive in suburban (OR = 1.033; 95% CI: 1.027–1.039) and rural (OR = 1.007; 95% CI: 1.002–1.012) areas, with no interactions by time.
Conclusions
Many healthy eating policies have been passed in urban areas; our results suggest such policies might also mitigate obesity risk in nonurban areas.
... Adopting and maintaining healthy lifestyle habits when using FDAs is recommended as a fundamental health principle. Thus, analysing their dietary habits, preferences and frequency using FDAs (72.7%) can express the future predominance of health risk behaviours such as high body mass index [22]. These health risks may become more prevalent and could persist after the pandemic among those students (82.2%) receiving monthly financial rewards (80.5%), aged between 18-24 years (64.9%), with either high school and lower qualifications (41.7%), or undergraduate and postgraduate degrees (58.3%), specificity for those who were not self-perceived obese (80%). ...
... Other studies showed similar findings about the increased intake of carbohydrates, fat and fried food consumption [5,32]. Therefore, unhealthy food consumption paired with low physical activity, especially for students with time constraints or busy schedules, may yield a positive energy balance, increased body weight and related chronic diseases [22,[33][34][35][36][37][38][39][40][41][42]. Similar findings concerning the increased consumption of high calories due to COVID-19 confinement were also observed [24,[43][44][45]. ...
Food delivery applications (FDAs) shined during COVID-19 global lockdown restrictions. Consequently, lifestyle changes imposed a greater use of these applications over this period. These changes may strongly influence the nutritional health of individuals, particularly adult Saudi females. A cross-sectional study was performed to examine the influence of using FDAs during COVID-19 lockdown restrictions on attitude behaviours, including dietary habits and preferences among Saudi adult females. Participants voluntarily submitted their answers to a questionnaire administered via the Google Survey platform. Results illustrated that most Saudi female users of FDAs were aged between 18–24 years with 64.9%, 91.5% being single and 37% ordering food online within one to two days a month. There was a significant association between the influence of using FDAs during COVID-19 lockdown restrictions and age, education, and average days of ordering food online (p ˂ 0.05). Another important factor is that higher education was associated with more frequent use of the FDAs, there were direct relationships between education level and using FDAs, 58% of the participants were educated as undergraduate or postgraduate. Although lifestyle changes increased the use of FDAs during COVID-19 global lockdown restrictions, these changes may negatively affect individuals’ dietary habits and preferences, particularly adult Saudi females. These findings can aid in promoting healthy diet management globally and in Saudi Arabia unless the governments lead to significant beneficial changes toward improving food delivery applications.
... Qualified researchers may request access to study documents (including the clinical study report, study protocol with any amendments, blank case report form, statistical analysis plan) that support the methods and findings reported in this manuscript. Data requests, including individual anonymized participant data, will be considered for sharing (1) once the product and indication has been approved by major health authorities (e.g., FDA, EMA, PMDA, etc.) or development of the product has been discontinued globally for all indications on or after April 2020 and there are no plans for future development, (2) if there is legal authority to share the data, and (3) there is not a reasonable likelihood of participant re-identification. Submit requests to https://vivli.org/ (the typical response time is 6-12 months). ...
Evolutionary pressures to protect against food scarcity likely resulted in highly-conserved pathways designed to minimize energy expenditure, one of which involves the minimization of muscle mass; these mechanisms may be counter-productive in a modern world suffering from obesity and sarcopenia. Growth differentiation factor 8 (GDF8)/myostatin, acting via ActRIIA/B receptors, is the best-characterized negative regulator of muscle mass, leading to therapeutic efforts to augment muscle growth by blocking GDF8 or ActRIIA/B. ActRIIA/B blockade approximately doubles the muscle increase of GDF8 blockade, and as ActRIIA/B responds to multiple other TGFβ-family members, this implies other ligands might also regulate muscle mass. Previously, we suggested that activin A (ActA) is the key second negative regulator acting via ActRIIA/B, as blockade of both GDF8 and ActA in mice/monkeys matches the muscle growth of ActRIIA/B blockade. Here, we extend these observations to humans in a two-part, randomized, placebo-controlled Phase 1 trial (www.clinicaltrials.gov, NCT02943239) conducted at two sites in New Zealand. Eligible subjects included healthy postmenopausal females aged 45–70 years and males aged 35–60 years not intending to father children, with a body mass index of 18–32 kg/m². Part I tested single-dose administration of anti-GDF8 alone, anti-ActA alone, several dose combinations of anti-GDF8 + anti-ActA, or placebo in healthy postmenopausal females; part II tested multiple-dose administration of anti-ActA alone or placebo in healthy postmenopausal females, combination anti-GDF8 + anti-ActA or placebo in healthy postmenopausal females, and anti-ActA alone or placebo in healthy males. The primary outcome measure was the incidence and severity of treatment-emergent adverse events through week 16 for the single-dose part of the study and through week 40 for the multiple-dose part of the study. Secondary endpoints included percent and absolute change in thigh muscle volume, percent and absolute change in total and regional body composition, pharmacokinetic profiles of the GDF8 and ActA mAbs in serum over time, changes in serum total GDF8 and total ActA levels over time, and the presence of anti-drug antibodies against the GDF8 mAb or the ActA mAb. Magnetic resonance imaging was used to quantitate changes in thigh muscle volume and dual x-ray absorptiometry was used to quantitate changes in regional body composition (total lean mass, appendicular lean body mass, android fat mass, and total fat mass). A total of 82 subjects were enrolled (48 in the single-dose part and 34 in the multiple-dose part of the study). Baseline demographic and clinical characteristics were generally balanced across the single- and multiple-dose parts of the study. Combining GDF8 and ActA blocking antibodies led to greater muscle growth than either antibody alone; increases in muscle were accompanied by reductions in fat. The observed clinical effects on muscle and fat paralleled mAb exposure in serum. The combination was generally well tolerated, and no subjects tested positive for anti-drug antibodies post-treatment. These results suggest that GDF8 and ActA are the dominant negative regulators of muscle mass in humans, and that combined blockade may be a promising therapeutic approach in muscle atrophy and obesity settings.
... During much of evolutionary history, when food scarcity and caloric deprivation was a major evolutionary pressure, mechanisms evolved to minimize muscle size and thus decrease non-essential energy expenditure 42,44,55 . In much of the modern world, in which the population is now exposed to widely available and vastly excessive calories as well as to increasingly sedentary lifestyles [56][57][58][59] , these ancient survival-ensuring mechanisms are not merely irrelevant, but actually counter-productive and contribute to the obesity epidemic; it is disadvantageous to decrease muscle mass and associated energy expenditure during weight loss efforts that rely on caloric restriction. While GLP-1 RAs have provided an important new weapon for those suffering from profound obesity, they unfortunately trigger the same counter-productive mechanisms as other weight-loss efforts, which rely on caloric restriction, resulting in muscle loss, which limits the fat loss and metabolic benefit. ...
Glucagon-like peptide-1 receptor agonists act via appetite suppression and caloric restriction. These treatments can result in significant muscle loss, likely due to evolutionary mechanisms protecting against food scarcity as muscle is a major energy utilizer. One mechanism that reduces muscle mass involves activation of type II activin receptors, ActRIIA/B, which yield profound muscle growth in humans when blocked. We previously demonstrated GDF8, also known as myostatin, and activin A are the two major ActRIIA/B ligands mediating muscle minimization. Here, we report that dual blockade can also prevent muscle loss associated with glucagon-like peptide-1 receptor agonists – and even increase muscle mass – in both obese mice and non-human primates; moreover, this muscle preservation enhances fat loss and is metabolically beneficial. These data raise the possibility that supplementing glucagon-like peptide-1 receptor agonist treatment with GDF8 and activin A blockade could greatly improve the quality of weight loss during the treatment of obesity in humans.
... FF and full-service restaurants account for roughly 20% of daily calories in the US (3) while FF customers tend to underestimate how many calories they have consumed (4) . Over a recent thirty-year span, FF restaurants have increased the variety of their menus along with the portion size, calories served, and sodium content (5) . ...
Objective
While fast-food is typically considered highly processed, an analysis to demonstrate this has yet to be conducted. Therefore, the objective of this research was to examine the menu items and ingredients from six fast-food restaurant menus using the NOVA Classification.
Design
Cross-sectional study.
Setting
Data were collected from the top six highest selling United States restaurants, per each food category, identified using the Quick Service and Fast Casual Restaurants (QSR) 2020 Report.
Participants
A total of 740 menu items were identified and classified according to their degree of processing based on ingredient lists using the NOVA Classification: Minimally Processed (MPF), Culinary Processed Ingredient (CPF), Processed (PRF), or Ultra-processed (UPF). In addition, individual ingredients that appeared on at least three menus were classified into NOVA groups, and the 20 most common ingredients were identified based on frequency of appearance in ingredient lists.
Results
Across all menus, 85% (Range: 70-94%) of items were UPFs with only 11% (Range: 6-25%) being MPF (p<0.001). Additionally, 46% of the ingredients that appeared on at least three menus were ultra-processed ingredients. Three ultra-processed ingredients appeared on all six menus: natural flavors, xanthan gum, and citric acid.
Conclusions
These findings show that the vast majority of menu items from major fast-food restaurants are UPFs and there are few options for MPFs. Fast-food companies should consider reformulation or the addition of MPF to the menu to increase healthful food options for their patrons.
... Food serving sizes have increased considerably over time [1], with large servings and packages commonly available and attractively presented in the current food environment [2][3][4]. Constant exposure to larger sizes can result in consumers considering these as the new 'normal', a phenomenon commonly termed 'portion distortion' [5,6]. ...
Background
There are limited data on the amount of discretionary foods that people normally consume and consider as appropriate at one eating occasion. This study aimed to provide an overview of the range and assess differences of the ‘normal portion size’ and ‘perceived appropriate portion size’ of energy-dense nutrient-poor discretionary foods among consumers aged 18–65 years.
Methods
To measure normal and perceived appropriate portion sizes, a validated online image-series questionnaire consisting of eight successive portion size options for 15 discretionary foods was completed at two timepoints. Quantile regression models were used to estimate the ranges (lower boundary at 17th percentile, upper boundary at 83rd percentile) of normal and perceived appropriate portion sizes selected by two thirds of the study population. Models were adjusted for the effects of potential influencing factors including biological sex, age, usual physical activity level, cooking confidence, socio-economic status, body mass index, and baseline hunger levels.
Results
A final sample of 295 participants were included in the analysis (51% females, mean age 39.5 ± 14.1 years). The normal portion sizes were significantly higher than the perceived appropriate portion sizes across all test foods, with the effects of sex, age, and BMI being significant for some foods.
Conclusion
The finding suggests that consumers would normally consume a portion size that was larger than what they perceive to be appropriate for discretionary foods. The estimated lower and upper boundaries would be valuable for the development of pragmatic public health messages to empower consumers towards better portion control.
... Nevertheless, fast food products in themselves are not healthier whether in HICs or LMICs, regardless of the laws of demand and supply. In fact, robust studies demonstrate detrimental changes in the nutritional quality of fast food within the past 30 years including increased energy and sodium content [80]. Thus, health claims would only serve to promote the perception of healthfulness which might increase the effect of the fast food advertisement among adolescents in LMICs. ...
Objectives
To explore the promotion of fast food to lower-income adolescents on Instagram with the specific aims of (i) identifying the marketing strategies used by fast food brands on Instagram to promote fast food to Nigerian adolescents and (ii) examining the influence of these strategies on user engagement.
Design
A content analysis of posts from a 90-day period of the Instagram accounts of five fast-food brands in Nigeria was conducted. Overall, 576 posts were analysed, using a codebook developed based on the relevant literature, to identify adolescent-targeted strategies. User engagement was measured by number of likes each post received.
Results
The observed brands frequently utilised adolescent-targeted marketing strategies, with the most popular strategies being emotional appeal, ‘teen language’ and product appeal. The results of Mann-Whitney U tests revealed significant associations between the use of these promotional strategies and user engagement. Adolescent-aimed strategies like product appeal and competitions resulted in higher user engagement with fast food promotional content.
Conclusion
Fast food companies heavily target lower income adolescents through the use of Instagram. This raises health concerns related to the consumption of unhealthy food that arises from regular advertising in that demographic. Further, this exposure increases ad interactions that could cause adolescents to view fast foods more positively. Overall, findings indicate the need for actions aiming to limit and reduce the effect of adolescents’ exposure to fast food marketing on social media, to target the features of social media platforms which affords users the ability to interact with fast food advertisements.
... Additionally, agencing sociotechnical elements aiming to reduce the list of meals (Jones, 1983), fast food has been reframed, including an increase in food variety in the U.S., its center of origin, as demonstrated by McCrory et al. (2019). In particular, "there were substantial increases in the number of foods across and within menu categories, indicating a greater variety of food choices available, and the additional choices were not all healthy" (McCrory et al., 2019, p. 927). ...
Objective
in order to collaborate with the ongoing research program on how markets intersect and overlap, this theoretical essay introduces the notion of market interdefinition agencing.
Theoretical framework
the theoretical framework draws on previous constructivist market studies on the process of framing, overflowing, translation, and agencing in a market interaction context.
Methods
to illustrate the market interdefinition agencing, this article uses a theoretical essay on slow and fast food markets.
Results
this essay depicts how slow food can be seen as an overflow in opposition to fast food framing, agencing opposite sociotechnical elements for the construction of this new frame, and how slow food also contributes to a new fast food frame.
Conclusion
first, this essay shows that both food markets entangle and disentangle sociotechnical elements that move away from or closer to each other, translating and agencing their sociotechnical arrangements. Second, market interdefinition agencing is delineated as a process of market interrelation that happens through the capacity of actors to shape markets, where a previous market is used as a reference to influence another market frame.
Keywords:
markets interaction; fast food; slow food; market interdefinition agencing; constructivist market studies
... The weight proportion (%) was used, rather than an energy ratio, because it could capture UPFs that provide no or low energy (e.g., artificially sweetened drinks) [33]. The servings of UPFs were not used because the serving size differs across nations and changes over time [34,35]. In addition, the same unit of one serving across different foods may be hard to reflect different food content and processing methods. ...
... [25][26][27] However, given that most OFDS offer fast food, with expanded variety, portion size, energy, and sodium content over the last 30 years, this satisfaction value is closely related to increased intake of high-risk food, which can lead to various health impacts in the future. [28][29][30] In this study, the respondents with a high level of satisfaction made 3.8 times more frequent transactions. If customers feel satisfied with the transaction, their frequency of purchases will also increase. ...
Purpose: The increasing desire of the community towards fulfilling the practical needs of life is currently accommodated by the rapid development of communication technology in the last five years in Indonesia. One example is the emergence of various food delivery applications. This will affect the pattern of daily food consumption in the community. Therefore, this study determined the personal and socio-environmental factors that influence the frequency of online food ordering (OFO) behavior and also high-risk food consumption through online food delivery services (OFDS) among young adults in Depok City. Theoritical Framework: This study adopts the social cognitive theory, developed by Bandura, as its framework. This theory is one of the most widely applied theories to discusses the determinants of health behavior. It is built on an understanding of the interactions that occur between individuals and environment. Methods: This research was a cross-sectional study conducted with 686 participants of young adults aged 20–39 years that lived in Depok City, West Java Province, Indonesia, for minimal the last six months. They were administered a questionnaire through Alchemer, formerly SurveyGizmo. Descriptive statistics were employed for all variables measured. A T-test and a Chi-square test were conducted to determine the factors influencing the OFO frequency and high-risk food consumption through OFDS. Predictor variables were generated using multi-logistic regression models. Results: The personal and socio-environmental factors related to the frequency of OFO behavior were attitudes toward risk, benefit, barriers, features of OFDS, satisfaction with OFDS, socio-environmental influence, perception about OFDS, and online food preference. Furthermore, the factors associated with high-risk food consumption through OFDS were attitudes toward benefit, features, satisfaction with OFDS, socio-environmental influence, perception about OFDS, online food preference, and knowledge of OFDS. The predictor for the frequency of OFO behavior was satisfaction toward OFDS (ß = 3.3; CI: 2.4–4.7; p-value <0.001), while those for high-risk food consumption were personal and socio-environmental factors (ß = 1.8; CI: 1.3–2.5; p-value = 0.001 and ß = 1.7; CI: 1.2–2.4; p-value = 0.001, respectively). Conclusions: Satisfaction, social environment, and food preference play essential roles in OFDS. The findings demonstrated the urgency of conducting further studies to elaborate on the association of OFDS with non-communicable diseases.
... Moreover, some studies have investigated specific health problems caused by changes in the food environment as a result of OFD. For example, FAFH, which is closely supported by OFD, has been shown to be generally high in calories, added sugar, saturated fat, salt, and low in nutritional value [26,[35][36][37][38]. These food characteristics have been proven as key risk factors for chronic diseases such as obesity, high cholesterol, diabetes, and hypertension [20][21][22][23] [43] suggested that the low-nutrient food through OFD is a key factor leading to overweight and obesity. ...
Background
Today, the popularization of mobile internet technology has enabled the public’s need for food convenience and diversity arising from modern fast-paced lifestyles to be met at a relatively low cost. The digital age of the restaurant industry has arrived. Online food delivery (OFD) is rapidly developing globally. However, the public’s awareness of the nutritional quality of food through OFD and their knowledge of dietary nutrition remain to be investigated.
Methods
In the context of China, this study attempts to evaluate the nutritional quality of best-selling OFD set meals (i.e., meal combos) based on the current official Chinese dietary guidelines 2022. It accomplishes this by collecting data on popular OFD restaurants among consumers in 115 Chinese universities from the restaurants’ delivery addresses. Moreover, 20,430 valid questionnaires were collected online from undergraduates, graduate students, and other young groups aged 18–30 throughout China for descriptive analysis to investigate consumers’ perceptions of the nutritional quality of food through OFD and its health impact.
Results
The results of the nutritional quality evaluation of the OFD set meals ranged widely from 15 to 85, with a mean of 36.57 out of a possible maximum score of 100; and 89.56% scored less than 50. The nutritional quality of OFD foods was thus generally low. The nutritional quality of foods was negatively correlated with their popularity among consumers.
Conclusions
Young OFD consumers generally paid low attention to dietary nutrition knowledge and seldom paid attention to nutritional quality when choosing OFD foods while the nutritional quality of OFD foods was generally low. Respondents subjectively reported that long-term consumption of OFD food caused weight gain, increased blood lipids, and gastrointestinal discomfort. They thought that the reason might be excessive oil, salt, and sugar in the food, while ignoring the balance between different types of food.
... This means that cognitive shortcuts influence usual eating behaviours and habits, in turn influencing health. People are more susceptible to environmental influences than they may realiseportion size, advertising, marketing and price impact upon purchase and consumption behaviours (Coates et al, 2019;McCrory et al, 2019;Hallez et al, 2020). Focusing on personal responsibility but neglecting to recognise the influence of the obesogenic environment on weight-related behaviours, is counterproductive. ...
The coronavirus disease 2019 (COVID-19) pandemic has further emphasised the importance of recognising obesity as a health issue for adults and children, with associated increases in obesity prevalence and risk of severe illness and death from COVID-19. Obesity is highly visible and highly stigmatised. It is frequently regarded as a result of lifestyle choices and behaviours, with a focus on personal responsibility rather than as a complex, multifactorial disease with a strong genetic component. Healthcare professionals, including nurses, have an important role in supporting behaviour changes, and discussing weight with patients in neutral and respectful ways. This article outlines the effects of the COVID-19 pandemic on weight and weight-related behaviours and discusses the complexity of obesity and weight stigma. It also emphasises the importance of nurses advocating for action to address the obesogenic environment.
... [1][2][3][4][5][6][7] Data from the United States show that the portion sizes of salty snacks, fast food, and sugar-sweetened beverages in both adults and children have increased by more than 30% in 20 years. 1,4,8,9 Between 1995 and 2011-2012, the typical portion size of pizza and ice cream in Australia has increased by 66% and 39%, respectively. 5 Discretionary foods in large serving sizes and packages are presented attractively in the current food environment, usually at a lower unit price, providing greater value compared with smaller packages. ...
Context
Portion size norm is described as the perception of how much of a given food people choose to eat. Reducing the portion size norm of foods that are high in saturated fat, added sugar, and added salt toward smaller sizes might be a potential strategy to promote appropriate portion size selections. However, an overview of existing portion size norms for discretionary foods has yet to be established.
Objective
The aim of this systematic review was to examine the portion size norm of discretionary foods and assess the methodologies used to investigate the norm.
Data Sources
The literature search was conducted in 6 databases following the PRISMA guidelines (from inception to January 2022).
Data Extraction
Forty studies were eligible and grouped into 3 categories by portion size norm measures: normal (n = 26), appropriate (n = 8), and preferred portion sizes (n = 3). Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools.
Data Analysis
A wide range of portion sizes were considered normal for each food type, with means/medians varying from 2- to 4-fold among studies. Studies differed considerably in design, with variables including the setting, food type, food presentation, the manner in which portion-size-related questions were formulated, and the range and number of displayed serving size options. The quality of reviewed studies was mixed (25 studies had low or moderate risk of bias, 15 had high risk of bias), and the method of assessing portion size was not validated in 15 of 33 quantitative studies.
Conclusion
The assessment of portion size in future studies should be conducted using tools that are validated for the population of interest so that more definitive conclusions can be drawn regarding portion size norms for discretionary foods.
Systematic Review Registration
PROSPERO registration number CRD42021249911.
... Fast food is defined as processed food that is easy to prepare and serve in restaurants for takeout and fast food. Initially, fast food outlets were aimed at people busy working and who did not have time to eat [6]. However, along with the times, fast food outlets can be well received by the public because their presentation is quick, easy, and offers flexibility in consuming them. ...
Technology development causes easy access to various sectors, including ordering food online. Fast food is one of the foods that many people reviewed in online applications that are high in fat with a density of 40% of total calories. Meanwhile, the consumption of vegetables and fruits of Indonesia’s people is still inadequate; only 63.3% consume as recommended. These things will undoubtedly increase the body mass index (BMI) and increase the risk of overweight and obesity. This study aims to analyze the impact of online order development on fast food, vegetables, and fruits consumption behavior on students in Surabaya. This descriptive cross-sectional study enrolled 317 students in Surabaya City, East Java, Indonesia. The online survey collected data through online platforms, SurveyMonkey. Data were analyzed in statistical software SPSS 25.0 using multivariate binomial linear regression test. The significance level was set at p<0.05. Regression analysis shows that the habit of ordering boba drinks with a weekly frequency has a significant relationship with the incidence of overweight/obesity in respondents (p = 0.015; OR = 3.037; 95% CI (1.236-7.462)) when compared to respondents who have the habit of ordering and consuming boba drinks every month. Consumption habits of boba drink are associated with higher body mass index (BMI), increasing the risk of overweight and obesity. A policy from the government and related parties is needed to regulate boba consumption limits for the community.
... Alongside increased availability and convenience, portion sizes of many popular energy-dense-nutrient-poor products have increased over the past decades (Benson, 2009;Matthiessen et al., 2003;McCrory et al., 2019;Nielsen & Popkin, 2003;Steenhuis et al., 2010). The introduction of super-sized meals, sharing size packets of crisps, and more recently, sharing pouches of chocolate are examples of these changes. ...
The average adult in the UK consumes 200-300 calories beyond their Guideline Daily Amount. For working adults, more than one-third of calories are consumed in the workplace, making this an important environment for intervention. This thesis makes a contribution to the academic literature, by improving our understanding of how and when offering lower-energy alternatives (‘swaps’) is effective, and to public health by refining an intervention which could be delivered in workplace canteens. Two scoping reviews were conducted (studies 1 & 2) and pointed towards the potential effectiveness of pre-ordering lunch and offering healthier swaps as strategies that may help to improve the healthfulness of food and drink choices. When offering lower energy swaps for snacks and non-alcoholic drinks, studies 3 (n=449) and 4 (n=3,481) recruited samples of UK adults in employment to test the effect of different messages on the acceptance of swaps in an experimental online canteen. The results indicated that messages focusing on the lower-energy content of swaps offered may be an effective and acceptable approach. When highlighting the energy content of swaps offered, increasing the interpretability of this information, by providing physical activity calorie equivalent information (PACE) (i.e., the number of minutes walking required to expend the energy contained) further increased the acceptance of snack and drink swaps offered. In study 5, an online version of a real-world canteen was developed and the intervention (prompts to swaps accompanied by a PACE message) was due to be tested in a real-world trial with the healthcare organisation Bupa. However, due to Covid-19, it was tested qualitatively with employees (n=30) of this organisation across the full lunch menu to provide insights about the factors perceived to influence swap acceptance and the acceptability of the intervention. Swap acceptance was facilitated by the provision of PACE information, and swap similarity in terms of taste, texture, and expected satiety as well as the perception that alternatives provided meaningful energy savings. Overall, the intervention was viewed as an acceptable approach to help reduce energy intake in the workplace. Following refinements to the intervention, Study 6 tested the effect of offering lower-energy swaps with and without PACE messages on the energy of hypothetical lunches pre-ordered with a representative online sample of working adults (n=2,150). Offering swaps with and without a PACE message was found to significantly reduce average energy ordered at lunch compared to when no swaps were offered, the PACE message was more acceptable, and there was no evidence of significant interactions between intervention efficacy and participant characteristics. Offering lower-energy swaps in the workplace when employees pre-order is an acceptable and promising intervention to reduce the energy of foods and drinks ordered. Future work should replicate this research in real-world settings.
... The studies showed us that unbalanced nutrients, too much fat or salt intake and irregular dining times are the mainly problems people must be concerned about when choosing something to eat. Also, it is said that food away from home tends to higher in energy density but lower in fruits and vegetables [38,39,40,41]. Additionally, the problem we study today is related to food safety. ...
With food industry developing so fast around the world and food delivery becomes popular among young adults, people today tend to have meals that are not prepared at home. However, it reminds people to rethink about their body health especially gastric health. In this case, we decided to find out the association between the frequency of having meals not home prepared and the risk of having stomach or intestinal illness. We assumed that people who had meals away from home would be more likely to suffer from gastric diseases. 19,293 adults over twenty years old participated in diet and health questionnaires according to NHANES database from 2011 to 2018. Multivariable regression was used to measure the association between the frequency of having meals out and the risk of having gastric diseases by using Empower Stats. According to the p values and odds ratio values given by Empower Stats, no significant association between the exposure variable and the outcome variable was found. Thus, we drew a conclusion that there was no association between the frequency of eating out and the risk of having gastric diseases.
... given that most OFDS offer fast food, with expanded variety, portion size, energy, and sodium content over the last 30 years, this satisfaction value is closely related to increased intake of high-risk food, which can lead to various health impacts in the future. (25)(26)(27) In this study, the respondents with a high level of satisfaction made 3.8 times more frequent transactions. If customers feel satis ed with the transaction, their frequency of purchases will also increase. ...
Background
The increasing desire of the community towards fulfilling the practical needs of life is currently accommodated by the rapid development of communication technology in the last five years in Indonesia. One example is the emergence of various food delivery applications. This will affect the pattern of daily food consumption in the community. Therefore, this study determined the personal and socio-environmental factors that influence the frequency of online food ordering (OFO) behavior and also high-risk food consumption through online food delivery services (OFDS) among young adults in Depok City. Methods
This research was a cross-sectional study conducted with 686 participants of young adults aged 20–39 years that lived in Depok City, West Java Province, Indonesia, for minimal the last six months. They were administered a questionnaire through Alchemer, formerly SurveyGizmo. Descriptive statistics were employed for all variables measured. A T-test and a Chi-square test were conducted to determine the factors influencing the OFO frequency and high-risk food consumption through OFDS. Predictor variables were generated using multi-logistic regression models. The predictor for the frequency of OFO behavior was satisfaction toward OFDS (ß = 3.3; CI: 2.4–4.7; p-value = 0.000), while those for high-risk food consumption were personal and socio-environmental factors (ß = 1.8; CI: 1.3–2.5; p-value = 0.001 and ß = 1.7; CI: 1.2–2.4; p-value = 0.001, respectively).ResultsThe personal and socio-environmental factors related to the frequency of OFO behavior were attitudes toward risk, benefit, barriers, features of OFDS, satisfaction with OFDS, socio-environmental influence, perception about OFDS, and online food preference. Furthermore, the factors associated with high-risk food consumption through OFDS were attitudes toward benefit, features, satisfaction with OFDS, socio-environmental influence, perception about OFDS, online food preference, and knowledge of OFDS. Conclusions
Satisfaction, social environment, and food preference play essential roles in OFDS. The findings demonstrated the urgency of conducting further studies to elaborate on the association of OFDS with non-communicable diseases.
... Fried potatoes (chips) are also common in all countries and many type of restaurants as the most frequently offered side dish in the menus. These types of food have been described as high in fat, salt and energy (Garemo and al Naimi, 2018;McCrory et al., 2019;Sliwa et al., 2016), thus contributing to diet related diseases. Apart from this, fat highly increases palatability (Montmayeur et al., 2010), thus potentiating overeating and promoting the liking for these types of foods, which, as addressed before, is particularly significant for children while developing food preferences (Anzman-Frasca et al., 2018;Beckerman et al., 2017;Birch and Fisher, 1998). ...
Purpose
The aim of this study is to identify and characterize kids' menu offer in fast-food and traditional restaurants located in shopping centres in five different countries.
Design/methodology/approach
An observational cross-sectional study is carried out, though a study was performed in all restaurants located in shopping centres from main cities, in five countries: Brazil, Chile, Croatia, Hungary and Portugal. A tool for assessing the quality of menus is used for the analysis (Kids Menu Healthy Score (KIMEHS)). Menu prices between countries were compared.
Findings
A total of 192 kids' menus were collected, 44 in Portugal, 57 in Brazil, 66 in Chile, 15 in Hungary and 10 in Croatia. All the countries have average negative KIMEHS values for the menus, indicating that the offer is generally poor in terms of healthy options. The cost of children's menus in European countries is generally low. In Brazil, the price is significantly more expensive, which may limit the accessibility by social economically deprived populations. No significant differences were found in the average cost of meals from different restaurants typology. Traditional/Western restaurants present the highest price.
Practical implications
Globally, kids' menus are composed by unhealthy food items, pointing to the need of improvements in food availability, aiming to promote healthy food habits among children.
Originality/value
This study presents innovative data on children's menus, allowing for characterization of meals offered to children and comparison between different countries.
Key points Kids’ menus are composed by unhealthy food items.
Improvement of kids' menus quality will promote children food habits.
Healthier out-of-home food consumption will contribute to public health.
... For example, McDonalds opened its first restaurant in 1937, the first KFC franchise opened in 1952, and the first Burger King franchise opened in 1954. Moreover, the menu offerings of such establishments are becoming increasingly unhealthy over time (McCrory et al., 2019). ...
My thesis considers the theme of comorbidity between cardiometabolic disorders and schizophrenia by focussing on three key aspects: the nature of association between cardiometabolic disorders and schizophrenia; the potential for common underlying biological mechanisms for the comorbidity; and the prediction of cardiometabolic risk in young adults with psychosis. On the nature of association between cardiometabolic disorders and schizophrenia, using longitudinal repeat measure data from a large birth cohort, I found that disruption to glucose-insulin homeostasis through childhood/adolescence is associated with increased risk of psychosis in early-adulthood; may not be fully explained by common sociodemographic and lifestyle factors; and may be specific to it. On the mechanisms of association between cardiometabolic disorders and schizophrenia, I used a range of genetic and observational epidemiological methods to examine whether inflammation and shared genetic liability may be common underlying biological mechanisms for the comorbidity. Using birth cohort data, I show that genetic risk for type 2 diabetes is associated with psychosis-risk in adulthood, and vice versa. I also show that genetic risk for type 2 diabetes may influence psychosis risk by increasing systemic inflammation. Using summary data from large genome-wide association studies (GWAS), I show a thread of evidence for shared genetic overlap between schizophrenia, cardiometabolic and inflammatory traits. Finally, using Mendelian randomization, I show evidence supporting that inflammation may be a common cause for insulin resistance and schizophrenia. On the prediction of cardiometabolic risk in young adults with psychosis, I performed a systematic review of cardiometabolic risk prediction algorithms and explored their predictive performance in a sample of young people at risk of developing psychosis. In doing so, I show that none are likely to be suitable for this population. Then, using patient data, I developed and externally validated the Psychosis Metabolic Risk Calculator (PsyMetRiC), the first cardiometabolic risk prediction algorithm specifically tailored for young people with psychosis. Together, my work suggests that cardiometabolic disorders and schizophrenia share aetiologic mechanisms, namely inflammation and shared genetic liability. I have shown that it is possible to accurately predict cardiometabolic risk in young people with psychosis using a tool tailored for the population. Such tools can in future become valuable resources for clinicians to reduce the risk of long-term cardiometabolic morbidity and mortality in people with schizophrenia.
... However, after one decade since the beginning of the discussion, the marketers have not learned the new lesson yet. For example, to offer varied meals that please customers' taste, fast-food chains provide less balanced menus than 30 years ago (McCrory, Harbaugh, Appeadu, & Roberts, 2019), even in the face of the global obesity problem. Moreover, there is the case of excessive use of agrochemicals in the food industry to improve the aesthetic attributes of products and meet customer demands for a pleasing appearance on the supermarket shelf. ...
The new marketing myopia portrays companies that focus excessively on the customer, neglecting other stakeholders' demands that can transform the market and lead companies to failure. Although this discussion is present in marketing literature, researchers and marketers miss trails to identify new marketing myopia. This study aims to analyze business strategies under the new marketing myopia perspective. Qualitative and descriptive research was undertaken through a multiple case study of five South American companies acknowledge by Forbes for the customer orientation. This study demonstrates the companies' difficulty to equilibrate customers and other stakeholders’ demands to define their business strategies.
... From 1986 to 2016, fast-food consumption increased 226% in variety, portion size, and energy. 1 According to the Centers for Disease Control and Prevention (CDC), 6 in 10 adults have 1 or more chronic diseases that mostly can be controlled by nutrition. 2 But we rank number 1 in per capita use of pharmaceuticals, not knowing that these products are responsible for the fourth leading cause of death. ...
... On account of changing preferences owing to lifestyle in metro cities, high-income levels, rising middle class, and growing urbanization [1], there has been an ever-increasing dependency on organized retail stores along with round-the corner fast-food chains in the UAE. McCrory et al. [2] mention that fast food restaurants around the world are on the rise. The cold storage chains are thereby the life-blood for frozen (food) businesses. ...
The Cold Supply Chain (CSC) is an integral part of the supply chain of perishable products. The aim of this research is to examine the inhibitors that have a major impact on the performance of CSC operations in the United Arab Emirates (UAE). This study provides a synthesis and suggests a hierarchical model among CSC inhibitors and their respective relevance. The hierarchical synthesis of twelve (12) primary CSC inhibitors is achieved through a comprehensive literature review and consultation with academics and CSC professionals. This study used semi-structured interviews, a fuzzy interpretive structural modeling (FISM) and a Fuzzy-MICMAC (FMICMAC) analysis to explore and establish the relationship between and among identified inhibitors. FISM is used to examine the interaction between inhibitors, while FMICMAC analysis is used to examine the nature of inhibitors on the basis of their dependence and driving power. The results of the FISM and FMICMAC analysis show the inter-relationships and relative dominance of identified inhibitors. The results show that some inhibitors are of high strategic importance due to their high driving power and low dependence. These inhibitors seek more management attention in order to improve their effectiveness. The result of a hierarchical model helps to understand the influence of a particular inhibitor on others. ‘Higher capital and operating costs’ occupy the highest level in the FISM model. The ‘fragmented cold supply chains’, ‘lack of skilled labor’, ‘inadequate information system infrastructure’ and ‘lack of commitment by top level management’ had strong driving power but weak dependence, which characterizes them as independent inhibitors. Management should be extra careful when dealing with these inhibitors as they influence the effects of other variables at the top of the FISM hierarchy in the overall management of the cold supply chain. The study also suggests a number of recommendations for addressing these inhibitors in cold supply chains operating in the UAE. With due attention and care for these inhibitors, the operation of the cold supply chains is likely to be even more successful.
... During the past three decades, chain restaurant entrées have increased in portion sizes, calories, and sodium, along with the number of items available (32). Large portion sizes and higher energy density and fat content of restaurant meals can contribute to weight gain and obesity (33,34). ...
Background
Seafood has a nutritional profile that can be beneficial to human health, which gives it a role to play in healthy diets. In addition, because its production and harvesting can have fewer environmental impacts than some forms of animal protein, it can contribute to sustainable diets. However, the positive health and environmental outcomes are not guaranteed—they depend on how seafood is prepared and served and whether it is sourced from sustainable fisheries and aquaculture industries.
Objectives
We examined the availability and nutritional attributes of seafood meals at chain restaurants in the United States. We assessed nutritional attributes by store type and geography. We also assessed menu labeling for species, production methods, and origin.
Methods
The study population was 159 chain restaurants with 100,948 branch locations in the United States. Data were harvested from online restaurant menus, and the nutritional profile of seafood meals was calculated.
Results
The average seafood menu item provides up to 49–61% of the total daily limit of saturated fat, 65% of the total daily limit of sodium, and 58–71% of total daily protein requirement for adult men and women. Restaurant chains located in the Deep South and Ohio River Valley, and casual dining chains nationally, carry seafood meals with more total calories and saturated fat per 100 g than other regions or chain types. Most menu items did not list origin or production methods, which is information that would help consumers make informed decisions.
Conclusions
The added ingredients and cooking methods used at chain restaurants can attenuate the health benefits of seafood. We recommend reformulating menus to reduce portion sizes, total calories, added fat, and sodium content per meal and to improve consumer-facing information about origin and production methods.
... Restaurants are important intervention settings to improve nutrition and health. 1 Restaurants provide approximately 20% of US adults' daily calories 2 while meals "eaten out" exceed recommended portion sizes 3 and are more calorie-dense now than in previous decades. 4 Children also eat less healthy foods at restaurants versus home or school. 5 Community restaurant initiatives are one way to modify the food environment to increase availability of healthy options. ...
Purpose
Restaurants have the potential to improve nutrition and positively shape social norms. We describe lessons learned and recommended strategies from Eat Well El Paso! (EWEP), a local restaurant initiative.
Design
Descriptive case study.
Setting
EWEP partnered with local restaurants from 2012-2017 in El Paso, Texas, along the US/Mexico border.
Sample
Our sampling frame included EWEP staff and managers/owners at participating restaurants, of which the majority participated (80% and 85%, respectively).
Intervention
EWEP was a local restaurant initiative led by the city public health department. EWEP contracted registered dietitians to assist locally-owned restaurants to increase availability of healthy menu options.
Measures
Observation, key informant interviews, and document review assessed participation, barriers, and facilitators to restaurant participation and program sustainability.
Analysis
Thematic and descriptive analyses.
Results
57% of restaurants completed the full on-boarding process, but long-term retention was low (24% of completers). Restaurant managers/owners perceived value in marketing, nutritional analysis, and menu design. Barriers included scheduling, complexity of restaurant culture, fear of food inspections, restaurant turnover, competing responsibilities, and lack of dedicated funding.
Conclusion
Although local context and sample size may limit generalizability, lessons learned and recommended strategies are relevant and informative for communities working to increase restaurants’ healthy menu options.
There is a direct correlation between being overweight and iron deficiency. Physiological changes occur in obese adipose cells that contribute to the development of iron deficiency (ID) and iron deficiency anemia (IDA). These changes disrupt the normal iron metabolic checks and balances. Furthermore, bariatric surgery can lead to long-term ID and IDA. Oral iron supplementation may not be effective for many of these patients. Intravenous iron infusions can significantly increase the quality of life for individuals experiencing this condition but are also associated with potentially serious complications. Adequate knowledge about intravenous (IV) iron administration can greatly increase the safety of this beneficial therapy. This review article explains the relationship between obesity, ID/IDA, bariatric surgery and the safe administration of IV iron.
Background
There are limited data on the amount of discretionary foods that people normally consume and consider as appropriate at one eating occasion. This study aimed to provide an overview of the range and assess differences of the ‘normal portion size’ and ‘perceived appropriate portion size’ of energy-dense nutrient-poor discretionary foods among consumers aged 18–65 years.
Methods
To measure normal and perceived appropriate portion sizes, a validated online image-series questionnaire consisting of eight successive portion size options for 15 discretionary foods was completed at two timepoints. Quantile regression models were used to estimate the ranges (lower boundary at 17th percentile, upper boundary at 83rd percentile) of normal and perceived appropriate portion sizes selected by two thirds of the study population. Models were adjusted for the effects of potential influencing factors including biological sex, age, usual physical activity level, cooking confidence, socio-economic status, body mass index, and baseline hunger levels.
Results
A final sample of 295 participants were included in the analysis (51% females, mean age 39.5 ± 14.1 years). The normal portion sizes were significantly higher than the perceived appropriate portion sizes across all test foods, with the effects of sex, age, and BMI being significant for some foods.
Conclusion
The finding suggests that consumers would normally consume a portion size that was larger than what they perceive to be appropriate for discretionary foods. The estimated lower and upper boundaries would be valuable for the development of pragmatic public health messages to empower consumers towards better portion control.
Amaç: Bu çalışma, yetişkinlerin “fast food” tüketimi ile bireylerin diyet kalitelerini belirlemek amacıyla kullandığımız Sağlıklı Yeme İndeksi (HEI)-2015 ve Akdeniz Diyet Kalite İndeksi (PREDIMED) arasındaki ilişkileri değerlendirmek amacıyla yapılmıştır. Gereç ve Yöntemler: Çalışmaya Ankara’da yaşayan 19-64 yaş aralığındaki yetişkin 400 birey dahil edilmiştir. Veriler bireylerin sosyodemografik özellikleri, beslenme alışkanlıkları, antropometrik ölçümleri, PREDIMED, Uluslararası Fiziksel Aktivite Ölçeği (IPAQ) ve besin tüketim kaydı sorularından oluşan anket formu ile yüz yüze toplanmıştır. Beslenme durumlarının tespiti için 24 saatlik besin tüketim kaydı alınmıştır. Diyet kalitesini belirlemek için Sağlıklı Yeme İndeksi -2015 (SYİ-2015) kullanılmıştır. Verilerin analizinde tanımlayıcı istatistikler, ki-kare testi, t testi, One Way Anova, Mann Whitney U, Kruskal Wallis testi ve linear regresyon analizi kullanılmıştır. Bulgular: Katılımcıların %63,7’si kadın, %36,3’ü erkektir. Bireylerin %56,3’ünün “fast food” tükettiği, ortalama “fast food” tüketim sıklığının 3,7±1,5 hafta olduğu saptanmıştır. Yetişkin bireylerin %30,5’i fazla kilolu/obez iken, %85,0’inin hafif fiziksel aktivite yaptığı belirlenmiştir. “Fast food” tüketen bireylerin ortalama doymuş yağ ve tekli doymamış yağ alımları tüketmeyenlere kıyasla daha fazladır (p
The current situation of pediatric obesity is far from favorable in spite of the real advances in our knowledge of it. Firstly, the socioeconomic aspects and their variations according to the parts of the world and areas analyzed are described. The medical aspects are grouped into (1) increased knowledge about obesity, especially in the area of genomics, neural circuits, clinical, publications, statistical treatment, and predictive studies; (2) dietary intake where family habits and their modification can play a crucial role and the real role of those clinical guidelines periodically updated after the analysis of results; and (3) treatment where the continuity of the preventive bases is necessary to gain efficacy. Pharmacological treatment can provide genuine efficacy (GLP-1 agonists) even for pediatric patients. Finally, there is a reflection on actions that are feasible, but are done gradually or not at all.KeywordsObesityGovernment actionsClinical guidelines1000 first daysChildAdolescentEating habits
Food delivery apps are popular among young adults and often used to purchase calorie-dense foods. Limited research exists on the use of food delivery apps among young adults. The purpose of this study was to describe food delivery app use among young adults and examine the correlates of food delivery app use. Data are from a panel of U.S. young adults aged 18–25 (n = 1,576) who completed an online survey between January-April 2022. Participants were 51.8% female and 39.3% identified as non-Hispanic white, 24.4% as Hispanic/Latinx, 29.6% as non-Hispanic Black, and 6.8% as another race/ethnicity. Poisson regression was used to examine the relationship between food delivery app use and age, race, ethnicity, sex, SES, food insecurity, living arrangement, financial responsibility, and full-time student status. Young adults used food delivery apps approximately twice a week. Participants who identified as non-Hispanic Black and Hispanic/Latinx used food delivery apps more frequently than participants who identified as white. Having higher perceived subjective social status, food insecurity, financial responsibility, and being a full-time student were significantly associated with using food delivery apps more frequently. Living with someone else was associated with using food delivery apps less frequently. This study provides a first step in understanding the characteristics of young adults who use food delivery apps. Given that food delivery apps are a new technology that can both increase access to unhealthy food options as well as healthy food options, further research is needed to better understand the types of food purchased through food delivery apps.
The purpose of the study was to compare how health-related corporate social responsibility (CSR) factors impact customers’ dining intentions of casual restaurants in the US and China. The core variables revealed from the literature review include perceived health-related CSR, customer satisfaction, trust, brand awareness, and revisit intention. The study employed a survey-based approach with data collected in both countries. With a total of 828 completed responses, hypotheses were examined using structural equation modeling. Findings revealed significant differences between the responses of the two countries. Theoretically, a research framework depicting health-related CSR and its critical variables, and its relationships tested and verified, thus this study contributes to the body of knowledge from a cross-cultural perspective. From a practical perspective, these findings allow management to develop effective but different marketing strategies to promote CSR initiatives among consumers with diverse cultural, political, and economic conditions like US and China with the aim to increase its financial benefits as well as building consumer satisfaction and loyalty.The study is one of the few empirical studies that explore the decision-making factors of consumers impact on their dining intentions based on restaurants’ role in featuring the health-related CSR initiatives in countries with diverse market environments.
Online food delivery (OFD) platforms have become increasingly popular due to advanced technology, which is changing the way consumers purchase food prepared outside of the home. There is limited research investigating the healthiness of the digital food environment and its influence on consumer choice and dietary behaviours. This study is the first to examine the nutritional quality and marketing attributes of menu items from popular independent and franchise restaurants and takeaway outlets on New Zealand’s market leading OFD platform (UberEATS®). A total of 374 popular independent and franchise restaurants and takeaway outlets were identified to form a database of complete menus and marketing attributes. All 25,877 menu items were classified into 38 food and beverage categories based on the Australian Dietary Guidelines. Of complete menus, 73.3% (18,955/25,877) were discretionary. Thirty-six percent (9419/25,877) were discretionary cereal-based mixed meals, the largest of the 38 categories. Discretionary menu items were more likely to be categorized as most popular (OR: 2.0, 95% CI 1.7–2.2), accompanied by a photo (OR: 1.7, 95% CI 1.6–1.8), and offered as a value bundle (OR: 4.6, 95% CI 3.2–6.8). Two of the three discretionary mixed meal categories were significantly less expensive than their healthier counterparts (p < 0.001). The overwhelming availability and promotion of discretionary choices offered by restaurants and takeaway outlets on OFD platforms have implications for public health policy. Further research to explore direct associations between nutritional quality and consumers’ dietary choices is required.
Background
Food delivery applications (FDAs) shined during COVID-19 global lockdown restrictions. As a consequence, lifestyle changes imposed a greater use of these applications over this period. These changes may reflect a strong influence on the nutritional health of individuals, in particular adult Saudi females. This cross-sectional study aims to examine the influence of using FDAs during COVID-19 lockdown restrictions on knowledge and attitude lifestyle behaviours, including dietary habits and preferences among adult Saudi females.
Methods
A cross-sectional study was designed and conducted to examine the influence of using FDAs during COVID-19 between February and May 2021. Participants voluntarily submitted their answers to a survey questionnaire administered via the Google Survey platform.
Results
A total of 3667 adult Saudi female volunteers were enrolled with ages from 18 to 55 years old, residing in Saudi regions. Result illustrated that the majority of Saudi female users of FDAs were aged between 18-24 years with 64.9% , 91.5% were single and 37% were ordered food online within 1-2 days a month. There were a significant association between the influence of using FDAs during Covid-19 lockdown restrictions and age, education and average days of ordering food online (p ˂0.05)
Conclusions
Although lifestyle changes imposed a greater use of food delivery applications (FDAs) during COVID-19 global lockdown restrictions, these changes may reflect negatively associated with individuals' dietary habits and preferences, particularly adult Saudi females. These findings can aid to promote healthy diet management globally and in Saudi Arabia unless the governments lead a great changing approach toward improving food delivery applications. Additionally, future research is recommended to maximise the positive and reduce the adverse effects of using FDAs by accessing healthy foods for all populations during and post-pandemics. Thus, to succeed, all partners, healthcare providers and stakeholders, including online food delivery app's creators, providers, policy-makers, users, and academic research and development (R&D), should work together to increase the attention and awareness of healthy eating.
Zusammenfassung
In Deutschland zeigt die Prävalenz von Übergewicht und Adipositas ein hohes Niveau, was einen deutlichen Handlungsbedarf vor allem auf Präventionsebene nötig macht. Die Prävention stellt eine gesamtgesellschaftliche Aufgabe dar, bei der verschiedene Akteure eine wesentliche Rolle spielen. Dies ist vor allem der Tatsache geschuldet, dass die Entstehung von Übergewicht und Adipositas multifaktoriell ist. Die Hauptursache ist eine positive Energiebilanz, für welche verschiedene Faktoren ursächlich sind. Hierzu zählt das Angebot von energiedichten Lebensmitteln, zuckergesüßten Getränken und übermäßigen Portionsgrößen, die über Marketingstrategien beworben werden. Es ist vielfach belegt, dass sich die Lebensmittelwerbung vor allem an ungesunde Produkte richtet und die Werbemaßnahmen vor allem bei Kindern einen deutlichen Effekt auf die Auswahl der Lebensmittel und Getränke haben. Neben der Eindämmung und des Verbots an Kinder gerichtete Lebensmittelwerbung sind Anreize und Nudgingmaßnahmen für gesunde Lebensmittel und Getränke nötig, um einen gesundheitsförderlichen Lebensstil in allen Lebensphasen zu erleichtern.
Background:
Higher levels of intra-abdominal adipose tissue (IAAT) comprising visceral adipose tissue (VAT), intermuscular adipose tissue (IMAT), and liver fat are posited drivers of obesity-related chronic disease risk. Fast food is hypothesized to contribute to IAAT patterns.
Objectives:
We quantified levels of abdominal subcutaneous adipose tissue (SAT), IAAT, and odds of metabolic-associated fatty liver disease (MAFLD) in middle age according to average fast-food intake over the preceding 25 y.
Methods:
We analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants underwent 6 clinical exams and measurements over 25 y with computed tomography-measured VAT, SAT, and IMAT (n = 3156), plus MAFLD defined by liver attenuation (≤40 Hounsfield units) and 1 metabolic abnormality at year 25 (2010, n = 3001, n cases = 302). We estimated means of VAT, SAT, IMAT, and liver attenuation at the year 25 exam according to categories of average fast-food intake over the previous 25 y adjusted for sociodemographic and lifestyle factors and logistic regression to estimate the odds ratio of MAFLD at year 25.
Results:
With higher average fast-food intake over 25 y (categorized as follows: never-1×/mo, >1×-3×/mo, 1-<2×/wk, 2-<3×/wk, ≥3×/wk), there were monotonic higher levels of VAT (98.5, 127.6, 134.5, 142.0, 145.5 cm3), P-trend < 0.0001, which were consistent across anthropometrically classified obesity categories. There was a similar pattern with liver fat. There were higher levels of IMAT and SAT with higher fast-food intake (P-trend = 0.003, 0.0002, respectively), with amounts leveling off at ≥2×/wk. In addition, compared with participants who ate fast food never-1×/mo, there were monotonic higher odds of having MAFLD at year 25 with higher average fast-food intake, with participants who ate fast food ≥3×/wk having an OR of MAFLD = 5.18 (95% CI: 2.87, 9.37).
Conclusions:
There were monotonic higher levels of VAT, liver fat, and odds of having MAFLD in middle age according to higher average fast-food intake over the preceding 25 y.
A sociedade produtiva demanda a necessidade do trabalho em horários irregulares e períodos ininterruptos de atividade, tornando esses trabalhadores mais vulneráveis ao adoecimento físico e psíquico, sobretudo aos danos crônicos à saúde. Estudo transversal objetivou verificar o consumo alimentar, o perfil antropométrico e a percepção da qualidade do sono n as diversas escalas de trabalho de 1.215 trabalhadores de uma empresa de processamento avícola Nutriza, localizada na região Centro Oeste do Brasil. Coletou-se dados sociodemográficos, hábitos de vida, autopercepção da qualidade de sono por meio de escala analógica visual (0 a 10), questionário de frequência alimentar (validado para a população brasileira) e circunferência da cintura, peso, altura e calculado o Índice de Massa Corporal (IMC). Verificou-se o IMC apresentou média equivalente a sobrepeso em todos os turnos de trabalho. O consumo alimentar, de modo geral, foi considerado ruim, 96% de prevalência de inadequação do grupo de hortaliças (IC95% 94.80-97.00). Ademais, constatou-se médias inferiores da nota da qualidade de sono em trabalhadores do turno early morning (6.12, IC95% 5.85-6.38, DP 2.71) e noturno (6.28, IC95% 6.01-6.54, DP 2.55). Os resultados demonstraram vulnerabilidades dos trabalhadores em turnos, o que aponta para a necessidade de intervenções imediatas quanto à higiene do sono e qualidade da alimentação, na tentativa de reverter os danos crônicos à saúde dos indivíduos analisados.
Human exposure to endocrine-disrupting chemicals (EDCs) may increase risk for chronic disease. Diet is a significant source of EDC exposure, yet healthy diets recommended for chronic disease prevention have not been thoroughly examined for associations with EDC exposure. Using data from the National Health and Nutrition Examination Survey 2013–2016, we examined associations of dietary patterns with exposure to non-persistent EDCs potentially consumed through diet. EDCs were measured in spot urine samples. Diet was assessed using 24-h recalls. Multivariable linear regression was used to examine associations of three healthy diet scores [Healthy Eating Index (HEI), relative Mediterranean Diet (rMED), and Dietary Approaches to Stop Hypertension] and fast-food consumption with EDCs. In fully adjusted models, no diet was associated with exposure to the bisphenols, phthalates, or polycyclic aromatic hydrocarbons examined. A 1-point increase in rMED (of 18 possible points) was associated with 2.7% (95% CI: 1.7%, 3.8%) greater urinary nitrate. A 10-point increase in HEI (of 100 possible points) was associated with 5.3% (95% CI: 2.8%, 7.9%) greater nitrate and 6.8% (95% CI: 4.5%, 9.2%) greater perchlorate. Because perchlorate and nitrate can disrupt thyroid hormone production, we conducted an exploratory analysis to examine whether these chemicals mediate an association between diet and thyroid hormones. A 10-point increase in HEI was associated with 0.6% reduced serum total thyroxine (95% CI: 1.7%, 0.5%) among all adults, with 57.5% of the effect explained by perchlorate. Nitrate mediated an association of rMED with modestly reduced total triiodothyronine among females. Most EDCs examined had no association with the diets evaluated, indicating that recommended healthy diets were not protective against EDC exposures. As observed with two thyroid antagonists, some recommended diets may increase EDC exposures and related adverse health outcomes. Additional work should identify effective food production and processing practices to reduce dietary exposures to potentially harmful EDCs.
This study explores the nature of the consumption values that differentiate regular consumers of fast food and non-regular consumers using the consumption value model. Data was collected from a total of 307 respondents via a self-administered online survey. The collected data was then classified into two groups, regular consumers (RCs, n=140) and non-regular consumers (non-RCs, n=167), based on the respondents’ self-identification as either a regular fast food consumer or a non-consumer and their fast food consumption frequency (≥ 2-3 times a week for RCs and ≤ 1 time a fortnight for non-RCs). Using factor analysis, 15 factors were extracted for the six consumption values (functional, social, emotional, conditional, epistemic, and process values). Discriminant analysis showed that 5 factors out of those 15 are influential in discriminating RCs and non-RCs. Specifically, RCs were found to consume fast food due to convenience and taste whereas non-RCs were found to avoid fast food due to the feelings of guilt when consuming fast food and the sense of accomplishment when not consuming fast food. Also, RCs and Non-RCs were found to deviate from their normal behavior when certain conditions are present (e.g., food safety issue, time pressure, stress). In all, the results of this study provide marketers a clearer understanding of the consumption values that regular consumers and non- regular consumers perceive in fast foods, further enabling the development of marketing strategies that appeal better to current and potential customers.
Shifting consumer behavior towards more sustainable diets can benefit environmental sustainability and human health. Although more frequent home cooking is associated with a better diet quality and fast-food consumption with worse diet quality, the environmental impact of diets based on frequency of cooking or eating fast food is not well understood. The objective of this study was to investigate whether the frequency of cooking dinner at home or eating fast food is associated with dietary greenhouse gas emissions (GHGE). We linked 24-h dietary recall data from adult respondents in the 2007–2010 National Health and Nutrition Examination Survey (NHANES) (N = 11,469) to a database of GHGE factors to obtain a measure of dietary GHGE (kgCO2-eq/2000 kcal) (the sum of emissions released in the production of food for an individual’s diet), adjusted by energy intake (kgCO2-eq/2000 kcal). We examined associations between frequency of cooking dinner (the only meal for which cooking frequency was measured), frequency of eating fast food, and dietary GHGE and protein sources (beef, pork, poultry, other meat, and fish and seafood (g/2000 kcal)) using generalized linearized regression models that controlled for age, sex, and other socio-economic characteristics. Greater cooking frequency was associated with higher dietary GHGE. In fully adjusted models, cooking 5–6 times/week was associated with an additional 0.058 kgCO2-eq/2000 kcal (SE 0.033) and cooking 7 times/week was associated with an additional 0.057 kgCO2-eq/2000 kcal (SE 0.027) when compared to cooking 0–2 times/week. Individuals in households who cooked dinner more frequently consumed significantly more meat, poultry, and fish (cooking 7 times/week: 148.7 g/2000 kcal vs. cooking 0–2 times/week: 135.4 g/2000 kcal, p-trend = 0.005), which could explain the association with a higher carbon footprint diet. There were few associations of note between fast-food frequency and GHGE. Policies and interventions that reduce consumption of meat and increase consumption of plants when both cooking meals at home and eating meals out are needed to shift toward diets that will be beneficial for both human health and the health of the planet.
Unhealthy food environments may contribute to an elevated Body Mass Index (BMI), which is a chronic disease risk factor. We examined the association between residential fast-food outlet exposure, in terms of proximity and density, and BMI in the Dutch adult general population. Additionally, we investigated to what extent this association was modified by urbanisation level. In this cross-sectional study, we linked residential addresses of baseline adult Lifelines cohort participants (N = 147,027) to fast-food outlet locations using geo-coding. We computed residential fast-food outlet proximity, and density within 500 m(m), 1, 3, and 5 km(km). We used stratified (urban versus rural areas) multilevel linear regression models, adjusting for age, sex, partner status, education, employment, neighbourhood deprivation, and address density. The mean BMI of participants was 26.1 (SD 4.3) kg/m². Participants had a mean (SD) age of 44.9 (13.0), 57.3% was female, and 67.0% lived in a rural area. Having two or more (urban areas) or five or more (rural areas) fast-food outlets within 1 km was associated with a higher BMI (B = 0.32, 95% confidence interval (CI):0.03,0.62; B = 0.23, 95% CI:0.10,0.36, respectively). Participants in urban and rural areas with a fast-food outlet within <250 m had a higher BMI (B = 0.30, 95% CI:0.03,0.57; B = 0.20, 95% CI:0.09,0.31, respectively). In rural areas, participants also had a higher BMI when having at least one fast-food outlet within 500 m (B = 0.10, 95% CI:0.02,0.18). In conclusion, fast-food outlet exposure within 1 km from the residential address was associated with BMI in urban and rural areas. Also, fast-food outlet exposure within 500 m was associated with BMI in rural areas, but not in urban areas. In the future, natural experiments should investigate changes in the fast-food environment over time.
In the present work, we draw upon construal level theory and appraisal theory to propose a link between two vital elements of consumption that can influence product size preferences: the vice or virtue nature of products and types of size labeling. Three experiments demonstrate that by labeling a vice product with relative size labels (i.e., small/medium/large) and a virtue product with absolute size labels (i.e., ounces), consumer size preferences can be increased. These alignments lead consumers to experience more positive affect generated by imagining the good they are doing for their bodies (with absolute labeling of virtues) or focusing on the positive feelings of indulgence (with relative labeling of vices), leading to larger preferred sizes. Further, these effects are suppressed by increasing the ambiguity of size labeling, with ambiguous size labels leading to size preferences that appear to be based on a compromise effect (i.e., picking the middle size option).
Die Prävalenzen von juvenilem Übergewicht und Adipositas nehmen weltweit zu. Unter dem Begriff „adipogene Umwelten“ (obesogenic environments) werden vor allem sogenannte Ernährungs-umwelten international und zunehmend auch national in der Public Health und in den Gesundheitswissenschaften beachtet. Die Gastronomie ist ein Teil der Ernährungsumwelt. Vor diesem Hintergrund beschreibt und bewertet die vorliegende Studie das Angebot an Kindergerichten in der deutschen, inhabergeführten Gastronomie. Mit Hilfe einer systematischen Quotenstichprobe wurde eine Stichprobe von 500 landesweiten Voll-Service-Restaurants gezogen. Insgesamt wurden 1.877 Kindergerichte von 500 Speisekarten mit Hilfe eines selbst erarbeiteten Evaluationsbogens analysiert. Der Evaluationsbogen erfasste neben Angaben zum Restaurant und der Speisekarte Elemente des im amerikanischen Raum etablierten Children’s Menu Assessment (CMA) sowie Qualitätsstandards der Deutschen Gesellschaft für Ernährung. Im Durchschnitt enthielt jede Kinderspeisekarte 3,76 ± 1,31 Gerichte. Rund 80% der Kindergerichte beschränkten sich auf acht typische Gerichte und über 50% enthielten Pommes Frites oder eine andere Form frittierter Kartoffeln. Die Speisekarten waren selten kindgerecht dargestellt. In 81% wurden die Gerichte analog zum CMA als ungesund eingestuft. Das arithmetische Mittel des CMA-Scores betrug 0,73 ± 0,85. Ein automatischer Getränkeeinschluss, das kostenlose Nachfüllen oder die Verwendung von Marketingstrategien auf der Speisekarte waren ungewöhnlich. Feststehende Menükombinationen waren selten. Es bestand eine positive Korrelation zwischen dem Preis der Gerichte (durchschnittlich 5,51 € ± 1,41 €) und der Qualität der Gerichte. Die Mehrzahl der Gerichte wies jedoch eine hohe Energiedichte bei gleichzeitig geringer Nährstoffdichte auf. Gesunde Gerichte wurden nie gekennzeichnet oder hervorgehoben. Ebenso fehlten Nährwertinformationen. Rund 23% aller Gerichte erfüllten keines der von der Deutschen Gesellschaft für Ernährung festgelegten Qualitätskriterien, 38% erfüllten lediglich ein Kriterium. Im Durchschnitt wurden 1,33 ± 1,03 Kriterien erfüllt. Zusammenfassend ist das Angebot an Kindergerichten in der deutschen inhabergeführten Gastronomie häufig ungesund und monoton. Es zeigten sich die weltweit schlechtesten CMA-Scorewerte. Somit besteht ein dringender Verbesserungsbedarf sowohl in Bezug auf die Gestaltung der Kinderspeisekarten als auch in Bezug auf die Optimierung der angebotenen Speisen. Die vorliegende Studie kann als Ausgangspunkt für weitergehende Forschung und Interventionen dienen, um das Speiseangebot für Kinder und Jugendliche zu verbessern und ggf. in Zukunft auch zu einer Reduktion des juvenilen Übergewichtes bzw. Adipositas beizutragen. Insgesamt sind aus diesem Dissertationsprojekt zwei Publikationen inklusive einer Erstautorenschaft in internationalen Fachzeitschriften hervorgegangen (kumulierte Impact-Factor-Summe: 3.835). Die Ergebnisse dieser Dissertation fanden in den Medien bundesweit große Beachtung. Sie wurden im Ministerium für Ernährung und Landwirtschaft in Berlin mit der Bundesministerin Frau Klöckner und hochrangigen Vertretern der Wirtschaft besprochen. Das Ministerium hat in Reaktion auf diese Studie eine bundesweite Initiative ins Leben gerufen.
Background
A majority of children’s restaurant meals are nutritionally deficient; use of behavioral economics may improve healthful menu selections. Parents play a role in children’s restaurant meal selection, thus understanding parent preferences for potential behavioral economic strategies is warranted.
Objective
To examine parent-derived and -stated preferences for selected attributes of children’s restaurant menus, which included behavioral economic strategies (eg, optimal defaults and vice-virtue bundles).
Design
A descriptive, cross-sectional, within-subjects survey integrating a conjoint design was developed along with 8 children’s menus. Menus were manipulated by varying levels of attributes (meal price, healthful side dishes, number of side dish items, healthful entrées, and cost for sugar-sweetened beverages [SSB]). Parents rated menus and attributes using Likert scales.
Participants/setting
A national sample of US parents with children 4 to 10 years (n = 463) were recruited in August of 2019 via Amazon’s Mechanical Turk.
Analysis
A conjoint (regression) analysis was conducted to derive parent preference for each attribute and overall menu preference. Descriptive statistics (means) described overall stated parent menu preferences and ratings. Cluster analysis segmented parents into groups with similar preferences.
Results
Derived preferences showed parents had the strongest preference for choice of side dishes (β = .73) and low-priced menus (β = .51), and weak preferences for inclusion of healthful entrées (β = .04) and added cost for SSB (β = .18). Parents stated preference was for a menu that included healthful entrées, was low priced, and featured choices for side dishes. Cluster analysis revealed half of parents preferred the low-cost children’s menu with the other half of parents split evenly across preferences related to health, choice, and traditional menus.
Conclusion
Parents stated preference was for a socially desirable menu featuring healthful entrée options and added cost for SSB, which was contrary to the conjoint derived menu preferences. Understanding parent preferences may help guide nutrition professionals working to build a more healthful food environment through the use of behavioral economic strategies.
Purpose of review:
The aim of this review is to provide an overview of (1) underlying mechanisms of the effect of portion size on energy intake, (2) external factors explaining the portion size effect and (3) interventions and measurements aimed at food portion size.
Recent findings:
Previous studies have shown that portion sizes have increased in recent decades. Many experimental studies have been conducted to unravel the mechanisms underlying the portion-size effect on food intake (e.g. the appropriateness mechanism, the 'unit bias' mechanism, the 'previous experience/expectation' mechanism, the 'visual cue' mechanism and the 'bite size' mechanism). In addition, external factors have been found to drive food portion selection and consumption (e.g. value for money, mindless eating, levels of awareness, estimation bias. Research on several interventions (ranging from 'providing information' to 'eliminating choice') have been conducted, but remain scarce, especially intervention studies in which portion size is a key focus in weight loss. Moreover, only three new instruments with respect to portion control behavior have been developed. There is considerable evidence for the portion-size effect on energy intake. However, the work on interventions targeting portion size and measurements for portion control behavior are limited. Moreover, from the literature it is not yet clear what type of interventions work best, for whom and in what context.
Guidelines have recommended significant reductions in dietary sodium intake to improve cardiovascular health. However, these dietary sodium intake recommendations have been questioned as emerging evidence has shown that there is a higher risk of cardiovascular disease with a low sodium diet, including in individuals with type 2 diabetes. This may be related to the other pleotropic effects of dietary sodium intake. Therefore, despite recent review of dietary sodium intake guidelines by multiple organizations, including the dietary guidelines for Americans, American Diabetes Association, and American Heart Association, concerns about the impact of the degree of sodium restriction on cardiovascular health continue to be raised. This literature review examines the effects of dietary sodium intake on factors contributing to cardiovascular health, including left ventricular hypertrophy, heart rate, albuminuria, rennin–angiotensin–aldosterone system activation, serum lipids, insulin sensitivity, sympathetic nervous system activation, endothelial function, and immune function. In the last part of this review, the association between dietary sodium intake and cardiovascular outcomes, especially in individuals with diabetes, is explored. Given the increased risk of cardiovascular disease in individuals with diabetes and the increasing incidence of diabetes worldwide, this review is important in summarizing the recent evidence regarding the effects of dietary sodium intake on cardiovascular health, especially in this population.
Regulating the energy density of food could be used as a novel approach for successful body weight reduction in clinical practice. The aim of this study was to conduct a systemic review of the literature on the relationship between food energy density and body weight changes in obese adults to obtain solid evidence supporting this approach. The search process was based on the selection of publications in the English language listed in public databases. A meta-analysis was performed to combine individual study results. Thirteen experimental and observational studies were identified and included in the final analysis. The analyzed populations consist of 3628 individuals aged 18 to 66 years. The studies varied greatly in terms of study populations, study design and applied dietary approaches. The meta-analysis revealed a significant association between low energy density foods and body weight reduction, i.e., -0.53 kg when low energy density foods were eaten (95% CI: -0.88, -0.19). In conclusions, this study adds evidence which supports the energy density of food as a simple but effective measure to manage weight in the obese with the aim of weight reduction.
Background: There are growing concern globally regarding the alarming trend of fast food consumption and its related cardiometabolic outcomes including overweight and obesity. This study aimed to review the current evidences available in relation to adverse effects of fast food pattern on cardiometabolic risk factors.
Methods: Relevant articles including epidemiological and clinical studies with appropriate design and good quality were obtained through searches of the Medline, PubMed, Scopus databases and Google scholar with related key words including "fast foods", "processed foods", "obesity", "overweight", "insulin resistance", "diabetes", "cardiovascular disease", "metabolic syndrome", "dyslipidemia" and "hypertension".
Results: Fast food consumption and out-of-home eating behavior is a main risk factor for lower diet quality, higher calorie and fat intake and lower micronutrients density of diet. Frequent consumption of fast foods was accompanied with overweight and abdominal fat gain, impaired insulin and glucose homeostasis, lipid and lipoprotein disorders, induction of systemic inflammation and oxidative stress. Higher fast food consumption also increases the risk of developmental diabetes, metabolic syndrome and cardiovascular disease.
Conclusion: This review provides further evidence warning us against the irreparable effects of fast food consumption on public health especially the increasing global burden of obesity and cardiovascular diseases.
To examine the association between the frequency of consuming restaurant food and body fatness in adults.
Usual free-living dietary intake and the frequency of consuming food from seven different restaurant types (fried chicken, burger, pizza, Chinese, Mexican, fried fish, and "other") were assessed by food frequency questionnaire in 73 healthy men and women [ages 19 to 80, body mass index (BMI) 18 to 33]. In addition, body fatness (percent weight) was determined by hydrostatic weighing, and physical activity and other lifestyle parameters were assessed by questionnaire. The relationship between the frequency of consuming restaurant food and body fatness was determined after controlling for age, sex, and other confounders by using multiple regression techniques.
Restaurant food consumption averaged 7.5+/-8.5 (Standard Deviation) times/month. After controlling for age and sex, the frequency of consuming restaurant food was positively associated with body fatness (partial r = 0.36, p = 0.003). The strength of this association did not change after controlling for education level, smoking status, and alcohol intake, but after additionally controlling for physical activity, the partial r increased to 0.42 (p = 0.004). Total daily intakes of energy, fat, and fiber were significantly associated with restaurant food consumption frequency (r = 0.59, 0.28, and -0.45, respectively, p = 0.02 to 0.0001).
The frequency of consuming restaurant food was positively associated with increased body fatness in adults. The increasing proportion of household food income spent on food prepared away from home in the United States may therefore help explain the rising national prevalence of obesity.
Lifestyle choices influence 20–40 % of adult peak bone mass. Therefore, optimization of lifestyle factors known to influence peak bone mass and strength is an important strategy aimed at reducing risk of osteoporosis or low bone mass later in life. The National Osteoporosis Foundation has issued this scientific statement to provide evidence-based guidance and a national implementation strategy for the purpose of helping individuals achieve maximal peak bone mass early in life. In this scientific statement, we (1) report the results of an evidence-based review of the literature since 2000 on factors that influence achieving the full genetic potential for skeletal mass; (2) recommend lifestyle choices that promote maximal bone health throughout the lifespan; (3) outline a research agenda to address current gaps; and (4) identify implementation strategies. We conducted a systematic review of the role of individual nutrients, food patterns, special issues, contraceptives, and physical activity on bone mass and strength development in youth. An evidence grading system was applied to describe the strength of available evidence on these individual modifiable lifestyle factors that may (or may not) influence the development of peak bone mass (Table 1). A summary of the grades for each of these factors is given below. We describe the underpinning biology of these relationships as well as other factors for which a systematic review approach was not possible. Articles published since 2000, all of which followed the report by Heaney et al. [1] published in that year, were considered for this scientific statement. This current review is a systematic update of the previous review conducted by the National Osteoporosis Foundation [1].(Table presented.)Considering the evidence-based literature review, we recommend lifestyle choices that promote maximal bone health from childhood through young to late adolescence and outline a research agenda to address current gaps in knowledge. The best evidence (grade A) is available for positive effects of calcium intake and physical activity, especially during the late childhood and peripubertal years—a critical period for bone accretion. Good evidence is also available for a role of vitamin D and dairy consumption and a detriment of DMPA injections. However, more rigorous trial data on many other lifestyle choices are needed and this need is outlined in our research agenda. Implementation strategies for lifestyle modifications to promote development of peak bone mass and strength within one’s genetic potential require a multisectored (i.e., family, schools, healthcare systems) approach.
The impact of sugar consumption on health continues to be a controversial topic. The objective of this review is to discuss the evidence and lack of evidence that allows the controversy to continue, and why resolution of the controversy is important. There are plausible mechanisms and research evidence that supports the suggestion that consumption of excess sugar promotes the development of cardiovascular disease (CVD) and type 2 diabetes (T2DM) both directly and indirectly. The direct pathway involves the unregulated hepatic uptake and metabolism of fructose, leading to liver lipid accumulation, dyslipidemia, decreased insulin sensitivity and increased uric acid levels. The epidemiological data suggest that these direct effects of fructose are pertinent to the consumption of the fructose-containing sugars, sucrose and high fructose corn syrup (HFCS), which are the predominant added sugars. Consumption of added sugar is associated with development and/or prevalence of fatty liver, dyslipidemia, insulin resistance, hyperuricemia, CVD and T2DM, often independent of body weight gain or total energy intake. There are diet intervention studies in which human subjects exhibited increased circulating lipids and decreased insulin sensitivity when consuming high sugar compared with control diets. Most recently, our group has reported that supplementing the ad libitum diets of young adults with beverages containing 0%, 10%, 17.5% or 25% of daily energy requirement (Ereq) as HFCS increased lipid/lipoprotein risk factors for CVD and uric acid in a dose-response manner. However, un-confounded studies conducted in healthy humans under a controlled, energy-balanced diet protocol that enables determination of the effects of sugar with diets that do not allow for body weight gain are lacking. Furthermore, recent reports conclude that there are no adverse effects of consuming beverages containing up to 30% Ereq sucrose or HFCS, and the conclusions from several meta-analyses suggest that fructose has no specific adverse effects relative to any other carbohydrate. Consumption of excess sugar may also promote the development of CVD and T2DM indirectly by causing increased body weight and fat gain, but this is also a topic of controversy. Mechanistically, it is plausible that fructose consumption causes increased energy intake and reduced energy expenditure due to its failure to stimulate leptin production. Functional magnetic resonance imaging (fMRI) of the brain demonstrates that the brain responds differently to fructose or fructose-containing sugars compared with glucose or aspartame. Some epidemiological studies show that sugar consumption is associated with body weight gain, and there are intervention studies in which consumption of ad libitum high-sugar diets promoted increased body weight gain compared with consumption of ad libitum low- sugar diets. However, there are no studies in which energy intake and weight gain were compared in subjects consuming high or low sugar, blinded, ad libitum diets formulated to ensure both groups consumed a comparable macronutrient distribution and the same amounts of fiber. There is also little data to determine whether the form in which added sugar is consumed, as beverage or as solid food, affects its potential to promote weight gain. It will be very challenging to obtain the funding to conduct the clinical diet studies needed to address these evidence gaps, especially at the levels of added sugar that are commonly consumed. Yet, filling these evidence gaps may be necessary for supporting the policy changes that will help to turn the food environment into one that does not promote the development of obesity and metabolic disease.
To determine changes in the nutritional content of children's menu items at U.S. restaurant chains between 2010 and 2014.
The sample consisted of 13 sit down and 16 fast-food restaurant chains ranked within the top 50 US chains in 2009. Nutritional information was accessed in June-July 2010 and 2014. Descriptive statistics were calculated for nutrient content of main dishes and side dishes, as well as for those items that were added, removed, or unchanged during the study period.
Nutrient content of main dishes did not change significantly between 2010 and 2014. Approximately one-third of main dishes at fast-food restaurant chains and half of main dishes at sit down restaurant chains exceeded the 2010 Dietary Guidelines for Americans recommended levels for sodium, fat, and saturated fat in 2014. Improvements in nutrient content were observed for side dishes. At sit down restaurant chains, added side dishes contained over 50 % less calories, fat, saturated fat, and sodium, and were more likely to contain fruits/vegetables compared to removed sides (p < 0.05 for all comparisons). Added side dishes at fast-food restaurant chains contained less saturated fat (p < 0.05).
The majority of menu items, especially main dishes, available to children still contain high amounts of calories, fat, saturated fat, and sodium. Efforts must be made by the restaurant industry and policy makers to improve the nutritional content of children's menu items at restaurant chains to align with the Dietary Guidelines for Americans. Additional efforts are necessary to help parents and children make informed choices when ordering at restaurant chains.
Calorie intake and diet quality are influenced by the source of food and the place of consumption. This study examines the impacts of fast-food and full-service restaurant consumption on daily energy and nutrient intakes in US adults.
Nationally representative data of 18 098 adults 18 years of age and above from the National Health and Nutrition Examination Survey 2003-2010 waves were analyzed. Outcomes included daily intake of total calories and 24 nutrients of public health concern. The key predictors were any food/beverage consumption in a day from fast-food or full-service restaurant, differentiated by consumption at home versus away from home. First-difference estimator addressed confounding bias from time-invariant unobservables such as personal food/beverage preferences by using within-individual variations in diet and restaurant consumption status between two nonconsecutive 24-h dietary recalls.
Fast-food and full-service restaurant consumption, respectively, were associated with a net increase in daily total energy intake of 190.29 and 186.74 kcal, total fat of 10.61 and 9.58 g, saturated fat of 3.49 and 2.46 g, cholesterol of 10.34 and 57.90 mg, and sodium of 297.47 and 411.92 mg. The impact of fast-food and full-service restaurant consumption on energy and nutrient intakes differed by sex, race/ethnicity, education, income and weight status. Increased total energy, total fat, saturated fat, cholesterol and sodium intake were substantially larger when full-service restaurant food was consumed away from home than at home.
A holistic policy intervention is warranted to target the American's overall dining-out behavior rather than fast-food consumption alone.European Journal of Clinical Nutrition advance online publication, 1 July 2015; doi:10.1038/ejcn.2015.104.
Excess intakes of energy, sodium, saturated fat, and trans fat are associated with increased risk for cardiometabolic syndrome. Trends in fast-food restaurant portion sizes can inform policy decisions. We examined the variability of popular food items in 3 fast-food restaurants in the United States by portion size during the past 18 years.
Items from 3 national fast-food chains were selected: French fries, cheeseburgers, grilled chicken sandwich, and regular cola. Data on energy, sodium, saturated fat, and trans fat content were collated from 1996 through 2013 using an archival website. Time trends were assessed using simple linear regression models, using energy or a nutrient component as the dependent variable and the year as the independent variable.
For most items, energy content per serving differed among chain restaurants for all menu items (P ≤ .04); energy content of 56% of items decreased (β range, -0.1 to -5.8 kcal) and the content of 44% increased (β range, 0.6-10.6 kcal). For sodium, the content of 18% of the items significantly decreased (β range, -4.1 to -24.0 mg) and the content for 33% increased (β range, 1.9-29.6 mg). Absolute differences were modest. The saturated and trans fat content, post-2009, was modest for French fries. In 2013, the energy content of a large-sized bundled meal (cheeseburger, French fries, and regular cola) represented 65% to 80% of a 2,000-calorie-per-day diet, and sodium content represented 63% to 91% of the 2,300-mg-per-day recommendation and 97% to 139% of the 1,500-mg-per-day recommendation.
Findings suggest that efforts to promote reductions in energy, sodium, saturated fat, and trans fat intakes need to be shifted from emphasizing portion-size labels to additional factors such as total calories, frequency of eating, number of items ordered, menu choices, and energy-containing beverages.
Intakes of sodium, saturated fat, and trans fat remain high despite recommendations to limit these nutrients for cardiometabolic risk reduction. A major contributor to intake of these nutrients is foods prepared outside the home, particularly from fast-food restaurants.
We analyzed the nutrient content of frequently ordered items from 3 US national fast-food chains: fried potatoes (large French fries), cheeseburgers (2-oz and 4-oz), and a grilled chicken sandwich. We used an archival website to obtain data on sodium, saturated fat, and trans fat content for these items from 2000 through 2013. The amount of each nutrient per 1,000 kcal was calculated to determine whether there were trends in product reformulation.
Sodium content per 1,000 kcal differed widely among the 3 chains by food item, precluding generalizations across chains. During the 14-year period, sodium content per 1,000 kcal for large French fries remained high for all 3 chains, although the range narrowed from 316-2,000 mg per 1,000 kcal in 2000 to 700-1,420 mg per 1,000 kcal in 2013. Among the items assessed, cheeseburgers were the main contributor of saturated fat, and there was little change in content per 1,000 kcal for this item during the 14-year period. In contrast, there was a sharp decline in saturated and trans fat content of large French fries per 1,000 kcal. Post-2009, the major contributor of trans fat per 1,000 kcal was cheeseburgers; trans fat content of this item remained stable during the 14-year period.
With the exception of French fries, little evidence was found during the 14-year period of product reformulation by restaurants to become more consistent with dietary guidance to reduce intakes of sodium and saturated fat.
The role of dietary energy density (ED) in the regulation of energy intake (EI) is controversial. Methodologically, there is also debate about whether beverages should be included in dietary ED calculations. To address these issues, studies examining the effects of ED on EI or body weight in nonelderly adults were reviewed. Different approaches to calculating dietary ED do not appear to alter the direction of reported relations between ED and body weight. Evidence that lowering dietary ED reduces EI in short-term studies is convincing, but there are currently insufficient data to determine long-term effectiveness for weight loss. The review also identified key barriers to progress in understanding the role of ED in energy regulation, in particular the absence of a standard definition of ED, and the lack of data from multiple long-term clinical trials examining the effectiveness of low-ED diet recommendations for preventing both primary weight gain and weight regain in nonobese individuals. Long-term clinical trials designed to examine the impact of dietary ED on energy regulation, and including multiple ED calculation methods within the same study, are still needed to determine the importance of ED in the regulation of EI and body weight.
Background:
Away from home (AFH) meals are known to be energy-dense and of poor diet quality. Both direct and indirect exposure (for example, neighborhood restaurant density) to AFH meals have been implicated as contributors to higher body weight and adverse health outcomes.
Objective:
To examine the association of frequency of eating AFH and fast-food meals with biomarkers of chronic disease and dietary intake.
Design:
This cross-sectional study used frequency of AFH and fast-food meal and biomarker data from the NHANES 2005-2010. Information on weekly frequency of AFH and fast-food meals was collected via questionnaire during the household interview. The metabolic biomarkers examined included body mass index (BMI), serum cholesterol (total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL)), triglycerides, glycohemoglobin and fasting glucose (n=8314, age⩾20, National Health and Nutrition Examination Surveys (NHANES) 2007-2010). Biomarkers of dietary exposure included serum concentrations of vitamins A, D, E, C, B-6, B-12, folate and carotenoids (n=4162; 2005-2006). Multiple linear and logistic regression methods adjusted for complex survey methodology and covariates.
Results:
American adults reported a mean of 3.9 (95% confidence interval 3.7, 4.0) AFH and 1.8 (1.6, 1.9) fast-food meals/week. Over 50% of adults reported ⩾3 AFH and >35% reported ⩾2 fast-food meals/week. The mean BMI of more frequent AFH or fast-food meal reporters was higher (Ptrend⩽0.0004). Serum concentrations of total, LDL and HDL-cholesterol were related inversely with frequency of AFH meals (P<0.05). Frequencies of fast-food meals and serum HDL-cholesterol were also related inversely (P=0.0001). Serum concentrations of all examined micronutrients (except vitamin A and lycopene) declined with increasing frequency of AFH meals (P<0.05); women and ⩾50-year olds were at higher risk.
Conclusions:
Reporters of frequent AFH and fast-food meals had higher BMI and lower concentrations of HDL-cholesterol; however, profiles of other biomarkers did not indicate higher metabolic risk. However, the serum concentrations of nutrients with mostly plant foods as sources declined with increasing AFH meal frequency.
The objective of this study was to evaluate an intervention that combined mindful eating and online pre-ordering to promote healthier lunch purchases at work. The study took place at an urban hospital with 26 employees who were overweight or obese. The design included a contemporaneous comparison with delayed-treatment control and a three-phase prospective study. A minimum 4-week baseline period preceded a 4-week full-intervention, in which participants received mindful eating training, pre-ordered their lunches, and received price discounts toward lunch purchases. In a 4-week reduced intervention phase, participants pre-ordered lunches without price discounts. Participant lunch purchases were tracked electronically at the point of purchase. The primary outcome measures were the amounts of kilocalories and fat grams in purchased lunches. In contemporaneous comparisons, the treatment group purchased lunches with an average of 144.6 fewer kilocalories (p=0.01) and 8.9 fewer grams of fat (p=0.005) compared to controls. In multivariable longitudinal analyses, participants decreased the average number of calories in their meals by 114.6 kcal per lunch and the average grams of fat by 5.4 per lunch during the partial-intervention compared to the baseline (p<0.001). At the end of the study, a moderate increase was observed in participants' overall mindful eating behaviors as compared to the beginning of the study (p<0.001). The majority of participants (92%) said they would use the pre-ordering system if offered in the future. Combined mindful eating training and online pre-ordering appears a feasible and useful worksite intervention to improve food choices by employees.
Systematic studies have shown that providing individuals with larger portions of foods and beverages leads to substantial increases in energy intake. The effect is sustained over weeks, supporting the possibility that large portions have a role in the development of obesity. The challenge is to find strategies to effectively manage the effects of portion size. One approach involves teaching people to select appropriate portions and to use tools that facilitate portion control. Although tools such as portion-control plates have been shown in several randomized trials to improve weight loss, limited data are available on whether education and tools lead to long-term changes in eating behavior and body weight. Another approach is to use preportioned foods (PPFs) to add structure to meals and minimize decisions about the amount of food to eat. A number of randomized controlled trials have demonstrated the efficacy of both liquid meal replacements and solid PPFs for weight loss and weight loss maintenance, but it is not known if they lead to better understanding of appropriate portions. Although portion control is important for weight management, urging people simply to 'eat less' of all foods may not be the best approach as high-energy-dense foods disproportionately increase energy intake compared with those lower in energy density. A more effective strategy may be to encourage people to increase the proportion of foods low in energy density in their diets while limiting portions of high-energy-dense foods. If people lower the energy density of their diet, they can eat satisfying portions while managing their body weight.
Maximum likelihood or restricted maximum likelihood (REML) estimates of the
parameters in linear mixed-effects models can be determined using the lmer
function in the lme4 package for R. As for most model-fitting functions in R,
the model is described in an lmer call by a formula, in this case including
both fixed- and random-effects terms. The formula and data together determine a
numerical representation of the model from which the profiled deviance or the
profiled REML criterion can be evaluated as a function of some of the model
parameters. The appropriate criterion is optimized, using one of the
constrained optimization functions in R, to provide the parameter estimates. We
describe the structure of the model, the steps in evaluating the profiled
deviance or REML criterion, and the structure of classes or types that
represents such a model. Sufficient detail is included to allow specialization
of these structures by users who wish to write functions to fit specialized
linear mixed models, such as models incorporating pedigrees or smoothing
splines, that are not easily expressible in the formula language used by lmer.
As part of the efforts to curb obesity, a new focus seems to be put on taxing foods that are perceived as being associated with obesity (eg, sugar-sweetened beverages and foods high in fat, sugar, and salt content) as a policy instrument to promote healthier diets.
To assess the possible effects of such taxation policies by identifying and analyzing all studies which investigate the impact of price increases on consumption, caloric intake, or weight outcomes.
Electronic data bases were searched with appropriate terms and their combinations. Thereafter, abstracts were reviewed and studies were selected based on predefined criteria. The characteristics of the selected studies and the results were extracted in a special form and consequently were reviewed and synthesized.
Price increase may lead to a reduction in consumption of the targeted products, but the subsequent effect on caloric intake may be much smaller. Only a limited number of the identified studies reported weight outcomes, most of which are either insignificant or very small in magnitude to make any improvement in public health.
The effectiveness of a taxation policy to curb obesity is doubtful and available evidence in most studies is not very straightforward due to the multiple complexities in consumer behavior and the underling substitution effects. There is need to investigate in-depth the potential underlying mechanisms and the relationship between price-increase policies, obesity, and public health outcomes.
Since 2008, several states and municipalities have implemented regulations requiring provision of nutrition information at chain restaurants to address obesity. Although early research into the effect of such labels on consumer decisions has shown mixed results, little information exists on the restaurant industry's response to labeling. The objective of this exploratory study was to evaluate the effect of menu labeling on fast-food menu offerings over 7 years, from 2005 through 2011.
Menus from 5 fast-food chains that had outlets in jurisdictions subject to menu-labeling laws (cases) were compared with menus from 4 fast-food chains operating in jurisdictions not requiring labeling (controls). A trend analysis assessed whether case restaurants improved the healthfulness of their menus relative to the control restaurants.
Although the overall prevalence of "healthier" food options remained low, a noteworthy increase was seen after 2008 in locations with menu-labeling laws relative to those without such laws. Healthier food options increased from 13% to 20% at case locations while remaining static at 8% at control locations (test for difference in the trend, P = .02). Since 2005, the average calories for an à la carte entrée remained moderately high (approximately 450 kilocalories), with less than 25% of all entrées and sides qualifying as healthier and no clear systematic differences in the trend between chain restaurants in case versus control areas (P ≥ .50).
These findings suggest that menu labeling has thus far not affected the average nutritional content of fast-food menu items, but it may motivate restaurants to increase the availability of healthier options.
state that this condi-tion poses “the single greatest threat to public health inthis century.” It seems evident that the current obesityepidemic is caused by an excess of calorie intake overexpenditure encouraged by an environment that pro-motesexcessivefoodintakeanddiscouragesphysicalac-tivity. Restaurant foods, large portion sizes, and ubiqui-tous food, all heavily marketed, contribute to calorieoverconsumption.
Recent attempts to improve the healthfulness of away-from-home eating include regulations requiring restaurants to post nutrition information. The impact of such regulations on restaurant environments is unknown.
To examine changes in restaurant environments from before to after nutrition-labeling regulation in a newly regulated county versus a nonregulated county.
Using the Nutrition Environment Measures Survey-Restaurant version audit, environments within the same quick-service chain restaurants were evaluated in King County (regulated) before and 6 and 18 months after regulation enforcement and in Multnomah County (nonregulated) restaurants over a 6-month period. Data were collected in 2008-2010 and analyses conducted in 2011.
Overall availability of healthy options and facilitation of healthy eating did not increase differentially in King County versus Multnomah County restaurants aside from the substantial increase in onsite nutrition information posting in King County restaurants required by the new regulation. Barriers to healthful eating decreased in King County relative to Multnomah County restaurants, particularly in food-oriented establishments. King County restaurants demonstrated modest increases in signage that promotes healthy eating, although the frequency of such promotion remained low, and the availability of reduced portions decreased in these restaurants. The healthfulness of children's menus improved modestly over time, but not differentially by county.
A restaurant nutrition-labeling regulation was accompanied by some, but not uniform, improvements in other aspects of restaurant environments in the regulated compared to the nonregulated county. Additional opportunities exist for improving the healthfulness of away-from-home eating beyond menu labeling.
National recommendations for the prevention and treatment of obesity emphasize reducing energy intake. Foods purchased in restaurants provide approximately 35% of the daily energy intake in US individuals but the accuracy of the energy contents listed for these foods is unknown.
To examine the accuracy of stated energy contents of foods purchased in restaurants.
A validated bomb calorimetry technique was used to measure dietary energy in food from 42 restaurants, comprising 269 total food items and 242 unique foods. The restaurants and foods were randomly selected from quick-serve and sit-down restaurants in Massachusetts, Arkansas, and Indiana between January and June 2010.
The difference between restaurant-stated and laboratory-measured energy contents, which were corrected for standard metabolizable energy conversion factors.
The absolute stated energy contents were not significantly different from the absolute measured energy contents overall (difference of 10 kcal/portion; 95% confidence interval [CI], -15 to 34 kcal/portion; P = .52); however, the stated energy contents of individual foods were variable relative to the measured energy contents. Of the 269 food items, 50 (19%) contained measured energy contents of at least 100 kcal/portion more than the stated energy contents. Of the 10% of foods with the highest excess energy in the initial sampling, 13 of 17 were available for a second sampling. In the first analysis, these foods contained average measured energy contents of 289 kcal/portion (95% CI, 186 to 392 kcal/portion) more than the stated energy contents; in the second analysis, these foods contained average measured energy contents of 258 kcal/portion (95% CI, 154 to 361 kcal/portion) more than the stated energy contents (P <.001 for each vs 0 kcal/portion difference). In addition, foods with lower stated energy contents contained higher measured energy contents than stated, while foods with higher stated energy contents contained lower measured energy contents (P <.001).
Stated energy contents of restaurant foods were accurate overall. However, there was substantial inaccuracy for some individual foods, with understated energy contents for those with lower energy contents.
Introduction
Several studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state.
Objective
To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016.
Design and Setting
A systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year.
Main Outcomes and Measures
Prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed.
Results
Between 1990 and 2016, overall death rates in the United States declined from 745.2 (95% UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95% UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), and West Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5% (95% UI, 42.8% to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5% of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. Across all US states, the top risk factors in terms of attributable DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states).
Conclusions and Relevance
There are wide differences in the burden of disease at the state level. Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention. These data can be used to inform national health priorities for research, clinical care, and policy.
Background: Total-body iron stores (TBI), which are calculated from serum ferritin and soluble transferrin receptor concentrations, can be used to assess the iron status of populations in the United States.Objective: This analysis, developed to support workshop discussions, describes the distribution of TBI and the prevalence of iron deficiency (ID) and ID anemia (IDA) among toddlers, nonpregnant females, and pregnant females.Design: We analyzed data from NHANES; toddlers aged 12-23 mo (NHANES 2003-2010), nonpregnant females aged 15-49 y (NHANES 2007-2010), and pregnant females aged 12-49 y (NHANES 1999-2010). We used SAS survey procedures to plot distributions of TBI and produce prevalence estimates of ID and IDA for each target population. All analyses were weighted to account for the complex survey design.Results: According to these data, ID prevalences (± SEs) were 15.1% ± 1.7%, 10.4% ± 0.5%, and 16.3% ± 1.3% in toddlers, nonpregnant females, and pregnant females, respectively. ID prevalence in pregnant females increased significantly with each trimester (5.3% ± 1.5%, 12.7% ± 2.3%, and 27.5% ± 3.5% in the first, second, and third trimesters, respectively). Racial disparities in the prevalence of ID among both nonpregnant and pregnant females exist, with Mexican American and non-Hispanic black females at greater risk of ID than non-Hispanic white females. IDA prevalence was 5.0% ± 0.4% and 2.6% ± 0.7% in nonpregnant and pregnant females, respectively.Conclusions: Available nationally representative data suggest that ID and IDA remain a concern in the United States. Estimates of iron-replete status cannot be made at this time in the absence of established cutoffs for iron repletion based on TBI. The study was registered at clinicaltrials.gov as NCT03274726.
Introduction:
Consuming too much sodium is associated with increased risk for cardiovascular disease, and restaurant foods are a primary source of sodium. This study assessed recent trends in sodium content of menu items in U.S. chain restaurants.
Methods:
Data from 21,557 menu items in 66 top-earning chain restaurants available from 2012 to 2016 were obtained from the MenuStat project and analyzed in 2017. Generalized linear models were used to examine changes in calorie-adjusted, per-item sodium content of menu items offered in all years (2012-2016) and items offered in 2012 only compared with items newly introduced in 2013, 2014, 2015, and 2016.
Results:
Overall, calorie-adjusted sodium content in newly introduced menu items declined by 104 mg from 2012 to 2016 (p<0.02). However, the magnitude and direction of these changes varied by menu category and restaurant type; sodium content, particularly for main course items, was high. Sodium declined by 83 mg in fast food restaurants, 19 mg in fast casual restaurants, and 163 mg in full service restaurants. Sodium in appetizer and side items newly introduced in 2016 increased by 266 mg compared with items on the menu in 2012 only (p<0.01). Sodium in main courses newly introduced in 2016 declined by 124 mg compared with items on the menu in 2012 only (p=0.01), with the greatest decline, 207 mg (p=0.03), among salads.
Conclusions:
Average, adjusted, per-item sodium content was lower in newly introduced items in large chain restaurants. However, sodium content of core and new menu items remain high, and reductions are inconsistent across menu categories and restaurant types.
No prior studies examining changes in the calorie content of chain restaurants have included national data before and after passage of federal menu labeling legislation, required by the 2010 Affordable Care Act. This paper describes trends in calories available in large U.S. chain restaurants in 2008 and 2012 to 2015 using data were obtained from the MenuStat project (2012 to 2015) and from the Center for Science in the Public Interest (2008). This analysis included 44 of the 100 largest U.S. restaurants which are available in all years of the data (2008 and 2012-2015) (N=19,391 items). Generalized linear models were used to examine 1) per-item calorie changes from 2008 to 2015 among items on the menu in all years and 2) mean calories in new items in 2012, 2013, 2014 and 2015 compared to items on the menu in 2008 only. We found that Among items common to the menu in all years, overall calories declined from 327kcal in 2008 to 318kcal in 2015 (p-value for trend=0.03). No differences in mean calories among menu items newly introduced in 2012, 2013, 2014, and 2015 relative to items only on the menu in 2008 were found. These results suggest that the federal menu labeling mandate (to be implemented in May 2017) appears to be influencing restaurant behavior towards lower average calories for menu items.
Objectives:
To assess the US packaged food industry's progress from 2009 to 2014, when the National Salt Reduction Initiative had voluntary, category-specific sodium targets with the goal of reducing sodium in packaged and restaurant foods by 25% over 5 years.
Methods:
Using the National Salt Reduction Initiative Packaged Food Database, we assessed target achievement and change in sales-weighted mean sodium density in top-selling products in 61 food categories in 2009 (n = 6336), 2012 (n = 6898), and 2014 (n = 7396).
Results:
In 2009, when the targets were established, no categories met National Salt Reduction Initiative 2012 or 2014 targets. By 2014, 26% of categories met 2012 targets and 3% met 2014 targets. From 2009 to 2014, the sales-weighted mean sodium density declined significantly in almost half of all food categories (43%; 26/61 categories). Overall, sales-weighted mean sodium density declined significantly (by 6.8%; P < .001).
Conclusions:
National target setting with monitoring through a partnership of local, state, and national health organizations proved feasible, but industry progress was modest.
Public health implications:
The US Food and Drug Administration's proposed voluntary targets will be an important step in achieving more substantial sodium reductions. (Am J Public Health. Published online ahead of print August 23, 2016: e1-e5. doi:10.2105/AJPH.2016.303397).
Low bone mass leads to fracture risk. Osteoporosis affects over 10% of the population and one out of every two women over the age of 50 years. Genetics predicts more than half of bone mass. Diet and weight bearing exercise are two lifestyle choices that can influence the risk of fracture. Nutrients are the structural constituents of bone. As bone is a living tissue and turns over, albeit more slowly than other tissues, there is an obligatory loss of minerals daily that must be replaced through diet. Three servings of dairy products daily are recommended to replace those losses. Alternative sources of nutrients can come from calcium fortified orange juice, plant-based beverages, or tofu to provide many nutrients needed for bone health. Supplements can provide nutrients at risk for being inadequate such as calcium or vitamin D. This article is protected by copyright. All rights reserved.
Introduction:
A high intake of fast food is associated with increased obesity risk. This study assessed recent changes in caloric content and macronutrient composition in large U.S. fast food restaurants.
Methods:
Data from the MenuStat project included 11,737 menu items in 37 fast food restaurants from 2012 to 2014. Generalized linear models were used to examine changes in the caloric content and corresponding changes in the macronutrient composition (non-sugar carbohydrates, sugar, unsaturated fat, saturated fat, and protein) of menu items over time. Additionally, macronutrient composition was compared in menu items newly introduced in 2013 and 2014, relative to 2012. Analyses, conducted in January 2016, controlled for restaurant and were stratified by menu categories.
Results:
Overall, there was a 22-calorie reduction in food items from 2012 to 2014. Beverages had a 46-calorie increase, explained by an increase in calories from sugar (12 calories) and saturated fat (16 calories). Newly introduced main courses in 2014 had 59 calories fewer than those on 2012 menus, explained by a 54-calorie reduction in unsaturated fat, while other macronutrient content remained fairly constant. Newly introduced dessert items in 2014 had 90 calories more than those on 2012 menus, explained primarily by an increase of 57 calories of sugar.
Conclusions:
Overall, there were relatively minor changes in menu items' caloric and macronutrient composition. Although declines in caloric content among newly introduced fast food main courses may improve the public's caloric intake, it appears that the macronutrient composition of newly introduced items did not shift to a healthier profile.
Background:
Excess energy intake from meals consumed away from home is implicated as a major contributor to obesity, and ∼50% of US restaurants are individual or small-chain (non-chain) establishments that do not provide nutrition information.
Objective:
To measure the energy content of frequently ordered meals in non-chain restaurants in three US locations, and compare with the energy content of meals from large-chain restaurants, energy requirements, and food database information.
Design:
A multisite random-sampling protocol was used to measure the energy contents of the most frequently ordered meals from the most popular cuisines in non-chain restaurants, together with equivalent meals from large-chain restaurants.
Setting:
Meals were obtained from restaurants in San Francisco, CA; Boston, MA; and Little Rock, AR, between 2011 and 2014.
Main outcome measures:
Meal energy content determined by bomb calorimetry.
Statistical analysis performed:
Regional and cuisine differences were assessed using a mixed model with restaurant nested within region×cuisine as the random factor. Paired t tests were used to evaluate differences between non-chain and chain meals, human energy requirements, and food database values.
Results:
Meals from non-chain restaurants contained 1,205±465 kcal/meal, amounts that were not significantly different from equivalent meals from large-chain restaurants (+5.1%; P=0.41). There was a significant effect of cuisine on non-chain meal energy, and three of the four most popular cuisines (American, Italian, and Chinese) had the highest mean energy (1,495 kcal/meal). Ninety-two percent of meals exceeded typical energy requirements for a single eating occasion.
Conclusions:
Non-chain restaurants lacking nutrition information serve amounts of energy that are typically far in excess of human energy requirements for single eating occasions, and are equivalent to amounts served by the large-chain restaurants that have previously been criticized for providing excess energy. Restaurants in general, rather than specific categories of restaurant, expose patrons to excessive portions that induce overeating through established biological mechanisms.
Large chain restaurants reduced the number of calories in newly introduced menu items in 2013 by about 60 calories (or 12%) relative to 2012. This paper describes trends in calories available in large U.S. chain restaurants to understand whether previously documented patterns persist.
Data (a census of items for included restaurants) were obtained from the MenuStat project. This analysis included 66 of the 100 largest U.S. restaurants that are available in all three of the data years (2012-2014; N=23,066 items). Generalized linear models were used to examine: (1) per-item calorie changes from 2012 to 2014 among items on the menu in all years; and (2) mean calories in new items in 2013 and 2014 compared with items on the menu in 2012 only. Data were analyzed in 2014.
Overall, calories in newly introduced menu items declined by 71 (or 15%) from 2012 to 2013 (p=0.001) and by 69 (or 14%) from 2012 to 2014 (p=0.03). These declines were concentrated mainly in new main course items (85 fewer calories in 2013 and 55 fewer calories in 2014; p=0.01). Although average calories in newly introduced menu items are declining, they are higher than items common to the menu in all 3 years. No differences in mean calories among items on menus in 2012, 2013, or 2014 were found.
The previously observed declines in newly introduced menu items among large restaurant chains have been maintained, which suggests the beginning of a trend toward reducing calories.
Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
To examine changes in children's meal orders, price, and revenue following the implementation of a healthier children's menu in a full-service restaurant chain.
In April 2012, the healthier menu was implemented, featuring more meals meeting nutrition standards, healthy side dishes by default, and removal of French fries and soda (which could be substituted). Orders (n = 352,192) were analyzed before (September 2011 to March 2012; PRE) and after (September 2012 to March 2013; POST) implementation.
Children's meal prices increased by 0.19 for non-breakfast meals from PRE to POST. Revenue continued to increase post-implementation. Orders of healthy meals, strawberry and vegetable sides, milk, and juice increased, and orders of French fries and soda decreased (P < 0.0001). Orders at POST were more likely to include healthy sides (P < 0.0001) and substitutions (P < 0.0001) and less likely to include a la carte sides (P < 0.0001) and desserts (P < 0.01), versus PRE. Total calories ordered by children accepting all defaults decreased (684.2 vs. 621.2; P < 0.0001) and did not change for those not accepting defaults (935.0 vs. 942.9; P = 0.57).
Healthy children's menu modifications were accompanied by healthier ordering patterns, without removing choice or reducing revenue, suggesting that they can improve child nutrition while restaurants remain competitive.
© 2015 The Obesity Society.
Objective:
To compare micronutrient intake status of those overweight and those obese with normal weight adults.
Methods:
Using total nutrient intake (from foods and supplements) from the National Health and Nutrition Examination Survey (NHANES) 2001-2008, we determined usual intakes for micronutrients using the National Cancer Institute methodology in adults (n = 18,177). Only subjects with reliable dietary records were included and pregnant and lactating females were excluded. Subjects were categorized by body weight status as either normal weight (body mass index [BMI] < 25), overweight (BMI ≥ 25 to < 30), or obese (BMI ≥ 30).
Results:
A substantial proportion of the adult population (over 40%) had inadequate intakes of vitamin A, vitamin C, vitamin D, vitamin E, calcium, and magnesium. Compared to normal weight adults, obese adults had about 5% to 12% lower (p < 0.05) intakes of micronutrients and higher (p < 0.01) prevalence of nutrient inadequacy.
Conclusion:
We conclude that obese adults compared to normal weight adults have lower micronutrient intake and higher prevalence of micronutrient inadequacy.
Objective:
To examine the effect of fast-food and full-service restaurant consumption on adults' energy intake and dietary indicators.
Design:
Individual-level fixed-effects regression model estimation based on two different days of dietary intake data was used.
Setting:
Parallel to the rising obesity epidemic in the USA, there has been a marked upward trend in total energy intake derived from food away from home.
Subjects:
The full sample included 12 528 respondents aged 20-64 years who completed 24 h dietary recall interviews for both day 1 and day 2 in the National Health and Nutrition Examination Survey (NHANES) 2003-2004, 2005-2006, 2007-2008 and 2009-2010.
Results:
Fast-food and full-service restaurant consumption, respectively, was associated with an increase in daily total energy intake of 813·75 kJ (194·49 kcal) and 858·04 kJ (205·21 kcal) and with higher intakes of saturated fat (3·48 g and 2·52 g) and Na (296·38 mg and 451·06 mg). Individual characteristics moderated the impacts of restaurant food consumption with adverse impacts on net energy intake being larger for black adults compared with their white and Hispanic counterparts and greater for middle-income v. high-income adults.
Conclusions:
Adults' fast-food and full-service restaurant consumption was associated with higher daily total energy intake and poorer dietary indicators.
The goal of our study was to estimate the prevalence of osteoporosis and low bone mass based on bone mineral density (BMD) at the femoral neck and the lumbar spine in adults 50 years and older in the United States (US). We applied prevalence estimates of osteoporosis or low bone mass at the femoral neck or lumbar spine (adjusted by age, sex, and race/ethnicity to the 2010 Census) for the non-institutionalized population age 50 years and older from the National Health and Nutrition Examination Survey 2005–2010 to 2010 US Census population counts to determine the total number of older US residents with osteoporosis and low bone mass. There were over 99 million adults 50 years and older in the US in 2010. Based on an overall 10.3% prevalence of osteoporosis, we estimated that in 2010 10.2 million older adults had osteoporosis. The overall low bone mass prevalence was 43.9%, from which we estimated that 43.4 million older adults had low bone mass. We estimated that 7.7 million non-Hispanic White, 0.5 million non-Hispanic Black, and 0.6 million Mexican American adults had osteoporosis and another 33.8, 2.9, and 2.0 million had low bone mass, respectively. When combined, osteoporosis and low bone mass at the femoral neck or lumbar spine affected an estimated 53.6 million older US adults in 2010. Although most of the individuals with osteoporosis or low bone mass were non-Hispanic White women, a substantial number of men and women from other racial/ethnic groups also had osteoporotic BMD or low bone mass. © 2014 American Society for Bone and Mineral Research
Because restaurants routinely serve food with more calories than people need, dining out represents a risk factor for overweight, obesity, and other diet-related chronic diseases.
Most people lack the capacity to judge the caloric content of food and there is limited evidence that people make use of calorie-labeling information when it is available. Standardized portion sizes would not preclude people from eating as much as they want, but would make the amount they are getting fully transparent.
We describe the potential benefits and means of implementing a system of standardized portion sizes that might facilitate a healthier diet among the US population.
The food environment shapes individual diets, and as food options change, energy and sodium intake may also shift. Understanding whether and how restaurant menus evolve in response to labeling laws and public health pressures could inform future efforts to improve the food environment.
To track changes in the energy and sodium content of US chain restaurant main entrées between spring 2010 (when the Affordable Care Act was passed, which included a federal menu labeling requirement) and spring 2011.
Nutrition information was collected from top US chain restaurants' websites, comprising 213 unique brands. Descriptive statistics and regression analysis evaluated change across main entrées overall and compared entrées that were added, removed, and unchanged. Tests of means and proportions were conducted for individual restaurant brands to see how many made significant changes. Separate analyses were conducted for children's menus.
Mean energy and sodium did not change significantly overall, although mean sodium was 70 mg lower across all restaurants in added vs removed menu items at the 75th percentile. Changes were specific to restaurant brands or service model: family-style restaurants reduced sodium among higher-sodium entrées at the 75th percentile, but not on average, and entrées still far exceeded recommended limits. Fast-food restaurants decreased mean energy in children's menu entrées by 40 kcal. A few individual restaurant brands made significant changes in energy or sodium, but the vast majority did not, and not all changes were in the healthier direction. Among those brands that did change, there were slightly more brands that reduced energy and sodium compared with those that increased it.
Industry marketing and pledges may create a misleading perception that restaurant menus are becoming substantially healthier, but both healthy and unhealthy menu changes can occur simultaneously. Our study found no meaningful changes overall across a 1-year time period. Longer-term studies are needed to track changes over time, particularly after the federal menu labeling law is implemented.
To examine changes in the Na content of lunch/dinner menu offerings at eight of the leading fast-food restaurants in the USA between 1997/1998 and 2009/2010.
Menu offerings and nutrient composition information for the menu items were obtained from archival versions of the University of Minnesota Nutrition Coordinating Center (NCC) Food and Nutrient Database. Nutrient composition information for lunch/dinner menu items sold by the fast-food restaurants included in the present study was updated in the database biannually. Menus were analysed for changes in mean Na content of all menu offerings (except beverages) and specific categories of menu items among all restaurants and for each individual restaurant.
Lunch/dinner food menu of eight leading US fast-food restaurants.
Between 1997/1998 and 2009/2010 the mean Na content of menu offerings across the eight restaurants increased by 23·4 %. Examining specific food categories, mean Na content of entrées by increased 17·2 % and that of condiments increased by 26·1 %. Only side dishes showed a decrease of 6·6 %. None of the restaurants examined had a decrease in Na across the lunch/dinner menu offerings over the 14 years examined.
Results suggest that over the time period studied there has been no meaningful reduction in the Na content of lunch/dinner menu offerings at the leading fast-food restaurants examined in the present study.
Western industrialized societies are currently experiencing an epidemic expansion of hypertension (HTN), which extends alarmingly even to children and adolescents. HTN constitutes an independent risk factor for cardiorenal disease and represents an extremely common comorbidity of diabetes and obesity. Numerous randomized clinical trials and meta-analyses have provided robust scientific evidence that reduced dietary salt intake, increased dietary potassium intake, moderation of alcohol consumption, optimal weight maintenance, and the adoption of "heart-friendly" dietary patterns such as the Dietary Approaches to Stop Hypertension or the Mediterranean diet can effectively lower blood pressure. Interestingly, the susceptibility of blood pressure to nutritional interventions is greatly variable among individuals, depending on age, race, genetic background, and comorbidities. The purpose of this review is to provide a comprehensive overview of currently available scientific evidence in the constantly evolving field of diet and HTN, placing particular emphasis on the key role of dietary sodium, dietary potassium, and alcohol intake in the pathophysiology, prevention, and treatment of human hypertension.
Importance:
Excess consumption of sodium is an important cause of hypertension, a major risk factor for heart disease and stroke. The higher the level of consumption, the greater is a person's likelihood of developing hypertension. Numerous organizations have recommended reductions in sodium intake in the United States. Roughly 80% of the sodium consumed by Americans has been added by food manufacturers and restaurants.
Objective:
To compare the mean (SD) levels of sodium for identical products ascertained in 2005, 2008, and 2011.
Design and setting:
Comparison study in an academic research setting.
Participants and exposures:
Center for Science in the Public Interest staff have monitored sodium levels in selected processed foods and fast-food restaurant foods for many years.
Main outcomes and measures:
The sodium content in identical foods, as measured in 2005, 2008, and 2011.
Results:
Between 2005 and 2011, the sodium content in 402 processed foods declined by approximately 3.5%, while the sodium content in 78 fast-food restaurant products increased by 2.6%. Although some products showed decreases of at least 30%, a greater number of products showed increases of at least 30%. The predominant finding is the absence of any appreciable or statistically significant changes in sodium content during 6 years.
Conclusions and relevance:
Based on our sample, reductions in sodium levels in processed and restaurant foods are inconsistent and slow. These findings are in accord with other data indicating the slow pace of voluntary reductions in sodium levels in processed and restaurant foods. Stronger action (eg, phased-in limits on sodium levels set by the federal government) is needed to lower sodium levels and reduce the prevalence of hypertension and cardiovascular diseases.
Background:
Frequent consumption of fast-food menu items that are high in fat, sugar, and sodium contribute to poor dietary quality, increasing individuals' risk for diet-related chronic diseases.
Purpose:
To assess 14-year trends in the nutritional quality of menu offerings at eight fast-food restaurant chains in the U.S.
Methods:
Data on menu items and food and nutrient composition were obtained in 2011 from archival versions of the University of Minnesota Nutrition Coordinating Center Food and Nutrient Database for eight fast-food restaurant chains. In this database, ingredient and nutrition information for all foods sold by the fast-food restaurants were updated biannually between 1997/1998 and 2009/2010. Healthy Eating Index (HEI)-2005 scores were calculated for each restaurant menu as a measure of the extent to which menu offerings were consistent with Dietary Guidelines for Americans and compared over time.
Results:
Of a possible index total of 100 (healthiest), the HEI-2005 score across all eight fast-food restaurants was 45 in 1997/1998 and 48 in 2009/2010. Individually, restaurant scores in 1997/1998 ranged from 37 to 56 and in 2009/2010 ranged from 38 to 56. The greatest improvements in nutritional quality were seen in the increase of meat/beans, decrease in saturated fat, and decrease in the proportion of calories from solid fats and added sugars. The HEI-2005 score improved in six restaurants and decreased in two.
Conclusions:
The nutritional quality of menu offerings at fast-food restaurant chains included in this study increased over time, but further improvements are needed. Fast-food restaurants have an opportunity to contribute to a healthy diet for Americans by improving the nutritional quality of their menus.
Within the past decade, there has been increasing attention to the role of fast food in the American diet, including a rise in legislative and media-based efforts that address the healthfulness of fast food. However, no studies have been undertaken to evaluate changes in the energy content of fast-food chain restaurant menu items during this period.
To examine changes in the energy content of lunch/dinner menu offerings at eight of the leading fast-food chain restaurants in the U.S. between 1997-1998 and 2009-2010.
Menu offerings and nutrient composition information were obtained from archival versions of the University of Minnesota Nutrition Coordinating Center Food and Nutrient Database. Nutrient composition information for items was updated biannually. Changes in median energy content of all lunch/dinner menu offerings and specific categories of menu items among all restaurants and for individual restaurants were examined. Data were collected between 1997 and 2010 and analysis was conducted in 2011.
Spanning 1997-1998 and 2009-2010, the number of lunch/dinner menu items offered by the restaurants in the study increased by 53%. Across all menu items, the median energy content remained relatively stable over the study period. Examining specific food categories, the median energy content of desserts and condiments increased, the energy content of side items decreased, and energy content of entrées and drinks remained level.
Although large increases in the number of menu items were observed, there have been few changes in the energy content of menu offerings at the leading fast-food chain restaurants examined in this study.
The prevalence of overweight and obesity in US adults is currently 68%, compared with about 47% in the early 1970s. Many dietary factors have been proposed to contribute to the US obesity epidemic, including the percentage of energy intake from fat, carbohydrate and protein; glycemic index; fruit and vegetable intake; caloric beverage intake; and fast food or other restaurant food intake. One factor that may also be important is the variety of foods in the diet having different sensory properties, that is, flavors, textures, shapes and colors. A host of studies show that when presented with a greater variety of foods within a meal, humans consume about 22% more energy compared to when only one food is available. These data are supported by laboratory animal studies on the effects of sensory variety on consumption as well as body weight and fat gain. Longer term experimental trials in humans lasting 1-2wk had mixed results but generally showed an increase in intake of 50-60kcal/d per additional food offered, provided at least 5 different foods per day were available. In only two studies to date has reducing dietary variety been explored as a potential method for weight loss. In those studies, which also incorporated a standard behavioral weight loss approach, there was no difference in weight loss when either snack food variety or low nutrient dense, high energy dense variety was limited. However, a broader treatment approach may be more effective, for example limiting the excess variety of foods high in energy density yet which provide little benefit to vitamin and mineral intake at each meal, and further studies are needed in this area.
Policies on menu labeling have been proposed as a method to improve the food environment. However, there is little information on the nutrient content of chain restaurant menu items and changes over time.
To evaluate the energy, saturated fat, and sodium content of entrées 6 and 18 months post-implementation of restaurant menu labeling in King County of Washington State for items that were on the menu at both time periods, and across all items at 6 and 18 months and to compare energy content to recommendations provided by the 2005 Dietary Guidelines for Americans.
Eligible restaurants included sit-down and quick-service chains (eg, burgers, pizza, sandwiches/subs, and Tex-Mex) subject to King County regulations with four or more establishments. One establishment per chain was audited at each time period.
Hypothesis one examined entrées that were on the menu at both time periods using a paired t test and hypothesis two compared quartiles at 6 months to the distribution at 18 months using a Mantel-Haentzel odds ratios and 95% CIs, and a Cochrane-Armitage test for trend. The content of entrées at 18 months was compared with one-third (assuming three meals per day) of the nutrient intake recommendations for adults provided by the 2005 Dietary Guidelines for Americans.
The audit included 37 eligible chains of 92 regulated chains. Energy contents were lower (all chains -41, sit down -73, and quick service -19; paired t tests P<0.0001) for entrées that were on the menu at both time periods. There was a significant trend across quartiles for a decrease in energy, saturated fat, and sodium for all entrées at sit-down chains only. At 18 months entrées not designated for children exceeded 56%, 77%, and 89% of the energy, saturated fat, and sodium guidelines, respectively.
Modest improvements in the nutrient content of sit-down and quick-service restaurant entrées occurred but overall levels for energy, saturated fat, and sodium are excessive.
Much of the research in ingestive behavior has focused on the macronutrient composition of foods; however, these studies are incomplete, or could be misleading, if they do not consider the energy density (ED) of the diet under investigation. Lowering the ED (kcal/g) by increasing the volume of preloads without changing macronutrient content can enhance satiety and reduce subsequent energy intake at a meal. Ad libitum intake or satiation has also been shown to be influenced by ED when the proportions of macronutrients are constant. Since people tend to eat a consistent weight of food, when the ED of the available foods is reduced, energy intake is reduced. The effects of ED have been seen in adults of different weight status, sex, and behavioral characteristics, as well as in 3- to 5-year-old children. The mechanisms underlying the response to variations in ED are not yet well understood and data from controlled studies lasting more than several days are limited. However, both population-based studies and long-term clinical trials indicate that the effects of dietary ED can be persistent. Several clinical trials have shown that reducing the ED of the diet by the addition of water-rich foods such as fruits and vegetables was associated with substantial weight loss even when patients were not told to restrict calories. Since lowering dietary energy density could provide effective strategies for the prevention and treatment of obesity, there is a need for more studies of mechanisms underlying the effect and ways to apply these findings.
During the last decades, eating out of home (OH) has gained importance in the diets worldwide. We document the nutritional characteristics of eating OH and its associations with energy intake, dietary quality and socioeconomic status. We carried out a systematic review of peer-reviewed studies in eight databases up to 10 March 2011. Of the 7,319 studies retrieved, 29 met the inclusion criteria and were analysed in this review. The quality of the data was assessed and a sensitivity analysis was conducted by isolating nationally representative or large cohort data from 6 and 11 countries, respectively. OH foods were important sources of energy in all age groups and their energy contribution increased in adolescents and young adults. Eating OH was associated with a higher total energy intake, energy contribution from fat in the daily diet and higher socioeconomic status. Two large studies showed how eating OH was also associated with a lower intake of micronutrients, particularly vitamin C, Ca and Fe. Although the studies were cross-sectional and heterogeneous in the way they classified eating OH, we conclude that eating OH is a risk factor for higher energy and fat intake and lower micronutrient intake.
A regulation banning new fast-food establishments for one year in Los Angeles, California, was passed unanimously by the city council in July 2008. It was motivated by health concerns and excessive obesity rates in South Los Angeles. However, it might not have had the impact that was intended. This paper reviews the empirical evidence for the regulation and whether it is likely to target the primary levers of obesity. We argue that the premises for the ban were questionable. For example, the density of fast-food chain restaurants per capita is actually higher in other parts of Los Angeles than in South LA. Other changes, such as menu calorie labeling, are likely to have a bigger impact on overweight and obesity.
Daily Values (DVs) are the daily dietary intake standards used for nutrition labeling. Information on the derivation of DVs is important for dietetics professionals and nutrition educators who use DVs to educate and instruct patients and students about diet planning and evaluation and about adherence to modified diets. The first daily intake standards for nutrition labeling were established in 1973 and were referred to as the US Recommended Daily Allowances (US RDAs). They were based on the 1968 Recommended Dietary Allowances (RDAs) developed by the National Academy of Sciences. These intake standards were mandatory for 8 and optional for 12 food components on nutrition labels. Regulations revising the daily intake standards for nutrition labeling were published in 1993. The new standards included Reference Daily Intakes (RDIs) for 19 food components and Daily Reference Values (DRVs) for 8 food components. The RDIs were based on the 1973 US RDAs, and the DRVs were based on consensus recommendations. On the nutrition label, the RDIs and DRVs are referred to as DVs. Percent DVs are mandatory on nutrition labels for 10 food components and optional for 16 food components. In 1995, DVs were established by regulation for 6 additional food components; these DVs are optional for nutrition labels. The DVs established in 1995 were based on information from the 1980 and 1989 revisions of the RDAs and Estimated Safe and Adequate Daily Dietary Intakes. Currently, percent DVs are mandatory on nutrition labels for 10 food components and optional for 22. Optional percent DVs become mandatory if claims are made about the food components or if the food components are added to the food through fortification or as food additives.