Examining the consumer restaurant environment and dietary intake in children

Neighbourhood out-of-home food environment, menu healthiness, and their associations with meal purchasing and diet quality: a multiverse analysis

BACKGROUND

Governments worldwide have implemented various interventions to improve the healthiness of food offered by out-of-home outlets. However, there is limited evidence on whether healthier menus would influence individual dietary behaviours and quality. In this cross-sectional study, we investigated associations between different measures of the neighbourhood out-of-home food environment, incorporating menu healthiness, and out-of-home meal purchasing and diet quality.

METHODS

We used a sample of 3,481 adults in Great Britain (GB) with valid home postcodes from the 2021 International Food Policy Study. We linked this sample to a national database of food outlet geographical locations to characterise individuals' exposure to the out-of-home food environment. The exposure metrics included menu healthiness scores, availability, proximity, and relative composition of out-of-home food outlets in various neighbourhood buffers around the home (i.e., 500 - 1600 m). Outcomes considered were out-of-home meal consumption and overall diet quality. Using multiverse analyses, where multiple reasonable analytical choices can be tested, we investigated the associations between different exposure measures and these outcomes.

RESULTS

GB adults had access to an average of 97 (95% CI 91, 104) out-of-home food outlets within 1600 m of their homes. The number of both healthier and less healthy out-of-home food outlets was positively associated with the number of meals purchased out-of-home across all neighbourhood buffers, e.g., every 10 additional less healthy out-of-home food outlets within 500 m of the home corresponded to a 6% (95% CI = 2, 11) increase in the frequency of out-of-home meal purchases in the previous week. Proximity, relative composition, and menu healthiness of neighbourhood out-of-home outlets were not associated with out-of-home meal purchase frequency after adjusting for multiple comparisons. There were no consistent associations between out-of-home food environment exposures and diet quality.

CONCLUSION

The only aspect of the neighbourhood out-of-home food environment associated with out-of-home meal purchase frequency was the number of out-of-home food outlets. Menu healthiness of out-of-home food outlets was not associated with how often people purchased out-of-home meals or overall diet quality. Interventions focusing on mitigating the proliferation of out-of-home food outlets may be more effective in changing individual dietary behaviour than those focusing on food served.

The food retail environment around schools in a low-income Brazilian city: a street audit evaluation

This cross-sectional study evaluated the retail food environment (FE) around early childhood education centers (ECEC) in Rio Largo/AL, Brazil. Food retail outlets (FRO) were identified through a city street survey and audited using the Brazilian version of the Nutrition Environment Measurement Survey for Stores (NEMS-S). The Department of Education provided the ECEC's addresses, which were validated and geocoded (n=21). Schools' surroundings were defined by 400- and 800-meter buffers. The FE was analyzed using the healthy food availability index (HFAI), average distance between FRO and ECEC, and distribution and density of FRO according to the predominant type of food marketed (healthy, mixed, and unhealthy). Respectively, 332 (57.7%) and 505 (87.8%) FRO were identified in the 400- and 800-meter buffers. On average, 23 (400 m) and 54 (800 m) FRO were around schools, where ~60% were unhealthy (clustered throughout the city). The HFAI was very low for both buffers (400m: -1 points [IQR -6; 10]; 800m: -2 points [IQR -6; 10]). In conclusion, the city does not offer a supportive community food environment for children to develop and maintain healthy eating patterns.

Eating out of home in Portugal: characterisation and effects on dietary intake

This cross-sectional study aims to describe and compare energy, nutrient intake and food consumption according to eating location and by age groups using data from the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015/2016). Dietary intake was estimated by two non-consecutive days of food diaries (children)/24-h recalls (other age groups), and four eating location categories were defined according to the proportion of meals consumed at out-of-home locations: Home (at least 80 % of meals at home), Other Homes, School or Work and Restaurants and Other Places. The majority of meals (69·1 %) were consumed at home. Meals were also often taken at school by children and adolescents and in restaurants and similar outlets by adults and elderly. Children and adolescents in the School or Work category ate more fruit, vegetables and pulses and cereals and starchy tubers, whereas adults in this category ate more red and processed meats, sugar-sweetened beverages and sweets. Compared with Home category, Restaurants and Other Places was associated with worse diet adequacies among children (β = -1·0; 95 % CI = -2·0, -0·04), adolescents: (β = -2·4; 95 % CI = -3·2, -1·5) and adults (β = -1·3; 95 % CI = -1·6, -1·0) reflecting higher intakes of energy, fat, trans-fatty acids and SFA, and Na. The elderly consumed more free sugars and fat when eating out of home in general. Overall, findings reflect important variation in nutrient profiles by eating location, with meals taken at school or work contributing to higher consumption of nutrient-dense foods and those taken in restaurants and other similar settings implying higher consumption of energy-dense foods.

The Built Environment and Pediatric Health

Buildings, parks, and roads are all elements of the "built environment," which can be described as the human-made structures that comprise the neighborhoods and communities where people live, work, learn, and recreate (https://www.epa.gov/smm/basic-information-about-built-environment). The design of communities where children and adolescents live, learn, and play has a profound impact on their health. Moreover, the policies and practices that determine community design and the built environment are a root cause of disparities in the social determinants of health that contribute to health inequity. An understanding of the links between the built environment and pediatric health will help to inform pediatricians' and other pediatric health professionals' care for patients and advocacy on their behalf. This technical report describes the range of pediatric physical and mental health conditions influenced by the built environment, as well as historical and persistent effects of the built environment on health disparities. The accompanying policy statement outlines community design solutions that can improve pediatric health and health equity, including opportunities for pediatricians and the health care sector to incorporate this knowledge in patient care, as well as to play a role in advancing a health-promoting built environment for all children and families.