Contribution of foods prepared away from home to intakes of energy and nutrients of public health concern in adults: a systematic review

COVID-19 Relief Receipt and U.S. Household Food Expenditures

Introduction

COVID-19 relief payments and programs may have contributed to the shift in food expenditures from food away from home to food at home during the pandemic. This shift has public health implications given the differences in the nutritional quality between food at home and food away from home. The objective of this study is to examine the association between COVID-19 relief and household food at home and food away from home expenditure shares. Economic Impact Payments, Pandemic-Electronic Benefits Transfer, Supplemental Nutrition Assistance Program, and charitable food receipt are considered.

Methods

Food expenditure and COVID-19 relief data for 265,443 households were obtained from Phase 3.1 (April 28 to July 5, 2021) of the Household Pulse Survey. Poisson pseudo-maximum likelihood estimators were employed in 2023 to analyze the association between COVID-19 relief and household food at home and food away from home expenditure shares.

Results

Pandemic-Electronic Benefits Transfer receipt was associated with households allocating 3% less of food expenditures to food at home and 9% more to food away from home. Supplemental Nutrition Assistance Program and charitable food receipt were associated with spending 8% and 3% more of food expenditures on food at home and 22% and 9% less on food away from home, respectively. Recent Economic Impact Payment receipt was associated with reduced food at home and increased food away from home expenditure shares among households with low-income and/or a Black respondent.

Conclusions

Study results indicate that COVID-19 relief contributed to changing food expenditure patterns during the pandemic. Of note, Pandemic-Electronic Benefits Transfer and Economic Impact Payment receipt were associated with spending a greater share of food dollars on food away from home. Nutritional implications of COVID-19 relief warrant further investigation and should be carefully considered in the design of future nutrition assistance emergency relief.

No Money No Time Culinary Nutrition Website eHealth Challenge: A Pre-Post Evaluation of Impact on Diet Quality, Food Expenditure, and Engagement

No Money No Time (NMNT) is a culinary nutrition website designed to optimize diet quality. The primary aim was to evaluate the impact of an online targeted nutrition challenge email campaign that encouraged engagement with NMNT and goal setting to improve diet quality and weekly food expenditure. A secondary aim was to assess NMNT engagement. Australian adults ≥18 years were recruited to the eHealth nutrition challenge delivered via weekly emails. Diet quality was assessed using the Healthy Eating Quiz (HEQ) diet quality tool. Engagement was assessed using email open and click-through rates. Intention-to-treat (ITT) analysis was conducted using mixed effects linear regression. Of 481 adults (49.7 ± 13.9 years, 84% female) who enrolled 79 (16%) completed the challenge. ITT results indicated statistically significant 6-week increases in diet quality score (+3.8 points p ≤ 0.001, d = 0.58) with sub-scale improvements in vegetables (+0.9 points, p = 0.01, d = 0.32), fruit (+1.2 points, p ≤ 0.001, d = 0.55), and dairy (+0.9 points, p ≤ 0.001, d = 0.58). There were significant post-challenge reductions in household spending on takeaway/snacks/coffee of AUD 8.9 per week (p = 0.01, d = 0.29), body weight reduction (-0.6 kg, p = 0.03, d = 0.26), and BMI (-0.2 kg/m2p = 0.02, d = 0.28). The email open rate remained constant at around 67% (56% to 75%), with an average click-through rate of 18% (7.1% to 37.9%). The eHealth nutrition challenge significantly improved diet quality while reducing BMI and money spent on discretionary foods. Strategies to scale the challenge should be tested as an innovative population strategy for improving diet quality, health indicators, and managing household food budgets.

Energy-Dense and Low-Fiber Dietary Pattern May Be a Key Contributor to the Rising Obesity Rates in Brazil

Hybrid methods are a suitable option for extracting dietary patterns associated with health outcomes. This study aimed to identify the dietary patterns of Brazilian adults (20-59 years old; n = 28,153) related to dietary components associated with the risk of obesity. Data from the 2017-2018 Brazilian National Dietary Survey were analyzed. Food consumption was obtained through 24 h recall. Dietary patterns were extracted using partial least squares regression, using energy density (ED), percentage of total fat (%TF), and fiber density (FD) as response variables. In addition, 32 food groups were established as predictor variables in the model. The first dietary pattern, named as energy-dense and low-fiber (ED-LF), included with the positive factor loadings solid fats, breads, added-sugar beverages, fast foods, sauces, pasta, and cheeses, and negative factor loadings rice, beans, vegetables, water, and fruits (≥|0.15|). Higher adherence to the ED-LF dietary pattern was observed for individuals >40 years old from urban areas, in the highest income level, who were not on a diet, reported away-from-home food consumption, and having ≥1 snack/day. The dietary pattern characterized by a low intake of fruits, vegetables, and staple foods and a high intake of fast foods and sugar-sweetened beverages may contribute to the obesity scenario in Brazil.

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 Quality of Menu Offerings in Independently Owned Restaurants in Baltimore, Maryland: Results from Mixed-Methods Formative Research for the FRESH Trial

(1) Background: Independently owned restaurants (IORs) are prevalent in under-resourced racial and ethnic minority communities in the US and present a unique setting for public health nutrition interventions. (2) Methods: We conducted 14 in-depth interviews with IOR owners in Baltimore about their perceptions of healthy food, and customers' acceptance of healthier menus and cooking methods and concurrent observations of the availability of healthy options on their menus. Qualitative data were coded and analyzed using ATLAS.ti. Observations were analyzed with statistical analysis performed in R. (3) Results: Owners perceived non-fried options, lean proteins, and plant-based meals as healthy. While open to using healthier cooking fats, they had mixed feelings about reducing salt, adopting non-frying methods for cooking, and adding vegetables and whole grains to the menu, and were reluctant to reduce sugar in recipes and beverages. Only 17.5% of 1019 foods and 27.6% of 174 beverages in these IORs were healthy, with no significant differences in the healthfulness of restaurant offerings within low-healthy-food-access/low-income neighborhoods and those outside. (4) Conclusion: Healthy options are generally scarce in Baltimore's IORs. Insights from owners inform future interventions to tailor healthy menu offerings that are well-received by customers and feasible for implementation.

Local retail food environment exposure and diet quality in rural and urban adults: A longitudinal analysis of the ORISCAV-LUX cohort study

Despite growing interest in understanding how food environments shape dietary behaviors, European longitudinal evidence is scarce. We aimed to investigate the associations of 9-year average and change in exposure to local retail food environments with the diet quality of residents in Luxembourg. We used data from 566 adults enrolled in both waves of the nationwide ORISCAV-LUX study (2007-2017). Dietary quality was assessed by the Diet Quality Index-International (DQI-I). Exposure to "healthy" and "less healthy" food outlets was assessed by both absolute and relative GIS-based measurements. The results showed a 56.3% increase in less healthy food outlets over the period. In adjusted linear mixed models, high (vs. low) 9-year average exposure to less healthy food outlets was associated with lower DQI-I, when examining spatial access (β = -1.25, 95% CI: -2.29, -0.22) and proportions (β = -1.24, 95% CI: -2.15, -0.33). Stratified analyses showed these associations to be significant only among urban residents. There was no association between change in exposure to less healthy food outlets and DQI-I. Increased exposure to healthy outlets in rural areas, using absolute measurements, was associated with worsened DQI-I. Neighborhood socioeconomic status did not moderate the above associations. Findings suggest that the proliferation of less healthy food outlets may have contributed to the deterioration of the diet quality of urban residents, and support the use of relative measurements to fully capture the healthiness of food environments.

Sodium Intake and Sodium to Potassium Ratio among New York City Adults in the 2018 Heart Follow-Up Study

Background

High sodium and low potassium intake are positively associated with blood pressure, a significant risk factor for cardiovascular disease. The mean intake of sodium among United States adults exceeds the chronic disease risk reduction level of 2300 mg/d, whereas potassium intake remains lower than the recommended levels. From 2008 through 2019, there were several local and national initiatives to reduce sodium in New York City (NYC).

Objectives

We aimed to update and compare estimates of sodium intake among NYC adults overall and by covariates from the 2010 Heart Follow-Up Study (HFUS) with the 2018 HFUS. We also estimated the 2018 sodium-to-potassium ratio to understand overall diet quality among demographic groups.

Methods

This cross-sectional study used sodium and potassium measurements from 24-h urine collection and self-reported data from 2509 and 1656 participants in the 2018 and 2010 HFUS, respectively. The weighted mean daily intake of sodium and the sodium-to-potassium ratio were estimated. T-tests and multivariable linear regression models with tests for interactions were used to compare changes in sodium intake.

Results

The mean sodium intake of adult New Yorkers in 2018 was 3292 mg/d. Sodium intake did not change from 2010 (3234 mg/d, P = 0.45) to 2018 in the overall population, although there was a decrease in sodium intake among adults 18-24 y old (3445 mg/d to 2957 mg/d, P = 0.05). The daily mean sodium-to-potassium ratio was 1.7 mg/mg. The highest sodium-to-potassium ratios were among Black females 18-44 y old (2.0) and 45-64 y old (2.2) and Black (2.1) and Latino (2.1) males between 18 and 44 y old.

Conclusions

The lack of population-level changes in sodium intake and the high sodium-to-potassium ratios among Black females and younger Black and Latino males suggest that further efforts to reduce sodium in the food supply and address persistent inequities are needed.

Trends in Sugar From Packaged Foods and Beverages Purchased by US Households Between 2002 and 2020

BACKGROUND

Excess sugar consumption is a public health concern in the United States. How sugar purchases have changed over time, whether there are disparities across subpopulations, and the contribution of various food groups are unclear.

OBJECTIVE

To assess trends in sugar from packaged foods and beverages purchased by US households between 2002 and 2020.

DESIGN

This is an open cohort study.

PARTICIPANTS/SETTING

We obtained data from the NielsenIQ U.S. Homescan Consumer Panel, which collects data on household purchases of all consumer packaged goods in 52 metropolitan and 24 non-metropolitan markets across the United States. We assessed data on food and beverage purchases for 1,163,447 household-years.

MAIN OUTCOME MEASURES

The primary outcomes are the total sugar in grams purchased per capita per day and percentage of calories from sugar, by sociodemographic group.

STATISTICAL ANALYSES PERFORMED

We used linear regression to estimate trends in total grams of sugar per capita per day, percentage of calories from sugar, and percentage of total sugar purchases by food or beverage group. We estimated means for select years and tested for significance compared with 2002 and with the previous timepoint and calculated the overall P-value for the linear trend using time series regression.

RESULTS

Total sugar purchases decreased over the study period, both in absolute terms (-37.2 g/capita/day; 95% confidence interval [CI], -38.7, -35.6) and as a percentage of total calories purchased (-5.3 percentage points; 95% CI, -5.5, -5.2). Sugar purchases declined for all sociodemographic groups, but disparities have persisted or widened, particularly among individuals who are non-Hispanic Black, low-income, and with lower educational attainment. Beverages' contributions to sugar purchases decreased 8.1 percentage points (95% CI, -8.4, -7.8).

CONCLUSION

In the United States, purchases of sugar declined, but disparities by socioeconomic status and race or ethnicity persisted or widened. Policies to further reduce sugar consumption and the burden of diet-related disparities are needed.

Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021

Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.

Availability of calorie information on online food delivery service platforms among major chain restaurants in Canadian provinces with different calorie labelling policies

OBJECTIVE

This study aimed to characterize the availability of calorie labelling on major online food delivery (OFD) platforms for the largest restaurant brands in Canada to examine differences in provinces with and those without mandatory calorie labelling regulations.

METHODS

Data were collected for the 13 largest restaurant brands with locations in Ontario (with mandatory menu labelling) and Alberta and Quebec (with no mandatory menu labelling) from the web applications of the three largest OFD platforms in Canada. Data were sampled from three selected restaurant locations within each province (n = 117 locations across all provinces) on each platform. Univariate logistic regression models were used to test differences in the presence and amount of calorie labelling and other nutritional information across provinces and platforms.

RESULTS

The analytical sample included 48,857 food and beverage items (n = 16,011 in Alberta, n = 16,683 in Ontario, and n = 16,163 in Quebec). Items were more likely to have menu labelling in Ontario (68.7%) than in Alberta (44.4%, OR = 2.75, 95% CI 2.63-2.88) or Quebec (39.1%, OR = 3.42, 95% CI 3.27-3.58). In Ontario, 53.8% of restaurant brands had calorie labelling for  > 90% of items, compared to 23.0% in Quebec and 15.4% in Alberta. The presence of calorie labelling also differed across platforms.

CONCLUSION

Nutrition information from OFD services differed across provinces with and those without mandatory calorie labelling. Chain restaurants on OFD service platforms were more likely to provide calorie information in Ontario, where calorie labelling is mandatory, compared to elsewhere where no such policy exists. In all provinces, calorie labelling was inconsistently implemented across OFD service platforms.

Public's calorie literacy and perceived effectiveness of restaurant menu calorie labeling in the United Arab Emirates

Restaurant menu calorie labeling is regarded as a promising, cost-effective, and innovative method that will have an impact on the food environment, raise awareness among consumers, and aid in global efforts to prevent obesity. This study aimed to assess the public's calorie literacy, dining practices, and perceived effectiveness of restaurant menu labeling implementation in the United Arab Emirates (UAE). A descriptive, web-based cross-sectional study was conducted among 1279 adults in the UAE. Socio-demographic characteristics, calorie literacy, and perceived effectiveness of restaurant menu labeling among participants were investigated. Chi-square analysis was used to compare indicators across demographic characteristics. More females than males completed the online survey, (56.1% and 43.9%). Most of the participants aged < 30 years old (54.8%), The majority of participants reported eating away from home at least once per week (89.6%). 66.0% of participants were knowledgeable about calorie definition, but only 37.1% knew about average daily energy requirements. Younger participants, with a normal BMI, and higher education levels reported a significantly higher likelihood of eating at a chain restaurant with caloric information on the menu (p <0.05). The majority of participants (76.0%) preferred to see calorie information and other nutrition information on menus. To conclude, menu labeling is a welcomed policy to be implemented in food outlets. Further investigation is necessary to ascertain the most efficacious method of presenting nutrition information to consumers to facilitate informed purchasing decisions considering the potential benefits of mandating calorie declaration in obesity prevention efforts.

Changes in Online Food Access During the COVID-19 Pandemic and Associations With Deprivation: Longitudinal Analysis

BACKGROUND

Food prepared out of home is typically energy-dense and nutrient-poor. Online food delivery services have become a popular way to purchase such food. The number of accessible food outlets through these services can influence how frequently they are used. Anecdotally, food outlet access through online food delivery services increased in England between 2020 and 2022, in the context of the COVID-19 pandemic. However, the extent to which this access changed is poorly understood.

OBJECTIVE

We aimed to investigate monthly changes in online access to food prepared out of home in England in the context of the first 2 years of the COVID-19 pandemic compared with November 2019 and the extent to which any changes were associated with deprivation.

METHODS

In November 2019 and monthly between June 2020 and March 2022, we used automated data collection to construct a data set containing information about all food outlets in England registered to accept orders through the leading online food delivery service. Across postcode districts, we identified the number and percentage of food outlets registered to accept orders and the number that was accessible. We used generalized estimating equations (adjusted for population density, the number of food outlets in the physical food environment, and rural/urban classification) to investigate the change in outcomes compared with prepandemic levels (November 2019). We stratified analyses by deprivation quintile (Q).

RESULTS

Across England, the summed number of food outlets registered to accept orders online increased from 29,232 in November 2019 to 49,752 in March 2022. Across postcode districts, the median percentage of food outlets registered to accept orders online increased from 14.3 (IQR 3.8-26.0) in November 2019 to 24.0 (IQR 6.2-43.5) in March 2022. The median number of food outlets accessible online decreased from 63.5 (IQR 16.0-156.0) in November 2019 to 57.0 (IQR 11.0-163.0) in March 2022. However, we observed variation by deprivation. In March 2022, the median number of outlets accessible online was 175.0 (IQR 104.0-292.0) in the most deprived areas (Q5) compared with 27.0 (IQR 8.5-60.5) in the least deprived (Q1). In adjusted analyses, we estimated that the number of outlets accessible online in the most deprived areas was 10% higher in March 2022 compared with November 2019 (incidence rate ratios: 1.10, 95% CI 1.07-1.13). In the least deprived areas, we estimated a 19% decrease (incidence rate ratios: 0.81, 95% CI 0.79-0.83).

CONCLUSIONS

The number of food outlets accessible online increased only in the most deprived areas in England. Future research might attempt to understand the extent to which changes in online food access were associated with changes in online food delivery service use and the possible implications on diet quality and health.

Tap Water Avoidance Is Associated with Lower Food Security in the United States: Evidence from NHANES 2005-2018

BACKGROUND

Food insecurity has profound nutritional and public health consequences. Water insecurity may exacerbate food insecurity, yet little is known about the association between water and food insecurity in the United States or other high-income countries.

OBJECTIVE

This study aimed to estimate how tap water avoidance, a proxy of water insecurity, covaries with food insecurity; examine how the probability of food insecurity changed by tap water avoidance between 2005 and 2018; and test how the association between tap water avoidance and food insecurity differed across income and housing statuses.

DESIGN

This was a secondary analysis of the cross-sectional 2005-2018 National Health and Nutrition Examination Survey.

PARTICIPANTS/SETTING

Participants were 31,390 US adults 20 years and older.

MAIN OUTCOME MEASURES

The main outcome was food insecurity, using the US Food Security Survey Module.

STATISTICAL ANALYSES

Adjusted logistic regression models estimated how tap water avoidance was associated with the odds of food insecurity. Predicted probabilities of food insecurity over time and by income and housing status were plotted using marginal standardization.

RESULTS

Adults who avoided tap water had 21% higher odds (95% CI 1.09 to 1.34) of food insecurity compared with those who drank tap water. The probability of any food insecurity doubled between 2005-2006 and 2017-2018 and was consistently higher for tap water avoiders. Food insecurity decreased across both tap water drinkers and avoiders as income increased, but was higher among tap water avoiders at all income levels. Likewise, food insecurity was higher among renters than among homeowners but was higher among tap water avoiders in both housing groups.

CONCLUSIONS

Tap water avoidance is positively associated with food insecurity in the United States, and both insecurities have increased over time. Efforts to mitigate food insecurity should simultaneously address water insecurity issues, including tap water availability and quality, as these may be a modifiable contributors to food insecurity.

Coexistence of obesity and hunger in young adolescents: Evidence from the Global School-based Student Health Survey

BACKGROUND

Hunger and obesity among young adolescents are serious public health issues; however, the relationship between these issues in this demographic has yet to be examined.

OBJECTIVE

To determine whether both obesity and hunger coexist in young adolescents from a global perspective.

METHODS

We analysed data of 142 565 adolescents (age, 12-15 years) from 60 countries from the Global School-based Student Health Survey.

RESULTS

Total prevalence of moderate and severe hunger was 22.32% and 7.8%, respectively-with the highest in Africa (29.14% and 12.14%, respectively) and the lowest in the Americas (16.83% and 5.31%, respectively). The prevalence of obesity among adolescents with severe hunger was 1.26 (95% confidence interval [CI]: 1.15-1.38) times the prevalence among those without hunger; however, this association varied across countries or regions. Moreover, the prevalence of obesity was 17% (95% CI: 1.04-1.29) higher in adolescent girls with moderate hunger in high-income countries, 91% (95% CI: 1.23-2.58) higher in adolescents with severe hunger in low-income countries and 54% (95% CI: 1.34-1.76) higher in lower middle-income countries compared to those without hunger.

CONCLUSIONS

Both obesity and hunger coexist in adolescent populations worldwide. Our findings emphasize the need for double-duty actions to simultaneously address burdens of hunger and obesity among adolescents.

Unhealthy Food at Your Fingertips: Cross-Sectional Analysis of the Nutritional Quality of Restaurants and Takeaway Outlets on an Online Food Delivery Platform in New Zealand

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.

Consumption of food away from home in low- and middle-income countries: a systematic scoping review

Context

Consumption of food away from home represents an increasing share of people’s food consumption worldwide, although the percentage of food intake that is consumed away from home varies among countries and among individuals. Previous systematic reviews have reported that, overall, consumption away from home negatively affects an individual’s diet and nutritional status. However, these reviews have mainly focused on high-income countries, leaving a gap in knowledge and data for people in low- and middle-income countries (LMICs).

Objective

The present review aimed to describe trends in the consumption of food away from home in an apparently healthy population in low- and middle-income countries (LMICs) and to investigate any associations between this behavior and diet quality, nutritional status, and health outcomes.

Data Sources

A structured search strategy was developed for retrieving (from MEDLINE [via PubMed], Web of Science, and Scopus) peer-reviewed articles published in English from March 2011 until May 2021.

Data Extraction

Forty studies were included, and from them information was obtained based on data from 12 different countries. A qualitative and descriptive approach was used to review the evidence.

Data Analysis

It was found that there was large heterogeneity in the definition of food consumed away from home and the methods used to measure it, making comparisons and syntheses difficult. Consumption of food away from home in LMICs was relatively common and was positively driven by factors such as being a male, being young, having a high socio-economic status, being educated, and living in urban areas. As in high-income countries, consumption of food away from home in LMICs had unfavorable effects on an individual’s diet quality, nutritional status, and health.

Conclusion

There is a need to develop harmonized surveillance systems for better monitoring of the phenomenon of food consumption away from home in LMICs, including a need for a standardized definition for food consumed away from home, to enable the design of effective regulatory policies.

Psychiatric Symptoms and Frequency of Eating out among Commuters in Beijing: A Bidirectional Association?

Background: Mental illness places as a distant first in global burdens, exceeding both cardiovascular and circulatory diseases, in terms of the years lived with the disability. The emergence of the new and burgeoning area of “Nutrition Psychiatry” offers promise in improving mental health with diet. Mental health and well-being are critical to commuters but rarely recieve the attention they need. This study aimed to examine the bidirectional relationship between the frequency of eating out and depression, anxiety, and stress symptoms in a sample of Beijing commuters. Methods: A total of 3337 commuters (mean (SD) age, 38.78 (10.41); 74.74% males) from the cohort study CHCN-BTH were included. The psychiatric symptoms were evaluated using a 21-item self-reported depression–anxiety–stress scale (DASS-21). A Cochran–Armitage trend chi-square test, restricted cubic spline, multiple logistic regression, multinomial logit models, and E-values were performed to estimate the associations between eating out and psychiatric symptoms in both directions. Results: A daily rate of eating out more than 50% had a higher risk for depression (OR, 95% CI: 1.68, 1.184–2.393), anxiety (1.73, 1.259–2.369), and stress (1.99, 1.191–3.329) than the individuals eating at home. A higher frequency of eating out for lunch was significantly associated with an increased risk of depression (1.78, 1.28–2.46), anxiety (1.67, 1.26–2.23), and stress (2.05, 1.31–3.22). Similar results were found when eating out for dinner with increased risks for depression 2.20 (1.59, 3.06), anxiety 1.91 (1.42, 2.59), and stress 2.61 (1.68, 4.05). There is limited evidence supporting the effects of psychiatric symptoms on the frequency of eating out in the reverse analyses. Conclusions: The frequency of eating out is positively associated with an increased risk of psychiatric symptoms, especially when eating out for lunch and dinner. People eating at home have the lowest risk of suffering psychiatric symptoms, followed by those eating in the workplace canteen. Eating at home should be considered for future recommendations for the prevention of psychiatric symptoms.

Instabrand courtside: a content analysis of marketing strategies by food and beverage brands during the 2021 Australian Open tennis tournament

OBJECTIVE

To examine the marketing techniques food and beverage brands use on Instagram, as part of their sport sponsorship strategy.

METHODS

We conducted a qualitative content analysis of 31 Instagram accounts during the 2021 Australian Open tennis tournament. Branded food and beverage posts with tennis-linked content were coded based on an initial screening and previously published frameworks.

RESULTS

Of the 152 included posts, 92% were made by food and beverage companies that were official 'partners' of the Australian Open. Products in posts were mostly discretionary foods and alcohol. The most frequently used strategies were 'Engagement' (89%) and 'Branding' (80%) and nearly half (45%) of alcohol posts invited direct consumption of their product.

CONCLUSIONS

The powerful combination of sport and social media are utilised by brands to interact and build relationship with consumers while promoting the consumption of alcohol and discretionary foods - products which impede rather than promote health. The indirect marketing techniques favoured by brands make this form of advertising difficult to identify and control.

IMPLICATIONS FOR PUBLIC HEALTH

These results highlight the need for counter-marketing, policy and regulatory actions to remove unhealthy food and alcohol from sport and reorient sponsorship of sporting events towards products that promote health.

The Contribution of Nutrients of Concern to the Diets of 18-to-30-Year-Old Australians from Food Prepared Outside Home Differs by Food Outlet Types: The MYMeals Cross-Sectional Study

Young adults are frequent consumers of food prepared outside the home (FOH). In a cross-sectional survey, the MYMeals study, we showed FOH provided one-third of meals and snacks for young Australian adults, yet it contributed higher proportions of energy and nutrients of concern, such as saturated fat and sodium. This study aimed to determine the detailed proportional contribution of nutrients of concern from the nine food outlet types captured in the MYMeals study. Young adults residing in New South Wales (NSW), Australia, (n = 1001) used a validated smartphone app to report all types and amounts of food and beverages consumed for three consecutive days, as well as their preparation location. The proportions of daily energy, macronutrients, sodium, total sugars, and saturated fat were calculated for each of the nine following outlet types: bakeries or patisseries, coffee chains, cold-drink chains, fast-food chains, ice creamery or frozen yoghurt outlets, independent cafes or restaurants, pubs (hotels) and clubs, service stations or convenience stores, and others not fitting the above categories. Of all FOH outlet types, independent cafes or restaurants contributed the most energy (17.5%), sodium (20.0%) and saturated fat (17.8%) to the total diet, followed by fast-food chains (12.0% energy, 15.8% sodium, and 12.0% saturated fat) and other outlets, with smaller proportions. For males, the proportion of energy and nutrients contributed by fast-food outlets was higher than for females (14.8% versus 9.8% energy). Menu labelling at independent cafes and restaurants is recommended, comprising, in addition to the energy labels already in use in fast-food restaurants, the labelling of nutrients of concern. The feasibility of this recommendation warrants further exploration.

Investigating experiences of frequent online food delivery service use: a qualitative study in UK adults

BACKGROUND

Food prepared out-of-home is typically energy-dense and nutrient-poor. This food can be purchased from multiple types of retailer, including restaurants and takeaway food outlets. Using online food delivery services to purchase food prepared out-of-home is increasing in popularity. This may lead to more frequent unhealthy food consumption, which is positively associated with poor diet and living with obesity. Understanding possible reasons for using online food delivery services might contribute to the development of future public health interventions, if deemed necessary. This knowledge would be best obtained by engaging with individuals who use online food delivery services as part of established routines. Therefore, we aimed to investigate customer experiences of using online food delivery services to understand their reasons for using them, including any advantages and drawbacks.

METHODS AND RESULTS

In 2020, we conducted telephone interviews with 22 adults living in the UK who had used online food delivery services on at least a monthly basis over the previous year. Through codebook thematic analysis, we generated five themes: 'The importance of takeaway food', 'Less effort for more convenience', 'Saving money and reallocating time', 'Online food delivery service normalisation' and 'Maintained home food practices'. Two concepts were overarching throughout: 'Place. Time. Situation.' and 'Perceived advantages outweigh recognised drawbacks'. After considering each of the accessible food purchasing options within the context of their location and the time of day, participants typically selected online food delivery services. Participants reported that they did not use online food delivery services to purchase healthy food. Participants considered online food delivery service use to be a normal practice that involves little effort due to optimised purchasing processes. As a result, these services were seen to offer convenient access to food aligned with sociocultural expectations. Participants reported that this convenience was often an advantage but could be a drawback. Although participants were price-sensitive, they were willing to pay delivery fees for the opportunity to complete tasks whilst waiting for delivery. Furthermore, participants valued price-promotions and concluded that receiving them justified their online food delivery service use. Despite takeaway food consumption, participants considered home cooking to be irreplaceable.

CONCLUSIONS

Future public health interventions might seek to increase the healthiness of food available online whilst maintaining sociocultural values. Extending restrictions adopted in other food environments to online food delivery services could also be explored.

Systematic literature review of instruments that measure the healthfulness of food and beverages sold in informal food outlets

BACKGROUND

Informal food outlets, defined as vendors who rarely have access to water and toilets, much less shelter and electricity, are a common component of the food environment, particularly in many non-Western countries. The purpose of this study was to review available instruments that measure the quality and particularly the healthfulness of food and beverages sold within informal food outlets.

METHODS

PubMed, LILACS, Web of Science, and Scopus databases were used. Articles were included if they reported instruments that measured the availability or type of healthy and unhealthy foods and beverages by informal food outlets, were written in English or Spanish, and published between January 1, 2010, and July 31, 2020. Two trained researchers reviewed the title, abstract and full text of selected articles; discrepancies were solved by two independent researchers. In addition, the list of references for selected articles was reviewed for any additional articles of relevance. The quality of published articles and documents was evaluated using JBI Critical appraisal checklist for analytical cross-sectional studies.

RESULTS

We identified 1078 articles of which 14 were included after applying the selection criteria. Three additional articles were considered after reviewing the references from the selected articles. From the final 17 articles, 13 measurement tools were identified. Most of the instruments were used in low- and middle-income countries (LMIC). Products were classified as healthy/unhealthy or produce/non-produce or processed/unprocessed based on availability and type. Six studies reported psychometric tests, whereas one was tested within the informal food sector.

CONCLUSIONS

Few instruments can measure the healthfulness of food and beverages sold in informal food outlets, of which the most valid and reliable have been used to measure formal food outlets as well. Therefore, it is necessary to develop an instrument that manages to measure, specifically, the elements available within an informal one. These actions are extremely important to better understand the food environment that is a central contributor to poor diets that are increasingly associated with the obesity and Non-communicable disease (NCD) pandemic.

Influence of work hours and commute time on food practices: a longitudinal analysis of the Household, Income and Labour Dynamics in Australia Survey

OBJECTIVES

Work hours and commute time are key contributors to time scarcity, with potential detrimental implications for healthy eating. This study examined (1) associations between work and commute hours with food practices and (2) within-individual associations between changes in work and commute hours with changes in food practices.

DESIGN

Longitudinal study SETTING: Australia PARTICIPANTS: Data were from 14 807 respondents in waves 7 (2007), 9 (2009), 13 (2013) and 17 (2017) of the Household, Income and Labour Dynamics in Australia Survey. The sample for this analysis included individuals who were in paid employment in at least one of the four waves.

PRIMARY AND SECONDARY OUTCOME MEASURES

Outcomes included frequency of out-of-home food purchasing for breakfast, lunch, dinner and all three summed eating occasions, and fruit and vegetables consumption.

RESULTS

Results indicated the longer individuals spent working and commuting, the more likely they were to purchase out-of-home foods (frequency of total out-of-home food purchasing: incidence rate ratio (IRR)=1.007 (95% CI 1.007 to 1.008)), and the less they consumed fruit and vegetables, although reductions in fruit and vegetables servings were minimal (fruit: β=-0.002 (95% CI -0.003 to -0.001), vegetables: β=-0.002 (95% CI -0.003 to -0.001)). Similar results regarding associations with out-of-home food purchasing were observed when examining within-individual changes (IRR=1.006 (95% CI 1.005 to 1.007)).

CONCLUSIONS

Results suggest employment-related time demands push towards more frequent out-of-home food purchasing. In the long term, this may have negative health consequences as out-of-home foods tend to be less healthy than home-prepared foods.

Understanding the Online Environment for the Delivery of Food, Alcohol and Tobacco: An Exploratory Analysis of 'Dark Kitchens' and Rapid Grocery Delivery Services

Online spaces are increasingly important in the sale of food, alcohol and tobacco. This analysis focuses on two developments in online food delivery: delivery-only 'dark kitchens' and rapid grocery delivery services (RGDS), with the aim to understand and assess the availability of health harming and health promoting products through these services. Data was collected for one metropolitan local authority in London, UK, using publicly available online sources. Being explorative in nature, the analysis includes descriptive statistics and qualitative assessment. Three dark kitchens (renting kitchens to 116 food businesses), three grocery delivery apps, and 76 grocery businesses available through online delivery platforms were identified. Most businesses renting dark kitchen space were 'virtual restaurants' (52%) selling fast food (47%) or dessert (21%) through online delivery platforms. RGDS sold a variety of items, with a focus on pre-packaged foods high in fat, salt and sugar, alcoholic beverages and tobacco. These items were also most likely to be promoted through offers and promotional language. Fruits and vegetables were less commonly available and mainly on grocery delivery apps. Online delivery services increase the temporal and geographic availability and promotion of many unhealthy products. Research expanding on the geographic area of interest is needed.

Development and Evaluation of Integrated Chrono-Nutrition Weight Reduction Program among Overweight/Obese with Morning and Evening Chronotypes

This paper describes the development of an integrated chrono-nutrition weight reduction program and the evaluation of the attendance, retention, satisfaction and compliance towards the chrono-nutrition components among morning and evening chronotypes for overweight/obese non-shift workers. The present study was conducted in two phases: Phase I was composed of needs assessments on the chronotypes’ dietary patterns and chrono-nutrition through a scoping review and integrating the chrono-nutrition components (temporal eating pattern, meal timing and sleeping habits) alongside the existing weight reduction module, SLIMSHAPE™. Phase II consisted of a feasibility study to evaluate the integrated chrono-nutrition weight reduction program (SLIMSHAPE™ Chrono). A total of 91 overweight/obese non-shift workers participated in the 12-week weight reduction program (Age: 39.6 ± 6.3 years; 74.7% women; BMI: 31.2 ± 4.5 kg/m2). Low attrition rate was recorded, with 85 participants (93.4%) completing the pre- and post-intervention assessments. Overall, morning and evening chronotypes had increased their % energy intake in the early eating window (MT: 64.8 vs. 67.2%, ET: 62.7 vs. 65.6%, Mean difference (MD): 2.8, 95%CI: 0.3, 5.1, p = 0.028) and reduced their intake in the late eating window (MT: 35.2 vs. 32.8%, ET: 37.3 vs. 34.4%, MD: −2.8, 95%CI: −5.1, −0.3, p = 0.028) and earlier midpoint of eating (MT: 14:02 vs. 13:49; ET: 14:27 vs. 14:18, 95%CI: −0.4, −0.02, p = 0.029) and had a reduced night eating syndrome score (MT: 10.0 vs. 8.9; ET: 10.7 vs. 8.9, MD: −1.5, 95%CI: −2.5, −0.5, p = 0.004). There was no significant change in the first (MT: 08:12 vs. 08:04, ET: 08:24 vs. 08:22, MD: −0.1, 95%CI: −0.2, 0.03, p = 0.170) and last mealtime (MT: 19:52 vs. 19:33, ET: 20:29 vs. 20:14, MD: −0.3, 95%CI: −0.6, −0.04, p = 0.081), eating duration (MT: 11.7 vs. 11.5 h, ET: 12.1 vs. 11.9 h, MD: −0.2, 95%CI: −0.6, 0.2, p = 0.251) and the elapse time between sleep onset and last meal (MT: 3.1 vs. 3.5 h, ET: 3.5 vs. 3.2 h, MD: 0.1, 95%CI: −0.3, 0.4, p = 0.678). In terms of sleep, evening chronotypes increased their sleep duration (MD: 0.8 h, 95% CI: 0.4, 1.2, p < 0.001) and reduced social jetlag (MD: 19 min, 95% CI: 1.7, 36.3, p = 0.031) post-intervention compared to morning chronotypes. The integrated chrono-nutrition weight reduction program among morning and evening chronotypes improved the temporal pattern of energy intake, meal timing, night eating syndrome and sleep habits post-intervention. The chrono-nutrition practice could be a potentially modifiable behavior as an adjunct strategy in weight management.

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

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

COVID-19 Safety Measures in the Food Service Sector: Consumers' Attitudes and Transparency Perceptions at Three Different Stages of the Pandemic

The food service sector was among the hardest hit by the COVID-19 pandemic. This study aims to examine consumers' attitudes towards and transparency perceptions of COVID-19-related safety measures and to identify determinants of consumers' intentions and behaviour regarding visiting restaurants and bars once reopened. By also surveying food service businesses, this study allows for comparison between both target groups. A total of 1697 consumers and 780 businesses participated in this study, conducted in Belgium both during and in between waves of infections. The findings demonstrate that consumers evaluated safety measures as important when revisiting restaurants and bars, against business owners' expectations. Both consumers' revisit intentions and behaviours are influenced by the perceived importance of hygiene measures (negatively) and past visit frequency (positively). This study highlights the importance of good compliance with safety measures as a strategy to attract customers during the reopening period. Further, our findings emphasize the importance of transparent communication by food service businesses and the government.

The association of social and food preparation location context with the quality of meals and snacks consumed by young adults: findings from the MYMeals wearable camera study

PURPOSE

This study examined the association of social contexts and food preparation location with the quality of meals and snacks (predominately from the five food groups (FFG) versus discretionary foods) in a sample of young Australian adults (18-30 years old) using wearable camera technology.

METHODS

A sub-sample from the cross-sectional MYMeals study wore a wearable camera that captured images every 30 s for three consecutive days. Eating episodes from 133 participants (55% female) were classified across 4 domains: food quality (observed proportion of FFG and discretionary items), preparation location, social interaction, and screen use. Socio-economic status (SES) was assigned using residential postcode and gender self-reported. Associations of contexts and demographic factors with food quality stratified by meal type were determined using mixed binary logistic regression models.

RESULTS

Of the 1840 eating episodes identified, 1775 were included in analysis (n = 8 preparation location and n = 57 food components that could not be identified were excluded). Food prepared at home was more likely to be from the FFG at lunch (OR = 4.8 95% CI 2.7-8.6), dinner (OR = 14.8 95% CI 7.6-28.6), and snacks (OR = 3.2 95% CI 2.2-4.8). Participants from higher SES areas were more likely to consume breakfasts (OR = 3.2 95% CI 1.4-7.4) and lunches (OR = 1.9 95% CI 1.0-3.7) predominately from the FFG. Females were more likely to consume lunches (OR = 2.0 95% CI 1.1-3.8) that was largely from the FFG. Social interaction and screen use were not associated with meal or snack quality.

CONCLUSION

Wearable cameras have verified the importance of addressing meals and snacks prepared outside of home as an important contributor of discretionary food.

Do Temporal Eating Patterns Differ in Healthy versus Unhealthy Overweight/Obese Individuals?

This study examined whether the temporal patterns of energy and macronutrient intake in early and late eating windows were associated with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) among non-shift workers. A total of 299 overweight/obese non-shift workers (Age: 40.3 ± 6.9 years; 73.6% women; BMI: 31.7 ± 5.0 kg/m²) were recruited in the Klang Valley area of Malaysia. The biochemical parameters were determined from fasting blood samples, whereas information on dietary intake and timing was obtained from a 7-day diet history questionnaire. The midpoint of eating was used to determine the early and late windows. Compared to MHO non-shift workers (n = 173), MUO non-shift workers (n = 126) had lower energy intake from carbohydrates and protein during the early window. In contrast, MUO participants had greater energy intake from carbohydrates and fat during the late window. Participants with unhealthy metabolic status (regardless of their chronotypes) had similar temporal patterns of energy intake characterized by smaller energy intake during the early window and greater energy intake during the late window compared with participants with healthier metabolic status. Overall, the lowest percentile of energy intake during the early window was associated with an increased risk of MUO, after adjustment for potential confounders [odds ratio (OR) = 4.30, 95% confidence interval (CI) 1.41-13.11]. The greater the energy intake during the late window, the greater the risk of MUO (OR = 2.38, 95% CI 1.11-5.13) (OR = 2.33, 95% CI 1.03-5.32) (OR = 4.45, 95% CI 1.71-11.56). In summary, consuming less energy earlier in the day and more energy and carbohydrate later in the day was associated with a greater risk of MUO. Thus, a prospective study is needed to explore the potential role of chrono-nutrition practices in modifying risk factors to delay the transition of MHO to MUO.

Associations between online food outlet access and online food delivery service use amongst adults in the UK: a cross-sectional analysis of linked data

BACKGROUND

Online food delivery services facilitate 'online' access to food outlets that typically sell lenergy-dense nutrient-poor food. Greater online food outlet access might be related to the use of this purchasing format and living with excess bodyweight, however, this is not known. We aimed to investigate the association between aspects of online food outlet access and online food delivery service use, and differences according to customer sociodemographic characteristics, as well as the association between the number of food outlets accessible online and bodyweight.

METHODS

In 2019, we used an automated data collection method to collect data on all food outlets in the UK registered with the leading online food delivery service Just Eat (n = 33,204). We linked this with contemporaneous data on food purchasing, bodyweight, and sociodemographic information collected through the International Food Policy Study (analytic sample n = 3067). We used adjusted binomial logistic, linear, and multinomial logistic regression models to examine associations.

RESULTS

Adults in the UK had online access to a median of 85 food outlets (IQR: 34-181) and 85 unique types of cuisine (IQR: 64-108), and 15.1% reported online food delivery service use in the previous week. Those with the greatest number of accessible food outlets (quarter four, 182-879) had 71% greater odds of online food delivery service use (OR: 1.71; 95% CI: 1.09, 2.68) compared to those with the least (quarter one, 0-34). This pattern was evident amongst adults with a university degree (OR: 2.11; 95% CI: 1.15, 3.85), adults aged between 18 and 29 years (OR: 3.27, 95% CI: 1.59, 6.72), those living with children (OR: 1.94; 95% CI: 1.01; 3.75), and females at each level of increased exposure. We found no association between the number of unique types of cuisine accessible online and online food delivery service use, or between the number of food outlets accessible online and bodyweight.

CONCLUSIONS

The number of food outlets accessible online is positively associated with online food delivery service use. Adults with the highest education, younger adults, those living with children, and females, were particularly susceptible to the greatest online food outlet access. Further research is required to investigate the possible health implications of online food delivery service use.

Healthy Eating Index-2015 Scores Vary by Types of Food Outlets in the United States

Diet quality in the United States is improving over time but remains poor. Food outlets influence diet quality and represent the environments in which individuals make choices about food purchases and intake. The objective of this study was to use the Healthy Eating Index-2015 (HEI-2015) to evaluate the quality of foods consumed from the four major outlets where food is obtained—stores, full-service restaurants, quick-services restaurants, and schools—and to assess changes over time. This cross-sectional study used 24 h dietary recall data from eight cycles (2003–2004 to 2017–2018) of the National Health and Nutrition Examination Survey (NHANES). Linear trend estimation was used to test for changes in HEI scores over time, and balanced repeated replicate weighted linear regression was used to test for differences in total and component scores between types of food outlets. Overall, Americans are not consuming a mix of foods from any major category of food outlet that aligns with dietary guidelines. The total score for schools (65/100 points) and stores (62/100 points) was significantly higher than full-service (51/100 points) and quick-service (39/100 points) restaurants (p < 0.0001). HEI scores significantly improved over time for schools (p < 0.001), including an increase in whole grains from less than 1 point in 2003–2004 to 7 out of 10 points in 2017–2018. In 2017–2018, schools received the maximum score for total fruits, whole fruits, and dairy. Continued research on strategies for improving the quality of foods consumed from restaurants and stores is warranted.

Socioeconomic inequalities in food outlet access through an online food delivery service in England: A cross-sectional descriptive analysis

Online food delivery services facilitate 'online' access to food outlets selling food prepared away-from-home. Online food outlet access has not previously been investigated in England or across an entire country. Systematic differences in online food outlet access could exacerbate existing health inequalities, which is a public health concern. However, this is not known. Across postcode districts in England (n = 2118), we identified and described the number of food outlets and unique cuisine types accessible online from the market leader (Just Eat). We investigated associations with area-level deprivation using adjusted negative binomial regression models. We also compared the number of food outlets accessible online with the number physically accessible in the neighbourhood (1600m Euclidean buffers of postcode district geographic centroids) and investigated associations with deprivation using an adjusted general linear model. For each outcome, we predicted means and 95% confidence intervals. In November 2019, 29,232 food outlets were registered to accept orders online. Overall, the median number of food outlets accessible online per postcode district was 63.5 (IQR; 16.0-156.0). For the number of food outlets accessible online as a percentage of the number accessible within the neighbourhood, the median was 63.4% (IQR; 35.6-96.5). Analysis using negative binomial regression showed that online food outlet access was highest in the most deprived postcode districts (n = 106.1; 95% CI: 91.9, 120.3). The number of food outlets accessible online as a percentage of those accessible within the neighbourhood was highest in the least deprived postcode districts (n = 86.2%; 95% CI: 78.6, 93.7). In England, online food outlet access is socioeconomically patterned. Further research is required to understand how online food outlet access is related to using online food delivery services.

Hunger for Home Delivery: Cross-Sectional Analysis of the Nutritional Quality of Complete Menus on an Online Food Delivery Platform in Australia

Online food delivery (OFD) platforms have changed how consumers purchase food prepared outside of home by capitalising on convenience and smartphone technology. Independent food outlets encompass a substantial proportion of partnering outlets, but their offerings’ nutritional quality is understudied. Little is also known as to how OFD platforms influence consumer choice. This study evaluated the nutritional quality and marketing attributes of offerings from independent takeaway outlets available on Sydney’s market-leading OFD platform (UberEats^®). Complete menus and marketing attributes from 202 popular outlets were collected using web scraping. All 13841 menu items were classified into 38 food and beverage categories based on the Australian Dietary Guidelines. Of complete menus, 80.5% (11,139/13,841) were discretionary and 42.3% (5849/13,841) were discretionary cereal-based mixed meals, the largest of the 38 categories. Discretionary menu items were more likely to be categorised as most popular (OR: 2.5, 95% CI 1.9–3.2), accompanied by an image (OR: 1.3, 95% CI 1.2–1.5) and offered as a value bundle (OR: 6.5, 95% CI 4.8–8.9). Two of the three discretionary food categories were more expensive than their healthier Five Food Group counterparts (p < 0.02). The ubiquity of discretionary choices offered by independent takeaways and the marketing attributes employed by OFD platforms has implications for public health policy. Further research on the contribution of discretionary choices and marketing attributes to nutritional intakes is warranted.