Ready-to-Eat Food Environments and Risk of Incident Heart Failure: A Prospective Cohort Study

BACKGROUND

Food environments have been linked to cardiovascular diseases; however, few studies have assessed the relationship between food environments and the risk of heart failure (HF). We aimed to evaluate the association between ready-to-eat food environments and incident HF at an individual level in a large prospective cohort.

METHODS

Exposure to ready-to-eat food environments, comprising pubs or bars, restaurants or cafeterias, and fast-food outlets, were individually measured as both proximity and density metrics. We also developed a composite ready-to-eat food environment density score by summing the densities of 3 types of food environments. Cox proportional analyses were applied to assess the associations of each single type and the composite food environments with HF risk.

RESULTS

Closer proximity to and greater density of ready-to-eat food environments, particularly for pubs and bars and fast-food outlets (P<0.05 for both proximity and density metric) were associated with an elevated risk of incident HF. Compared with those with no exposure to composite ready-to-eat food environments, participants in the highest density score category had a 16% (8%-25%; P<0.0001) higher risk of HF. In addition, we found significant interactions of food environments with education, urbanicity, and density of physical activity facilities on HF risk (all Pinteraction<0.05); the ready-to-eat food environments-associated risk of HF was stronger among participants who were poorly educated, living in urban areas, and without physical activity facilities.

CONCLUSIONS

Exposure to ready-to-eat food environments is associated with a higher risk of incident HF, suggesting the potential importance of minimizing unfavorable food environments in the prevention of HF.

Wisely Choosing a Fast-Food Burger Meal Results in Meaningful Reduction in Sodium: Implications for Kidney Stone Patients

OBJECTIVE

Stone formers trying to limit dietary sodium may be unable to give up fast food. For the classic American hamburger, it is unclear if lower sodium preparations of this item are available and how this could affect sodium intake. We determined the impact of careful selection at national chains.

METHODS

Nutritional guides for 14 national chains were analyzed for all beef-based burgers and french fries. A meal was defined as 1 burger and an order of fries. The daily sodium limit (recommended daily sodium allowance [RDA]) was considered to be 2,300 mg. The maximal sodium reduction was defined as the difference between the highest and lowest sodium-containing meals. The Kruskal-Wallis test with Dunn's method was used to compare food items among the chains.

RESULTS

Of the total 263 different burgers and 74 different fries, median sodium was 1130 mg (range 180-3520) and 565 mg (range 30-1480), respectively. Mean sodium for burgers at individual chains ranged from a low of 590 mg to a high of 1721 mg (P < .001). The mean sodium for fries at individual chains ranged from a low of 245 mg to a high of 947 mg (P < .001). Post-hoc testing revealed 26 significant differences between pairs of restaurants for sodium content of burgers with P < .05 for each. The median maximal sodium reduction among the different chains was 1925 mg. Depending on the chain, sodium content of 1 meal could be reduced by as little as 830 mg (36% RDA) or as much as 3360 mg (146% RDA) by careful selection.

CONCLUSION

Stone formers should be aware of significant variation in sodium content of burgers and fries among chains and within a chain. Wisely selecting just 1 fast-food burger meal can significantly reduce sodium intake.

Characterizing restrictions on commercial advertising and sponsorship of harmful commodities in local government policies: a nationwide study in England

BACKGROUND

Commercial advertising and sponsorship drive the consumption of harmful commodities. Local authorities (LAs) have considerable powers to reduce such exposures. This study aimed to characterize local commercial policies across all English LAs.

METHODS

We conducted a census of all English LAs (n = 333) to identify local commercial policies concerning advertising and sponsorship of tobacco, alcohol, less healthy foods and gambling, through online searches and Freedom of Information requests. We explored policy presence, commodity frequency and type, and associations with LA characteristics (region, urban/rural and deprivation).

RESULTS

Only a third (106) of LAs in England had a relevant policy (32%). These included restrictions on tobacco (91%), gambling (79%), alcohol (74%) and/or less healthy foods (24%). Policy prevalence was lowest in the East of England (22%), North East (25%) and North West (27%), higher in urban areas (36%) than rural areas (28%) and lower in the least (27%) compared with the most (38%) deprived areas. Definitions in policies varied, particularly for alcohol and less healthy foods.

CONCLUSIONS

English LAs currently underutilize their levers to reduce the negative impacts of harmful commodity industry marketing, particularly concerning less healthy foods. Standardized guidance, including clarity on definitions and application, could inform local policy development.

Relationship between metabolic syndrome and intake of ultra-processed foods in Korean adults: based on 6th and 7th Korea National Health and Nutrition Examination Survey (2013-2018)

BACKGROUND/OBJECTIVES

Metabolic syndrome is closely associated with lifestyle factors, including diet and nutritional intake. Modern trends show a shift in food consumption from healthy home-cooked meals to processed and instant foods. Therefore, this study analyzed the association between ultra-processed food intake and the development of metabolic syndrome in Korean adults based on the data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2013-2018.

SUBJECTS/METHODS

The subjects of this study were 17,414 adults aged 19-80 years who participated in the 6th-7th KNHANES. Processed food was classified into four categories, NOVA1 to NOVA4, using 24-h recall data. The higher the NOVA category, the more processed the food. Statistical analysis was conducted using logistic regression to investigate the prevalence of metabolic syndrome according to the consumption of ultra-processed foods.

RESULTS

Among the diagnostic criteria for metabolic syndrome, hypertension (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.62-0.85; Q4 vs. Q1, P-trend < 0.001) and high triglycerides (OR, 0.83; 95% CI, 0.72-0.94; Q4 vs. Q1, P-trend < 0.001) showed a correlation with the percentages of energy consumed from ultra-processed foods. The OR for metabolic syndrome, according to the percentages of energy consumed from ultra-processed foods, is shown only for men. The OR showed that the percentages of energy consumed from ultra-processed foods were associated with increased metabolic syndrome.

CONCLUSIONS

This study suggests that consumption of ultra-processed foods raises the risk of metabolic syndrome especially among men. To prevent metabolic syndrome, it is necessary to prepare appropriate dietary guidelines for Korean adults.

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.

Consumption of sugar-sweetened beverages and fast foods deteriorates adolescents' mental health

Introduction

Sugar-sweetened beverage (SSB) and fast-food consumption is significantly associated with adolescents' poor mental health. Furthermore, sugar-sweetened beverage and fast-food consumption might form clustered diet patterns with significant positive associations in adolescent high school students. Thus, the combined consumption of SSBs and fast foods may have more negative effects on mental health with synergetic effects than the sum of their independent consumption.

Methods

This study aimed to identify the effects of combining the consumption of sugar-sweetened beverages and fast foods on mental health, including stress, depressive symptoms, and suicidal ideation among Korean high school students. Secondary data from 24,006 high school students were analyzed from the 17th Korea Youth Risk Behavior Web-based Survey, 2021. For statistical analysis, complex sampling analysis using the SPSS Statistics 26.0 software was applied for descriptive statistics and logistic regression analysis.

Results

In Korean adolescents, combining more than medium consumption of sugar-sweetened beverages and fast foods was associated with more stress, depressive symptoms, and suicidal ideation than their independent consumption. In addition, combining high consumption of sugar-sweetened beverages and low to high consumption of fast foods might have dose-dependent negative effects on stress, depressive symptoms, and suicidal ideation in Korean adolescents.

Discussion

Based on the results of this study, healthcare providers in schools and communities might develop various interventions including school/community-based feeding programs and policies targeting the restriction of SSB and fast-food consumption to improve adolescents' mental health.

The Ecuadorian School Food Environment: Association With Healthy and Unhealthy Food and Beverage Consumption and BMI

BACKGROUND

Schools can play an important role in promoting healthy child diet and body weight. However, this issue is understudied in Latin American and other populations undergoing nutrition and epidemiologic transition.

OBJECTIVES

2018 Ecuadorian National Health and Nutrition Survey data were used to examine the association of school food sources with healthy and unhealthy food intake and body mass index (BMI) in primary (n = 12632) and secondary students (n = 6617).

METHODS

Data on school food environment characteristics were collected by questionnaire, intakes of fruits, vegetables, plain water, sweetened beverages, processed snacks, and fast foods by food frequency questionnaire, and BMI using measured weight and height. Data were analyzed using multivariable methods.

RESULTS

The major school food sources were competitive foods sold by commercial outlets (73%), School Breakfast Program (SBP; 52%), and home-packed items (37%). Most (69%) competitive food outlets sold fruits and vegetables but only 44% offered free clean drinking water and 60% sold prohibited "red traffic light" foods. Primary and secondary students who bought competitive foods consumed sweetened beverages, processed snacks, and fast food more frequently than nonpurchasers (P = .0001). Those who packed home foods had higher fruit and vegetable intakes (P = .0001). Plain water intakes were reduced among all SBP participants (P = .0001). However, primary students in the SBP consumed fast foods less frequently (P = .0001) and had lower average BMI and odds for being obese compared to nonparticipants (P = .0001).

CONCLUSION

The findings from this nationally representative study underscore the important contribution of the school food environment to child nutrition.

Differences in Weight Gain Following Residential Relocation in the Moving to Health (M2H) Study

BACKGROUND

Neighborhoods may play an important role in shaping long-term weight trajectory and obesity risk. Studying the impact of moving to another neighborhood may be the most efficient way to determine the impact of the built environment on health. We explored whether residential moves were associated with changes in body weight.

METHODS

Kaiser Permanente Washington electronic health records were used to identify 21,502 members aged 18-64 who moved within King County, WA between 2005 and 2017. We linked body weight measures to environment measures, including population, residential, and street intersection densities (800 m and 1,600 m Euclidian buffers) and access to supermarkets and fast foods (1,600 m and 5,000 m network distances). We used linear mixed models to estimate associations between postmove changes in environment and changes in body weight.

RESULTS

In general, moving from high-density to moderate- or low-density neighborhoods was associated with greater weight gain postmove. For example, those moving from high to low residential density neighborhoods (within 1,600 m) gained an average of 4.5 (95% confidence interval [CI] = 3.0, 5.9) lbs 3 years after moving, whereas those moving from low to high-density neighborhoods gained an average of 1.3 (95% CI = -0.2, 2.9) lbs. Also, those moving from neighborhoods without fast-food access (within 1600m) to other neighborhoods without fast-food access gained less weight (average 1.6 lbs [95% CI = 0.9, 2.4]) than those moving from and to neighborhoods with fast-food access (average 2.8 lbs [95% CI = 2.5, 3.2]).

CONCLUSIONS

Moving to higher-density neighborhoods may be associated with reductions in adult weight gain.

Evaluation of the nutritional quality of ultra-processed foods (ready to eat + fast food): Fatty acids, sugar, and sodium

The average American consumes more than 50% of their total dietary energy from ultra-processed foods (UPFs). From a nutritional standpoint, as UPFs intake increases, fiber, vitamin, and mineral intake decrease. High consumption of UPFs, mainly from fast foods (FF) and ready-to-eat (RTE) food items, emerges as a critical public health concern linking nutritional quality and food safety. In the present work, a systematic database of the fatty acid composition of the most consumed UPFs in the Midwest is reported. Saturated and monounsaturated fatty acids were predominant in RTE (42.5%) and FF (43.2%), respectively. In addition, the fatty acid profile in UPFs is reported according to six food categories: meat and poultry, eggs and derivatives, dairy products, seafood, baby foods, and others. Meat and poultry, and dairy products were the dominant food categories among UPFs. Meanwhile, polyunsaturated fatty acids were abundant in the eggs and seafood groups UPFs (61.8% and 46.4%, respectively) regardless of the food group. Furthermore, no significant differences were found in sugar content in UPFs. Caloric content was positively correlated with sodium (ρ = 0.748) and price (ρ = 0.534). The significance of this study relies on providing new quantitative data on the fat, sodium, and sugar contents of the most consumed UPFs in the Midwestern area of the United States. This information suggests paying more attention to these nutritional attributes, aiming to reduce their incorporation in UPF preparations. Additionally, more quantitative data are needed regarding other nutritional parameters such as protein and lipid degradation in UPFs. PRACTICAL APPLICATION: This study provides a profile of the fatty acid composition of the most consumed UPFs in the Midwestern region of the United States, as well as correlations with fat, sodium, and sugar contents in UPFs. The information offered a new perspective on the nutrition quality of UPFs, suggesting the reduction of the incorporation of these attributes in UPFs. Additionally, it will help define priority interventions for more advanced precision nutrition, especially for vulnerable populations, for example, children and older people. The overall decrease in added sugar and sodium and the service size in UPFs will significantly improve the nutritional quality of the Western diet.

Validation Study of the Estimated Glycemic Load Model Using Commercially Available Fast Foods

The recent popularization of low-glycemic foods has expanded interest in glycemic index (GI) not only among diabetic patients but also healthy people. The purpose of this study is to validate the estimated glycemic load model (eGL) developed in 2018. This study measured the glycemic load (GL) of 24 fast foods in the market in 20 subjects. Then, the transportability of the model was assessed, followed by an assessment of model calibration and discrimination based on model performance. The transportability assessment showed that the subjects at the time of model development are different from the subjects of this validation study. Therefore, the model can be described as transportable. As for the model's performance, the calibration assessment found an x² value of 11.607 and a p-value of 0.160, which indicates that the prediction model fits the observations. The discrimination assessment found a discrimination accuracy exceeding 0.5 (57.1%), which confirms that the performance and stability of the prediction model can be discriminated across all classifications. The correlation coefficient between GLs and eGLs measured from the 24 fast foods was statistically significant at 0.712 (p < 0.01), indicating a strong positive linear relationship. The explanatory powers of GL and eGL was high at 50.7%. The findings of this study suggest that this prediction model will greatly contribute to healthy food choices because it allows for predicting blood glucose responses solely based on the nutrient content labeled on the fast foods.

Changes in fast food intake in Iranian households during the lockdown period caused by COVID-19 virus emergency, National Food and Nutrition Surveillance

Background

Fast foods, though very popular, are commonly known as unhealthy foods. However, coronavirus pandemic may have influenced on food choices of the general population. This study investigated the changes in fast food consumption during epidemic lockdown 2020.

Materials and Methods

This study was part of a nationwide survey having been conducted using a web‐based electronic self‐administered questionnaire. The questionnaire link was extensively distributed among the whole population both through popular social media platforms and by nutrition and health workers of health offices and medical universities of all provinces. The questionnaire included questions about socio‐demographic characteristics, changes in frequency of fast food consumption as compared with before pandemic, and the reasons for these changes.

Results

A total of 21,290 households took part in the study of whom 89.8% were male‐headed, and almost 74% were from urban areas. Decrease in fast food consumption was reported by 74.8%, while increase in fast food consumption was reported by 2% of the households during the COVID‐19 quarantine. Among those who decreased their fast food consumption, about 82% had completely omitted them from their food baskets. Fear of contamination of fast foods by coronavirus and increase in the number of people at home were the most and the least frequent reasons for decreasing fast food consumption, respectively.

Conclusion

Fast food consumption has dramatically decreased during the lockdown period in Iranian households. Though it may be considered a pleasant offshoot of disastrous COVID‐19 epidemic, the foods replaced fast foods in Iranian households and the overall health consequences warrant further studies.

isolated from fast foods sold in different restaurants of Mymensingh, Bangladesh

OBJECTIVE

Fast foods are often responsible for staphylococcal foodborne illness. The present study was carried out to isolate Staphylococcus spp. from various fast foods sold in Mymensingh and to determine their antibiogram.

MATERIALS AND METHODS

Overall, 60 samples of fast foods sold in different restaurants were screened by culture, biochemical tests, and polymerase chain reaction (PCR) to isolate and identify Staphylococcus spp., followed by employing of disk diffusion method to determine their antibiotic resistance patterns.

RESULTS

Among these 60 samples, 8 [13.33%, 95% confidence interval (CI): 6.91%-24.17%] were positive for Staphylococcus spp. by cultural and biochemical properties. By PCR, four (6.67%, 95% CI: 2.62%-15.93%) isolates were confirmed as Staphylococcus aureus by targeting nuc gene. Additionally, all the S. aureus isolates were coagulase-positive. By antibiogram profiles, all the Staphylococcus isolates exhibited resistance to azithromycin and erythromycin (95% CI: 67.56%-100.00%), and frequently resistance to cefixime (75%, 95% CI: 40.93%-95.56%), ampicillin (50%, 95% CI: 21.52%-78.48%), and amoxicillin (37.5%, 95% CI: 13.68%-69.43%); moderate to lower resistance was found against cefotaxime, gentamicin, and doxycycline. In addition, all the isolates were sensitive to ciprofloxacin and chloramphenicol. Interestingly, 75% (6/8; 95% CI: 40.93%-95.56%) isolates were multidrug-resistant (MDR) in nature. Furthermore, the indices of multiple antibiotic resistance (MAR) were ranged from 0.2 to 0.6.

CONCLUSION

This study revealed that fast foods sold in restaurants were contaminated with MDR and MAR Staphylococcus isolates, having potential public health significance.

Association Between Social Isolation and Eating Alone on Foods Consumed by Chinese Adolescents

Obesity is increasingly affecting Chinese adolescents due to trends in unhealthy eating, including lower fruit and vegetable consumption and increased consumption of processed foods. A cross-sectional study of adolescents was conducted in Wuhan, China, in October 2019 that included measurements of perceived social isolation, eating when anxious or depressed, diet composition, body weight, and height. Social isolation, eating when sad or anxious, and eating alone were significant predictors of processed food and sugar-sweetened beverage consumption, although only eating when sad or anxious was a significant predictor of fruit and vegetable consumption. Eating when anxious or depressed did not mediate these relationships. Social isolation was associated with consumption of processed foods and sugar-sweetened beverages by boys, but not by girls, and only eating home-cooked dinner was associated with fruit and vegetable consumption by female adolescents. Eating when sad or anxious, eating alone, and eating home-cooked meals were all associated with fruit and vegetable consumption among male adolescents. The effects of social isolation, anxiety, and depression could act to increase unhealthy eating through several mechanisms potentially mediated by chronic stress, while eating alone could also act to increase unhealthy eating due to effects of self-efficacy and food availability. The interplay between diet and outside factors, including environment, social factors, and personal psychology specific to Chinese adolescents needs to be better understood to develop comprehensive interventions for this population.

Determiners of fast-food consumption in Iranian university students: Application of prototype/willingness model

BACKGROUND

Today, marked by advanced scientific approach, urbanism, and changing life style, there is an ever-growing rate of fast-food consumption, which has significantly affected public health. Hence, the present research aimed to predict factors involved in fast-food consumption in light of the prototype/willingness model among the students of Rafsanjan University of Medical Sciences.

MATERIALS AND METHODS

In the present descriptive/analytical research conducted in 2018-2019, 350 students in Rafsanjan University of Medical Sciences were selected through proportionate stratified random sampling. The required data were collected using a self-administrated questionnaire in light of the constructs within the prototype/willingness model and fast-food consumption behavior. The data were analyzed in SPSS version 16.0 using descriptive and inferential statistics including mean scores, standard deviation, correlation coefficient, and linear regression.

RESULTS

Behavioral intention of fast-food consumption showed to be positively correlated with positive willingness, positive prototype, positive subjective norms, and positive attitude toward fast-food consumption. Furthermore, the correlation between positive behavioral intention of consuming fast food and positive subjective norms and positive attitude toward fast-food consumption was statistically significant (P < 0.05). The underlying constructs of prototype/willingness model altogether managed to explain 13% of the total variance of fast-food consumption behavior. Behavioral intention showed to be the strongest predictor of the behavior (β = 1.613).

CONCLUSION

It is suggested that the preventive measures aimed to reduce fast-food consumption among the youth focus more on strengthening negative attitudes and subjective norms concerning fast-food consumption.

Effects of Advertising on Food Consumption Preferences in Children

(1) Background: Childhood obesity is a public health problem. The purpose of this study was to know if exposure to commercial messages which advertise food products exerts any effect on the short-term consumption preferences of 4- to 6-year-old children. (2) Methods: A double-blind and randomized experimental design. Sample consisted of 421 boys and girls from twelve schools in a city in Spain. (3) Results: In three of the four product pairs shown, the products advertised in the intervention were preferred. In the results of applying the model for the first product pair presented, sugared cereals, the predictive variable which best explains the behavior of the preferences expressed is gender (Odds Ratio 0.285 (0.19–0.42); p < 0.05). For the second pair, chocolate cookies, the family’s nationality has a strong weight in the model. As regards the regression model calculated for the last pair (filled rolls), the predictive variable which showed having more influence was gender. Boys had a 1.39 times higher risk of selecting the advertised product than girls. (4) Conclusions: The persuasive effect of commercials has shown to be influential in a general, immediate, and significant way only in the case of products with wide brand awareness. This study reinforces the importance of advertising and emphasizes the need to initiate measures to control the content of TV commercials.

The Frequency of Fast Food Consumption in Relation to Wheeze and Asthma Among Adolescents in Gauteng and North West Provinces, South Africa

The prevalence of asthma and allergic diseases have been on the rise, especially in developing countries due to life-style changes. The study aimed to investigate the association between the frequency of fast food consumption with wheeze and asthma among adolescents. A previously validated self-completed questionnaire from the International Study of Asthma and Allergies in Childhood was used to collect information on demographics, socioeconomic status, house characteristics, adolescent respiratory health and diet. The prevalence of wheeze was 38.2% and of asthma was 16.37% among the adolescents. The results from the adjusted regression analyses indicated that eating fast foods three or more times per week was a statistically significant risk factor for wheeze (OR = 1.60; 95% CI: 1.26–2.03) and asthma (OR = 1.37; 95% CI: 1.04–1.91). The study found an association between eating fast foods three or more times per week and wheeze and asthma among adolescents in South Africa. Unhealthy diet plays a crucial role in respiratory health among adolescents; healthy eating habits are encouraged to reduce the burden of respiratory symptoms and diseases.

Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-Food Consumption: A Meta-Analysis of Global School-Based Student Health Surveys

BACKGROUND

Adolescence presents an opportunity to influence diet, which impacts present and future health outcomes, yet adolescent diets globally are poorly understood.

OBJECTIVE

We generate evidence on adolescent diets globally and explore patterns and trends by subpopulation.

METHODS

We estimated mean frequency of consumption and prevalence of less-than-daily fruit and vegetable consumption, at-least-daily carbonated beverage consumption, and at-least-weekly fast-food consumption among school-going adolescents aged primarily 12 to 17 years from the Global School-based Student Health Surveys in Africa, Asia, Oceania, and Latin America between 2008 and 2015. Random-effects meta-analysis was used to pool estimates globally and by subgroup.

RESULTS

On average, adolescents consumed fruit 1.43 (95% confidence interval [CI] 1.26-1.60) times per day, vegetables 1.75 (1.58-1.92) times per day, carbonated soft drinks 0.99 (0.77-1.22) times per day, and fast food 1.05 (0.78-1.32) times per week. Overall, 34.5% (95% CI 29.4-39.7) consumed fruit less than once per day, 20.6% (15.8-25.9) consumed vegetables less than once per day, 42.8% (35.2-50.7) drank carbonated soft drinks at least once per day, and 46.1% (38.6-53.7) consumed fast food at least once per week. Mean daily frequency of fruit consumption was particularly low in South and East Asia (1.30 [1.02-1.58]); carbonated soft drink consumption high in Latin America (1.54 [1.31-1.78]), high-income countries (1.66 [1.29-2.03]), and modern food system typologies (1.44 [0.75-2.12]); and mean weekly fast food consumption high in mixed food system typologies (1.29 [0.88-1.71]).

CONCLUSIONS

School-going adolescents infrequently consume fruits and vegetables and frequently consume carbonated soft drinks, but there is wide variability by subpopulation.

Environmental factors associated with allergy in urban and rural children from the South African Food Allergy (SAFFA) cohort

BACKGROUND

The prevalence of allergic diseases differs in urban and rural populations.

OBJECTIVE

We sought to assess associations between environmental and dietary factors with allergic diseases in urban and rural South African children.

METHODS

Toddlers aged 12 to 36 months were assessed for food allergen and aeroallergen sensitization, atopic dermatitis, allergic rhinitis, asthma, and challenge-proved food allergy. Information was collected on family history of allergic diseases, household size, socioeconomic status, delivery mode, antibiotic and probiotic use, exposure to fermented and unpasteurized milk, antihelminth treatment, sunlight exposure, pet and farm animal exposure, cigarette smoke, and household cooking and heating fuels. Antenatal exposures to pets, livestock, and cigarette smoke were assessed. A subsection completed questions on consumption of fruits and vegetables, fast foods, soft drinks/fruit juices, and fried/microwaved meat.

RESULTS

Risk and protective factors differed between urban and rural settings. Exposure to farm animals in infants and their mothers during pregnancy was protective against allergic outcomes in the rural population. Consumption of unpasteurized milk is uncommon in this group of rural children and is unlikely to be an important factor in rural protection. In urban children birth by cesarean section is associated with food allergy, and consumption of fermented milk products is associated with reduced asthma and atopic dermatitis. In both cohorts antenatal maternal smoking and environmental smoking exposure were predominantly associated with asthma, and consumption of fast foods and fried meats were associated with allergy.

CONCLUSION

In this rural environment exposure to livestock is the strongest protective factor. In urban communities, where animal contact is rare, risk factors include cesarian section, and protective factors include consumption of fermented milk products. Modifiable risk factors urgently require interventions to prevent increasing allergy rates in countries undergoing rapid urbanization.

Rapid Prediction of Low (<1%) trans Fat Content in Edible Oils and Fast Food Lipid Extracts by Infrared Spectroscopy and Partial Least Squares Regression

The United States Food and Drug Administration (FDA) ruled that partially hydrogenated oils (PHO), the major dietary source of industrially produced trans fat (TF), were no longer "generally recognized as safe (GRAS)" for any use in human food. Consequently, the objective of this study was to develop a rapid screening procedure using attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy in conjunction with partial least squares regression (PLSR) for the quantitative and accurate prediction of low concentrations of trans fatty acid (TFAs) (<1% of total fatty acids (FAs)). Broad-based calibration models were developed for a combined set of samples consisting of edible oils and fast food lipid extracts. Predicted concentrations of TFAs in the two matrices showed good correlation with the primary reference data generated by gas chromatography (GC) (R² > 0.99) and high accuracy as evidenced by low root-mean-square error of cross-validation (RMSECV) values. The lowest TFA concentration, determined by GC to be 0.13% of total FAs, was accurately predicted by ATR-FTIR/PLSR as 0.18% of total FAs. This simple, rapid ATR-FTIR/PLSR methodology has the potential for use as a screening alternative to conventional gas chromatographic methods for predicting the TFA content of edible oils and food lipid extracts for regulatory purposes and quality control of raw material and processed food.

PRACTICAL APPLICATIONS

FDA ruled that partially hydrogenated oils were no longer "generally recognized as safe (GRAS)" for any use in human food. Consequently, we have proposed a rapid screening procedure, based on infrared spectroscopy and chemometrics, to rapidly and accurately predict low concentrations of trans fatty acids (<1% of total fatty acids) in edible oils and food lipid extracts.

Fast Foods, Sweets and Beverage Consumption and Risk of Colorectal Cancer: A Case-Control Study in Jordan

Background:

The effects of consuming fast foods, sweets and beverages on the development of colorectal cancer (CRC) are unclear. The aim of this case-control study was to assess possible associations between the consumption of different fast foods, sweets and beverages and CRC risk in a Jordanian population.

Methods:

Two hundred and twenty diagnosed CRC cases and 281 controls were enrolled. Diet history was obtained using a validated quantitative questionnaire.

Results:

Consumption of some types of fast food, and particularly falafel, was associated with an increased risk of developing CRC. Elevated risk was found for potato and corn chips with an AOR of 4.36 (95%CI: 1.24-15.28) for daily consumption and 3.33 (95%CI: 1.00-11.11) for ≥5 servings/week. Consuming 1-2 or >5 servings per week of fried potatoes or 2-3 servings per week of chicken in sandwiches also increased the risk while exposure to fresh tomato juice and hot pepper sauce on a monthly basis appeared to exert a protective effect.

Conclusions:

Consumption of fried fast food items was significantly linked with an increased risk of developing CRC in Jordan.

Examining the Frequency and Contribution of Foods Eaten Away From Home in the Diets of 18- to 30-Year-Old Australians Using Smartphone Dietary Assessment (MYMeals): Protocol for a Cross-Sectional Study

Background

Young Australians aged between 18 and 30 years have experienced the largest increase in the body mass index and spend the largest proportion of their food budget on fast food and eating out. Frequent consumption of foods purchased and eaten away from home has been linked to poorer diet quality and weight gain. There has been no Australian research regarding quantities, type, or the frequency of consumption of food prepared outside the home by young adults and its impact on their energy and nutrient intakes.

Objectives

The objective of this study was to determine the relative contributions of different food outlets (eg, fast food chain, independent takeaway food store, coffee shop, etc) to the overall food and beverage intake of young adults; to assess the extent to which food and beverages consumed away from home contribute to young adults’ total energy and deleterious nutrient intakes; and to study social and physical environmental interactions with consumption patterns of young adults.

Methods

A cross-sectional study of 1008 young adults will be conducted. Individuals are eligible to participate if they: (1) are aged between 18 and 30 years; (2) reside in New South Wales, Australia; (3) own or have access to a smartphone; (4) are English-literate; and (5) consume at least one meal, snack, or drink purchased outside the home per week. An even spread of gender, age groups (18 to 24 years and 25 to 30 years), metropolitan or regional geographical areas, and high and low socioeconomic status areas will be included. Participants will record all food and drink consumed over 3 consecutive days, together with location purchased and consumed in our customized smartphone app named Eat and Track (EaT). Participants will then complete an extensive demographics questionnaire. Mean intakes of energy, nutrients, and food groups will be calculated along with the relative contribution of foods purchased and eaten away from home. A subsample of 19.84% (200/1008) of the participants will complete three 24-hour recall interviews to compare with the data collected using EaT. Data mining techniques such as clustering, decision trees, neural networks, and support vector machines will be used to build predictive models and identify important patterns.

Results

Recruitment is underway, and results will be available in 2018.

Conclusions

The contribution of foods prepared away from home, in terms of energy, nutrients, deleterious nutrients, and food groups to young people’s diets will be determined, as will the impact on meeting national recommendations. Foods and consumption behaviors that should be targeted in future health promotion efforts for young adults will be identified.

Mobilizing social media users to become advertisers: Corporate hashtag campaigns as a public health concern

OBJECTIVE

With the growing popularity of social media, corporate marketers are increasingly launching hashtag campaigns to encourage consumers to create branded user-generated content on their behalves. If successful, these campaigns may expand the reach of harmful marketing messages and capitalize on peer-effects among adolescents. To shed light on these novel corporate campaigns, we performed a case study of the user-generated Instagram content created in response to a hashtag campaign promoting the quick-service restaurant Kentucky Fried Chicken (KFC).

METHODS

We performed a content analysis of one week's worth of user-generated Instagram posts created with the hashtag #HowDoYouKFC between 24 April 2015-1 May 2015. Posts were coded to discern: (a) relevance to KFC as a brand and/or food; (b) themes in the post, (c) the content of images/videos, and (d) overall sentiment toward KFC. Posts that were deleted or made private during the study period were removed. Descriptive statistics were calculated to discern trends in post content.

RESULTS

Instagram users created 196 posts with #HowDoYouKFC during the study period. After removing irrelevant and deleted/private posts, analysis of the 128 remaining user-generated posts revealed that 45% of posts were explicitly positive toward KFC and 39% lacked a specific stance or emotion related to KFC. Of the posts, 55% depicted KFC chicken and 65% included depictions of the brand hashtag on food packaging.

CONCLUSIONS

Findings indicate that corporations are successfully converting individual social media users into positive advertisers for harmful products. Novel efforts are needed to counter corporate user-generated content campaigns.

A Concept-Wide Association Study of Clinical Notes to Discover New Predictors of Kidney Failure

BACKGROUND AND OBJECTIVES

Identifying predictors of kidney disease progression is critical toward the development of strategies to prevent kidney failure. Clinical notes provide a unique opportunity for big data approaches to identify novel risk factors for disease.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We used natural language processing tools to extract concepts from the preceding year's clinical notes among patients newly referred to a tertiary care center's outpatient nephrology clinics and retrospectively evaluated these concepts as predictors for the subsequent development of ESRD using proportional subdistribution hazards (competing risk) regression. The primary outcome was time to ESRD, accounting for a competing risk of death. We identified predictors from univariate and multivariate (adjusting for Tangri linear predictor) models using a 5% threshold for false discovery rate (q value <0.05). We included all patients seen by an adult outpatient nephrologist between January 1, 2004 and June 18, 2014 and excluded patients seen only by transplant nephrology, with preexisting ESRD, with fewer than five clinical notes, with no follow-up, or with no baseline creatinine values.

RESULTS

Among the 4013 patients selected in the final study cohort, we identified 960 concepts in the unadjusted analysis and 885 concepts in the adjusted analysis. Novel predictors identified included high-dose ascorbic acid (adjusted hazard ratio, 5.48; 95% confidence interval, 2.80 to 10.70; q<0.001) and fast food (adjusted hazard ratio, 4.34; 95% confidence interval, 2.55 to 7.40; q<0.001).

CONCLUSIONS

Novel predictors of human disease may be identified using an unbiased approach to analyze text from the electronic health record.

Factors Affecting Underweight and Obesity Among Elementary School Children in South Korea

PURPOSE

The purpose of the study was to determine factors associated with underweight and obesity in elementary school children in Korea.

METHODS

Study participants included 4,895 children attending 59 elementary schools across Korea. Children were grouped into underweight [< 5% body mass index (BMI)-for-age], normal weight (5%-85% BMI-for-age), and overweight/obese (≥ 85% BMI-for age). The questionnaire included demographic characteristics, health status, and diet and exercise behavior of children, and environmental characteristics of schools.

RESULTS

Twelve percent of the children were overweight or obese. The results showed that demographic (age and gender), health status (atopic dermatitis and poor subjective health), and the characteristics of diet and exercise (unbalanced diet and diet experiences) were associated with underweight (p < .05), while demographic (age and gender), health status (poor subjective health), behavioral characteristics (fast food consumption and diet experiences), and school environmental characteristics (rural area) were associated with overweight/obesity (p < .05).

CONCLUSIONS

Programs and interventions to reduce underweight and overweight/obesity in Korean elementary schools must consider behavioral and environmental characteristics of children.

Dietary Behaviours, Impulsivity and Food Involvement: Identification of Three Consumer Segments

This study aims to (1) identify consumer segments based on consumers' impulsivity and level of food involvement, and (2) examine the dietary behaviours of each consumer segment. An Internet-based cross-sectional survey was conducted among 530 respondents. The mean age of the participants was 49.2 ± 16.6 years, and 27% were tertiary educated. Two-stage cluster analysis revealed three distinct segments; "impulsive, involved" (33.4%), "rational, health conscious" (39.2%), and "uninvolved" (27.4%). The "impulsive, involved" segment was characterised by higher levels of impulsivity and food involvement (importance of food) compared to the other two segments. This segment also reported significantly more frequent consumption of fast foods, takeaways, convenience meals, salted snacks and use of ready-made sauces and mixes in cooking compared to the "rational, health conscious" consumers. They also reported higher frequency of preparing meals at home, cooking from scratch, using ready-made sauces and mixes in cooking and higher vegetable consumption compared to the "uninvolved" consumers. The findings show the need for customised approaches to the communication and promotion of healthy eating habits.

Street Food Environment in Maputo (STOOD Map): a Cross-Sectional Study in Mozambique

Background

Street food represents a cultural, social, and economic phenomenon that is typical of urbanized areas, directly linked with a more sedentary lifestyle and providing a very accessible and inexpensive source of nutrition. Food advertising may contribute to shaping consumers’ preferences and has the potential to drive the supply of specific foods.

Objective

The purpose of this study is to characterize the street food offerings available to the urban population of Maputo, the capital city of Mozambique, and the billboard food advertising in the same setting.

Methods

People selling ready-to-eat foods, beverages, or snacks from venues such as carts, trucks, stands, and a variety of improvised informal setups (eg, shopping carts, trunks of cars, sides of vans, blankets on the sidewalk, etc) will be identified in the district of KaMpfumu. We will gather information about the actual food being sold through direct observation and interviews to vendors, and from the billboard advertising in the same areas. A second phase of the research entails collecting food samples to be analyzed in a specialized laboratory. The street food environment will be characterized, overall and according to socioeconomic and physical characteristics of the neighborhood, using descriptive statistics and spatial analysis. The study protocol was approved by the National Committee for Bioethics for Health in Mozambique.

Results

Data collection, including the identification of street food vending sites and billboard advertising, started on October 20, 2014, and lasted for 1 month. The collection of food samples took place in December 2014, and the bromatological analyses are expected to be concluded in August 2015.

Conclusions

The district of KaMpfumu is the wealthiest and most urbanized in Maputo, and it is the area with the highest concentration and variety of street food vendors. The expected results may yield important information to assess the nutritional environment and the characteristics of the foods to which a great majority of the urban population living or working in Maputo are exposed. Furthermore, this study protocol provides a framework for a stepwise standardized characterization of the street food environment, comprising 3 steps with increasing complexity and demand for human and technical resources: Step 1 consists of the evaluation of food advertising in the streets; Step 2 includes the identification of street food vendors and the characterization of the products available; and Step 3 requires the collection of food samples for bromatological analyses. This structured approach to the assessment of the street food environment may enable within-country and international comparisons as well as monitoring of temporal trends.

Restaurant menu labelling: Is it worth adding sodium to the label?

OBJECTIVE

Several provincial and federal bills have recommended various forms of menu labelling that would require information beyond just calories; however, the additional benefit of including sodium information is unknown. The objective of this study was to determine whether sodium information on menus helps consumers make lower-sodium choices and to understand what other factors influence the effect of menu labelling on consumers' meal choices.

METHODS

A total of 3,080 Canadian consumers completed an online survey that included a repeated measures experiment in which consumers were asked to select what they would typically order from four mock-restaurant menus. Subsequently, consumers were randomly allocated to see one of three menu-labelling treatments (calories; calories and sodium; or calories, sodium and serving size) and were given the option to change their order.

RESULTS

There was a significant difference in the proportion of consumers who changed their order, varying from 17% to 30%, depending on the restaurant type. After participants had seen menu labelling, sodium levels decreased in all treatments (p&lt;0.0001). However, in three of the four restaurant types, consumers who saw calorie and sodium information ordered meals with significantly less sodium than consumers who saw only calorie information (p&lt;0.01). Consumers who saw sodium labelling decreased the sodium level of their meal by an average of 171-384 mg, depending on the restaurant. In the subset of consumers who saw sodium information and chose to change their order, sodium levels decreased by an average of 681-1,360 mg, depending on the restaurant. Sex, intent to lose weight and the amount of calories ordered at baseline were the most important predictors of who used menu labelling. Eighty percent of survey panelists wanted to see nutrition information when dining out.

CONCLUSION

Including sodium information alongside calorie information may result in a larger decrease in the amount of sodium ordered by restaurant-goers.

Association between neighbourhood fast-food and full-service restaurant density and body mass index: a cross-sectional study of Canadian adults

OBJECTIVE

Frequent fast-food consumption is a well-known risk factor for obesity. This study sought to determine whether the availability of fast-food restaurants has an influence on body mass index (BMI).

METHODS

BMI and individual-level confounding variables were obtained from the 2007-08 Canadian Community Health Survey. Neighbourhood socio-demographic variables were acquired from the 2006 Canadian Census. The geographic locations of all restaurants in Canada were assembled from a validated business registry database. The density of fast-food, full-service and non-chain restaurants per 10,000 individuals was calculated for respondents' forward sortation area. Multivariable regression analyses were conducted to analyze the association between restaurant density and BMI.

RESULTS

Fast-food, full-service and non-chain restaurant density variables were statistically significantly associated with BMI. Fast-food density had a positive association whereas full-service and non-chain restaurant density had a negative association with BMI (additional 10 fast-food restaurants per capita corresponded to a weight increase of 1 kilogram; p&lt;0.001). These associations were primarily found in Canada's major urban jurisdictions.

CONCLUSIONS

This research was the first to investigate the influence of fast-food and full-service restaurant density on BMI using individual-level data from a nationally representative Canadian survey. The finding of a positive association between fast-food restaurant density and BMI suggests that interventions aiming to restrict the availability of fast-food restaurants in local neighbourhoods may be a useful obesity prevention strategy.

Ready-to-use therapeutic food for home-based treatment of severe acute malnutrition in children from six months to five years of age

BACKGROUND

Malnourished children have a higher risk of death and illness. Treating severe acute malnourished children in hospitals is not always desirable or practical in rural settings, and home treatment may be better. Home treatment can be food prepared by the carer, such as flour porridge, or commercially manufactured food such as ready-to-use therapeutic food (RUTF). RUTF is made according to a standard, energy-rich composition defined by the World Health Organization (WHO). The benefits of RUTF include a low moisture content, long shelf life without needing refrigeration and that it requires no preparation.

OBJECTIVES

To assess the effects of home-based RUTF on recovery, relapse and mortality in children with severe acute malnutrition.

SEARCH METHODS

We searched the following electronic databases up to April 2013: Cochrane Central Register of Clinical Trials (CENTRAL), MEDLINE, MEDLINE In-process, EMBASE, CINAHL, Science Citation Index, African Index Medicus, LILACS, ZETOC and three trials registers. We also contacted researchers and clinicians in the field and handsearched bibliographies of included studies and relevant reviews.

SELECTION CRITERIA

We included randomised and quasi-randomised controlled trials where children between six months and five years of age with severe acute malnutrition were treated at home with RUTF compared to a standard diet, or different regimens and formulations of RUTFs compared to each other. We assessed recovery, relapse and mortality as primary outcomes, and anthropometrical changes, time to recovery and adverse outcomes as secondary outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial eligibility using prespecified criteria, and three review authors independently extracted data and assessed trial risk of bias.

MAIN RESULTS

We included four trials (three having a high risk of bias), all conducted in Malawi with the same contact author. One small trial included children infected with human immunodeficiency virus (HIV). We found the risk of bias to be high for the three quasi-randomised trials while the fourth trial had a low to moderate risk of bias. Because of the sparse data for HIV, we reported below the main results for all children together. RUTF meeting total daily requirements versus standard dietWhen comparing RUTF with standard diet (flour porridge), we found three quasi-randomised cluster trials (n = 599). RUTF may improve recovery slightly (risk ratio (RR) 1.32; 95% confidence interval (CI) 1.16 to 1.50; low quality evidence), but we do not know whether RUTF improves relapse, mortality or weight gain (very low quality evidence). RUTF supplement versus RUTF meeting total daily requirementsWhen comparing RUTF supplement with RUTF that meets total daily nutritional requirements, we found two quasi-randomised cluster trials (n = 210). For recovery, relapse, mortality and weight gain the quality of evidence was very low; therefore, the effects of RUTF are unknown. RUTF containing less milk powder versus standard RUTFWhen comparing a cheaper RUTF containing less milk powder (10%) versus standard RUTF (25% milk powder), we found one trial that randomised 1874 children. For recovery, there was probably little or no difference between the groups (RR 0.97; 95% CI 0.93 to 1.01; moderate quality evidence). RUTF containing less milk powder may lead to slightly more children relapsing (RR 1.33; 95% CI 1.03 to 1.72; low quality evidence) and to less weight gain (mean difference (MD) -0.5 g/kg/day; 95% CI -0.75 to -0.25; low-quality evidence) than standard RUTF. We do not know whether the cheaper RUTF improved mortality (very low quality evidence).

AUTHORS' CONCLUSIONS

Given the limited evidence base currently available, it is not possible to reach definitive conclusions regarding differences in clinical outcomes in children with severe acute malnutrition who were given home-based ready-to-use therapeutic food (RUTF) compared to the standard diet, or who were treated with RUTF in different daily amounts or formulations. For this reason, either RUTF or flour porridge can be used to treat children at home depending on availability, affordability and practicality. Well-designed, adequately powered pragmatic randomised controlled trials of HIV-uninfected and HIV-infected children with severe acute malnutrition are needed.

Sodium intakes of US children and adults from foods and beverages by location of origin and by specific food source

Sodium intakes, from foods and beverages, of 22,852 persons in the National Health and Nutrition Examination Surveys (NHANES 2003-2008) were examined by specific food source and by food location of origin. Analyses were based on a single 24-h recall. Separate analyses were conducted for children (6-11 years of age), adolescents (12-19), and adults (20-50 and ≥51 years). Grouping of like foods (e.g., food sources) used a scheme proposed by the National Cancer Institute, which divides foods/beverages into 96 food subgroups (e.g., pizza, yeast breads or cold cuts). Food locations of origin were stores (e.g., grocery, convenience and specialty stores), quick-service restaurant/pizza (QSR), full-service restaurant (FSR), school, or other. Food locations of sodium were also evaluated by race/ethnicity amongst adults. Stores provided between 58.1% and 65.2% of dietary sodium, whereas QSR and FSR together provided between 18.9% and 31.8% depending on age. The proportion of sodium from QSR varied from 10.1% to 19.9%, whereas that from FSR varied from 3.4% to 13.3%. School meals provided 10.4% of sodium for 6-11 year olds and 6.0% for 12-19 year olds. Pizza from QSR, the top away from home food item, provided 5.4% of sodium in adolescents. QSR pizza, chicken, burgers and Mexican dishes combined provided 7.8% of total sodium in adult diets. Most sodium came from foods purchased in stores. Food manufacturers, restaurants, and grocery stores all have a role to play in reducing the amount of sodium in the American diet.

Sodium levels in Canadian fast-food and sit-down restaurants

OBJECTIVE

To evaluate the sodium levels in Canadian restaurant and fast-food chain menu items.

METHODS

Nutrition information was collected from the websites of major sit-down (n=20) and fast-food (n=65) restaurants across Canada in 2010 and a database was constructed. Four thousand and forty-four meal items, baked goods, side dishes and children's items were analyzed. Sodium levels were compared to the recommended adequate intake level (AI), tolerable upper intake level (UL) and the US National Sodium Reduction Initiative (NSRI) targets.

RESULTS

On average, individual sit-down restaurant menu items contained 1455 mg sodium/serving (or 97% of the AI level of 1500 mg/day). Forty percent of all sit-down restaurant items exceeded the AI for sodium and more than 22% of sit-down restaurant stir fry entrées, sandwiches/wraps, ribs, and pasta entrées with meat/seafood exceeded the daily UL for sodium (2300 mg). Fast-food restaurant meal items contained, on average, 1011 mg sodium (68% of the daily AI), while side dishes (from sit-down and fast-food restaurants) contained 736 mg (49%). Children's meal items contained, on average, 790 mg/serving (66% of the sodium AI for children of 1200 mg/day); a small number of children's items exceeded the children's daily UL. On average, 52% of establishments exceeded the 2012 NSRI density targets and 69% exceeded the 2014 targets.

CONCLUSION

The sodium content in Canadian restaurant foods is alarmingly high. A population-wide sodium reduction strategy needs to address the high levels of sodium in restaurant foods.

The Happy Meal® Effect: the impact of toy premiums on healthy eating among children in Ontario, Canada

OBJECTIVES

"Toy premiums", offered with McDonald's Happy Meals®, are a prominent form of food marketing directed at children. Two California jurisdictions recently implemented policies that only permit offering fast-food toy premiums with meals that meet certain nutritional criteria. The primary objective of the current study was to examine elements of this policy in a Canadian context and determine if children select healthier food products if toy premiums are only offered with healthier food options. The study also examined if the impact of restricting toy premiums to healthier foods varied by gender and age.

METHODS

A between-groups experimental study was conducted with 337 children aged 6-12 years attending day camps in Ontario, Canada. Children were offered one of four McDonald's Happy Meals® as part of the camp lunch program: two "healthier" meals that met the nutritional criteria and two meals that did not. In the control condition, all four meals were offered with a toy premium. In the intervention condition, the toy was only offered with the two "healthier" meals.

RESULTS

Children were significantly more likely to select the healthier meals when toys were only offered with meals that met nutritional criteria (OR=3.19, 95% CI: 1.89-5.40). The effect of pairing toys with healthier meals had a stronger effect on boys than girls (OR=1.90, 95% CI: 1.14-3.17).

CONCLUSION

Policies that restrict toy premiums to food that meet nutritional criteria may promote healthier eating at fast-food restaurants.

Dietary and lifestyle habits amongst adolescents in Bahrain

Background

Changes in dietary habits and lifestyle are considered the main factors associated with several diet-related diseases in the Arab Gulf countries. The aim of this study was, therefore, to describe the dietary and lifestyle habits amongst adolescents in Bahrain.

Design

A cross-sectional study was carried out amongst male and female secondary school students selected using the multi-stage stratified random sampling technique. A sample size of 735 subjects (339 males and 396 females), aged 15–18 years, was selected from government schools from all the governorates of Bahrain.

Results

Skipping breakfast was significantly greater in females (62.8%) compared to males (37.2%), (P<0.01). About 88% of adolescents snacked during school break, 70.7% procuring food from the school canteen. Fruit was not consumed by about 27.7% of respondents (33.5% males, 66.5% females) and the gender difference was statistically significant (P<0.01). Fish and lentils were less preferred, while chicken was more popular. There was no significant difference between gender and frequency of eating fast food. About 8.4% of respondents reported not eating burgers, with 68.8% preferring regular size burgers. Furthermore, 24.4% preferred large portions of potato chips (53.1% male, 46.9% female). About 29.8% watched TV for more than 5 hours a day (51.2% females, 48.8% males). About 69% of males practiced sports everyday as against 30.8% of females (P<0.01) and 81.6% of those who participated in sport activity outside school were males compared to 18.4% of females.

Conclusion

It seems that the adolescents in Bahrain are moving toward unhealthy dietary habits and lifestyles, which in turn will affect their health status in the future. Promoting healthy lifestyle and eating habits should be given a priority in school health programs.