Date Published: June 07, 2018
Publisher: Oxford University Press
Author(s): Nida Ziauddeen, Polly Page, Tarra L Penney, Sonja Nicholson, Sara FL Kirk, Eva Almiron-Roig.
Where children eat has been linked to variations in diet quality, including the consumption of low-nutrient, energy-dense food, a recognized risk factor for obesity.
The aim of this study was to provide a comprehensive analysis of consumption patterns and nutritional intake by eating location in British children with the use of a nationally representative survey.
Cross-sectional data from 4636 children (80,075 eating occasions) aged 1.5–18 y from the UK National Diet and Nutrition Survey Rolling Program (2008–2014) were analyzed. Eating locations were categorized as home, school, work, leisure places, food outlets, and “on the go.” Foods were classified into core (considered important or acceptable within a healthy diet) and noncore (all other foods). Other variables included the percentage of meals eaten at home, sex, ethnicity, body mass index, income, frequency of eating out, takeaway meal consumption, alcohol consumption, and smoking.
The main eating location across all age groups was at home (69–79% of eating occasions), with the highest energy intakes. One-third of children from the least-affluent families consumed ≤25% of meals at home. Eating more at home was associated with less sugar and takeaway food consumption. Eating occasions in leisure places, food outlets, and “on the go” combined increased with age, from 5% (1.5–3 y) to 7% (11–18 y), with higher energy intakes from noncore foods in these locations. The school environment was associated with higher intakes of core foods and reduced intakes of noncore foods in children aged 4–10 y who ate school-sourced foods.
Home and school eating are associated with better food choices, whereas other locations are associated with poor food choices. Effective, sustained initiatives targeted at behaviors and improving access to healthy foods in leisure centers and food outlets, including food sold to eat “on the go,” may improve food choices. Home remains an important target for intervention through family and nutrition education, outreach, and social marketing campaigns. This trial was registered with the ISRTCN registry (https://www.isrctn.com) as ISRCTN17261407.
Poor diet in childhood and adolescence has been recognized as a risk factor for obesity and associated conditions during adulthood (1, 2). The food environment is an important determinant of children’s dietary behavior (3–5), and therefore improvements in food environments could facilitate healthier eating behaviors (2, 6). Specifically, eating out-of-home in children has been linked to the consumption of nutrient-poor, energy-dense foods (7, 8), also known as “noncore foods,” including sugar-sweetened beverages (SSBs), cakes, and potato chips.
The sample consisted of 4636 children (819 children aged 1.5–3 y, 1772 aged 4–10 y, and 2045 aged 11–18 y) with a total of 80,075 eating occasions. The main eating location across all age groups was home (68.8–79.1% of eating occasions) followed by school (7.1–17.0% of eating occasions) (Figure 1). The percentage of eating occasions in leisure places, food outlets, and “on the go” combined increased with age from 4.9% for children aged 1.5–3 y to 5.6% for children aged 4–10 y and 7.2% for children aged 11–18 y.
Our analysis of 4636 children involving >80,000 eating occasions shows that most of the energy intake in this nationally representative sample came from foods eaten at home. As children aged, they ate out of home and school (or work) more frequently and more energy came from less-healthy food options in these settings. Specifically, food outlets, leisure places, and “on the go” were the out-of-home food environments associated with the highest proportion of energy from noncore foods. For children aged 4–18 y, approximately one-third of total daily energy intake came from such foods in these locations, with core foods only contributing less than one-fifth in the same locations. A parallel analysis in adults aged ≥19 y from the NDNS RP showed a similar pattern, in that eating at food outlets, leisure places, and “on the go” was linked to higher energy intakes from noncore foods, with a disproportionately higher energy intake in these locations than at home and work (38). These results clearly highlight the potential impact that the immediate food environment can have on food choices in children and their potential effect in undermining health-promoting government messages.