Jennifer M. Poti

Trends in Energy Intake among US Children by Eating Location and Food Source, 1977-2006

BACKGROUND Little is known about the influence of location of food consumption and preparation upon daily energy intake of children. OBJECTIVE To examine trends in daily energy intake by children for foods eaten at home or away from home, by source of preparation, and for combined categories of eating location and food source. SUBJECTS The analysis uses data from 29,217 children aged 2 to 18 years from the 1977-1978 Nationwide Food Consumption Survey, 1989-1991 and 1994-1998 Continuing Survey of Food Intakes by Individuals, and 2003-2006 National Health and Nutrition Examination Surveys. METHODS Nationally representative weighted percentages and means of daily energy intake by eating location were analyzed for trends from 1977 to 2006. Comparisons by food source were examined from 1994 to 2006. Analyses were repeated for three age groups: 2 to 6 years, 7 to 12 years, and 13 to 18 years. Difference testing was conducted using a t test. RESULTS Increased energy intake (+179 kcal/day) by children from 1977-2006 was associated with a major increase in energy eaten away from home (+255 kcal/day). The percentage of daily energy eaten away from home increased from 23.4% to 33.9% from 1977-2006. No further increase was observed from 1994-2006, but the sources of energy shifted. The percentage of energy from fast food increased to surpass intake from schools and become the largest contributor to foods prepared away from home for all age groups. For foods eaten away from home, the percentage of daily energy from stores increased to become the largest source of energy eaten away from home. Fast food eaten at home and store-bought food eaten away from home increased significantly. CONCLUSIONS Eating location and food source significantly influence daily energy intake for children. Foods prepared away from home, including fast food eaten at home and store-prepared food eaten away from home, are fueling the increase in total energy intake. However, further research using alternative data sources is necessary to verify that store-bought foods eaten away from home are increasingly store-prepared.

The association of fast food consumption with poor dietary outcomes and obesity among children: is it the fast food or the remainder of the diet?

BACKGROUND Although fast food consumption has been linked to adverse health outcomes, the relative contribution of fast food itself compared with the rest of the diet to these associations remains unclear. OBJECTIVE Our objective was to compare the independent associations with overweight/obesity or dietary outcomes for fast food consumption compared with dietary pattern for the remainder of intake. DESIGN This cross-sectional analysis studied 4466 US children aged 2-18 y from NHANES 2007-2010. Cluster analysis identified 2 dietary patterns for the non-fast food remainder of intake: Western (50.3%) and Prudent. Multivariable-adjusted linear and logistic regression models examined the association between fast food consumption and dietary pattern for the remainder of intake and estimated their independent associations with overweight/obesity and dietary outcomes. RESULTS Half of US children consumed fast food: 39.5% low-consumers (≤30% of energy from fast food) and 10.5% high-consumers (>30% of energy). Consuming a Western dietary pattern for the remainder of intake was more likely among fast food low-consumers (OR: 1.51; 95% CI: 1.24, 1.85) and high-consumers (OR: 2.21; 95% CI: 1.60, 3.05) than among nonconsumers. The remainder of diet was independently associated with overweight/obesity (β: 5.9; 95% CI: 1.3, 10.5), whereas fast food consumption was not, and the remainder of diet had stronger associations with poor total intake than did fast food consumption. CONCLUSIONS Outside the fast food restaurant, fast food consumers ate Western diets, which might have stronger associations with overweight/obesity and poor dietary outcomes than fast food consumption itself. Our findings support the need for prospective studies and randomized trials to confirm these hypotheses.

Where are kids getting their empty calories? Stores, schools, and fast-food restaurants each played an important role in empty calorie intake among US children during 2009-2010.

Consumption of empty calories, the sum of energy from added sugar and solid fat, exceeds recommendations, but little is known about where US children obtain these empty calories. The objectives of this study were to compare childrens empty calorie consumption from retail food stores, schools, and fast-food restaurants; to identify food groups that were top contributors of empty calories from each location; and to determine the location providing the majority of calories for these key food groups. This cross-sectional analysis used data from 3,077 US children aged 2 to 18 years participating in the 2009-2010 National Health and Nutrition Examination Survey. The empty calorie content of childrens intake from stores (33%), schools (32%), and fast-food restaurants (35%) was not significantly different in 2009-2010. In absolute terms, stores provided the majority of empty calorie intake (436 kcal). The top contributors of added sugar and solid fat from each location were similar: sugar-sweetened beverages, grain desserts, and high-fat milk∗ from stores; high-fat milk, grain desserts, and pizza from schools; and sugar-sweetened beverages, dairy desserts, french fries, and pizza from fast-food restaurants. Schools contributed about 20% of childrens intake of high-fat milk and pizza. These findings support the need for continued efforts to reduce empty calorie intake among US children aimed not just at fast-food restaurants, but also at stores and schools. The importance of reformed school nutrition standards was suggested, as prior to implementation of these changes, schools resembled fast-food restaurants in their contributions to empty calorie intake.

Changes in prices, sales, consumer spending, and beverage consumption one year after a tax on sugar-sweetened beverages in Berkeley, California, US: A before-and-after study

Background Taxes on sugar-sweetened beverages (SSBs) meant to improve health and raise revenue are being adopted, yet evaluation is scarce. This study examines the association of the first penny per ounce SSB excise tax in the United States, in Berkeley, California, with beverage prices, sales, store revenue/consumer spending, and usual beverage intake. Methods and findings Methods included comparison of pre-taxation (before 1 January 2015) and first-year post-taxation (1 March 2015–29 February 2016) measures of (1) beverage prices at 26 Berkeley stores; (2) point-of-sale scanner data on 15.5 million checkouts for beverage prices, sales, and store revenue for two supermarket chains covering three Berkeley and six control non-Berkeley large supermarkets in adjacent cities; and (3) a representative telephone survey (17.4% cooperation rate) of 957 adult Berkeley residents. Key hypotheses were that (1) the tax would be passed through to the prices of taxed beverages among the chain stores in which Berkeley implemented the tax in 2015; (2) sales of taxed beverages would decline, and sales of untaxed beverages would rise, in Berkeley stores more than in comparison non-Berkeley stores; (3) consumer spending per transaction (checkout episode) would not increase in Berkeley stores; and (4) self-reported consumption of taxed beverages would decline. Main outcomes and measures included changes in inflation-adjusted prices (cents/ounce), beverage sales (ounces), consumers’ spending measured as store revenue (inflation-adjusted dollars per transaction) in two large chains, and usual beverage intake (grams/day and kilocalories/day). Tax pass-through (changes in the price after imposition of the tax) for SSBs varied in degree and timing by store type and beverage type. Pass-through was complete in large chain supermarkets (+1.07¢/oz, p = 0.001) and small chain supermarkets and chain gas stations (1.31¢/oz, p = 0.004), partial in pharmacies (+0.45¢/oz, p = 0.03), and negative in independent corner stores and independent gas stations (−0.64¢/oz, p = 0.004). Sales-unweighted mean price change from scanner data was +0.67¢/oz (p = 0.00) (sales-weighted, +0.65¢/oz, p = 0.003), with +1.09¢/oz (p < 0.001) for sodas and energy drinks, but a lower change in other categories. Post-tax year 1 scanner data SSB sales (ounces/transaction) in Berkeley stores declined 9.6% (p < 0.001) compared to estimates if the tax were not in place, but rose 6.9% (p < 0.001) for non-Berkeley stores. Sales of untaxed beverages in Berkeley stores rose by 3.5% versus 0.5% (both p < 0.001) for non-Berkeley stores. Overall beverage sales also rose across stores. In Berkeley, sales of water rose by 15.6% (p < 0.001) (exceeding the decline in SSB sales in ounces); untaxed fruit, vegetable, and tea drinks, by 4.37% (p < 0.001); and plain milk, by 0.63% (p = 0.01). Scanner data mean store revenue/consumer spending (dollars per transaction) fell 18¢ less in Berkeley (−

Solid fat and added sugar intake among U.S. children: The role of stores, schools, and fast food, 1994-2010.

0.36, p < 0.001) than in comparison stores (−

Eating and aging: Trends in dietary intake among older Americans from 1977–2010

0.54, p < 0.001). Baseline and post-tax Berkeley SSB sales and usual dietary intake were markedly low compared to national levels (at baseline, National Health and Nutrition Examination Survey SSB intake nationally was 131 kcal/d and in Berkeley was 45 kcal/d). Reductions in self-reported mean daily SSB intake in grams (−19.8%, p = 0.49) and in mean per capita SSB caloric intake (−13.3%, p = 0.56) from baseline to post-tax were not statistically significant. Limitations of the study include inability to establish causal links due to observational design, and the absence of health outcomes. Analysis of consumption was limited by the small effect size in relation to high standard error and Berkeley’s low baseline consumption. Conclusions One year following implementation of the nation’s first large SSB tax, prices of SSBs increased in many, but not all, settings, SSB sales declined, and sales of untaxed beverages (especially water) and overall study beverages rose in Berkeley; overall consumer spending per transaction in the stores studied did not rise. Price increases for SSBs in two distinct data sources, their timing, and the patterns of change in taxed and untaxed beverage sales suggest that the observed changes may be attributable to the tax. Post-tax self-reported SSB intake did not change significantly compared to baseline. Significant declines in SSB sales, even in this relatively affluent community, accompanied by revenue used for prevention suggest promise for this policy. Evaluation of taxation in jurisdictions with more typical SSB consumption, with controls, is needed to assess broader dietary and potential health impacts.

Where people shop is not associated with the nutrient quality of packaged foods for any racial-ethnic group in the United States

BACKGROUND Little is known about the role of location in U.S. childrens excess intake of energy from solid fat and added sugar, collectively referred to as SoFAS. PURPOSE The goal of this study was to compare the SoFAS content of foods consumed by children from stores, schools, and fast-food restaurants and to determine whether trends from 1994 to 2010 differ across these locations. METHODS Children aged 2-18 years (N=22,103) from five nationally representative surveys of dietary intake from 1994 to 2010 were studied. SoFAS content was compared across locations for total intake and key foods. Regression models were used to test and compare linear trends across locations. Data were analyzed in 2012. RESULTS The mean percentage of total energy intake consumed from each location that was provided by SoFAS remained above recommendations, despite significant improvements between 1994 and 2010 at stores (1994, 38.3%; 2004, 33.2%); schools (1994, 38.7%; 2004, 31.2%); and fast-food restaurants (1994, 34.6%; 2004, 34.6%). For each key food, SoFAS content decreased significantly at stores and schools, yet progress at schools was comparatively slower. Milk was higher in SoFAS at schools compared to stores because of shifts toward flavored milk at schools. Schools provided french fries that were higher in solid fat than store-bought versions and pizza that was not significantly different in SoFAS content than fast-food pizza. However, schools made significantly greater progress for sugar-sweetened beverages, as lower-sugar beverages replaced regular sodas. Key fast foods showed little improvement. CONCLUSIONS These findings can inform future strategies targeted to the specific locations and foods where continued progress is needed to reduce childrens SoFAS consumption.

Parenting styles and body mass index: a systematic review of prospective studies among children

ObjectiveWe examined trends from 1977–2010 in calorie, macronutrient, and food group intake among US adults 55 and older.DesignCross-sectional time series.SettingA nationally representative sample of the US non-institutionalized population.ParticipantsOlder Americans aged ≥55 years (n=18,603) from four surveys of dietary intake in 1977–1978, 1989–1991, 1994–1996, and 2005–2010.MeasurementsDietary intake was assessed using one 24-hour recall. Multivariable linear regression models were used to determine adjusted per capita mean energy and macronutrient intake for each survey year. Interactions were used to examine differences by race/ethnicity, gender, and generation. The top five food group contributors to total calorie intake were identified for each year.ResultsMean total calorie intake increased significantly among older Americans from 1977–2010. Increases in carbohydrate intake (43% to 49% of total calories) were coupled with decreases in total fat intake (from 40% to 34%) while saturated fat (11%) remained constant. Corresponding shifts in food group intake were observed, as red meat intake greatly declined while bread and grain desserts became dominant calorie sources. Calorie intake was significantly higher for whites compared to blacks from 1994–2010. Cohort analysis indicated a shift from decreasing caloric intake with age to relatively stable calorie intake despite increasing age in more recent cohorts.ConclusionIncreases in total calorie intake from 1977–2010, coupled with the finding that more recent generations did not show the expected age-related decrease in caloric consumption, raise concerns about obesity risk among older Americans. Additionally, despite declines across time in total fat intake, saturated fat intake continues to exceed recommendations, and shifts toward increased consumption of grain-based desserts suggest that high discretionary calorie intake by older Americans might make it difficult to meet nutrient requirements while staying within energy needs.

Highly Processed and Ready-to-Eat Packaged Food and Beverage Purchases Differ by Race/Ethnicity among US Households

BACKGROUND In the literature, it has been suggested that there are race-ethnic disparities in what Americans eat. In addition, some studies have shown that residents of African American and low-income neighborhoods have less access to grocery stores and supermarkets, which tend to stock healthier foods. However, it is unclear whether differences in food shopping patterns contribute to the poorer nutrient profile of food purchases made by racial-ethnic minorities. OBJECTIVES We examined whether the mix of food stores where people shop (i.e., food-shopping patterns) was associated with the nutrient profile of packaged food purchases (PFPs) and the types of foods and beverages purchased, and we determined whether these associations differ across racial-ethnic groups. DESIGN We used PFPs by US households (Nielsen National Consumer Panel) from 2007 to 2012 and implemented a cluster analysis to categorize households according to their food-shopping patterns. Longitudinal random-effects linear regression models were used to examine the association between food shopping patterns and the nutrient qualities and types of packaged foods and beverages purchased by race-ethnicity in US households. RESULTS Shopping primarily at grocery chains was not associated with a better nutrient profile of household PFPs or the food and beverages that households purchased than was shopping primarily at mass merchandisers (value-oriented stores that sell merchandise lines in multiple departments) or at a combination of large and small stores. These results were consistent across racial-ethnic groups. Regardless of where households shopped, non-Hispanic African American households purchased foods with higher energy, total sugar, and sodium densities than did non-Hispanic white and Hispanic households. CONCLUSION Policy initiatives that focus on increasing physical access to stores or helping stores sell healthier products to encourage healthier purchases may be ineffective because other factors may be more important determinants of food and beverage purchases than where people shop or what is available in the store.

SSB taxes and diet quality in US preschoolers: estimated changes in the 2010 Healthy Eating Index.

Parenting style may be an important determinant of an individuals future weight status. However, reviews that evaluate the relationship between parenting style and weight‐related outcomes have not focused on prospective studies.