Abstract: This study was design to determine whether there is a difference in the number of meals consumed away from home (restaurant or fast food) between low socioeconomic status (SES) and high SES adolescents. Additionally, this study sought to determine if the nutrients and food group chosen differs among children who consume meals away from home versus those who do not. Eighty four adolescences (51 boys and 33 girls) ages 12-16 years and their parents from Shiraz, Iran completed the three 24 h diet recalls (one weekend and two week days). The demographics questionnaire was also completed from each participant. Data analyzed using SPSS and hypothesis tested using one way ANOVA. There was no significant difference in the number of meals consumed away from home in low SES adolescents compared to high SES (p = 0.464). However, those who consumed meals away from home reported a higher percentage of calories from fat (p = 0.007) and serving of fried vegetables (p = 0.010) compared to those who consumed no meals away from home. These findings suggest that intervention for adolescents eating patterns should provide information on choosing healthy meals away from home.
INTRODUCTION
Rapid increase in obesity across different age groups coupled by the reduction in the age when obesity occurs, force us to focus on the dietary habits of children and youth. Dietary habits that result in suboptimal nutrient intake increase the probability of developing chronic diseases such as coronary heart disease, type 2 diabetes, or hypertension (Nicklas et al., 2003; Steffen et al., 2005). On the other hand, dietary habits during adolescence that result in the consumption of a well-balanced diet may decrease the risk of obesity and other related diseases during adulthood and increase the quality of life (Nicklas et al., 2003).
The increasing prevalence of overweight children and adolescents is attributed to many dietary factors including the increase in consumption of soft drink, fast food and energy-dense foods coupled with non-healthy foods consumed away from home and decreased physical activity (Nicklas et al., 2003; Nielsen et al., 2002; Kant and Graubard, 2004; Austin et al., 2005; Morland et al., 2002).
In a 2004 study, researchers concluded that children who consumed fast-food, in comparison with children that did not, consumed more energy, total fat, total carbohydrate, added sugar, sugar beverages and less milk, fruit and non-starchy vegetables (Bowman et al., 2004).
Recent studies have suggested that families in the area of lower socioeconomic status don’t eat as healthy as families of higher socioeconomic status, partly due to decreased availability of healthy foods (Morland et al., 2002). Apart from lack of availability of good quality foods in lower socioeconomic status area, lack of education has been positively associated with caloric dense and nutrient deficient diet (Stang, 2004).
The purpose of this study was to determine whether there are differences in the number of meals consumed away from home between low and high socioeconomic status adolescence and to determine if nutrient and food group contents differs among children who consumed foods away from home versus those who do not.
MATERIALS AND METHODS
Eighty four adolescents (51 boys and 33 girls) ages 12-16 years with their parents from eight junior high schools at eight different locations in Shiraz were recruited to participate in this study in November 2007. Each participant met the following criteria (a) age 12-16 years, (b) able to self-report data and © able to answer the questionnaire. Exclusionary criteria included the presence of any illness or medical problem that includes special dietary or drug treatment.
Procedure: A trained dietitian asked to explain the study to adolescents and their parents at school visit and obtained parental consent and child assent from each who agreed to participate in the study. Then, each participant asked to complete a demographic questionnaire.
Education levels are commonly used as a surrogate for income; therefore, parents’ education level was used as a surrogate for socioeconomic status in this study, with a high school degree or less classified as low socioeconomic status and more than a high school degree classified as high socioeconomic status.
The number of meals eaten away from home was divided by the total number of meals eaten in each day to obtain the percentage of meals eaten away from home. The average meals eaten away from home were determined for three day to estimate the percentage of meals consumed away from home. The frequency or percentages of meals consumed away from home between adolescents from high socioeconomic status versus low socioeconomic status were compared.
The total nutrient and food group content for adolescents who consumed meals away from home was compared to that of adolescents who didn't consume meals away from home.
Nutrients/food groups of adolescents who consumed meals away from home and adolescents that didn’t consume meals away from home were compared.
Questionnaire: Three 24 h diets recalls (one weekend and two week days) were administered to participants and their parents in the study. Adolescents were asked to recall the total dietary intake of the last 24 h.
Portion size aids were used to obtain accurate serving sizes. Meals eaten away from home were classified according to location and included restaurants and fast food.
Dietary analysis: Analyzed of dietary intakes were assessed using Nutrition Data Systems (NDS-R software, Taken from the NDS-R manual (2005) from FAQ-How do I cite NDS-R). The following nutrients were assessed: energy, total fat (percent of energy, kcal), saturated fat (percent of energy, kcal) and fiber (g). The following food groups were also assessed: fruits (servings, kcal), vegetables (servings, kcal), fried vegetables (servings, kcal), soft drink (mL), milk (mL), water (mL) and whole grains (serving, kcal). Serving sizes were based on food guide pyramid (Stang, 2004).
Statistical analysis: Descriptive statistics were used to describe the demographics of study. Meals away from home and socioeconomic status were tested by using one-way ANOVA (percentage of meals eaten away home by socioeconomic status) and the level of significance was set at 0.05. The data were analyzed using SPSS, Version 13.
RESULTS
Among eighty four adolescents (51 boys and 33 girls) included in the study, majority of participants (94.04%) were classified as at risk for overweight or were overweight according to the 2000 center for disease control revised sex specific Body Mass Index (BMI) for age growth charts (Lucas, 2004). Parents' socioeconomic status according to educational level was evenly distributed, with approximately one-half attaining more than a high school degree and the other half having a high school degree or less. Approximately 40% of participants consumed at least one meal away from home during the three days analysis (Table 1).
Soft drink consumption was high among study participants with an average of
360 mL day-1. Consumption of fat (37% of energy, 566 kcal with 12%
saturated fat; 183 kcal) were high as compare with the recommended 20-35% of
calories (306-535 kcal) from fat and less than 10% of calories (153 kcal) from
saturated fat. Fruit and vegetable intakes were low (1.82 serving per day, 109.2
kcal and 1.45 serving per day, 36.25 kcal respectively); 5-9 servings of fruits
and vegetables per day is recommended according to the United States Department
of Agriculture food guide pyramid (USDA, 2006). Furthermore, the youth consumed
1 serving of whole grains (30 g), 11.6 g fiber and 180 mL milk day-1
(Table 2).
| Table 1: | Demographics of study population (n = 84) |
| Table 2: | Estimated nutrient and food intake of study population |
| Table 3: | Analysis of variance between restaurant meals and nutrient intake |
| *p≤0.01, **p≤0.05 | |
No significant difference in the number of meals eaten away from home between adolescents from a low socioeconomic status versus a high socioeconomic status (p = 0.464) were found.
Significant differences were found between the two groups for the percentage of calories from fat and servings of fried fat vegetables (p = 0.007 and p = 0.01, respectively). Adolescents who ate at least one meal away from home consumed more fat and more fried vegetables (Table 3).
DISCUSSION
At a time of increased concern about obesity and its link to hypertension, heart disease, diabetes and cancer few studies have focused on the trends in adolescents total energy intake and its sources (Melnik et al., 1998; Hassapidou et al., 2006; Nkungula and Harris, 2005). Adolescents worldwide have increased their energy consumption over the past 20 years; the most significant trend is the shift of energy intake form home to away from home sources (Kant and Graubard, 2004). In the present study, number of meals consumed away from home and socioeconomic status were used to establish the association between youth eating patterns and overweight status in adolescences. The finding of this study showed not only the prevalence of overweight among adolescents, but several eating patterns were also positively related to overweight, such as high consumption of soft drinks, fatty food, fried vegetables and low intake of fruit and vegetables.
The finding of this study support the Bogalusa heart study which shows an association between the consumption of sweated beverages and total gram of low quality foods with obesity (Nicklas et al., 2003). Other studies also suggested an association between high fat food (Basiotis et al., 1998), soft drinks (Ludwig et al., 2001; Dennison et al., 1997; Teresia et al., 2006) and overweight status.
Present result showed that consumption of fat accounted for 37% of total energy, while the average soft drink intake was 360 mL day-1 that it was high too. Nielson et al. (2002) have also showed dietary shift from healthy eating to large increase in total fat consumption and soft drinks in recent years.
A particular interesting finding was the lack of significant differences in the number of meals eaten away from home between low and high socioeconomic status adolescents, which to our knowledge; no other study has determined such association. The study showed that adolescents who ate meals away from home consumed more fat than those who didn’t. Mccrory et al. (1999) also reported a positive link between body fatness and frequency of consuming fast food meals. Such findings are also in consistent with other reports of Hassapidou et al. (2006) and Hulshof et al. (2003) who showed that consuming a fast food or eating in a restaurant is associated with higher energy intake.
In conclusion, it is apparent that people of all ages in general and adolescents in specific are making unhealthy choices when they eat out. This should be the focus of public health policies and intervention.