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The percentage of energy from fast foods consumed by US adults declined from 12.8% in 2007 to 2008 to 11.3% in 2009 to 2010.1 Other than analyses of menu offerings,2 there are no comparable data on fast food consumption by children. While sources of energy by food groups and sources have previously been evaluated,3 to our knowledge, no study has evaluated trends in energy by fast food restaurant (FFR) type. This study used data from the National Health and Nutrition Examination Survey to analyze trends in children’s energy consumption by FFR type.
Data on the locations of origin for all foods/beverages including FFRs in the National Health and Nutrition Examination Survey were first collected in 2003 to 2004.4 The present analyses were based on the first 24-hour recall from 4 cycles from 2003 to 2010.
Per University of Washington policies, the use of publicly available data was not considered human participant research. Participants or their parent/guardian provided written informed consent and all procedures were approved by the National Center for Health Statistics Research Ethics Review Board.
A multistep algorithm was developed to assign FFR eating occasions into 8 segments by the following restaurant type: burger, pizza, sandwich, chicken, Mexican cuisine, Asian cuisine, coffee/snack, or fish. Data on the latter 3 FFR types were not presented owing to their infrequent use by children. The dietary recall data were scanned for 1 of 26 sentinel foods characteristic of each FFR segment (eg, hamburger/pizza). Eating events with multiple sentinel foods were flagged for additional scrutiny. Details of the algorithm have been published.5
The survey-weighted arithmetic means of energy intakes were estimated by FFR type. Trends were tested using survey-weighted linear regression. The proportions of children who were FFR consumers were evaluated using survey-weighted logistic regression. Amounts of energy consumed per FFR eating occasion defined by meal name and time were evaluated to distinguish between the number of FFR eating events and the amount of energy consumed. All analyses used Stata 13 (StataCorp), accounted for the complex survey design, and were representative of the US population 4 to 19 years of age.
Panel A in Figure 1 shows population-wide trends in children’s mean energy intakes by FFR type. Energy intakes from burger, pizza, and chicken FFRs decreased significantly while energy intakes from other FFRs remained constant (P > .15 for others). Panel B in Figure 1 shows that the percentage of children consuming fast food on a given day dropped from 38.8% in 2003 to 2004 to 32.6% in 2009 to 2010 (P = .008). The proportion of children eating at burger restaurants remained stable (P = .35) and a modest drop was observed for chicken restaurants (P = .01). The observed decrease in energy from pizza restaurants may have been driven in part by a decrease in the number of consumers. While 12.2% of children obtained food/beverages from pizza restaurants in 2003 to 2004, only 6.4% did so in 2009 to 2010. The percentage consuming the other FFR types remained constant (P ≥ .29). Median energy consumption per eating occasion declined (Figure 2) except for chicken and sandwich FFRs.
Analyses of nationally representative data by FFR type compared with menus can provide insights into the contribution of fast foods to children’s diets. Publicly available data can complement data obtained from consumer panels, which are costly, inaccessible to many public health stakeholders, and may not be representative of the US population, limiting their value to inform policy. The present results were consistent with published sales reports. The decline in total pizza sales from 2003 to 2010 has been noted by industry sources.6 Burger and pizza restaurants accounted for much of the reduction in energy intakes. No fast food market segment experienced a significant increase in energy during the 8-year study. Analyses of population-based National Health and Nutrition Examination Survey dietary intakes data separated by FFR market segment should allow researchers to focus on children and other populations and can also be extended to monitor consumption for other dietary constituents of concern, including sodium, added sugars, and solid fats.
Corresponding Author: Colin D. Rehm, PhD, MPH, Center for Public Health Nutrition, Department of Epidemiology, University of Washington, PO Box 353410, Seattle, WA 98195 (firstname.lastname@example.org).
Published Online: March 30, 2015. doi:10.1001/jamapediatrics.2015.38.
Author Contributions: Dr Rehm had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Both authors.
Acquisition, analysis, or interpretation of data: Both authors.
Drafting of the manuscript: Both authors.
Critical revision of the manuscript for important intellectual content: Both authors.
Statistical analysis: Rehm.
Obtained funding: Drewnowski.
Administrative, technical, or material support: Drewnowski.
Study supervision: Drewnowski.
Conflict of Interest Disclosures: Dr Drewnowski advises McDonald’s Corporation on global issues related to public health nutrition. No other disclosures were reported.
Funding/Support: This study was funded by a research grant from McDonald’s Corporation to the University of Washington. The University of Washington has received grants, donations, and contracts from both the public and the private sector.
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Rehm CD, Drewnowski A. Trends in Energy Intakes by Type of Fast Food Restaurant Among US Children From 2003 to 2010. JAMA Pediatr. 2015;169(5):502–504. doi:10.1001/jamapediatrics.2015.38
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