Determinants of Dietary Intake and Consequences of Away-from-home Food Consumption

Dietary intake is a complex and multidimential behavior which has clear associations with many adverse health outcomes, including obesity. Away-from-home foods have received considerable attention as modifiable determinant of weight gain and a target for obesity prevention efforts. However, epidemiologic evidence of a link between away-from-home eating and weight gain is mixed, which may result from differences in the definition of away-from-home food or discrepancies in analytic methods. Furthermore, although a variety of individual-level determinants of away-from-home eating specifically, and dietary intake in general, have been explored, direct associations between intake and food price are understudied. Our research addresses these substantive gaps in the literature, providing both methodological and substantive contributions to the field, by investigating the direct effect of change in food price on consumption, refining the definition of and differentiating between sources of away-from-home food (i.e. sit-down style restaurants versus fast food outlets), and examining the long-term health consequences of frequent away-from-home eating. These analyses were conducted using data from the Coronary Artery Risk Development in Young Adults Study, a 20-year prospective longitudinal cohort of 5,115 young adults. Community food prices were linked to detailed diet and health data by residential location over the full 20-year period. We report that food and beverage price seems to be an important determinant of dietary behavior: price changes were significantly associated with changes in consumption, total energy intake, body weight, and measures of insulin resistance over a 20-year period. In addition, we show important independent consequences of frequent restaurant versus fast food consumption on subsequent body weight, cholesterol levels, and measures of insulin resistance. In summary, this research makes significant contributions to the field by advancing our understanding of the influence of food price on consumption behavior and identifying the differential effects of restaurant versus fast food consumption on health. Combined, these results have important implications for the creation of effective educational campaigns, obesity interventions or prevention efforts, and state and national nutrition policies