Diet quality of frequent fast-food consumers on non-fast food intake day is similar to a day with fast food. What We Eat In America, NHANES 2013-2016

Authors: Hoy, M Katherine; Murayi, Theophile; Moshfegh, Alanna

Submitted to: Journal of the Academy of Nutrition and Dietetics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/11/2022
Publication Date: 2/15/2022
Citation: Hoy, M.K., Murayi, T., Moshfegh, A.J. 2022. Diet quality of frequent fast-food consumers on non-fast food intake day is similar to a day with fast food. What We Eat In America, NHANES 2013-2016. Journal of the Academy of Nutrition and Dietetics. https://doi.org/10.1016/j.jand.2022.02.007.
DOI: https://doi.org/10.1016/j.jand.2022.02.007

Interpretive Summary: Consuming fast food (FF) is associated with higher intakes of energy, fat and saturated fat and sodium, and lower intakes of fruits, vegetables and whole grains. Frequent FF consumers may try to make more healthful food choices at other eating occasions. However, factors that influence the need or desire for inexpensive, convenient food may impact food choices at other eating occasions that do not include FF. Thus, it is not clear if poor diet quality of those who consume FF frequently is a function of FF consumption or less healthful food choices overall. Therefore, the purpose of this study was to compare diet quality and nutrient intakes of infrequent FF consumers with frequent FF consumers either on a non-FF intake day or a FF intake day. Adults who participated in NHANES 2013-2016 (N=10,844) were included if they had completed a 24-hour recall interview and screening questions from the NHANES Diet and Behavior Questionnaire. Two questions were used to classify adults on frequency of FF consumption. Participants were first asked how many meals they had in the past 7 days that were prepared away from home. If they responded one or more, they were then asked how many meals were from a FF or pizza restaurant. Infrequent FF consumers (N=2,142) were those who said they had FF or pizza prepared away from home zero times in the past 7 days. Frequent FF consumers were those who said they had FF or pizza prepared away from home three or more times in the past 7 days. Frequent consumers were further subdivided into two groups: those who had FF on the intake day (N=1,632) and those whose intake day was a non-FF day (N=415). Nutrient and food intakes were determined and diet quality was evaluated using the Healthy Eating Index (HEI) 2015. Groups were compared and differences were considered significant at P<0.001. Reporting frequent FF consumption appeared to be more common among males, 20-39 year olds, Non-Hispanic blacks, obese individuals, smokers, and those who did not take vitamin-mineral supplements. In contrast, reporting infrequent FF consumption appeared to be more common among females, those 60+ years, Non-Hispanic Asian, former smokers, and normal weight individuals. On a day when FF was consumed by frequent FF consumers, energy, carbohydrate, and fat intakes were significantly higher than infrequent consumers, and intakes of vitamin C, most carotenoids, and fiber were significantly lower (P<0.001). And, compared to infrequent consumers, frequent FF consumers also consumed significantly less whole fruits and whole grains and more refined grains and added sugars on a day when FF was consumed; their overall diet quality using the HEI-2015 was also significantly lower than infrequent FF consumers. On a non-FF intake day, dietary and nutrient intakes of frequent FF consumers did not differ significantly from either a FF intake day or from infrequent consumers. However, overall diet quality was significantly lower than infrequent consumers and not different from a FF intake day. Results suggest that food choices of frequent FF consumers may be somewhat better on a non-FF intake day, but diet quality is still lower than infrequent FF consumers. Regardless, diet quality of all adults needs improvement.

Technical Abstract: Consuming fast food (FF) is associated with higher intakes of energy, fat and saturated fat, and sodium, and lower intakes of fruits, vegetables and whole grains. Frequent FF consumers may try to make more healthful food choices at other eating occasions. However, factors that influence the need or desire for inexpensive, convenient food may impact food choices at other eating occasions that do not include FF. Thus, it is not clear if poor diet quality of those who consume FF frequently is a function of FF consumption or less healthful food choices overall. Therefore, the purpose of this study was to compare diet quality and nutrient intakes of infrequent FF consumers with frequent FF consumers either on a non-FF intake day or a FF intake day. Of the adults (N=10,844) who participated in NHANES 2013-2016, 9,817 had a complete 24-hour recall for one day and completed two questions from the NHANES Diet and Behavior Questionnaire used to classify FF consumption frequency. Participants were first asked how many meals they had in the past 7 days that were prepared away from home. If they responded one or more, they were then asked how many meals were from a FF or pizza restaurant. Infrequent FF consumers (INFREQ) (N=2,142) were those who said they had zero meals, FF, or pizza meals prepared away from home in the past 7 days. Frequent FF consumers were those who said they had FF or pizza meals prepared away from home three or more times in the past 7 days. Frequent consumers were further subdivided into two groups: those whose intake day was a FF day (FF_DAY) (N=1,632) and those whose intake day was a non-FF day (FF_NON) (N=415). One day of dietary intake data was used to determine nutrient and food intake using the Food and Nutrient Database for Dietary Studies. Diet quality was determined using the Healthy Eating Index (HEI) 2015. Groups were compared by t-tests in a regression model adjusting for age, sex, income, race/ethnicity, smoking, and weight status. Differences were considered significant at P<0.001. Reporting frequent FF consumption appeared to be more common among males, 20-39 year olds, Non-Hispanic blacks, obese individuals, smokers, and those who did not take vitamin-mineral supplements. In contrast, reporting infrequent FF consumption appeared to be more common among females, those 60+ years, Non-Hispanic Asian, former smokers, and normal weight individuals. Energy, carbohydrate, and fat intakes of FF_DAY were significantly higher than INFREQ, and intakes of vitamin C, most carotenoids, and fiber were significantly lower. Compared to INFREQ, FF_DAY also consumed significantly less whole fruits and whole grains and more refined grains and added sugars. Overall diet quality using the HEI-2015 of FF_DAY was also significantly lower than INFREQ. Dietary and nutrient intakes of FF_NON did not differ significantly from either FF_DAY or INFREQ, though overall diet quality was significantly lower than INFREQ and not different from FF_DAY. Results suggest that food choices of frequent FF consumers may be somewhat better on a non-FF intake day, but diet quality is still lower than infrequent FF consumers. Regardless, diet quality of all adults needs improvement.