High-risk environments for eating foods surplus to requirements: a multilevel analysis of adolescents’ non-core food intake in the National Diet and Nutrition Survey (NDNS)

Abstract

Objective

Interventions to reduce adolescents’ non-core food intake (i.e. foods high in fat and sugar) could target specific people or specific environments, but the relative importance of environmental contexts v. individual characteristics is unknown.

Design

Cross-sectional.

Setting

Data from 4d food diaries in the UK National Diet and Nutrition Survey (NDNS) 2008–2012 were analysed. NDNS food items were classified as ‘non-core’ based on fat and sugar cut-off points per 100g of food. Linear multilevel models investigated associations between ‘where’ (home, school, etc.) and ‘with whom’ (parents, friends, etc.) eating contexts and non-core food energy (kcal) per eating occasion (EO), adjusting for variables at the EO (e.g. time of day) and adolescent level (e.g. gender).

Participants

Adolescents ( n 884) aged 11–18 years.

Results

Only 11 % of variation in non-core energy intake was attributed to differences between adolescents. In adjusted models, non-core food intake was 151 % higher (ratio; 95 % CI) in EO at ‘Eateries’ (2·51; 2·14, 2·95) and 88 % higher at ‘School’ (1·88; 1·65, 2·13) compared with ‘Home’. EO with ‘Friends’ (1·16; CI 1·03, 1·31) and ‘Family & friends’ (1·21; 1·07, 1·37) contained 16–21 % more non-core food compared with eating ‘Alone’. At the individual level, total energy intake and BMI, but not social class, gender or age, were weakly associated with more non-core energy intake.

Conclusions

Regardless of individual characteristics, adolescents’ non-core food consumption was higher outside the home, especially at eateries. Targeting specific eating contexts, not individuals, may contribute to more effective public health interventions.