Household food insecurity is associated with CVD risk factors in low-income adults, but research on these associations among adolescents is inconsistent. This study investigates whether household and child food insecurity is associated with CVD risk factors in lower-income adolescents.

Cross-sectional. Multivariable linear regression assessed the association between household and child food security and CVD risk factors. Household and child food security was measured using the US Food Security Survey Module. The analyses were adjusted for adolescent’s age, sex, race/ethnicity, smoking status, physical activity and sedentary time, as well as household income and the head-of-household’s education and marital status.

The USA.

The sample was comprised of 2876 adolescents, aged 12–17 years, with household incomes at or below 300 % federal poverty line from the National Health and Nutrition Examination Survey cycles 2007–2016.

The weighted prevalence of household food insecurity in the analytic sample was 33·4 %, and the weighted prevalence of child food insecurity was 17·4 %. After multivariable adjustment, there were no significant associations between household and child food insecurity and BMI-for-age Z-score, systolic and diastolic blood pressure, HDL-cholesterol, total cholesterol, fasting TAG, fasting LDL-cholesterol and fasting plasma glucose.

Despite observed associations in adults, household food insecurity was not associated with CVD risk factors in a national sample of lower-income adolescents. Child food insecurity was also not associated with CVD risk factors. More research should be conducted to confirm these associations.

To examine the prevalence and nutrient composition of menu offerings targeted to customers with dietary restrictions at US fast casual and full-service chain restaurants.

We used 2018 data from MenuStat, a database of nutrient information for menu items at large US chain restaurants. Five alternative diets were examined: gluten-free, low-calorie, low-carbohydrate, low-fat and vegetarian. Diet offerings were identified by searching MenuStat item descriptions and reviewing online menus. For each diet, we reported counts and proportions. We used bootstrapped multilevel models to examine differences in predicted mean kilojoules, saturated fat, Na and sugars between diet and non-diet menu items.

Forty-five US fast casual and full-service chain restaurants in 2018 (including 6419 items in initial analytic sample across small plates, salads and main dishes).

None.

The most prevalent diets were gluten-free (n 631, 9·8 % of menu items), low-calorie (n 306, 4·8 %) and vegetarian (n 230, 3·6 %). Compared with non-diet counterparts, low-calorie main dishes had significantly lower levels of all nutrients examined and vegetarian main dishes had significantly lower levels of all nutrients except saturated fat. Gluten-free small plates had significantly fewer kilojoules, grams of saturated fat and milligrams of Na compared with non-diet small plates.

A small proportion of fast casual and full-service restaurant menus are targeted towards customers with dietary restrictions. Compared with non-diet items, those classified as gluten-free, low-calorie or vegetarian generally have healthier nutrient profiles, but overall nutrient values are still too high for most menu items, regardless of dietary label.

To compare the nutritional quality of children’s combination meals offered at large US chain restaurants characterised by three versions – default (advertised), minimum (lower-energy) and maximum (higher-energy).

We identified default children’s meals (n 92) from online restaurant menus, then constructed minimum and maximum versions using realistic additions, substitutions and/or portion size changes for existing menu items. Nutrition data were obtained from the MenuStat database. Bootstrapped linear models assessed nutrition differences between meal versions and the extent to which meal components (main dish, side dish, beverage) drove differences across versions. For each version, we examined the proportion of meals meeting the Guidelines for Responsible Food Marketing to Children.

Twenty-six fast-food and fast-casual restaurants, in 2017.

None.

Nutrient values differed significantly across meal versions for energy content (default 2443 kJ (584 kcal), minimum 1674 kJ (400 kcal), maximum 3314 kJ (792 kcal)), total fat (23, 17, 33 g), saturated fat (8, 6, 11 g), Na (1046, 915, 1287 mg) and sugar (35, 14, 51 g). The substitution of lower-energy beverages resulted in the greatest reduction in energy content (default to minimum, −418 kJ (−100 kcal)) and sugar (−20 g); choosing lower-energy side dishes resulted in the greatest reduction in total fat (default to minimum, −4 g), saturated fat (−1·1 g) and Na (−69 mg). Only 3 % of meals met guidelines for all nutrients.

Realistic modifications to children’s combination meals using existing menu options can significantly alter a meal’s nutrient composition. Promoting lower-energy items as the default option, especially for beverages and side dishes, has a potential to reduce fat, saturated fat and/or sugar in children’s meals.

To understand price incentives to upsize combination meals at fast-food restaurants by comparing the calories (i.e. kilocalories; 1 kcal = 4·184 kJ) per dollar of default combination meals (as advertised on the menu) with a higher-calorie version (created using realistic consumer additions and portion-size changes).

Combination meals (lunch/dinner: n 258, breakfast: n 68, children’s: n 34) and their prices were identified from online menus; corresponding nutrition information for each menu item was obtained from a restaurant nutrition database (MenuStat). Linear models were used to examine the difference in total calories per dollar between default and higher-calorie combination meals, overall and by restaurant.

Ten large fast-food chain restaurants located in the fifteen most populous US cities in 2017–2018.

None.

There were significantly more calories per dollar in higher-calorie v. default combination meals for lunch/dinner (default: 577 kJ (138 kcal)/dollar, higher-calorie: 707 kJ (169 kcal)/dollar, difference: 130 kJ (31 kcal)/dollar, P < 0·001) and breakfast (default: 536 kJ (128 kcal)/dollar, higher-calorie: 607 kJ (145 kcal)/dollar, difference: 71 kJ (17 kcal)/dollar, P = 0·009). Results for children’s meals were in the same direction but were not statistically significant (default: 536 kJ (128 kcal)/dollar, higher-calorie: 741 kJ (177 kcal)/dollar, difference: 205 kJ (49 kcal)/dollar, P = 0·053). Across restaurants, the percentage change in calories per dollar for higher-calorie v. default combination meals ranged from 0·1 % (Dunkin’ Donuts) to 55·0 % (Subway).

Higher-calorie combination meals in fast-food restaurants offer significantly more calories per dollar compared with default combination meals, suggesting there is a strong financial incentive for consumers to ‘upsize’ their orders. Future research should test price incentives for lower-calorie options to promote healthier restaurant choices.

To summarize stakeholder recommendations and ratings of strategies to reduce sugar-sweetened beverage (SSB) consumption and increase water access and intake among young children (0–5 years).

Two online surveys: survey 1 asked respondents to recommend novel and innovative strategies to promote healthy beverage behaviour; survey 2 asked respondents to rank each of these strategies on five domains (overall importance, feasibility, effectiveness, reach, health equity). Open-ended questions were coded and analysed for thematic content.

Using a snowball sampling approach, respondents were invited to complete the survey through an email invitation or an anonymous listserv link. Of the individuals who received a private email invitation, 24 % completed survey 1 and 29 % completed survey 2.

Survey 1 (n 276) and survey 2 (n 182) included expert stakeholders who work on issues related to SSB and water consumption.

Six overarching strategies emerged to change beverage consumption behaviours (survey 1): education; campaigns and contests; marketing and advertising; price changes; physical access; and improving the capacity of settings to promote healthy beverages. Labelling and sugar reduction (e.g. reformulation) were recommended as strategies to reduce SSB consumption, while water testing and remediation emerged as a strategy to promote water intake. Stakeholders most frequently recommended (survey 1) and provided higher ratings (survey 2) to strategies that used policy, systems and/or environmental changes.

The present study is the first to assess stakeholder opinions on strategies to promote healthy beverage consumption. This knowledge is key for understanding where stakeholders believe resources can be best utilized.