Frequent eating out significantly associated with higher all-risk mortality

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Emerging, although still limited, evidence suggests that frequent consumption of meals prepared away from home is significantly associated with increased risk of all-cause mortality, as well as increased risk of chronic diseases, such as obesity and diabetes and biomarkers of other chronic diseases, according to an analysis in the Journal of the Academy of Nutrition and Dietetics.

Dining out is a popular activity worldwide, but there has been little research into its association with health outcomes. Investigators looked at the association between eating out and risk of death and concluded that eating out very frequently is significantly associated with an increased risk of all-cause death, which warrants further investigation.

Eating out is a popular activity. The US Department of Agriculture recently estimated that Americans’ daily energy intake from food away from home increased from 17% in 1977-1978 to 34% in 2011-2012. At the same time, the number of restaurants has grown steadily, and restaurant-industry sales are forecasted to increase significantly.

Although some restaurants provide high-quality foods, the dietary quality for meals away from home, especially from fast-food chains, is usually lower compared with meals cooked at home. Evidence has shown that meals away from home tend to be higher in energy density, fat, and sodium, but lower in fruits, vegetables, whole grains, and protective nutrients such as dietary fibre and antioxidants.

“Emerging, although still limited, evidence suggests that eating out frequently is associated with increased risk of chronic diseases, such as obesity and diabetes and biomarkers of other chronic diseases,” explained lead investigator Dr Wei Bao, assistant professor, department of epidemiology, College of Public Health-University of Iowa. “However, little is known about the association between eating meals away from home and risk of mortality.

Investigators analysed data from responses to questionnaires administered during face-to-face household interviews from 35,084 adults aged 20 years or older who participated in the National Health and Nutritional Examination Survey 1999-2014. Respondents reported their dietary habits including frequency of eating meals prepared away from home. “We linked these records to death records through December 31, 2015, looking especially at all-cause mortality, cardiovascular mortality, and cancer mortality,” noted first author Dr Yang Du, PhD candidate, department of epidemiology, College of Public Health-University of Iowa.

During 291,475 person-years of follow-up, 2,781 deaths occurred, including 511 deaths from cardiovascular disease and 638 deaths from cancer. After adjustment for age, sex, race/ethnicity, socioeconomic status, dietary and lifestyle factors, and body mass index, the hazard ratio of mortality among participants who ate meals prepared away from home very frequently (two meals or more per day) compared with those who seldom ate meals prepared away from home (fewer than one meal per week) was 1.49 (95% CI 1.05 to 2.13) for all-cause mortality, 1.18 (95% CI 0.55 to 2.55) for cardiovascular mortality, and 1.67 (95% CI 0.87 to 3.21) for cancer mortality.

“Our findings from this large nationally representative sample of US adults show that frequent consumption of meals prepared away from home is significantly associated with increased risk of all-cause mortality,” commented Du.

“This is one of the first studies to quantify the association between eating out and mortality,” concluded Bao. “Our findings, in line with previous studies, support that eating out frequently is associated with adverse health consequences and may inform future dietary guidelines to recommend reducing consumption of meals prepared away from home.”

“The take-home message is that frequent consumption of meals prepared away from home may not be a healthy habit. Instead, people should be encouraged to consider preparing more meals at home,” concluded the investigators.

Future studies are still needed to look more closely at the association of eating out with death from cardiovascular disease, cancer, dementia, and other chronic diseases.

“It is important to note that the study design for this research examines associations between frequency of eating meals prepared away from home and mortality. While encouraging clients to consider preparing healthy meals at home, registered dietitian nutritionists might also focus on how selections from restaurant menus can be healthy.

Tailoring strategies to each client by reviewing menus from restaurants they frequent can help them make healthy food choices,” added co-investigator Dr Linda G Snetselaar, professor and chair, preventive nutrition education, department of epidemiology, College of Public Health-University of Iowa.

 

Study details
Association Between Frequency of Eating Away-From-Home Meals and Risk of All-Cause and Cause-Specific Mortality

Yang Du, Shuang Rong, Yangbo Sun, Buyun Liu, Yuxiao Wu, Linda G Snetselaar, Robert B Wallace, Wei Bao

Published in the Journal of the Academy of Nutrition and Dietetics on 25 March 2021

Abstract
Background
Dining out is a popular activity worldwide. Evidence on the association between eating meals away from home and long-term health outcomes is still limited.
Objective
The objective of this study was to examine the association of frequency of eating meals prepared away from home with all-cause and cause-specific mortality.
Participants/setting
This study included 35,084 adults aged 20 years or older from the National Health and Nutritional Examination Survey 1999-2014, who reported their dietary habits including frequency of eating meals prepared away from home in a questionnaire during face-to-face household interviews.
Main outcome measures
All-cause mortality, cardiovascular mortality, and cancer mortality were ascertained by linkage to death records through December 31, 2015.
Statistical analyses performed
Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios of mortality from all-cause, cardiovascular, and cancer mortality.
Results
During 291,475 person-years of follow-up, 2,781 deaths occurred, including 511 deaths from cardiovascular disease and 638 death from cancer. After adjustment for age, sex, race/ethnicity, socioeconomic status, dietary and lifestyle factors, and body mass index, the hazard ratio of mortality among participants who ate meals prepared away from home very frequently (2 meals or more per day) compared with those who seldom ate meals prepared away from home (fewer than 1 meal/wk) was 1.49 (95% CI 1.05 to 2.13) for all-cause mortality, 1.18 (95% CI 0.55 to 2.55) for cardiovascular mortality, and 1.67 (95% CI 0.87 to 3.21) for cancer mortality.
Conclusions
Frequent consumption of meals prepared away from home is significantly associated with increased risk of all-cause mortality. The association of eating meals prepared away from home with cardiovascular mortality and cancer mortality warrants additional investigation.

 

Elsevier material (Restricted access)

Journal of the Academy of Nutrition and Dietetics study (Restricted access)

 

See also MedicalBrief archives:

High BP in students linked with eating out

Eating out riskier than public transportation or haircuts — CDC analysis

Restaurant claims of ‘gluten-free’ are often incorrect — US study


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