Consumption of Foods Away from Home Is Associated with Lower Diet Quality Among Adults Living in Puerto Rico

Abstract

Background: Consuming foods away from home (FAFH) is ubiquitous, yet, it is unclear how it influences diet in diverse populations.

Objective: The study aimed to evaluate the association between frequency and type of consumption of FAFH and diet quality.

Design: The study had a cross-sectional design. Participants self-reported the frequency of consuming FAFH as "rarely" (≤1 time per week) vs "frequently" (≥2 times per week) at various commercial establishments or noncommercial FAFH (ie, friends' or relatives' homes).

Participants/setting: Participants were adults (aged 30 through 75 years) from the PRADLAD (Puerto Rico Assessment of Diet, Lifestyle, and Diseases) study conducted in San Juan, Puerto Rico metro area (n = 239) in 2015.

Main outcome measures: A validated food frequency questionnaire captured dietary intake. The Alternate Healthy Eating Index-2010 defined diet quality. Secondary outcomes included whether participants met 2015-2020 Dietary Guidelines for Americans recommendations for sodium, added sugars, saturated fat, dietary fiber, total energy, and alcohol.

Statistical analyses performed: Linear or logistic regression models adjusted for age, sex, employment, income, education, and food insufficiency tested differences in mean Alternate Healthy Eating Index-2010 scores or odds of meeting (vs not meeting) intake recommendations by FAFH type and frequency.

Results: Overall, 54.4% and 37.2% of participants reported consuming commercial FAFH and noncommercial FAFH "frequently," respectively. Consuming FAFH "frequently" (vs "rarely") was associated with lower mean Alternate Healthy Eating Index-2010 scores for both commercial FAFH (57.92 vs 63.58; P = .001) and noncommercial FAFH (56.22 vs 62.32; P < .001). Consuming commercial FAFH "frequently" (vs "rarely") at any type of food establishment was associated with lower odds of meeting the dietary fiber Dietary Reference Intakes (odds ratio 0.43; 95% CI 0.23 to 0.81). Consuming noncommercial FAFH "frequently" was associated with lower odds of meeting recommendations for sodium (odds ratio 0.30; 95% CI 0.11 to 0.79) and added sugars (odds ratio 0.41; 95% CI 0.18 to 0.93).

Conclusions: Frequent consumption of FAFH is associated with lower diet quality and lower adherence to dietary recommendations in Puerto Rico. Future studies should explore whether diet quality can be improved by prioritizing healthy at-home meals and reformulating the quality of commercial FAFH.

Keywords: Diet quality; Dietary recommendations; Food away from home; Meal occasion; Puerto Rico.