Eating outside of the home environment on a frequent basis has been associated with weight gain. Food choices when eating out are usually high in energy content, which contributes to excessive energy intake; however, the available data on out-of-home eating and obesity are far from conclusive. This systematic review assesses the association between out-of-home eating and body weight in adults over 18 years of age. The literature databases searched included Medline, Embase, Lilacs, The Cochrane Library, and the ISI Web of Knowledge. The review includes a comprehensive quality assessment of all included observational studies, 20 cross-sectional studies, and 8 prospective cohort studies. All but one of the prospective cohort studies and about half of the cross-sectional analyses found a positive association between out-of-home eating and body weight. However, many methodological differences among the studies were found, such as the definition of out-of-home eating and its assessment, which limits comparisons. The results of the present analysis suggest that in future studies fast-food restaurants and other out-of-home dining venues should be analyzed separately, assessments based on a single 24-h recall should be avoided, and controls for at-home choices (which were not included in any of the studies reviewed) are necessary to evaluate this association.

Objective: The aim of the present study was to investigate the relationship between out-of-home (OH) eating and overweight and obesity among adults in Brazil. Sit-down meals and soft drinks were the most frequently reported food groups. Both were positively associated with overweight (OR 5 1?34 for meals; OR 5 1?17 for soft drinks, P , 0?05) and obesity (OR 5 1?51 for meals; OR 5 1?39 for soft drinks, P , 0?05) among men, but negatively associated with overweight and obesity among women. Conclusions: OH eating was associated with overweight and obesity only among men, whereas, among women, eating sit-down meals out of home was protective for obesity, suggesting that women make healthier food choices when they eat out of home. Keywords Eating out of home Obesity Household budget survey BrazilThe prevalence of obesity is rising worldwide and also in Brazil (1,2) . In 2003, 40 % of Brazilian adults (over 20 years of age) presented body weight excess (BMI . 25 kg/m 2 ) and 11?1 % were obese (BMI $ 30 kg/m 2 ). The prevalence of obesity in Brazil has been shown to increase along with income among men, while among women this relationship is curvilinear (2) , i.e. prevalences increase in the low-income groups and then decrease in the other income groups.

OBJECTIVE:To describe foods consumed away from home and associated factors in Brazil. METHODS:The study was based on the National Dietary Survey which was conducted among residents aged over 10 years old in 24% of households participating in the Household Budget Survey in 2008-2009 (n = 34,003). The consumption of food and beverages was collected through records of foods consumed, type of preparation, quantity, time and food source (inside or outside home). The frequency with which individuals consumed food away from home was calculated according to age, gender, income, household area location, family size, presence of children at home and age of head of household in Brazil and in each Brazilian region. Specifi c sampling weight and effect of the sampling design were considered in the analyses. RESULTS:Consumption of food away from home in Brazil was reported by 40% of respondents, varying from 13% among the elderly in the Midwest Region to 51% among adolescents in the Southeast. This percentage decreased with age and increased with income in all regions of Brazil and was higher among men and in urban areas. Foods with the highest percentage of consumption outside home were alcoholic beverages, baked and fried snacks, pizza, soft drinks and sandwiches. CONCLUSIONS:Foods consumed away from home showed a predominance of high energy content and poor nutritional content, indicating that the consumption of foods away from home should be considered in public health campaigns aimed at improving Brazilians' diet.

OBJECTIVE: To estimate energy and nutrient intake and prevalence of inadequate micronutrient intake among Brazilian adults. METHODS:Data from the National Dietary Survey, from the [2008][2009] Household Budget Survey, were used. Food consumption was evaluated through food record on two non-consecutive days. A total of 21,003 individuals (52.5% women), between 20-59 years old, participated in the survey. Usual nutrient intake was estimated according to the National Cancer Institute method. The Estimated Average Requirement (EAR) cut-off points were used to determine the prevalence of inadequate micronutrient intake. For manganese and potassium, the Adequate Intake (AI) was used as cut-off. Sodium intake was compared with the Tolerable Upper Intake Level (UL). The probability approach was used to determine the prevalence of inadequate iron intake. The data were analyzed according to the location of the household (urban or rural) and macro regions of Brazil. RESULTS:The mean energy intake was 2,083 kcal among men and 1,698 kcal among women. Prevalence of inadequacy equal to or greater than 70% were observed for calcium among men and magnesium, vitamin A, and sodium among both men and women. Prevalence equal to or greater than 90% were found for calcium in women and vitamins D and E in both genders. Prevalence lower than 5% were found for iron in men and for niacin in men and women. In general, prevalence of inadequate intake was higher in the rural area and in the Northeast region. CONCLUSIONS:Energy intake was higher among individuals who live in urban areas and in the North region. The greatest risk groups of inadequate micronutrient intake were women and those living in rural areas and in the Northeast region.

The objectives of the present study were to estimate the dietary contribution of away-from-home food consumption, to describe the contribution of away-from-home foods to energy intake, and to investigate the association between eating away from home and total energy intake in Brazilian urban areas. In the first Brazilian Nationwide Dietary Survey, conducted in 2008 -9, food records were collected from 25 753 individuals aged 10 years or older, living in urban areas of Brazil. Foods were grouped into thirty-three food groups, and the mean energy intake provided by away-from-home food consumption was estimated. Linear regression models were used to evaluate the association between away-from-home food consumption and total energy intake. All analyses considered the sample design effect. Of the total population, 43 % consumed at least one food item away from home. The mean energy intake from foods consumed away from home was 1408 kJ (337 kcal), averaging 18 % of total energy intake. Eating away from home was associated with increased total energy intake, except for men in the highest income level. The highest percentage of away-from-home energy sources was for food with a high content of energy, such as alcoholic beverages (59 %), baked and deep-fried snacks (54 %), pizza (42 %), soft drinks (40 %), sandwiches (40 %), and sweets and desserts (30 %). The consumption of foods away from home was related to a greater energy intake. The characterisation of away-from-home food habits is necessary in order to properly design strategies to promote healthy food consumption in the away-from-home environment.

BackgroundThe aims of this study were to evaluate whether a diversity of healthy foods in a household would decrease the availability of unhealthy foods and to evaluate the association between a healthy dietary diversity score (DDS) and nutritional status among adults.MethodsData from the 2002-2003 Brazilian Household Budget Survey were used. This nationwide survey used a two-stage sampling technique: households were selected after selection of primary sample units (PSUs). Analyses were based on 3,393 PSUs, evaluating 659,816 records of food items purchased by 35,237 households. The DDS was based on the healthy food groups according to Brazilian food guidelines. Per capita acquisition of sugar, sweets, sugar-sweetened beverages and crackers, cookies and cakes (unhealthy food groups) in PSUs was also calculated. Individual weight and height were measured at household. Multivariate linear regression models estimated the association of underweight and overweight and obesity (excess weight) with the PSUs' DDS.ResultsGreater acquisition of unhealthy food groups was associated with higher DDS. A high PSU's DDS was negatively associated with underweight (β = -0.38; p-value = 0.04) and positively associated with excess weight (β = 0.98; p-value = 0.05) after adjustment for availability of unhealthy food groups and socioeconomic variables.ConclusionsOur data indicate that there was no replacement of unhealthy food groups by healthy food groups, therefore a healthy diet message for obesity prevention should be combined with a message focused on eating less.

OBJECTIVE:To estimate the prevalence of inadequate nutrient intake in the Brazilian elderly. METHODS:This study was based on data from the National Dietary Survey, part of the Household Budget Survey 2008-2009. All individuals aged 60 and over, totaling 4,322 individuals, were included. Individual food intake was obtained from food records from two non-consecutive days. The habitual intake for each nutrient was estimated by the National Cancer Institute method, in which sex and region were included as covariates. The prevalence of inadequate nutrient intake was estimated stratifi ed by sex and region using the EAR method to defi ne cut-off points. RESULTS:A high prevalence of inadequate intake (> 50%) of vitamins E, D and A, calcium, magnesium and pyridoxine was observed for both sexes. In all regions, 100% inadequate vitamin E intake was observed. Vitamin D showed almost 100% inadequate intake except in the North region. The prevalence of inadequate vitamin A intake was higher than 70% in the North, Northeast, and Midwest regions. Among the minerals evaluated, calcium and magnesium showed the highest prevalence of inadequate intake (> 80%) in all regions. CONCLUSIONS:The present study found a high prevalence of inadequate intake of nutrients recognized as being protective against chronic diseases among the Brazilian elderly.

OBJECTIVE: to assess energy and nutrient consumption and the prevalence of inadequate micronutrient intake among Brazilian adolescents. METHODS:A random sample composed of 6,797 adolescents (49.7% girls), between 10 and 18 years old, was evaluated in the fi rst National Dietary Survey, part of the Household Budget Survey carried out in [2008][2009]. Expansion factors, sample complexity design and correction of intraindividual variability were considered. The prevalence of inadequate micronutrient intake was based on the proportion of adolescents with intake below the Estimated Average Requirement. The prevalence of intake above the Tolerable Upper Intake Level (UL) was estimated for sodium. RESULTS:The mean energy intake ranged between 1,869 kcal (10 to 13 year old females) and 2,198 kcal (14 to 18 year old males). Of the total energy intake, 57% came from carbohydrates, 27% from lipids and about 16% from proteins. Inadequacies were higher for calcium (> 95%), phosphorous (54% to 69%) and vitamins A (66% to 85%), E (100%) and C (27% to 49%). More than 70% of adolescents reported sodium intake above the UL. CONCLUSIONS:Mean energy consumption and distribution of macronutrients were adequate, but prevalence of inadequate vitamin and mineral intake were high and notable consumption of sodium above the recommended levels, low levels of calcium consumption and, in 14 to 18 year old females, important inadequacies in iron intake were found.