NIHR Signal Takeaways linked to increased cardiovascular risk factors and obesity in children

Published on 13 February 2018

Children who eat takeaways once or more each week have more body fat and higher low-density lipoprotein (LDL) “bad” cholesterol levels than those who never or hardly ever eat them. Their diets were also higher in fat and lower in protein and calcium.

This cross-sectional study looked in depth at eating habits and risk markers for coronary heart disease, obesity and diabetes in 2,529 children in England. Though this type of study can only show an association between takeaways and risk markers, it is one of the first of its type, and the results do give cause for concern.

Increasing numbers of people are eating takeaways in the UK. Local authorities and healthcare professionals are well placed to encourage parents and children to choose healthier foods, in line with current national guidance.

Takeaways linked to increased cardiovascular risk factors and obesity in children

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Why was this study needed?

Childhood obesity rates are increasing in the UK, where one in five children aged 10 to 11 is now obese. Being overweight or obese increases the risk of type 2 diabetes.

Both type 2 diabetes and being overweight or obese increases the risk of coronary heart disease. Other risk factors include high levels of triglycerides and LDL cholesterol fats in the blood.

Takeaways tend to have higher fat, sugar and salt levels compared with other foods.

The researchers wanted to find out if eating takeaways were linked with an increase in risk markers for coronary heart disease, obesity and type 2 diabetes in children.

What did this study do?

This cross-sectional study used data from the Child Heart and Health Study, collected between 2006 and 2007. It involved 1,948 nine to 10-year-old children from 85 primary schools in London, Birmingham and Leicester.

The researchers asked how often children ate takeaways. The children then completed a 24-hour diet recall questionnaire. The researchers measured their height, body fat, skinfold thickness, waist circumference and blood pressure. Finally, they did fasting blood tests for glucose, insulin, HbA1c (a marker of longer-term blood glucose), triglycerides, total cholesterol, high-density lipoprotein cholesterol and LDL cholesterol.

This was an observational study without any follow up over time, so we can’t say eating takeaways directly causes increased coronary heart disease or diabetes risk markers in children. There may, for example, have been other factors in these families’ environment of lifestyles that also impact health.

What did it find?

  • A total of 499 children (26%) never or hardly ever ate a takeaway, 894 (46%) ate a takeaway less than once a week and 555 (28%) ate a takeaway once a week or more.
  • In children who ate a takeaway once or more per week, the average LDL cholesterol level was 2.68mmol/L compared with 2.58mmol/L in children who never or hardly ever ate takeaway meals (mean difference 0.10mmol/L, 95% confidence interval [CI] 0.02 to 0.18).
  • The fat mass index was 5.06% higher (95% CI 0.53% to 9.79%) in children who ate takeaways once or more per week compared with those who never or hardly ever ate takeaways (2.01kg/m2 versus 2.11kg/m2). The fat mass index is similar to body mass index but is calculated by the amount of body fat divided by height squared and not total weight.
  • Skinfold thickness was 6.14mm higher (95% CI 0.05 to 12.60) in children who ate takeaways once or more a week compared with those who never or hardly ever ate them.
  • Children who ate takeaways once or more per week ate on average 228 calories more each day than those who never or rarely ate takeaways. Their diets also had higher total fat, saturated fat and monounsaturated fat, and lower starch, protein and calcium.

What does current guidance say on this issue?

NICE 2015 guidance recommends that local authorities maintain an up-to-date list of local lifestyle weight management programmes and make it available to the public. Healthcare professionals should ensure they are aware of the lifestyle weight management programmes for children and young people in their area and how to enrol people on them.

They also recommend local authorities limit the number of takeaways near schools and restrict their opening hours within current laws.

NICE 2016 guidelines recommend healthcare professionals provide dietary advice to children and young people with type 2 diabetes and their family members or carers.

What are the implications?

The results of this study lend further weight to the argument for local authorities to restrict takeaway access for children. Though the differences in LDL cholesterol, fat mass index and skinfold thickness appear small, it is not a huge leap to consider the cumulative effects of a poor diet and takeaways over a sustained period.

The results should be included in public health campaigns to inform parents of the potential risks of regular takeaway consumption. Local authorities already have the ability to regulate the number of takeaways in their communities.

Citation and Funding

Donin AS, Nightingale CM, Owen CG, et al. Takeaway meal consumption and risk markers for coronary heart disease, type 2 diabetes and obesity in children aged 9-10 years: a cross-sectional study. Arch Dis Child. 2017. [Epub ahead of print].

Donin AS was supported by the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care, South London and by Diabetes UK (BDA 11/0004317). Data collection in the CHASE study was supported by grants from the Wellcome Trust (068362/Z/02/Z) and the UK Medical Research Council National Prevention Research Initiative (NPRI) (G0501295). The funding partners for this NPRI award were: British Heart Foundation; Cancer Research UK, Department of Health; Diabetes UK; Economic and Social Research Council; Research and Development Office for the Northern Ireland Health and Social Services; Chief Scientist Office, Scottish Executive Health Department; and Welsh Assembly Government.

Bibliography

NHS Choices. Diabetes. London: Department of Health; updated 2016.

NHS Choices. High cholesterol. London: Department of Health; updated 2015.

NHS Choices. Obesity. London: Department of Health; updated 2016

NICE. Cardiovascular disease prevention. London: National Institute for Health and Care Excellence; 2010.

NICE. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. London: National Institute for Health and Care Excellence; 2016.

NICE. Obesity in children and young people: prevention and lifestyle weight management programmes. London: National Institute for Health and Care Excellence; 2015.

Why was this study needed?

Childhood obesity rates are increasing in the UK, where one in five children aged 10 to 11 is now obese. Being overweight or obese increases the risk of type 2 diabetes.

Both type 2 diabetes and being overweight or obese increases the risk of coronary heart disease. Other risk factors include high levels of triglycerides and LDL cholesterol fats in the blood.

Takeaways tend to have higher fat, sugar and salt levels compared with other foods.

The researchers wanted to find out if eating takeaways were linked with an increase in risk markers for coronary heart disease, obesity and type 2 diabetes in children.

What did this study do?

This cross-sectional study used data from the Child Heart and Health Study, collected between 2006 and 2007. It involved 1,948 nine to 10-year-old children from 85 primary schools in London, Birmingham and Leicester.

The researchers asked how often children ate takeaways. The children then completed a 24-hour diet recall questionnaire. The researchers measured their height, body fat, skinfold thickness, waist circumference and blood pressure. Finally, they did fasting blood tests for glucose, insulin, HbA1c (a marker of longer-term blood glucose), triglycerides, total cholesterol, high-density lipoprotein cholesterol and LDL cholesterol.

This was an observational study without any follow up over time, so we can’t say eating takeaways directly causes increased coronary heart disease or diabetes risk markers in children. There may, for example, have been other factors in these families’ environment of lifestyles that also impact health.

What did it find?

  • A total of 499 children (26%) never or hardly ever ate a takeaway, 894 (46%) ate a takeaway less than once a week and 555 (28%) ate a takeaway once a week or more.
  • In children who ate a takeaway once or more per week, the average LDL cholesterol level was 2.68mmol/L compared with 2.58mmol/L in children who never or hardly ever ate takeaway meals (mean difference 0.10mmol/L, 95% confidence interval [CI] 0.02 to 0.18).
  • The fat mass index was 5.06% higher (95% CI 0.53% to 9.79%) in children who ate takeaways once or more per week compared with those who never or hardly ever ate takeaways (2.01kg/m2 versus 2.11kg/m2). The fat mass index is similar to body mass index but is calculated by the amount of body fat divided by height squared and not total weight.
  • Skinfold thickness was 6.14mm higher (95% CI 0.05 to 12.60) in children who ate takeaways once or more a week compared with those who never or hardly ever ate them.
  • Children who ate takeaways once or more per week ate on average 228 calories more each day than those who never or rarely ate takeaways. Their diets also had higher total fat, saturated fat and monounsaturated fat, and lower starch, protein and calcium.

What does current guidance say on this issue?

NICE 2015 guidance recommends that local authorities maintain an up-to-date list of local lifestyle weight management programmes and make it available to the public. Healthcare professionals should ensure they are aware of the lifestyle weight management programmes for children and young people in their area and how to enrol people on them.

They also recommend local authorities limit the number of takeaways near schools and restrict their opening hours within current laws.

NICE 2016 guidelines recommend healthcare professionals provide dietary advice to children and young people with type 2 diabetes and their family members or carers.

What are the implications?

The results of this study lend further weight to the argument for local authorities to restrict takeaway access for children. Though the differences in LDL cholesterol, fat mass index and skinfold thickness appear small, it is not a huge leap to consider the cumulative effects of a poor diet and takeaways over a sustained period.

The results should be included in public health campaigns to inform parents of the potential risks of regular takeaway consumption. Local authorities already have the ability to regulate the number of takeaways in their communities.

Citation and Funding

Donin AS, Nightingale CM, Owen CG, et al. Takeaway meal consumption and risk markers for coronary heart disease, type 2 diabetes and obesity in children aged 9-10 years: a cross-sectional study. Arch Dis Child. 2017. [Epub ahead of print].

Donin AS was supported by the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care, South London and by Diabetes UK (BDA 11/0004317). Data collection in the CHASE study was supported by grants from the Wellcome Trust (068362/Z/02/Z) and the UK Medical Research Council National Prevention Research Initiative (NPRI) (G0501295). The funding partners for this NPRI award were: British Heart Foundation; Cancer Research UK, Department of Health; Diabetes UK; Economic and Social Research Council; Research and Development Office for the Northern Ireland Health and Social Services; Chief Scientist Office, Scottish Executive Health Department; and Welsh Assembly Government.

Bibliography

NHS Choices. Diabetes. London: Department of Health; updated 2016.

NHS Choices. High cholesterol. London: Department of Health; updated 2015.

NHS Choices. Obesity. London: Department of Health; updated 2016

NICE. Cardiovascular disease prevention. London: National Institute for Health and Care Excellence; 2010.

NICE. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. London: National Institute for Health and Care Excellence; 2016.

NICE. Obesity in children and young people: prevention and lifestyle weight management programmes. London: National Institute for Health and Care Excellence; 2015.

Takeaway meal consumption and risk markers for coronary heart disease, type 2 diabetes and obesity in children aged 9–10 years: a cross-sectional study

Published on 3 December 2017

A Donin, C Nightingale, C Owen, A Rudnicka, D Cook, P Whincup

BMJ Archives of Disease in Childhood , 2017

Objective To investigate associations between takeaway meal consumption and risk markers for coronary heart disease, type 2 diabetes and obesity risk markers in children. Design A cross-sectional, school-based observational study. Setting 85 primary schools across London, Birmingham and Leicester. Participants 1948 UK primary school children in year 5, aged 9–10 years. Main outcome measures Children reported their frequency of takeaway meal consumption, completed a 24-hour dietary recall, had physical measurements and provided a fasting blood sample. Results Among 1948 participants with complete data, 499 (26%) never/hardly ever consumed a takeaway meal, 894 (46%) did so <1/week and 555 (28%) did ≥1/week. In models adjusted for age, sex, month, school, ethnicity and socioeconomic status, more frequent takeaway meal consumption was associated with higher dietary intakes of energy, fat % energy and saturated fat % energy and higher energy density (all P trend <0.001) and lower starch, protein and micronutrient intakes (all P trend <0.05). A higher frequency of takeaway meal consumption was associated with higher serum total cholesterol and low-density lipoprotein (LDL) cholesterol (P trend=0.04, 0.01, respectively); children eating a takeaway meal ≥1/week had total cholesterol and LDL cholesterol 0.09 mmol/L (95% CI 0.01 to 0.18) and 0.10 mmol/L (95% CI 0.02 to 0.18) higher respectively than children never/hardly ever eating a takeaway meal; their fat mass index was also higher. Conclusions More frequent takeaway meal consumption in children was associated with unhealthy dietary nutrient intake patterns and potentially with adverse longer term consequences for obesity and coronary heart disease risk.

Expert commentary

This study demonstrates that even at primary school age, regular takeaway food consumption is associated with metabolic health: adverse lipid profiles and body fat compared to those never consuming such products.

Takeaway consumption as a regular feature of weekly family life is increasing due to easier access (greater numbers of outlets and home delivery services) with the highest rises in areas of greatest deprivation.

It seems prudent for local councils to actively manage planning permission for hot food takeaways. In 2015, Gateshead Council only allowed new outlets in wards where less than 10% of year six children were obese: strikingly, no ward fitted this criterion.

Julian Hamilton-Shield, Professor in Diabetes and Metabolic Endocrinology, University of Bristol