Abstract
The rising trend of consumption of food away from home (FAFH) among young professionals in developing countries, such as India and South Africa, is raising significant concerns due to its potential association with an increased risk of non-communicable diseases (NCDs). These diseases encompass diabetes, hypertension, cardiovascular conditions, cancer, and obesity. Research indicates that FAFH typically contains higher levels of calories, fat, and sodium, while often lacking sufficient amounts of fruits, vegetables, and whole grains. These dietary factors are known contributors to the burden of various NCDs.
Despite existing evidence, there is a significant lack of research on the relationship between FAFH consumption and NCD risk factors, specifically among young professionals in developing country contexts. While studies have addressed the determinants of FAFH consumption and expenditure in developed nations, comparable research is relatively scarce in developing countries. Furthermore, it remains unclear whether the sociodemographic risk profiles for NCDs among young adults in low- and middle-income countries (LMICs) are aligned with those observed in high-income nations.
To address this critical gap, the study aimed to evaluate the consumption and expenditure patterns of FAFH among young professionals in India and South Africa, while also examining the correlation between FAFH consumption and indicators related to NCD risk through an integrated approach. The study is structured around four specific objectives: 1) to conduct a systematic review and meta-analysis of the existing literature, 2) to perform a secondary data analysis, 3) to develop a smartphone-based dietary intake application, and 4) to execute primary data collection and analysis via a survey.
The first objective consisted of performing a systematic review and meta-analysis. Separate searches were performed across six databases: Ingenta, Web of Science, Scopus, the Cochrane Library, Medline, and CAB Direct. From an initial pool of 4,015 articles, 79 were carefully selected for full-text review. After a thorough examination of these 79 articles, 26 studies were ultimately included in the review based on specific eligibility criteria. Additionally, the researchers identified three supplementary studies by reviewing the references cited in the selected articles, bringing the total number of studies included to 29. All 29 studies were population-based, ensuring that the findings represented broader demographics. The meta-analysis revealed that the pooled prevalence of FAFH consumption, as observed in the 29 studies, was 39.96%. The prevalence of FAFH consumption varied significantly, ranging from
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11% to 92% across different study populations. Moreover, the meta-analysis demonstrated a notable positive correlation between FAFH consumption and various NCD markers, including obesity, elevated blood pressure, and dyslipidemia.
The second objective involved a secondary data analysis of nationally representative data from India and South Africa regarding the consumption and expenditure on FAFH and its correlation with the risk of NCDs. The data for India was sourced from the India Human Development Survey (IHDS) II. This survey examined the sociodemographic and economic factors that influence household expenditures on eating out. Analysis of macroeconomic indicators, such as Gross State Domestic Product (GSDP) and Per Capita Income (PCI), did not show consistent trends. However, the logistic regression analysis results indicated a significant positive association between expenditures on eating out and several specific factors. These factors included belonging to reserved caste categories such as Other Backward Classes (OBC) and Scheduled Castes/Scheduled Tribes (SC/ST/Others), the education level of household heads being at least secondary or higher, residing in urban areas, having income from the organized sector, possessing a higher annual income, incurring higher annual consumption expenditures, and being above the poverty line.
Data on South Africa was sourced from the South African Demographic and Health Survey (SADHS) VII. The study concentrated on four categories of processed foods: fried foods, takeaway/fast foods, salty snacks/packaged chips, and processed meats. It also investigated eight NCDs, including hypertension, cardiac arrest, cancer, stroke, hypercholesterolemia, diabetes, chronic bronchitis, and asthma. The logistic regression analysis findings indicated a heightened likelihood of processed food consumption across all provinces in South Africa, particularly in urban areas and among young adults. Additionally, there was a significant increase in the consumption of processed meats within the Coloured population. In contrast, fried foods, fast foods, and salty snacks were more prevalent among White people. Notably, both processed meats and salted snacks were linked to five chronic health conditions.
In the third objective of the study, a smartphone-based dietary application called "FoodLog" was developed and tested. This app enables users to track and monitor their food and beverage consumption and their spending on dietary intake. To test the app's usability, a pilot study was conducted among young working adults in Pune, India. mHealth App Usability Questionnaire (MAUQ) was utilized to gather data. The average rating for all 18 items on the scale was 2.67, indicating a positive response towards the application. No significant differences in opinions
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were observed among the various usability sub-scales. Overall, users expressed a notably favourable opinion of the FoodLog app.
In the fourth and final objective of the study, a population-based survey was conducted to examine the factors associated with the consumption of FAFH and its relationship to the risk of NCDs among young working adults in Pune, India, and Johannesburg, South Africa. A case-control study design was employed, targeting young adults aged 25 to 45 who were engaged in various sectors, including information technology, finance, insurance, professional services, and customer service.
In Pune, the sample comprised 347 cases and 693 controls, totalling 1,040 participants. In Johannesburg, there were 155 cases and 309 controls, totalling 464 participants. Data was collected using a semi-structured questionnaire administered through Google Forms. This questionnaire included questions about the participants’ sociodemographic characteristics, lifestyle factors, and health status. Additionally, a smartphone app called ‘FoodLog’ was used to track participants’ dietary intake.
In Pune, approximately 35% of participants reported consuming FAFH during the seven-day recall period. Additionally, about 33% of participants had at least one chronic condition. Logistic regression analysis indicated a link between FAFH consumption and several factors, including male gender, being married or in a domestic partnership, living alone, levels of physical activity, alcohol consumption, and cigarette smoking. The analysis also revealed significant associations between chronic conditions and factors such as being an older adult, working in specific professions, physical inactivity, alcohol consumption, smoking cigarettes, and consuming FAFH.
In Johannesburg, South Africa, over 33% of participants reported consuming FAFH during the seven-day recall period, with roughly 33% also having at least one chronic condition. The logistic regression analysis showed an association between FAFH consumption and characteristics such as being female, holding a postgraduate or higher level of education, physical inactivity, and reduced vegetable intake. Furthermore, there were significant associations between chronic conditions and factors like being an older adult, physical inactivity, eating non-vegetarian food, and consuming FAFH.
The findings from all four objectives of the study underscore the critical influence of individual, behavioural, and environmental factors on the consumption of FAFH. This trend of FAFH
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consumption is particularly concerning, as it is shown to significantly contribute to the escalating burden of NCDs in developing countries. The research reveals that individual choices, such as dietary preferences and lifestyle habits, interact with broader behavioural patterns influenced by cultural norms and socioeconomic status. Additionally, environmental factors, including the availability and promotion of FAFH options, play a pivotal role in shaping these consumption habits. By examining these interconnected pathways, this study provides valuable insights into how FAFH contributes to the rising prevalence of NCDs, with particular emphasis on regions like India and South Africa, where such consumption is becoming increasingly common. The research enriches our understanding of these complex dynamics, highlighting the need for targeted interventions and policies that address both individual behaviours and the broader environmental context to mitigate the health impacts of FAFH consumption in these rapidly urbanizing regions.