Nutritional Quality of Children’s Menus Offered by Fast-Food and Traditional-Food Chain Restaurants in Costa Rica
DOI:
https://doi.org/10.15517/zw5de480Keywords:
children’s menus, nutritional quality, food environment, KIMEHSAbstract
Introduction: This study characterizes foods offered by children’s menus at chain restaurants and determines whether differences exist in the nutritional quality between fast-food and traditional restaurants. Methodology: this is a cross-sectional study. After evaluating its inter-observer reliability, the Kids Menu Healthy Score (KIMEHS) was used to determine the nutritional quality of children’s menus. Setting: Chain restaurants located within major shopping centers in the Greater Metropolitan Area (GMA) of Costa Rica in 2023. Participants: 74 unique chain restaurants were included. Outcomes: Availability of children´s menus, KIMEHS individual categories (presence/absence) and overall KIMEHS score. Results: Of all restaurants, 41.9% offered a children’s menu. According to KIMEHS, 97% of these menus were considered unhealthy. There were no significant differences between fast food and traditional restaurants. The most frequent main dishes were chicken nuggets (83.9%), hamburgers (54.8%) and pasta (41.9%). Most restaurants (83.9%) included French fries as a side dish, while only 6.4% offered fruit in their menus. Conclusion: The children’s menus offered had poor nutritional quality, with limited variety and availability of healthy options. There is a need for policies and practices that promote better nutritional quality of food available to children when they eat outside the home in the restaurant setting.
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Cassady, D., Housemann, R., & Dagher, C. (2004). Measuring Cues for Healthy Choices on Restaurant Menus: Development and Testing of a Measurement Instrument. American Journal of Health Promotion, 18(6), 444-449. https://doi.org/10.4278/0890-1171-18.6.444 DOI: https://doi.org/10.4278/0890-1171-18.6.444
Duran, A. C., Mialon, M., Crosbie, E., Jensen, M. L., Harris, J. L., Batis, C., Corvalán, C., & Taillie, L. S. (2021). Food environment solutions for childhood obesity in Latin America and among Latinos living in the United States. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity, 22 Suppl 3(Suppl 3), e13237. https://doi.org/10.1111/obr.13237 DOI: https://doi.org/10.1111/obr.13237
Euromonitor International. (2023). Chained Consumer Foodservice Retail Selling Price in Latin America, by brand and company name, 2013-2022.
French, S., Story, M., Neumark-Sztainer, D., Fulkerson, J., & Hannan, P. (2001). Fast food restaurant use among adolescents: Associations with nutrient intake, food choices and behavioral and psychosocial variables. International Journal of Obesity, 25(12), 1823-1833. https://doi.org/10.1038/sj.ijo.0801820 DOI: https://doi.org/10.1038/sj.ijo.0801820
Gesteiro, E., García-Carro, A., Aparicio-Ugarriza, R., & González-Gross, M. (2022). Eating out of Home: Influence on Nutrition, Health, and Policies: A Scoping Review. Nutrients, 14(6), 1265. https://doi.org/10.3390/nu14061265 DOI: https://doi.org/10.3390/nu14061265
Jia, P., Luo, M., Li, Y., Zheng, J., Xiao, Q., & Luo, J. (2021). Fast‐food restaurant, unhealthy eating, and childhood obesity: A systematic review and meta‐analysis. Obesity Reviews, 22(Suppl 1), e12944. https://doi.org/10.1111/obr.12944 DOI: https://doi.org/10.1111/obr.12944
Kellershohn, J., Walley, K., & Vriesekoop, F. (2021). An international study of fast-food dining perceptions: Millennial parents, non-millennial parents, and peer judgement during fast-food family dining. International Journal of Culture Tourism and Hospitality Research, 15(4), 598-614. https://doi.org/10.1108/IJCTHR-06-2020-0119 DOI: https://doi.org/10.1108/IJCTHR-06-2020-0119
Krukowski, R. A., Eddings, K., & Smith West, D. (2011). The Children’s Menu Assessment: Development, Evaluation, and Relevance of a Tool for Evaluating Children’s Menus. Journal of the American Dietetic Association, 111(6), 884-888. https://doi.org/10.1016/j.jada.2011.03.018 DOI: https://doi.org/10.1016/j.jada.2011.03.018
Landais, E., Miotto-Plessis, M., Bene, C., Maitre d’Hotel, E., Truong, M. T., Somé, J. W., & Verger, E. O. (2023). Consumption of food away from home in low- and middle-income countries: A systematic scoping review. Nutrition Reviews, 81(6), 727-754. https://doi.org/10.1093/nutrit/nuac085 DOI: https://doi.org/10.1093/nutrit/nuac085
Mazariegos, S., Chacon, V., Cole, A., & Barnoya, J. (2016). Nutritional quality and marketing strategies of fast food children’s combo meals in Guatemala. BMC Obes, 3, 52. https://doi.org/10.1186/s40608-016-0136-y DOI: https://doi.org/10.1186/s40608-016-0136-y
McHugh, M. L. (2012). Interrater reliability: The kappa statistic. Biochemia Medica, 22(3), 276-282. DOI: https://doi.org/10.11613/BM.2012.031
Mercado, D. (2020). Procesos de Servicio En Restaurante (1st edition). Paraninfo.
Mueller, M. P., Wilde, P., Folta, S. C., Anzman-Frasca, S., & Economos, C. D. (2019). Availability of Healthier Children’s Menu Items in the Top Selling Quick Service Restaurant Chains (2004–2015). American Journal of Public Health, 109(2), 267-269. https://doi.org/10.2105/AJPH.2018.304800 DOI: https://doi.org/10.2105/AJPH.2018.304800
Palos Lucio, A. G., Sansores Martínez, D. N.-H., Olvera Miranda, C., Quezada Méndez, L., & Tolentino-Mayo, L. (2020). Nutritional Quality of Fast Food Kids Meals and Their Contribution to the Diets of School-Aged Children. Nutrients, 12(3). https://doi.org/10.3390/nu12030612 DOI: https://doi.org/10.3390/nu12030612
Pérez-Ferrer, C., Auchincloss, A. H., de Menezes, M. C., Kroker-Lobos, M. F., Cardoso, L. de O., & Barrientos-Gutierrez, T. (2019). The food environment in Latin America: A systematic review with a focus on environments relevant to obesity and related chronic diseases. Public Health Nutrition, 22(18), 3447-3464. https://doi.org/10.1017/S1368980019002891 DOI: https://doi.org/10.1017/S1368980019002891
Pulker, C. E., Aberle, L. M., Butcher, L. M., Whitton, C., Law, K. K., Large, A. L., Pollard, C. M., & Trapp, G. S. A. (2023). Development of the Menu Assessment Scoring Tool (MAST) to Assess the Nutritional Quality of Food Service Menus. International Journal of Environmental Research and Public Health, 20(5), 3998. https://doi.org/10.3390/ijerph20053998 DOI: https://doi.org/10.3390/ijerph20053998
Rocha, A., & Viegas, C. (2020). KIMEHS—Proposal of an Index for Qualitative Evaluation of Children’s Menus—A Pilot Study. Foods, 9(11), 1618. https://doi.org/10.3390/foods9111618 DOI: https://doi.org/10.3390/foods9111618
Saelens, B. E., Glanz, K., Sallis, J. F., & Frank, L. D. (2007). Nutrition Environment Measures Study in restaurants (NEMS-R): Development and evaluation. American Journal of Preventive Medicine, 32(4), 273-281. https://doi.org/10.1016/j.amepre.2006.12.022 DOI: https://doi.org/10.1016/j.amepre.2006.12.022
Seguin, R. A., Aggarwal, A., Vermeylen, F., & Drewnowski, A. (2016). Consumption Frequency of Foods Away from Home Linked with Higher Body Mass Index and Lower Fruit and Vegetable Intake among Adults: A Cross-Sectional Study. Journal of Environmental and Public Health, 2016, 1-12. https://doi.org/10.1155/2016/3074241 DOI: https://doi.org/10.1155/2016/3074241
Silva, N. A., Monteiro, M. C. D. C., & Pinto, A. M. D. S. (2021). Quality assessment of children’s menus served in commercial restaurants in view of the new food classification in the Food Guide for the Brazilian Population. DEMETRA: Alimentação, Nutrição & Saúde, 16, e59748. https://doi.org/10.12957/demetra.2021.59748 DOI: https://doi.org/10.12957/demetra.2021.59748
StataCorp. (s. f.). Stata Statistical Software: Release 16 [Software]. StataCorp LP.
Trapp, G. S. A., Pulker, C. E., Hurworth, M., Law, K. K., Brinkman, S., Pollard, C. M., Harray, A. J., Sambell, R., Mandzufas, J., Anzman-Frasca, S., & Hickling, S. (2022). The Nutritional Quality of Kids’ Menus from Cafés and Restaurants: An Australian Cross-Sectional Study. Nutrients, 14(13), 2741. https://doi.org/10.3390/nu14132741 DOI: https://doi.org/10.3390/nu14132741
Turner, C., Kalamatianou, S., Drewnowski, A., Kulkarni, B., Kinra, S., & Kadiyala, S. (2020). Food Environment Research in Low- and Middle-Income Countries: A Systematic Scoping Review. Advances in Nutrition (Bethesda, Md.), 11(2), 387-397. https://doi.org/10.1093/advances/nmz031 DOI: https://doi.org/10.1093/advances/nmz031
Venzke, J. G., Aranalde, G. A., Scarparo, A. L. S., & Rocha, A. (2023). Quality of children’s menus in malls in Brazil. Revista Brasileira de Saúde Materno Infantil, 23, e20220054. https://doi.org/10.1590/1806-9304202300000054-en DOI: https://doi.org/10.1590/1806-9304202300000054-en
Viegas, C., Lima, J., Afonso, C., Toth, A. J., Bálint Illés, C., Bittsánszky, A., Šatalić, Z., Vidaček Filipec, S., Fabijanic, V., Duran, S., Torres, J. A., Spinelli, M., Matias, A., Souza Pinto, A. M., & Rocha, A. (2022). Children’s menus in shopping centre restaurants: A multicentric study. British Food Journal, 124(10), 3169-3182. https://doi.org/10.1108/BFJ-05-2021-0504 DOI: https://doi.org/10.1108/BFJ-05-2021-0504
World Health Organization. (2023). WHO acceleration plan to stop obesity. https://www.who.int/publications/i/item/9789240075634
Young, M., Coppinger, T., & Reeves, S. (2019). The Nutritional Value of Children’s Menus in Chain Restaurants in the United Kingdom and Ireland. Journal of Nutrition Education and Behavior, 51(7), 817-825. https://doi.org/10.1016/j.jneb.2019.04.018 DOI: https://doi.org/10.1016/j.jneb.2019.04.018
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