Who gets an annual review for coeliac disease? Patients with lower health literacy and lower dietary adherence consider them important.

BACKGROUND: A lifelong gluten-free (GF) diet to manage coeliac disease is recognised to be challenging. This paper comprises two studies: study one aimed to report the opinions of adults with coeliac disease on review provision and explore factors influencing dietary adherence. Study two aimed to report dietetic provision for adults with coeliac disease. METHODS: A cross-sectional online survey was completed by 722 adults with coeliac disease, including validated dietary adherence, health literacy and quality-of-life questionnaires. An online and paper survey designed to capture the provision of dietetic services to adults with coeliac disease was completed by 88 dietetic departments within the United Kingdom. RESULTS: Only 26% of adults with coeliac disease were offered annual reviews. In contrast, 85% considered reviews important, with 62% preferring dietetic provision. Those who considered reviews important had lower health literacy, greater dietary burden, poorer GF dietary adherence and lower GF food knowledge (all p < 0.05) compared with those who did not consider reviews important. GF dietary adherence was associated with health literacy, self-regulatory behaviours, dietary burden and GF food knowledge; 53% agreed with the 'cost of GF food restricts what I eat'; they had poorer GF dietary adherence compared with those who disagreed (p < 0.001). More than 72% of dietetic coeliac review provision provided content on improving access to GF foods and eating out of the home. CONCLUSIONS: A subpopulation of adults with coeliac disease have a greater need for support and guidance, which supports the viewpoint that limited resources should be targeted towards patients with the most need for support to enable successful disease management.

Meal deals, combos and bundling: the impact on the nutrition composition of children's meals in restaurants.

Increased consumption of food outside the home means that the nutritional content of meals served in restaurants now makes a significant contribution to overall diet. Children's menus in restaurants, usually aimed at those aged 10 years and younger, are frequently high in energy, fat, salt, sugar and lack variety. The food and drink on children's menus are often bundled together as a combo or meal deal that may be convenient to order and sometimes, but not always, cheaper. Bundling has the potential to add additional foods that may not have been selected individually thus increasing the amount ordered and consumed. Substituting some meal deal items for healthier options has the potential to make it easier to eat well when eating outside the home and improve dietary intakes. However, the impact of such measures on child health has yet to be fully explored.

Effect of carbohydrate-protein supplementation on endurance training adaptations.

PURPOSE: To examine the influence of post-exercise protein feeding upon the adaptive response to endurance exercise training. METHODS: In a randomised parallel group design, 25 healthy men and women completed 6 weeks of endurance exercise training by running on a treadmill for 30-60 min at 70-75% maximal oxygen uptake (VO2max) 4 times/week. Participants ingested 1.6 g per kilogram of body mass (g kg BM-1) of carbohydrate (CHO) or an isocaloric carbohydrate-protein solution (CHO-P; 0.8 g carbohydrate kg BM-1 + 0.8 g protein kg BM-1) immediately and 1 h post-exercise. Expired gas, blood and muscle biopsy samples were taken at baseline and follow-up. RESULTS: Exercise training improved VO2max in both groups (p ≤ 0.001), but this increment was not different between groups either in absolute terms or relative to body mass (0.2 ± 0.2 L min-1 and 3.0 ± 2 mL kg-1 min-1, respectively). No change occurred in plasma albumin concentration from baseline to follow-up with CHO-P (4.18 ± 0.18 to 4.23 ± 0.17 g dL-1) or CHO (4.17 ± 0.17 to 4.12 ± 0.22 g dL-1; interaction: p > 0.05). Mechanistic target of rapamycin (mTOR) gene expression was up-regulated in CHO-P (+ 46%; p = 0.025) relative to CHO (+ 4%) following exercise training. CONCLUSION: Post-exercise protein supplementation up-regulated the expression of mTOR in skeletal muscle over 6 weeks of endurance exercise training. However, the magnitude of improvement in VO2max was similar between groups.

Effects of Body Mass Index on Bone Loading Due to Physical Activity.

The aim of the current study was to compare bone loading due to physical activity between lean, and overweight and obese individuals. Fifteen participants (lower BMI group: BMI < 25 kg/m2, n = 7; higher BMI group: 25 kg/m2 < BMI < 36.35 kg/m2, n = 8) wore a tri-axial accelerometer on 1 day to collect data for the calculation of bone loading. The International Physical Activity Questionnaire (short form) was used to measure time spent at different physical activity levels. Daily step counts were measured using a pedometer. Differences between groups were compared using independent t-tests. Accelerometer data revealed greater loading dose at the hip in lower BMI participants at a frequency band of 0.1-2 Hz (P = .039, Cohen's d = 1.27) and 2-4 Hz (P = .044, d = 1.24). Lower BMI participants also had a significantly greater step count (P = .023, d = 1.55). This corroborated with loading intensity (d ≥ 0.93) and questionnaire (d = 0.79) effect sizes to indicate higher BMI participants tended to spend more time in very light activity, and less time in light and moderate activity. Overall, participants with a lower BMI exhibited greater bone loading due to physical activity; participants with a higher BMI may benefit from more light and moderate level activity to maintain bone health.

Metabolic consequences of obesity and insulin resistance in polycystic ovary syndrome: diagnostic and methodological challenges.

Women with polycystic ovary syndrome (PCOS) have a considerable risk of metabolic dysfunction. This review aims to present contemporary knowledge on obesity, insulin resistance and PCOS with emphasis on the diagnostic and methodological challenges encountered in research and clinical practice. Variable diagnostic criteria for PCOS and associated phenotypes are frequently published. Targeted searches were conducted to identify all available data concerning the association of obesity and insulin resistance with PCOS up to September 2016. Articles were considered if they were peer reviewed, in English and included women with PCOS. Obesity is more prevalent in women with PCOS, but studies rarely reported accurate assessments of adiposity, nor split the study population by PCOS phenotypes. Many women with PCOS have insulin resistance, though there is considerable variation reported in part due to not distinguishing subgroups known to have an impact on insulin resistance as well as limited methodology to measure insulin resistance. Inflammatory markers are positively correlated with androgen levels, but detailed interactions need to be identified. Weight management is the primary therapy; specific advice to reduce the glycaemic load of the diet and reduce the intake of pro-inflammatory SFA and advanced glycation endproducts have provided promising results. It is important that women with PCOS are educated about their increased risk of metabolic complications in order to make timely and appropriate lifestyle modifications. Furthermore, well-designed robust studies are needed to evaluate the mechanisms behind the improvements observed with dietary interventions.

Breakfast habits, beliefs and measures of health and wellbeing in a nationally representative UK sample.

The aim of this study was to report UK adult breakfasting habits, beliefs and the relationship of both with measures of personality, health and wellbeing including physical activity and body mass index (BMI). A nationally representative sample of 1068 adults completed a web-based survey, combining standardised scales and self-designed questionnaire statements. Sixty-four percent of respondents consumed breakfast daily whilst 6% never ate breakfast. Breakfasting frequency was found to correlate with conscientiousness, wellbeing and age and general health. The survey found that breakfast eaters strongly believe that breakfast helps weight control and weight loss. Breakfast eaters were more likely to partake in vigorous exercise, although there was no significant difference in BMI. Multi-variate analysis identified conscientiousness, cognitive restraint and age as making unique contributions to predicting breakfast frequency. This study provides further support for the view that breakfast eating is likely to be a proxy-variable for a healthy lifestyle. The role of breakfast and related beliefs should be taken into consideration in breakfast behaviour research, interventions and health and wellbeing campaigns.

From ToyBox Study to eToyBox: Advancing Childhood Obesity Reduction in Malaysian Kindergartens.

Prevention and treatment of childhood obesity is a global concern, and in Malaysia, it is considered a national public health priority. Determinants of childhood obesity are multifactorial and include factors that directly and indirectly influence energy balance-related behaviours, including energy intake and energy expenditure. Interventions to address childhood obesity that have multiple components at different levels have been shown to be the most influential. The ToyBox-study is a childhood obesity intervention aimed at preschool-aged children and their families that had been shown to be effective in several European countries and so was chosen for adaption for the Malaysian setting. Materials were translated and adjusted for the Malaysian context and audience and implemented in kindergartens in Peninsular Malaysia and Sarawak. However, during the COVID-19 pandemic and lockdown, teaching transitioned to being online. This brought an opportunity to reach a wider audience and consider the long-term sustainability of the intervention, and thus eToybox was born. eToybox aims to bring support for healthy energy balance behaviours directly to the teachers, into kindergartens and homes, to encourage families to be active and eat healthily, and prevent or reduce obesity. Through online innovation, the Toybox Study Malaysia programme has been expanded to enhance its potential to impact the promotion of healthy lifestyles among preschoolers and their families, highlighting the importance of a holistic approach to preventing and treating childhood obesity in Malaysia.

Ethnic dress, vitamin D intake, and calcaneal bone health in young women in the United Kingdom.

Clothing styles that conceal skin from ultraviolet sun radiation contribute to vitamin D deficiency, especially in veiled female minorities in high latitudes. This is the first research into possible effects of ethnic dress on the os calcis and the first study outside North Africa and the Middle East to investigate whether discernible differences in bone quality exist between veiled and unveiled women. The limited previous research into clothing habits and bone health has been inconclusive. One hundred eight women aged 18--45yr living in the United Kingdom (around 51° north) were analyzed. Forty-three consistently covered arms, hair, and neck when outdoors, whereas 65 consistently had arms, hair, neck, and possibly legs exposed. The quantitative ultrasound scanning (QUS) measurements at the calcaneus were speed of sound (SOS) and broadband ultrasound attenuation (BUA), which were translated into a single clinical value, stiffness index (SI). Dietary intake of vitamin D and calcium was estimated using a validated food frequency questionnaire, and several other risk factors were assessed. There was no significant difference in SI between veiled and unveiled participants (101.30±1.71 vs 99.98±1.86; p=0.721); SOS and BUA were also not significantly different. However, smoking and long-term use of steroid medication were significant predictors of calcaneal bone quality, confirming existing research. Our analysis suggests that clothing style alone does not lead to appreciable differences in the quality of the os calcis in young women in the United Kingdom as assessed by QUS.

Does consuming breakfast influence activity levels? An experiment into the effect of breakfast consumption on eating habits and energy expenditure.

OBJECTIVE: To experimentally compare the effects of eating or skipping breakfast on energy expenditure, activity levels and dietary habits. DESIGN: A randomised cross-over trial, lasting 2 weeks. Participants were provided breakfast during one week and were required to fast until mid-day during the other week. SETTING: University campus. SUBJECTS: Forty-nine participants (twenty-six female and twenty-three male participants) were recruited. Food intake was monitored using food diaries, and energy expenditure was assessed using pedometers and heart rate monitors. Morningness-eveningness, physical activity and health were assessed using validated questionnaires. RESULTS: Across all participants, daily energy expenditure did not differ between the two experimental conditions. Total energy intake over 24 h did not vary with condition (male participants: 8134 (sd 447) kJ/d and 7514 (sd 368) kJ/d; female participants: 7778 (sd 410) kJ/d and 7531 (sd 535) kJ/d, for the breakfast and no-breakfast conditions, respectively). However, when comparing habitual breakfast eaters with those with irregular or breakfast-skipping habits, it was found that male non-habitual breakfast eaters consumed significantly (P = 0·029) more energy during the breakfast condition. Furthermore, female participants who were habitual breakfast eaters were found to eat significantly (P = 0·005) more and later in the day under the no-breakfast condition. CONCLUSIONS: Although the suggestion that breakfast is a behavioural marker for appropriate dietary and physical activity patterns is not refuted by the present findings, our data suggest that the effect of breakfast may vary as a function of gender and morning eating habits, and thus there may be other mechanisms that link BMI and breakfast consumption behaviour.

Nutrition and culture in professional football. A mixed method approach.

An adequate diet is essential for the optimal performance of professional football (soccer) players. Existing studies have shown that players fail to consume such a diet, without interrogating the reasons for this. The aim of this study was to explore the difficulties professional football players experience in consuming a diet for optimal performance. It utilized a mixed method approach, combining nutritional intake assessment with qualitative interviews, to ascertain both what was consumed and the wider cultural factors that affect consumption. The study found a high variability in individual intake which ranged widely from 2648 to 4606 kcal/day. In addition, the intake of carbohydrate was significantly lower than that recommended. The study revealed that the main food choices for carbohydrate and protein intake were pasta and chicken respectively. Interview results showed the importance of tradition within the world of professional football in structuring the players' approach to nutrition. In addition, the players' personal eating habits that derived from their class and national habitus restricted their food choice by conflicting with the dietary choices promoted within the professional football clubs.

Optimising protein intake in older people to maintain their musculoskeletal health.

The concept of healthy ageing has become a significant aspect of the public health approach to older people's well-being. Physiological changes that occur with ageing, such as a lack of mobility and sarcopenia (an age-related decline in muscle mass and strength), have the potential to negatively affect older people's quality of life and musculoskeletal health, often contributing to falls and fractures. Protein intake is a crucial element in maintaining optimal health in older people, and is important in delaying sarcopenia. This article discusses the role of protein in healthy ageing and outlines various recommendations for optimising protein intake in older people.

Experiences of Outpatient Clinics and Opinions of Telehealth by Caucasian and South Asian Patients' With Celiac Disease.

Outpatient clinics are an important part of chronic disease management, including that of celiac disease. During the coronavirus disease 2019 (COVID-19) global pandemic, telephone and online video consultations with health care professionals have substantially increased. This study aimed to explore the experience and opinions of adults, with celiac disease, toward face-to-face clinic appointments and alternatives, such as telehealth. Semistructured qualitative interviews with 37 patients were undertaken (75% White Caucasians, 25% South Asians; 29 patients were not adhering to the gluten-free diet). Interviews were recorded, transcribed, and analyzed by NVivo. Frequently reported issues with face-to-face appointments included travel and car parking costs, needing to take time off work, and frequent changes to appointment time. In addition, South Asian patients highlighted issues with linguistics barriers. Telephone consultations were considered acceptable and practical by the majority of patients based on ease and convenience. Online video consultations were favored by just 9 patients, however it is acknowledged that since the COVID-19 pandemic, there has been a greater exposure to this type of technology. These patient experiences can inform health care service development and are not biased by external health concerns connected with in-person visits during the pandemic.

Telephone clinic improves gluten-free dietary adherence in adults with coeliac disease: sustained at 6 months.

BACKGROUND: A gluten-free (GF) diet is the only treatment for coeliac disease (CD), non-adherence to the diet is associated with greater morbidity. The study aimed to examine the effect of a telephone clinic, designed to increase GF dietary knowledge and adherence, in adults with CD. METHODS: A prospective study of 125 patients with histologically confirmed CD. Patients, not adhering to a GF diet (n=30), engaged in a personalised telephone clinic. Validated questionnaires were used to assess GF dietary adherence (Coeliac Disease Adherence Test; CDAT), knowledge of GF foods and CD-related quality of life (QoL). GF dietary adherence was assessed up to 12 months post telephone clinic. The control group completed the questionnaires only. RESULTS: GF dietary adherence (CDAT) median scores significantly improved at 3 and 6 months after the telephone clinic compared with baseline (16, 13 and 13, respectively, p<0.01). Reassuringly, the dietary burden QoL score remained similar to baseline values. No change in CDAT scores were observed in the control group. Change in GF dietary knowledge score was associated with improved GF dietary adherence CDAT score (r=-0.22; p=0.039). At 9 and 12 months, CDAT scores were similar to baseline values. CONCLUSIONS: Telephone clinics have a positive impact on dietary knowledge and GF dietary adherence in adults with CD, promoting health-benefitting behaviours in those previously not adhering to a GF diet. The study highlights the need for patients to have regular follow-up, with targeted reviews for those not adhering to a GF diet.

A randomized controlled trial to isolate the effects of fasting and energy restriction on weight loss and metabolic health in lean adults.

Intermittent fasting may impart metabolic benefits independent of energy balance by initiating fasting-mediated mechanisms. This randomized controlled trial examined 24-hour fasting with 150% energy intake on alternate days for 3 weeks in lean, healthy individuals (0:150; n = 12). Control groups involved a matched degree of energy restriction applied continuously without fasting (75% energy intake daily; 75:75; n = 12) or a matched pattern of fasting without net energy restriction (200% energy intake on alternate days; 0:200; n = 12). Primary outcomes were body composition, components of energy balance, and postprandial metabolism. Daily energy restriction (75:75) reduced body mass (-1.91 ± 0.99 kilograms) almost entirely due to fat loss (-1.75 ± 0.79 kilograms). Restricting energy intake via fasting (0:150) also decreased body mass (-1.60 ± 1.06 kilograms; P = 0.46 versus 75:75) but with attenuated reductions in body fat (-0.74 ± 1.32 kilograms; P = 0.01 versus 75:75), whereas fasting without energy restriction (0:200) did not significantly reduce either body mass (-0.52 ± 1.09 kilograms; P ≤ 0.04 versus 75:75 and 0:150) or fat mass (-0.12 ± 0.68 kilograms; P ≤ 0.05 versus 75:75 and 0:150). Postprandial indices of cardiometabolic health and gut hormones, along with the expression of key genes in subcutaneous adipose tissue, were not statistically different between groups (P > 0.05). Alternate-day fasting less effectively reduces body fat mass than a matched degree of daily energy restriction and without evidence of fasting-specific effects on metabolic regulation or cardiovascular health.

Effects of peer influence on dietary intake and physical activity in schoolchildren.

OBJECTIVE: To investigate the dietary intake and physical activity of boys and girls aged 9-13 years, and the influence of peers on these behaviours. DESIGN: Cross-sectional study. SETTING: Nine primary and secondary schools in south-west London. SUBJECTS: A total of 315 children wore sealed pedometers, provided self-report measures of dietary intake and answered a questionnaire relating to peer influence. Anthropometric measures of height and weight were also obtained. RESULTS: Obese children had the lowest reported energy intakes and the lowest step counts per day. Boys took significantly more steps per day than girls, however girls were closer to achieving their recommended cut-offs for physical activity. Girls had lower energy intakes per day and lower BMI Z-scores than boys, however both genders, across all age groups, had higher than recommended intakes of saturated fat. There were significant associations between peer influence and physical activity levels but not between peer influence and dietary intake. CONCLUSIONS: Low energy intake and physical activity levels but high saturated fat intakes among boys and girls across all age groups highlight the importance of promoting both physical activity and healthy food choices. The finding that peers have a significant effect on physical activity levels but not on dietary intake offers an important approach for the design of health promotion interventions and obesity prevention programmes. Such designs may be particularly beneficial for obese youth, since the low physical activity levels found could be a major contributing factor to the maintenance of the condition.

Postprandial regulation of prouroguanylin in humans of a healthy weight and those who are overweight or with obesity.

Uroguanylin is a peptide gut hormone proposed to have a role in signalling post meal satiety. Uroguanylin circulates as its pro-hormone, prouroguanylin. There has been limited investigation of the regulation of prouroguanylin by food; therefore we investigated prouroguanylin regulation following meals. In separate experiments we investigated the effects of high calorie (1451 kcal) and medium calorie (725 kcal), high fat meals, on plasma prouroguanylin concentrations. We then examined the effect of a 722.5 kcal high carbohydrate breakfast on prouroguanylin concentrations, comparing the response in healthy weight adults versus those who are overweight/ with obesity. The 1451 kcal meal increased prouroguanylin concentrations, versus fasting at 60 (P < 0.05), 90 (P < 0.01) and 120 (P < 0.001) minutes. After the 725 kcal meal hormone concentrations rose more slowly and were significant versus fasting concentrations at 120 min (P < 0.01). The high carbohydrate breakfast 722.5 kcal, led to an initial suppression of hormone concentrations at 30 min. post meal (P < 0.05) followed by an increase in concentrations until they were significant versus fasting at 120 min. (P < 0.01). Participants overweight/ with obesity had lower fasting prouroguanylin concentrations (P < 0.05), but post meal concentrations did not differ between the groups. Our results suggest there is a delayed increase in prouroguanylin concentrations following, large and regular sized mixed macronutrient meals rich in fat or carbohydrate. Fasting levels are suppressed in people who are overweight/ with obesity, but the post meal response remains intact. There may be potential to target post meal release of prouroguanylin in obesity.

Dietary Intake, Body Composition, and Nutrition Knowledge of Irish Dancers.

Irish dance requires lengthy, intensive training to perform at a high level in competitions and professionally. Irish dancers have been known to have high injury rates. Appropriate nutrient and fluid intakes have been shown to minimize the risk of fatigue and injury during training and performance in sport, but there is a lack of evidence as to whether and how this might apply in Irish dance. Forty adult Irish dancers, 35 females (age 21 ± 3 years) and five males (aged 27 ± 8 years), professionals or in full time training, were recruited for this study to investigate nutrition knowledge, dietary intake, and body composition. Participants were asked to complete "The Sport Nutrition Questionnaire," a sport- and dance-specific nutrition knowledge questionnaire, 4 day estimated food diaries, and under-take a dual x-ray absorptiometry (DXA) scan to assess body composition. Food diaries were analyzed using Dietplan 7. Reported energy, fiber, iron (females), magnesium (females), selenium, iodine (females), and folate (females) intakes were below United Kingdom dietary reference values. Fruit and vegetable intakes were low: 2.7 ± 1.4 portions per day. Sixteen percent of days reported contained no fruits or vegetables. Mean body mass index (BMI) for 35 female participants was 23.2 ± 3.3 kg/m², mean BMI for five male participants was 22.2 ± 1.6 kg/m². Mean body fat measured by DXA in 18 female participants was 33.4% ± 6.9%, which was higher than seen in other dance populations. Mean lean mass was 40.8 ± 5.6 kg. Mean score for the nutrition knowledge questionnaire in which the maximum score is 65, was 30.5 ± 7.6 (47% ± 11.7%), range: 9 to 44 (14% to 68%). The ability of the Irish dancers to correctly identify foods as being high or low in carbohydrate, protein, and fat varied widely. Body composition did not correlate with intake of any nutrient but did correlate with nutrition knowledge questionnaire score (r = -.663, p < 0.001). Given the dietary intakes and nutrition knowledge exhibited by the dancers in this study, further work is needed to inform and improve diets and support the demands of Irish dance.

Effect of Plain Versus Sugar-Sweetened Breakfast on Energy Balance and Metabolic Health: A Randomized Crossover Trial.

OBJECTIVE: This study investigated the effect of 3 weeks of high-sugar ("Sweet") versus low-sugar ("Plain") breakfast on energy balance, metabolic health, and appetite. METHODS: A total of 29 healthy adults (22 women) completed this randomized crossover study. Participants had pre- and postintervention appetite, health, and body mass outcomes measured, and they recorded diet, appetite (visual analogue scales), and physical activity for 8 days during each intervention. Interventions were 3 weeks of isoenergetic Sweet (30% by weight added sugar; average 32 g of sugar) versus Plain (no added sugar; average 8 g of sugar) porridge-based breakfasts. RESULTS: Pre- to postintervention changes in body mass were similar between Plain (Δ 0.1 kg; 95% CI: -0.3 to 0.5 kg) and Sweet (Δ 0.2 kg; 95% CI: -0.2 to 0.5 kg), as were pre- to postintervention changes for biomarkers of health (all P ≥ 0.101) and psychological appetite (all P ≥ 0.152). Energy, fat, and protein intake was not statistically different between conditions. Total carbohydrate intake was higher during Sweet (287 ± 82 g/d vs. 256 ± 73 g/d; P = 0.009), driven more by higher sugar intake at breakfast (116 ± 46 g/d vs. 88 ± 38 g/d; P < 0.001) than post-breakfast sugar intake (Sweet 84 ± 42 g/d vs. Plain 80 ± 37 g/d; P = 0.552). Participants reported reduced sweet desire immediately after Sweet but not Plain breakfasts (trial × time P < 0.001). CONCLUSIONS: Energy balance, health markers, and appetite did not respond differently to 3 weeks of high- or low-sugar breakfasts.

The Nutritional Value of Children's Menus in Chain Restaurants in the United Kingdom and Ireland.

OBJECTIVE: Obesity in the United Kingdom and the Republic of Ireland is rising, as is the frequency of eating out in restaurants. The aim of this study was to investigate the nutritional quality of children's menus in restaurants. DESIGN: Cross-sectional review of menus aimed at children from 20 popular chain restaurants in the United Kingdom and Ireland. MAIN OUTCOME MEASURES: Total energy, fat, saturated fat, and salt were collected from every food item on the menu in each restaurant. All potential meal combinations were created. A total of 39,266 meals were analysed. ANALYSIS: Meals were compared with UK nutritional guidelines. Meals from fast food and full-service restaurants and main meals and meal deals were compared. RESULTS: The average meal for younger children (aged 2-5 years) contained 609 ±117 kcal, and for older children (6-12 years) 653 ± 136 kcal compared with guidelines of 364 and 550 kcal, respectively. A total of 68% of younger children's and 55% of older children's meals contained more total fat than recommended and more than 4 times the amount of saturated fat. Fast food restaurant meals contained less energy, fat, and salt than did full-service restaurants, and meal deals were less likely to meet dietary guidelines than were main meals alone. CONCLUSION AND IMPLICATIONS: Eating in chain restaurants, in particular meal deals, does not contribute positively to the diet of children in the United Kingdom and Ireland.