title: The association of fast food consumption with poor dietary outcomes and obesity among children: is it the fast food or the remainder of the diet?
abstract: BACKGROUND
  Although fast food consumption has been linked to adverse health outcomes, the relative contribution of fast food itself compared with the rest of the diet to these associations remains unclear.
  
  
  OBJECTIVE
  Our objective was to compare the independent associations with overweight/obesity or dietary outcomes for fast food consumption compared with dietary pattern for the remainder of intake.
  
  
  METHODS
  This cross-sectional analysis studied 4466 US children aged 2-18 y from NHANES 2007-2010. Cluster analysis identified 2 dietary patterns for the non-fast food remainder of intake: Western (50.3%) and Prudent. Multivariable-adjusted linear and logistic regression models examined the association between fast food consumption and dietary pattern for the remainder of intake and estimated their independent associations with overweight/obesity and dietary outcomes.
  
  
  RESULTS
  Half of US children consumed fast food: 39.5% low-consumers (≤30% of energy from fast food) and 10.5% high-consumers (>30% of energy). Consuming a Western dietary pattern for the remainder of intake was more likely among fast food low-consumers (OR: 1.51; 95% CI: 1.24, 1.85) and high-consumers (OR: 2.21; 95% CI: 1.60, 3.05) than among nonconsumers. The remainder of diet was independently associated with overweight/obesity (β: 5.9; 95% CI: 1.3, 10.5), whereas fast food consumption was not, and the remainder of diet had stronger associations with poor total intake than did fast food consumption.
  
  
  CONCLUSIONS
  Outside the fast food restaurant, fast food consumers ate Western diets, which might have stronger associations with overweight/obesity and poor dietary outcomes than fast food consumption itself. Our findings support the need for prospective studies and randomized trials to confirm these hypotheses.
authors.affiliation: Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC (JMP, KJD, and BMP), and the Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA (KJD).
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Poti
authors.forename: Kiyah J
authors.initials: KJ
authors.lastname: Duffey
authors.forename: Barry M
authors.initials: BM
authors.lastname: Popkin
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D004032:Diet; D002149:Energy Intake; D057140:Fast Foods / Q000009:adverse effects*; D005247:Feeding Behavior; D006801:Humans; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009749:Nutrition Surveys; D009765:Obesity / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012044:Regression Analysis; D012147:Restaurants; D012959:Socioeconomic Factors