title: Association between home and school food environments and dietary patterns among 9-11-year-old children in 12 countries.
abstract: OBJECTIVE
  We investigated the roles of home and school environments on dietary patterns among children from 12 countries differing widely in geographic region and levels of human and economic development.
  
  
  METHODS
  The sample included a total of 6685 (54% girls) 9-11-year-old children. Parents/guardians reported the availability of certain foods in the home, and trained researchers performed school audits recording the availability of foods for sale at schools. Foods were then divided into wholesome (nutrient-dense) and empty-calorie (nutrient-poor) foods and scored according to their availability. Children reported if their school provided school lunch and how many times during the last week they had eaten meals prepared away from home and school. Via principal components analysis, data-driven dietary pattern scores were calculated from food frequency questionnaires. Multilevel models were used to study the associations between home and school food environments (wholesome and empty-calorie foods) and dietary patterns (healthy and unhealthy diet pattern scores).
  
  
  RESULTS
  For low unhealthy diet pattern scores, low availability of empty-calorie foods at home was found to be more important than high availability of wholesome foods. More meals eaten outside home and school were associated with the higher unhealthy diet pattern scores. The availability of wholesome foods at home was positively associated with the healthy diet pattern scores. Food availability at school was not associated with the dietary patterns.
  
  
  CONCLUSIONS
  In this sample, the home food environment was more significant than the school food environment in predicting the dietary patterns. The availability of empty-calorie foods was associated with the unhealthy dietary pattern even when the availability of wholesome foods at home was high. Meals prepared away from home contributed to the unhealthy dietary pattern. Therefore, parents should be encouraged to limit the availability of empty-calorie foods and eating outside the home.
authors.affiliation: Department of Food and Environmental Sciences, Division of Nutrition, University of Helsinki , Helsinki, Finland.
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authors.initials: H
authors.lastname: Vepsäläinen
authors.affiliation: Department of Food and Environmental Sciences, Division of Nutrition, University of Helsinki , Helsinki, Finland.
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authors.lastname: Mikkilä
authors.affiliation: Department of Food and Environmental Sciences, Division of Nutrition, University of Helsinki , Helsinki, Finland.
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authors.lastname: Erkkola
authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, LA, USA.
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authors.initials: ST
authors.lastname: Broyles
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
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authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, LA, USA.
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authors.affiliation: St. Johns Research Institute , Bangalore, India.
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authors.initials: R
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authors.affiliation: St. Johns Research Institute , Bangalore, India.
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authors.initials: EV
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authors.affiliation: Alliance for Research In Exercise Nutrition and Acticity (ARENA), School of Health Sciences, University of South Australia , Adelaide, South Australia, Australia.
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authors.lastname: Maher
authors.affiliation: CIFI2D, Faculdade de Desporto, University of Porto , Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Maia
authors.affiliation: Centro de Estudos do Laboratório de Aptidão Física de São Caetano do Sul , Sao Paulo, Brazil.
authors.forename: V
authors.initials: V
authors.lastname: Matsudo
authors.affiliation: Alliance for Research In Exercise Nutrition and Acticity (ARENA), School of Health Sciences, University of South Australia , Adelaide, South Australia, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Olds
authors.affiliation: Department of Recreation Management and Exercise Science, Kenyatta University , Nairobi, Kenya.
authors.forename: V
authors.initials: V
authors.lastname: Onywera
authors.affiliation: School of Medicine, Universidad de los Andes , Bogota, Colombia.
authors.forename: O L
authors.initials: OL
authors.lastname: Sarmiento
authors.affiliation: Department for Health, University of Bath , Bath, UK.
authors.forename: M
authors.initials: M
authors.lastname: Standage
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors.forename: M S
authors.initials: MS
authors.lastname: Tremblay
authors.affiliation: Pennington Biomedical Research Center, Baton Rouge, LA, USA; Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Tudor-Locke
authors.affiliation: Tianjin Women's and Children's Health Center , Tianjin, China.
authors.forename: P
authors.initials: P
authors.lastname: Zhao
authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, LA, USA.
authors.forename: T S
authors.initials: TS
authors.lastname: Church
authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, LA, USA.
authors.forename: P T
authors.initials: PT
authors.lastname: Katzmarzyk
authors.affiliation: Department of Food and Environmental Sciences, Division of Nutrition, University of Helsinki , Helsinki, Finland.
authors.forename: M
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authors.lastname: Fogelholm