To examine whether the density of neighbourhood restaurants affected the frequency of eating restaurant meals and subsequently affected diet quality.

Cross-sectional and longitudinal designs. Structural equation models assessed the indirect relationship between restaurant density (≤3 miles (4·8 km) of participant addresses) and dietary quality (Healthy Eating Index 2010 (HEI)) via the frequency of eating restaurant meals, after adjustment for sociodemographics, select health conditions, region, residence duration and area-level income.

Urbanised areas in multiple regions of the USA, years 2000–2002 and 2010–2012.

Participants aged 45–84 years were followed for 10 years (n 3567).

Median HEI (out of 100) was fifty-nine at baseline and sixty-two at follow-up. The cross-sectional analysis found that residing in areas with a high density of restaurants (highest-ranked quartile) was associated with 52 % higher odds of frequently eating restaurant meals (≥3 times/week, OR: 1·52, 95 % CI 1·18, 1·98) and 3 % higher odds of having lower dietary quality (HEI lowest quartile < 54, OR: 1·03, 95 % CI 1·01, 1·06); associations were not sustained in longitudinal analyses. The cross-sectional analysis found 34 % higher odds of having lower dietary quality for those who frequently ate at restaurants (OR: 1·34, 95 % CI 1·12, 1·61), and more restaurant meals (over time increase ≥ 1 time/week) were associated with higher odds of having worse dietary quality at follow-up (OR: 1·21, 95 % CI 1·00, 1·46).

Restaurant density was associated with frequently eating out in cross-sectional and longitudinal analyses but was associated with the lower dietary quality only in cross-sectional analyses. Frequent restaurant meals were negatively related to dietary quality. Interventions that encourage less frequent eating out may improve population dietary quality.

To assess the frequency with which soft drinks and premiums are available with children’s meals marketed on the top restaurant chains’ websites worldwide.

Cross-sectional structured observational assessment of secondary information about top international restaurant chain children’s meals.

Websites of top restaurant chains for 193 countries and five regions of the United Nations.

Top restaurant chains (including McDonald’s, Subway, Burger King and KFC) across 193 countries. Children’s meal images and descriptions were reviewed to determine if the meal was marketed with a soft drink as a beverage option and whether the meal offered a premium.

Children’s meals were marketed online on restaurant websites by at least one of the four chains in a total of seventy eight of the 193 countries (40·4 %). Overall, 56·3 % of countries with any online children’s meal marketing by the four chains included at least one chain that marketed soft drinks and 92·3 % marketed premiums with the meal.

Every region in the world includes marketing of children’s meals on the websites of the top restaurant chains. The high prevalence of premiums marketed online with children’s meals is of concern. Similarly, with over 50 % of countries with online children’s meal marketing having at least one chain that offers soft drinks as part of the meals, additional regulation and education may be warranted.

Whole-grain intake among children is well below recommendations. The purpose of the present study was to test the acceptability and liking of pizza made with whole-grain crust compared with refined-grain crust among children in restaurant and school settings.

Plate waste data were collected via observation from child restaurant patrons consuming pizza made with either whole-grain or refined-grain crust. Waste was estimated by trained observers over eight months (August 2012–March 2013). Percentage waste was calculated and compared by crust type. A taste test was conducted with school children who tasted pizza made with whole-grain crust alongside pizza made with refined-grain crust and rated their liking of each product. Liking ratings were compared by crust type.

Five Green Mill restaurant (a Midwest US chain) locations and one elementary school in the Minneapolis/St. Paul metropolitan area, Minnesota, USA.

Child restaurant patrons (n 394) and school children (n 120, grades 3–5).

Children consumed as much of the pizza made with whole-grain crust (42·1 %) as the pizza made with refined-grain crust (44·6 %; P=0·55), based on an average serving size of 350–400 g. Liking ratings for both types of pizza were high (>4·5 of 5) and did not differ by crust type (P=0·47).

These positive consumption and liking outcomes indicate that whole-grain pizza crust is well accepted among children in a restaurant setting. The impact on whole-grain intake could be substantial if large, national restaurant chains served pizza made with whole-grain crust.