Public Health Nutrition

Research Paper

Eating out of home and its correlates in 10 European countries. The European Prospective Investigation into Cancer and Nutrition (EPIC) study

Philippos Orfanosa1, Androniki Naskaa1, Dimitrios Trichopoulosa2, Nadia Slimania3, Pietro Ferraria3, Marit van Bakela3, Genevieve Deharvenga3, Kim Overvada4, Anne Tjønnelanda5, Jytte Halkjæra5, Maria Santucci de Magistrisa6, Rosario Tuminoa7, Valeria Palaa8, Carlotta Sacerdotea9, Giovanna Masalaa10, Guri Skeiea11, Dagrun Engeseta11, Eiliv Lunda11, Paula Jakszyna12, Aurelio Barricartea13, Maria-Dolores Chirlaquea14, Carmen Martinez-Garciaa15, Pilar Amianoa16, J Ramon Quirósa17, Sheila Binghama18, Ailsa Welcha18, Elizabeth A Spencera19, Timothy J Keya19, Sabine Rohrmanna20, Jakob Linseisena20, Jennifer Raya21, Heiner Boeinga21, Petra H Peetersa22, H Bas Bueno-de-Mesquitaa23, Marga Ockea23, Ingegerd Johanssona24, Gerd Johanssona25, Göran Berglunda26, Jonas Manjera26, Marie-Christine Boutron-Ruaulta27, Mathilde Touviera27, Françoise Clavel-Chapelona27 and Antonia Trichopouloua1 c1

a1 Department of Hygiene and Epidemiology, University of Athens Medical School, 75 Mikras Asias Street, Athens 11527, Greece

a2 Hellenic Health Foundation, Greece

a3 Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France

a4 Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aarhus, Denmark

a5 Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark

a6 Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy

a7 Cancer Registry, Azienda Ospedaliera Civile–MP Arezzo, Ragusa, Italy

a8 Nutritional Epidemiology Unit, National Cancer Institute, Milan, Italy

a9 CPO–Piemonte, Torino, Italy

a10 Molecular and Nutritional Epidemiology Unit, CSPO–Scientific Institute of Tuscany, Florence, Italy

a11 Institute of Community Medicine, University of Tromsø, Norway

a12 Department of Epidemiology and Cancer Registry, Catalan Institute of Oncology, Barcelona, Spain

a13 Public Health Institute of Navarra, Pamplona, Spain

a14 Epidemiology Department, Murcia Health Council, Spain

a15 Andalusian School of Public Health, Granada, Spain

a16 Department of Public Health of Gipuzkoa, Donostia-San Sebastian, Spain

a17 Public Health & Health Planning Directorate, Asturias, Spain

a18 MRC Dunn Human Nutrition Unit, Cambridge, UK & MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge, UK

a19 Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, UK

a20 Division of Clinical Epidemiology, German Cancer Research Centre, Heidelberg, Germany

a21 Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany

a22 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands

a23 Cancer Epidemiology Centre for Nutrition and Health, National Institute of Public Health and the Environment, Bilthoven, The Netherlands

a24 Departments of Odontology/Section of Cardiology and Public Health and Medicine/Section of Nutritional Research, Umeå University, Sweden

a25 Department of Public Health and Medicine/Section of Nutritional Research, Umeå University, Sweden

a26 Malmö Diet and Cancer Study, University Hospital, Malmö, Sweden

a27 Institute Gustave Roussy, E3N-EPIC Group, INSERM, Villejuif, France


Objective To compare the average out-of-home (OH) consumption of foods and beverages, as well as energy intake, among populations from 10 European countries and to describe the characteristics of substantial OH eaters, as defined for the purpose of the present study, in comparison to other individuals.

Design Cross-sectional study. Dietary data were collected through single 24-hour dietary recalls, in which the place of consumption was recorded. For the present study, substantial OH eaters were defined as those who consumed more than 25% of total daily energy intake at locations other than the household premises. Mean dietary intakes and the proportion of substantial OH eaters are presented by food group and country. Logistic regression analyses were used to estimate the odds of being a substantial OH eater in comparison to not being one, using mutually adjusted possible non-dietary determinants.

Setting Ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Subjects The subjects were 34 270 individuals, 12 537 men and 21 733 women, aged 35–74 years.

Results The fraction of energy intake during OH eating was generally higher in northern European countries than in the southern ones. Among the food and beverage groups, those selectively consumed outside the home were coffee/tea/waters and sweets and, to a lesser extent, cereals, meats, added lipids and vegetables. Substantial OH eating was positively associated with energy intake and inversely associated with age and physical activity. Substantial OH eating was less common among the less educated compared with the more educated, and more common during weekdays in central and north Europe and during the weekend in south Europe.

Conclusions Eating outside the home was associated with sedentary lifestyle and increased energy intake; it was more common among the young and concerned in particular coffee/tea/waters and sweets.

(Received November 13 2006)

(Accepted February 21 2007)


c1 Corresponding author: Email