Eating out intensity, ultra-processed foods and body mass index among Albanian youth.

OBJECTIVE Ultra-processed foods (UPFs) and eating out of home (OH) are changing nutrition, particularly among youth in constrained settings. We aimed to assess the role of eating OH intensity on the associations of UPFs and unprocessed/minimally processed foods (UMPFs) with body mass index (BMI) among Albanian youth. DESIGN Cross-sectional. SETTING Albania, a south-eastern European country. PARTICIPANTS 281 youth, predominantly females. METHODS UPFs and UMPFs were defined based on NOVA, while eating OH intensity based on energy percentage from OH foods. Multivariable models tested associations of UPFs and UMPFs with BMI stratified by eating OH intensity, controlled for relevant covariates including diet quality, portion size and costs. RESULTS The respondents age ranged between 18-23 years with a female predominance(87.5%). Mean energy from UPFs and UMPFs was 846(SD:573.0) and 802.9(422.5)kcals, respectively. Among substantial at home eaters UPF intake was not associated (β=-0.07,95%CI:-0.13;0.267) with BMI, however UMPFs negatively associated with BMI (β=-0.24,95%CI:-0.43;-0.06). Among those defined as substantial out of home eaters, UPFs (β=0.24, 95%CI:0.08;0.40) and UMPFs (β=0.18,95%CI:0.04;0.33) were positively associated with BMI. CONCLUSIONS Our findings provide evidence for the hypothesis that eating OH plays an important role in the association of UPFs and UMPFs with BMI in youth. While causality cannot be established due to cross-sectional design, to the best of our knowledge, we provide the first assessment of UPFs and UMPFs intake in a south-eastern European setting, while highlighting the need for establishing and integrating youth nutrition into national nutritional surveillance systems for key dietary risk factors in Albania.