Objective Evidence for effective food environment interventions to improve the quality of out-of-home foods is limited in Asia. The Healthier Dining Programme (HDP) is a voluntary government programme designed to increase the availability and accessibility of healthier foods and beverages at eateries in Singapore, a multi-ethnic, urbanized and developed nation. The objective of our study was to evaluate effects of the HDP on the out-of-home dietary intakes of consumers at an institute of higher

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... learning. Design/Setting: We used a cluster-randomized trial design. Six food centers (two food courts and four canteens) at a large university campus were randomly assigned to the intervention or control arm. Participants were university students or staff aged ≥ 18 years (n = 408) who frequently dined at these six food centers. Relevant data were gathered by interview and a 7-day food diary before and after 10 weeks of the intervention. Generalized estimating equations for logistic and linear regression were used to assess the difference in intake of out-of-home healthier dishes between the two study arms. Results Participants in the intervention arm were more likely to have at least one healthier out-of-home dish per week as compared to those in the control arm (84% vs. 65%, unadjusted OR: 2.79 95% CI: 1.59, 4.88). This was due mainly to the higher consumption of dishes prepared with healthier oil blends (unadjusted OR: 3.24 95% CI: 1.95, 5.38) and lower-sodium salt (unadjusted OR: 4.36 95% CI: 1.64, 11.58) in the intervention arm. Whilst saturated and polyunsaturated fat intake in the two arms were comparable, participants in the intervention arm had lower total fat (-1.27 g/1000 kcal, 95% CI: -2.48, -0.06) and monounsaturated fat intakes (-0.50 g/1000 kcal, 95% CI: -0.94, -0.06), from out-of-home dishes as compared with the control arm. Conclusions These findings suggest that environmental interventions at institutes of higher learning to increase healthier food availability and accessibility can improve dietary intake from out-of-home foods.