Healthiness of US Chain Restaurant Meals in 2017

doi:10.1016/j.jand.2020.01.006

Journal of the Academy of Nutrition and Dietetics

Volume 120, Issue 8, August 2020, Pages 1359-1367

https://doi.org/10.1016/j.jand.2020.01.006 Get rights and content

Abstract

Background

Given the popularity of restaurants as a meal source in the United States, it is important to understand the healthiness of their offerings.

Objective

This study’s purpose was to examine the healthiness of meals at national US chain restaurants in 2017 using the American Heart Association’s (AHA) Heart-Check meal certification criteria.

Design

Data for this cross-sectional study were obtained from MenuStat, an online database that includes nutrition information for menu items from the 100 restaurant chains with the largest sales in the United States in 2017. All possible meal combinations (meals defined as including an entrée and side item) were created at the 73 restaurants that reported nutrition information aligning with the AHA criteria: calories, total fat, saturated fat, trans fat, cholesterol, sodium, protein, and fiber.

Main outcomes measure

Healthy meal (0=did not meet AHA criteria; 1=did meet AHA criteria).

Statistical analyses performed

We used χ² tests to compare the percent of restaurant meals and meal components compliant with each AHA criterion and the percent of restaurant meals and meal components meeting varying numbers of AHA criteria across restaurant service types (ie, fast food, full service, fast casual).

Results

Among all restaurants, the median calories, total fat, saturated fat, cholesterol, and sodium of meals exceeded the AHA criteria. Fewer than 20% of meals met the saturated fat and sodium criteria; 22% of restaurant meals met zero to one AHA criteria, 50% met two to four AHA criteria, 20% met five to six AHA criteria, and 8% met all seven AHA criteria.

Conclusions

Given the popularity of restaurants as a source of meals, efforts are needed to improve the healthiness of restaurant meals.

Section snippets

Data

This study was deemed exempt by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board. Data were obtained from MenuStat, an online database that includes nutrition information for menu items from the 100 restaurant chains with the highest sales in the United States each year. This study used data for calendar year 2017.²⁵

Menu items in the MenuStat database are sourced annually from restaurant websites. Restaurants must post nutrition information online to be included in

Results

Table 1 shows the median and range of nutrients in the 175,937 restaurant meals analyzed, among all restaurants and stratified by service type. Among meals at all restaurants, the median calories, total fat, saturated fat, cholesterol, and sodium surpassed the AHA criteria. Median protein was over nine times the AHA criteria threshold. Full-service restaurants had the highest median meal calories (820 calories), fat (42 g), cholesterol (125 mg), and sodium (2,000 mg) relative to other

Discussion

This study reports the results of the first national study of the healthiness of US restaurant meals, based on the AHA criteria. Although some differences were found in the healthiness of restaurant meals and meal components at fast-food, full-service, and fast-casual restaurants, less than 10% of meals at each restaurant service type met all seven AHA criteria. These findings suggest that efforts to improve the healthiness of restaurant meals should target fast-casual and full-service as well

Conclusions

Given the popularity of dining out and the health risks associated with poor diet, it is important to understand the healthiness of US restaurant meals. More than half of US restaurant meals in 2017 did not meet the AHA criteria for calories, total fat, saturated fat, cholesterol, and sodium. Only 8% of restaurant meals met all seven of the AHA criteria. Given the high burden of obesity and other chronic conditions in the United States and the high prevalence of meals consumed at chain

Acknowledgements

We thank the New York City Department of Health and Mental Hygiene for the MenuStat data.

Author Contributions

All authors contributed to the design of the study. E. Alexander led secondary data analysis and manuscript writing. E. E. McGinty, L. Rutkow, K. A. Gudzune, and J. E. Cohen contributed revisions to the manuscript and approved the final manuscript for submission.

E. Alexander is a PhD candidate, Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

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E. Alexander is a PhD candidate, Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

L. Rutkow is a professor, Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

E. E. McGinty is an associate professor, Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

J. E. Cohen is a professor, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

K. A. Gudzune is an associate professor, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.

: STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

: FUNDING/SUPPORT There is no funding to disclose.

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ResearchOriginal Research: BriefHealthiness of US Chain Restaurant Meals in 2017

Abstract

Background

Objective

Design

Main outcomes measure

Statistical analyses performed

Results

Conclusions

Section snippets

Data

Results

Discussion

Conclusions

Acknowledgements

Author Contributions

J Acad Nutr Diet

J Acad Nutr Diet

J Acad Nutr Diet

Am J Prev Med

Am J Prev Med

Prev Med

Am J Prev Med

Am J Prev Med

Am J Prev Med

J Nutr Educ Behav

Am J Prev Med

Am J Prev Med

J Acad Nutr Diet

Am J Prev Med

Adult obesity facts

Diet

Americans’ dining-out frequency little changed from 2008. Gallup, Inc

The food environment, eating out, and body weight: A review of the evidence. USDA

Consumption frequency of foods away from home linked with higher body mass index and lower fruit and vegetable intake among adults: A cross-sectional study

J Environ Public Health

Fast-food and full-service restaurant consumption and daily energy and nutrient intakes in US adults

Eur J Clin Nutr

Research
Original Research: Brief
Healthiness of US Chain Restaurant Meals in 2017