Healthiness of US Chain Restaurant Meals in 2017.

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 χ 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.