Because of the prevalence of eating out, the connection between fast food consumption and disease risk has garnered widespread attention.1 However, less attention has been given to the disease-promoting potential of meals from sit-down restaurants (referred to as “SDRs” and defined by the presence of table service), which account for a larger share of total away-from-home food spending and whose share is expected to rise over the next decade.2
To our knowledge, no study has systematically documented the nutrient levels in meals from SDRs. In particular, nutrients of concern include calories, fat, saturated fat, and sodium, whose excess consumption is associated with obesity, hypertension, heart disease, diabetes and, cancer.3,4 The objective of this study was to analyze the nutritional profile of breakfast, lunch, and dinner meals from SDRs.
Twenty-six chain sit-down restaurants that provided Canadian nutrition information online and had 10 or more locations were identified using the 2010 Directory of Restaurant and Fast Food Chains in Canada.5 Menus were retrieved from the restaurant websites in 2012. All breakfast, lunch, and dinner meals whose constituents were present in the University of Toronto restaurant nutrition database (constructed in 2010-2011) were included. Seven restaurants were excluded because more than 60% of their meals could not be calculated using the database. The nutritional profile of every potential meal combination (entree, plus side dish[es] and sauces that are customarily served with the meal) was calculated. With a few minor exceptions, the majority of “upgrades” that cost extra (such as upgrading from regular fries to sweet potato fries) were excluded.
In total, 3507 different variations of 685 meals, as well as 156 desserts from 19 SDRs, were included. Data were weighted so that meals with many different variations were not overrepresented. Nutrient values were calculated as a percentage of the daily value (%DV).6 Descriptive statistics were calculated for calories, fat, saturated fat, trans fat, cholesterol, sodium, percentage of total calories derived from fat, and the percentage of total fat derived from saturated fats using SAS version 9.3 software (SAS Institute Inc).
On average, breakfast, lunch, and dinner meals from 19 chain SDRs contained 1128 calories (56% of the average daily 2000 calorie recommendation), 151% of the amount of sodium an adult should consume in a single day (2269 mg), 89% of the daily value for fat (58 g), 83% of the daily value for saturated and trans fat (16 g of saturated fat and 0.6 g of trans fat), and 60% of the daily value for cholesterol (179 mg) (Table).
With respect to sodium, more than 80% of meals exceeded the daily adequate intake level (1500 mg), with more than 50% exceeding the daily upper tolerable intake level (2300 mg). Only 1% of meals had less than 600 mg of sodium, the “healthy level” for meals, according to the Food and Drug Administration.7 Almost 50% of meals exceeded the daily value for fat (65 g) and 25% exceeded the daily value for saturated fat and cholesterol.
Furthermore, a dessert, if ordered, would add an additional 549 calories, 27 g of fat (43%DV), 13 g of saturated fat, 0.6 g of trans fat (68%DV), and 46 g of sugar.
Meals identified by the restaurants as being “healthy” contained on average 474 calories, 13 g of fat (20%DV), 3 g of saturated fat (17%DV), and 752 mg of sodium (50% of the daily adequate intake level).
This study presents the average nutrient levels in a variety of different breakfast, lunch, and dinner meals from the major SDR chains. On average, meals contained more than a full day’s worth of sodium and nearly a day’s worth of fat and saturated fat.
The high level of saturated fat is worrisome because according to the Institute of Medicine, intakes of saturated fat should be kept as low as possible.3 Furthermore, though recommendations suggest that approximately 20% to 35% of energy should come from fat; in this study, 45% was derived from fat.3
On a positive note, the results showed that trans fat levels were commendably low. Furthermore, meals advertised as being “healthy” were substantially healthier compared with average meals.
At present there is no data on the nutritional profile of meals from SDRs. Previous research on meals purchased from fast food chains reported an average of 1751 mg of sodium and 881 calories,8 which is lower than the levels seen in SDR meals in this study.
Limitations include the fact that the data represented meals available in restaurants and did not reflect actual meals consumed by restaurant patrons. Furthermore, beverages, appetizers, and condiments that are often added by the consumer, and would further increase intake levels, were not accounted for.
Overall, the results of this study demonstrate that calorie, fat, saturated fat, and sodium levels are alarmingly high in breakfast, lunch, and dinner meals from multiple chain SDRs. Therefore, addressing the nutritional profile of restaurant meals should be a major public health priority.
Corresponding Author: Dr L’Abbe, Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, 150 College St, FitzGerald Building, Room 315, Toronto, ON M5S 3E2, Canada (email@example.com).
Published Online: May 13, 2013. doi:10.1001/jamainternmed.2013.6159.
Author Contributions: Ms Scourboutakos and Dr L’Abbe had full access to all of the data in the study and take full responsibility for the integrity and accuracy of the data analysis.
Study concept and design: Scourboutakos and L’Abbe.
Acquisition of data: Scourboutakos and Semnani-Azad.
Analysis and interpretation of data: Scourboutakos, Semnani-Azad, and L’Abbe.
Drafting of the manuscript: Scourboutakos.
Critical revision of the manuscript for important intellectual content: Scourboutakos, Semnani-Azad, and L’Abbe.
Statistical analysis: Scourboutakos and Semnani-Azad.
Obtained funding: L’Abbe.
Study supervision: L’Abbe.
Conflict of Interest Disclosures: None reported.
Funding/Support: Funding was provided by the Canadian Institutes of Health Research (CIHR) Strategic Training Program in Public Health Policy (Ms Scourboutakos); CIHR/Canadian Stroke Network Operating Grant Competition 201103SOK (Dr L’Abbe); and University of Toronto Earle W. McHenry Chair unrestricted research grant (Dr L’Abbe).
Additional Contributions: Wendy Lou, PhD, assisted with statistical analysis.
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