Measured energy content of frequently purchased restaurant meals: multi-country cross sectional study

Authors: ROBERTS, SUSUAN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; DAS, SAI KRUPA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; SUEN, VIVIEN - Universidad De Sao Paulo; PIHLAJAMAKI, JUSSI - University Of Eastern Finland; KURIYAN, REBECCA - St John'S National Academy Of Health Sciences; STEINER-ASIEDU, MATILDA - University Of Ghana; TAETZSCH, AMY - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; ANDERSON, ALEX - University Of Georgia; SILVER, RACHEL - Tufts University; BARGER, KATHRYN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; KRAUSS, AMY - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; KARHUNEN, LEILA - University Of Eastern Finland; ZHANG, XUEYING - Chinese Academy Of Sciences; HAMBLY, CATHERINE - University Of Aberdeen; SCHWAB, URSULA - University Of Eastern Finland; MELO, ANDRESA - Universidade De Ribeirao Preto; FASSINI, PRISCILLA - Universidad De Sao Paulo; TAYLOR, SALIMA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; ECONOMOS, CHRISTINA - Tufts University; KURPAD, ANURA - St John'S National Academy Of Health Sciences; SPEAKMAN, JOHN - University Of Aberdeen

Submitted to: British Medical Journal
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/28/2018
Publication Date: 12/12/2018
Citation: Roberts, S., Das, S., Suen, V.M., Pihlajamaki, J., Kuriyan, R., Steiner-Asiedu, M., Taetzsch, A.G., Anderson, A.K., Silver, R.E., Barger, K., Krauss, A.J., Karhunen, L., Zhang, X., Hambly, C., Schwab, U., Melo, A.T., Fassini, P.G., Taylor, S.F., Economos, C., Kurpad, A.V., Speakman, J.R. 2018. Measured energy content of frequently purchased restaurant meals: multi-country cross sectional study. British Medical Journal. 363:k4864. https://doi.org/10.1136/bmj.k4864.
DOI: https://doi.org/10.1136/bmj.k4864

Interpretive Summary: This multi-country study provides unique information on the measured energy content of popular meals from 80 randomly selected full-service and fast-food restaurants in five countries (Brazil, China, Finland, Ghana and India) and five worksite canteens in Finland. Data are compared to existing information from the U.S. Only restaurants in China served meals containing significantly less energy than restaurants in the U.S. In Finland, worksite canteens served meals with lower energy content than other commercial establishments. In addition, and in contrast to widespread assumptions, fast-food meals contained 15% less dietary energy on average compared to meals from full-service restaurants. The high energy content of both full-service and fast-food restaurant meals is a widespread global phenomenon that may be an important contributor to the global obesity epidemic and a potentially impactful target for public health interventions.

Technical Abstract: Objective: Fast-food has been implicated in high rates of global obesity but there is little information on meal energy contents from other types of restaurants. This study measured the energy contents of frequently-ordered meals from full-service and fast-food restaurants in five countries and compared values to U.S. data. Design: Observational study. Setting: The most frequently-ordered meals in 80 randomly selected full-service and fast-food restaurants serving popular cuisines in Brazil, China, Finland, Ghana, and India, and in five worksite canteens in Finland. Methods: Meal energy content was measured by bomb calorimetry. Data were compared to information from comparable U.S. restaurants using estimated least squares means from an ANOVA model. Predictors of energy content were evaluated in a factorial ANOVA. Contributions of meals to typical energy requirements were modelled. Main outcome measure: Meal energy content. Results: Compared to the U.S., weighted mean restaurant meal energy was lower only in China, 619 kcal (95% confidence interval 557 to 687) versus 1088 kcal (1002 to 1181; P<0.001). In regression models, fast-food contained 15% less energy than full-service meals (P=0.002). In Finland, worksite canteens provided 25% less energy than full-service and fast-food restaurants (880+/-156 versus 1166+/-298; P=0.009). Country, restaurant type, number of meal components and meal weight predicted meal energy content in a multivariable model (R^2=0.64, P<0.001). 84% of full-service meals and 77% of fast-food meals contained >/= 600 kcal. Modelling indicated that, except in China, consuming current servings of a full-service entree and a fast-food meal daily would supply between 70 and 120% of the daily energy requirements of a sedentary women, (depending on the country) without additional meals, drinks, snacks, appetizers or desserts. Conclusion: Very high dietary energy content of both fast-food and full-service restaurant meals is a widespread phenomenon that is probably contributing to global obesity and provides a valid intervention target for widespread use.