Introduction

Prev Chronic Dis

PCD

Preventing Chronic Disease

1545-1151

Centers for Disease Control and Prevention

25551184

4283359

14_0202

10.5888/pcd11.140202

Original Research

Peer Reviewed

Temporal Trends in Fast-Food Restaurant Energy, Sodium, Saturated Fat, and Trans Fat Content, United States, 1996–2013

Urban

Lorien E.

PhDRoberts

Susan B.

PhDFierstein

Jamie L.

MSGary

Christine E.

MSLichtenstein

Alice H.

DScAuthor Affiliations: Lorien E. Urban, Susan B. Roberts, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; Jamie L. Fierstein, Christine E. Gary, Freidman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.

Corresponding Author: Alice H. Lichtenstein, DSc, Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St, Boston, MA 02111. Telephone: 617-556-3127. E-mail: alice.lichtenstein@tufts.edu.

2014

31122014

E229

Introduction

Excess intakes of energy, sodium, saturated fat, and trans fat are associated with increased risk for cardiometabolic syndrome. Trends in fast-food restaurant portion sizes can inform policy decisions. We examined the variability of popular food items in 3 fast-food restaurants in the United States by portion size during the past 18 years.

Methods

Items from 3 national fast-food chains were selected: French fries, cheeseburgers, grilled chicken sandwich, and regular cola. Data on energy, sodium, saturated fat, and trans fat content were collated from 1996 through 2013 using an archival website. Time trends were assessed using simple linear regression models, using energy or a nutrient component as the dependent variable and the year as the independent variable.

Results

For most items, energy content per serving differed among chain restaurants for all menu items (P ≤ .04); energy content of 56% of items decreased (β range, −0.1 to −5.8 kcal) and the content of 44% increased (β range, 0.6–10.6 kcal). For sodium, the content of 18% of the items significantly decreased (β range, −4.1 to −24.0 mg) and the content for 33% increased (β range, 1.9–29.6 mg). Absolute differences were modest. The saturated and trans fat content, post-2009, was modest for French fries. In 2013, the energy content of a large-sized bundled meal (cheeseburger, French fries, and regular cola) represented 65% to 80% of a 2,000-calorie-per-day diet, and sodium content represented 63% to 91% of the 2,300-mg-per-day recommendation and 97% to 139% of the 1,500-mg-per-day recommendation.

Conclusion

Findings suggest that efforts to promote reductions in energy, sodium, saturated fat, and trans fat intakes need to be shifted from emphasizing portion-size labels to additional factors such as total calories, frequency of eating, number of items ordered, menu choices, and energy-containing beverages.

Introduction

Excess intakes of energy, sodium, saturated fat, and trans fat are associated with elevated risk for cardiometabolic disorders (1–3). For this reason, Dietary Guidelines for Americans (1) and health advocacy organizations (4–6) recommend limiting intakes and maintaining a healthy weight. Nevertheless, intakes of these nutrients exceed recommendations (1–7).

The contribution of away-from-home foods to total energy has nearly doubled in the past 30 years, rising from 18% in 1977 to 33% in 2010 (8,9), and fast food in particular has historically contributed a disproportional amount of dietary sodium, saturated fat, and trans fat (10–12), making these foods a target for modification. Although there has been progress in this area, including an increase in the number of “healthier” offerings, sales for the most frequently ordered items from fast-food restaurants remain strong (15).

One area that has gained attention is the portion size (ie, amount served to customer) of frequently ordered items. Between 1998 and 2006, fast-food retailers attempted to minimize publicizing the issue of changing portion sizes by redesignating sizing (eg, medium renamed small), which resulted in an increase of portion sizes in absolute terms (13). Little information exists for trends in the energy content of fast-food items since 2006 or trends in the amounts of sodium, saturated fat, and trans fat in fast-food menu items over time. These data are important because, in addition to changes in menu options, they can be used as an indicator of whether foods as served outside the home have been modified to be consistent with population-wide dietary guidance. They also provide a basis on which to evaluate industry trends and provide data to inform public health campaigns and clinical programs designed to promote improvements in dietary patterns.

Our aim was to collate available data for energy, saturated fat, trans fat, and sodium for some of the most frequently ordered fast-food items from 3 national fast-food chains by portion size and describe trends over a 18-year period from 1996 through 2013.

Methods

Three fast-food chain restaurants (designated Chain A, Chain B, and Chain C) were selected as examples on the basis of their offering similar menu items, having a national presence, and being in the top 10 for total US sales revenue (14). Chain A was identified as the top restaurant on the basis of sales; the other restaurants were then chosen according to the criteria described above. The most commonly ordered menu items offered according to a recent report (15) included French fries (fried potatoes; small, medium, and large), cheeseburger (approximately 2 oz and 4 oz, uncooked beef weight), grilled chicken sandwich (1 available size), and regular cola drink (small, medium, and large). To obtain objective and complete information, the Wayback Machine (http://www.archive.org/web/web.php) was used to collate data for energy (kcal/portion), sodium (mg/portion), saturated fat (g/portion), and trans fat (g/portion). The Wayback Machine is a publicly available web archive database that includes information, in this case, from company websites. For the 4% of data not available from the Wayback Machine website, nutrition information was obtained directly from restaurant websites or found at other Internet sites.

Our analysis included 3 food items for energy, sodium, saturated fat, and trans fat; 1 beverage item was included in the energy analysis only, because the sodium content of cola beverages is low and may vary by local water supply, and the beverage did not contain fat. Because fast-food restaurant orders and special offers frequently include a cheeseburger, French fries, and regular cola (bundled meal), we assessed the combined energy, sodium, saturated fat, and trans fat amounts and calculated the relative contribution of each in each chain for small and large portions.

Time trends were assessed for energy, sodium, saturated fat, and trans fat per serving for individual menu items at each chain using simple linear regression models in which energy content or the nutrient was the dependent variable and year was the independent variable. Differences among chains for individual menu items were assessed using analysis of variance for the mean energy or nutrient components across the 18-year period, and the Tukey post hoc procedure was used to control for multiple comparisons. Statistical analyses were performed using SAS 9.3 (SAS Institute Inc).

ResultsIndividual menu itemsEnergy

The energy content of the 27 items examined differed among chain restaurants for all menu items (P ≤ .04) except for large French fries. The energy content of 15 items (56%) decreased over the 18-year period (β range, −0.1 to −5.8 kcal); of these, the differences were significant for 8 items (30%; β range, −0.6 to −5.8 kcal, P < .01) (Figure 1). For items whose energy content decreased, 5 items were offered at Chain A, 2 items at Chain B, and 1 item at Chain C. The energy content of 12 items (44%) increased over the 18-year period (β range, 0.6–10.6 kcal); of these, the differences were significant for 9 items (33%) (β range, 1.8–10.6 kcal, P ≤ .05). For items whose energy content increased, 6 items were offered at Chain C, whereas Chain A offered 1 item and Chain B offered 2 items. In absolute terms, a similar number of items increased and decreased in energy content, and the mean changes were modest.

Figure 1

Energy content (kcal per portion) for popular menu items at 3 large, national fast-food chains. Energy content for 3 sizes of French fries (small, medium, large); 2 sizes of cheeseburgers (2 oz, 4 oz); 1 size of grilled chicken sandwich; and 3 sizes of cola beverages (small, medium, large) from chains A, B, and C from 1996 through 2013. β estimates and P values derived from individual simple linear models; chain comparison P values derived from ANOVA (analysis of variance) models comparing mean values between restaurants. Dashes indicate that data were not available; blank cells indicate that the item was not offered for the year(s). Abbreviations: S, small; M, medium; L, large; NS, nonsignificant. ^a Difference is between Chain B versus Chain C. ^b Difference is between Chain B versus Chains A and C.

Chain/Year French Fries, kcal
Cheeseburger, kcal
Grilled Chicken Sandwich, kcal Cola, kcal
S M L 2 oz 4 oz S M L
Chain A
1996 210 450 540 320 530 150 — —
1997 210 450 540 320 530 440 150 — —
1998 210 450 540 320 530 440 150 — —
1999 210 450 540 320 530 440 150 210 310
2000 210 450 540 320 530 450 150 210 310
2001 210 450 540 330 530 450 150 210 310
2002 210 450 540 330 530 450 150 210 310
2003 210 450 540 330 530 400 150 210 310
2004 220 350 520 330 540 400 150 210 310
2005 230 350 520 310 510 420 150 210 310
2006 250 380 570 310 510 420 150 210 310
2007 250 380 570 300 510 420 150 210 310
2008 230 380 500 300 510 420 150 210 310
2009 230 380 500 300 510 420 150 210 310
2010 230 380 500 300 510 420 150 210 310
2011 230 380 500 300 510 350 150 210 310
2012 230 380 500 300 520 350 150 210 310
2013 230 380 500 300 520 350 140 200 280
β 1.8 −0.6 −2.7 −1.8 −1.4 −5.5 −0.2 −0.3 −0.8
P value <.001 <.001 .007 <.001 .002 <.001 .10 .11 .11
Chain B
1996 — — — — — — — —
1997 — 370 380 730 550 204 280 —
1998 — — — — — — — —
1999 250 400 590 360 760 530 204 280 407
2000 250 400 590 360 760 530 204 280 407
2001 230 360 500 370 780 550 — — —
2002 230 360 500 360 850 580 160 230 330
2003 230 360 500 360 800 580 160 230 330
2004 230 360 500 350 800 570 160 200 330
2005 230 360 500 350 800 570 140 200 290
2006 230 360 500 330 760 510 140 200 290
2007 230 360 500 330 760 510 140 200 290
2008 230 360 500 340 770 490 140 210 290
2009 340 480 580 340 770 490 210 290 390
2010 340 440 540 310 770 490 210 290 390
2011 340 440 540 300 760 470 190 290 380
2012 340 410 500 280 760 470 190 290 380
2013 340 410 500 288 710 510 190 290 380
β 8.9 3.9 −2.0 −5.8 −1.7 −5.5 −0.1 1.5 0.6
P value .001 .05 .36 <.001 .39 .002 .97 .52 .85
Chain C
1996 260 380 460 320 490 310 90 108 180
1997 270 390 470 320 490 310 90 108 180
1998 270 470 570 320 490 310 90 108 180
1999 270 470 570 320 490 310 90 108 180
2000 270 470 570 320 490 310 90 108 180
2001 270 420 470 310 480 300 104 130 208
2002 250 390 440 310 480 300 112 140 224
2003 250 390 440 310 480 300 112 140 224
2004 250 390 440 310 480 360 112 140 224
2005 280 440 490 320 490 360 112 140 224
2006 370 420 540 320 490 370 140 224 294
2007 330 420 520 320 500 320 140 224 294
2008 340 430 550 260 500 320 140 210 280
2009 330 420 540 270 540 350 160 240 320
2010 330 410 540 270 540 340 160 240 320
2011 320 420 530 270 550 360 160 240 320
2012 320 420 530 290 620 390 160 — —
2013 310 410 500 290 600 390 160 240 320
β 4.9 −0.5 1.8 −3.0 6.1 4.5 5.2 10.3 10.6
P value .001 .73 .40 <.001 <.001 <.001 <.001 <.001 <.001
Chain comparison P value ≤.002 .04^a NS ≤.008^b <.001^b <.001 ≤.01 ≤.02 <.001^b

Chain/Year	French Fries, kcal	Cheeseburger, kcal	Grilled Chicken Sandwich, kcal	Cola, kcal
Chain A
1996	210	450	540	320	530		150	—	—
1997	210	450	540	320	530	440	150	—	—
1998	210	450	540	320	530	440	150	—	—
1999	210	450	540	320	530	440	150	210	310
2000	210	450	540	320	530	450	150	210	310
2001	210	450	540	330	530	450	150	210	310
2002	210	450	540	330	530	450	150	210	310
2003	210	450	540	330	530	400	150	210	310
2004	220	350	520	330	540	400	150	210	310
2005	230	350	520	310	510	420	150	210	310
2006	250	380	570	310	510	420	150	210	310
2007	250	380	570	300	510	420	150	210	310
2008	230	380	500	300	510	420	150	210	310
2009	230	380	500	300	510	420	150	210	310
2010	230	380	500	300	510	420	150	210	310
2011	230	380	500	300	510	350	150	210	310
2012	230	380	500	300	520	350	150	210	310
2013	230	380	500	300	520	350	140	200	280
β	1.8	−0.6	−2.7	−1.8	−1.4	−5.5	−0.2	−0.3	−0.8
P value	<.001	<.001	.007	<.001	.002	<.001	.10	.11	.11
Chain B
1996	—	—		—	—	—	—	—	—
1997	—	370		380	730	550	204	280	—
1998	—	—		—	—	—	—	—	—
1999	250	400	590	360	760	530	204	280	407
2000	250	400	590	360	760	530	204	280	407
2001	230	360	500	370	780	550	—	—	—
2002	230	360	500	360	850	580	160	230	330
2003	230	360	500	360	800	580	160	230	330
2004	230	360	500	350	800	570	160	200	330
2005	230	360	500	350	800	570	140	200	290
2006	230	360	500	330	760	510	140	200	290
2007	230	360	500	330	760	510	140	200	290
2008	230	360	500	340	770	490	140	210	290
2009	340	480	580	340	770	490	210	290	390
2010	340	440	540	310	770	490	210	290	390
2011	340	440	540	300	760	470	190	290	380
2012	340	410	500	280	760	470	190	290	380
2013	340	410	500	288	710	510	190	290	380
β	8.9	3.9	−2.0	−5.8	−1.7	−5.5	−0.1	1.5	0.6
P value	.001	.05	.36	<.001	.39	.002	.97	.52	.85
Chain C
1996	260	380	460	320	490	310	90	108	180
1997	270	390	470	320	490	310	90	108	180
1998	270	470	570	320	490	310	90	108	180
1999	270	470	570	320	490	310	90	108	180
2000	270	470	570	320	490	310	90	108	180
2001	270	420	470	310	480	300	104	130	208
2002	250	390	440	310	480	300	112	140	224
2003	250	390	440	310	480	300	112	140	224
2004	250	390	440	310	480	360	112	140	224
2005	280	440	490	320	490	360	112	140	224
2006	370	420	540	320	490	370	140	224	294
2007	330	420	520	320	500	320	140	224	294
2008	340	430	550	260	500	320	140	210	280
2009	330	420	540	270	540	350	160	240	320
2010	330	410	540	270	540	340	160	240	320
2011	320	420	530	270	550	360	160	240	320
2012	320	420	530	290	620	390	160	—	—
2013	310	410	500	290	600	390	160	240	320
β	4.9	−0.5	1.8	−3.0	6.1	4.5	5.2	10.3	10.6
P value	.001	.73	.40	<.001	<.001	<.001	<.001	<.001	<.001
Chain comparison P value	≤.002	.04^a	NS	≤.008^b	<.001^b	<.001	≤.01	≤.02	<.001^b

No one-time trend characterized the changes that occurred across chains. For example, the final energy content in 2013 of small French fries at chains A, B, and C was 20 kcal, 90 kcal, and 50 kcal higher, respectively, than in 1996 (all P ≤ .001) (Figure 1). For large French fries, the time trend changes were significant only for Chain A (P = .007), and for that chain the final energy content was 40 kcal lower in 2013 than in 1996. For cola we found a significant difference in time trends among the 3 restaurant chains (P ≤ .01).

Sodium

Of the 18 items examined for sodium, the sodium content of 5 (27%) items decreased significantly (β range, −4.1 to −24.0 mg, P ≤ .05) (Figure 2). In contrast, the sodium content of 7 (39%) items significantly increased (β range, 1.9–29.6 mg, P ≤ .04). Average sodium content differed among chains for all individual menu items (P ≤ .01) except the 2-oz cheeseburger. We found marked heterogeneity among chains.

Figure 2

Sodium content (mg per portion) for popular menu items at 3 large, national fast-food chains. Sodium content for 3 sizes of French fries (small, medium, large), 2 sizes of cheeseburgers (2 oz, 4 oz), and 1 size of grilled chicken sandwich from Chains A, B, and C from 1996 through 2013. β estimates and P values derived from individual simple linear models, with energy as the dependent variable and time as the independent variable; chain comparison P values derived from ANOVA (analysis of variance) models comparing mean values between restaurants. Dashes indicate that data were not available; blank cells indicate that the item was not offered for the year(s). Abbreviation: NS, nonsignificant. ^a Difference is between Chain B versus Chains A and C.

Chain/Year French Fries
Cheeseburger
Grilled Chicken Sandwich
Small Medium Large 2 oz 4 oz
Sodium, mg
Chain A
1996 135 290 350 770 1,200
1997 135 290 350 820 1,290 1,040
1998 135 290 350 820 1,290 1,040
1999 135 290 350 820 1,290 1,040
2000 135 290 350 830 1,310 970
2001 135 290 350 830 1,310 970
2002 135 290 350 830 1,310 970
2003 135 290 350 800 1,250 890
2004 150 220 340 790 1,240 1,020
2005 140 220 330 740 1,150 1,240
2006 140 220 330 740 1,150 1,240
2007 140 220 330 750 1,190 1,190
2008 160 270 350 750 1,190 1,190
2009 160 270 350 750 1,190 1,190
2010 160 270 350 750 1,190 1,190
2011 160 270 350 750 1,190 820
2012 160 270 350 680 1,100 820
2013 160 270 350 680 1,100 820
β 1.9 −2.1 −0.2 −7.5 −10.2 −2.8
P value <.001 .10 .63 <.001 <.001 .71
Chain B
1996 — — — — —
1997 — 240 770 1,350 480
1998 — — — — —
1999 550 820 1,180 760 1,380 1,060
2000 550 820 1,180 760 1,380 1,060
2001 630 690 940 750 1,390 1,110
2002 410 640 880 790 1,430 1,370
2003 410 640 880 790 1,420 1,370
2004 410 640 880 770 1,450 1,410
2005 410 640 880 770 1,450 1,410
2006 380 590 820 780 1,450 1,180
2007 380 590 820 780 1,450 1,180
2008 380 590 820 780 1,450 1,250
2009 590 820 990 770 1,450 1,220
2010 530 670 830 740 1,450 1,220
2011 530 670 830 710 1,410 1,100
2012 480 570 710 690 1,410 1,330
2013 480 570 710 690 1,240 1,350
β −1.7 2.1 −24.0 −4.1 <0.1 23.7
P value .75 .79 <.001 .01 .99 .04
Chain C
1996 85 120 150 770 1,130 780
1997 85 120 150 830 1,240 790
1998 85 150 180 830 1,240 790
1999 85 150 180 830 1,240 790
2000 85 150 180 830 1,240 790
2001 85 130 150 800 1,180 740
2002 220 340 380 820 1,210 740
2003 220 340 380 820 1,230 730
2004 220 340 380 820 1,230 1,100
2005 270 430 480 820 1,220 1,100
2006 380 430 550 810 1,200 1,070
2007 340 430 550 800 1,220 950
2008 290 370 480 690 1,190 950
2009 300 380 500 700 1,260 1,000
2010 280 350 460 730 1,290 1,030
2011 350 460 570 670 1,270 1,110
2012 350 460 570 820 1,440 880
2013 330 440 540 800 1,220 1,000
β 18.8 22.0 29.6 −4.7 5.9 17.9
P value <.001 <.001 <.001 .05 .03 .002
Chain comparison P value ≤.01 <.001^a <.001^a NS <.001^a ≤.001^a

Chain/Year	French Fries	Cheeseburger	Grilled Chicken Sandwich
Chain A
1996	135	290	350	770	1,200
1997	135	290	350	820	1,290	1,040
1998	135	290	350	820	1,290	1,040
1999	135	290	350	820	1,290	1,040
2000	135	290	350	830	1,310	970
2001	135	290	350	830	1,310	970
2002	135	290	350	830	1,310	970
2003	135	290	350	800	1,250	890
2004	150	220	340	790	1,240	1,020
2005	140	220	330	740	1,150	1,240
2006	140	220	330	740	1,150	1,240
2007	140	220	330	750	1,190	1,190
2008	160	270	350	750	1,190	1,190
2009	160	270	350	750	1,190	1,190
2010	160	270	350	750	1,190	1,190
2011	160	270	350	750	1,190	820
2012	160	270	350	680	1,100	820
2013	160	270	350	680	1,100	820
β	1.9	−2.1	−0.2	−7.5	−10.2	−2.8
P value	<.001	.10	.63	<.001	<.001	.71
Chain B
1996	—	—		—	—	—
1997	—	240		770	1,350	480
1998	—	—		—	—	—
1999	550	820	1,180	760	1,380	1,060
2000	550	820	1,180	760	1,380	1,060
2001	630	690	940	750	1,390	1,110
2002	410	640	880	790	1,430	1,370
2003	410	640	880	790	1,420	1,370
2004	410	640	880	770	1,450	1,410
2005	410	640	880	770	1,450	1,410
2006	380	590	820	780	1,450	1,180
2007	380	590	820	780	1,450	1,180
2008	380	590	820	780	1,450	1,250
2009	590	820	990	770	1,450	1,220
2010	530	670	830	740	1,450	1,220
2011	530	670	830	710	1,410	1,100
2012	480	570	710	690	1,410	1,330
2013	480	570	710	690	1,240	1,350
β	−1.7	2.1	−24.0	−4.1	<0.1	23.7
P value	.75	.79	<.001	.01	.99	.04
Chain C
1996	85	120	150	770	1,130	780
1997	85	120	150	830	1,240	790
1998	85	150	180	830	1,240	790
1999	85	150	180	830	1,240	790
2000	85	150	180	830	1,240	790
2001	85	130	150	800	1,180	740
2002	220	340	380	820	1,210	740
2003	220	340	380	820	1,230	730
2004	220	340	380	820	1,230	1,100
2005	270	430	480	820	1,220	1,100
2006	380	430	550	810	1,200	1,070
2007	340	430	550	800	1,220	950
2008	290	370	480	690	1,190	950
2009	300	380	500	700	1,260	1,000
2010	280	350	460	730	1,290	1,030
2011	350	460	570	670	1,270	1,110
2012	350	460	570	820	1,440	880
2013	330	440	540	800	1,220	1,000
β	18.8	22.0	29.6	−4.7	5.9	17.9
P value	<.001	<.001	<.001	.05	.03	.002
Chain comparison P value	≤.01	<.001^a	<.001^a	NS	<.001^a	≤.001^a

Saturated and <italic>trans</italic> fat

The saturated fat content of French fries, post-2001, was modest for all chains (1.5–6.0 g) (Figure 3). We found a noticeable decline in the saturated fat content of chain B’s French fries between 2000 and 2001. Nevertheless, the saturated fat content of the large-sized meal in 2013 contained 61% to 80% of the recommended 10% of energy upper limit (22 g/2,000 kcal) (1) and 104% and 135% of the recommended 6% of energy upper limit (13 g/2,000 kcal)(6).

Figure 3

Saturated fat content (g per portion) for popular menu items at 3 large, national fast-food chains. Saturated fat content per serving for 3 sizes of French fries (small, medium, large), 2 sizes of cheeseburgers (2 oz, 4 oz), and 1 size of grilled chicken sandwich from Chains A, B, and C from 1996 through 2013. β estimates and P values derived from individual simple linear models; chain comparison P values derived from ANOVA (analysis of variance) models comparing mean values between restaurants. Dashes indicate that data were not available; blank cells indicate that the item was not offered for the year(s). Abbreviations: NS, nonsignificant; NC, no change. ^a Difference is between Chain B versus Chains A and C.

Chain/Year French Fries
Cheeseburger
Grilled Chicken Sandwich
Small Medium Large 2 oz 4 oz
Saturated Fat, g
Chain A
1996 1.5 4.0 4.5 6.0 13.0
1997 1.5 4.0 4.5 6.0 13.0 3.0
1998 1.5 4.0 4.5 6.0 13.0 3.0
1999 1.5 4.0 4.5 6.0 13.0 3.0
2000 1.5 4.0 4.5 6.0 13.0 3.0
2001 1.5 4.0 4.5 6.0 13.0 3.0
2002 1.5 4.0 4.5 6.0 13.0 3.0
2003 1.5 4.0 4.5 6.0 13.0 3.0
2004 2.0 3.0 4.5 6.0 13.0 3.0
2005 2.0 3.0 5.0 6.0 12.0 2.0
2006 2.5 4.0 6.0 6.0 12.0 2.0
2007 2.5 4.0 6.0 6.0 12.0 2.0
2008 1.5 2.5 3.5 6.0 12.0 2.0
2009 1.5 2.5 3.5 6.0 12.0 2.0
2010 1.5 2.5 3.5 6.0 12.0 2.0
2011 1.5 2.5 3.5 6.0 12.0 2.0
2012 1.5 2.5 3.5 6.0 12.0 2.0
2013 1.5 2.5 3.5 6.0 12.0 2.0
β <0.1 −0.1 −0.1 NC −0.1 −0.1
P value .61 <.001 .08 NS <.001 <.001
Chain B
1996 — — — — —
1997 — 5.0 9.0 16.0 6.0
1998 — — — — —
1999 5.0 8.0 12.0 9.0 17.0 5.0
2000 5.0 8.0 12.0 9.0 17.0 5.0
2001 3.0 5.0 7.0 9.0 17.0 5.0
2002 3.0 5.0 7.0 8.0 30.0 5.0
2003 3.0 5.0 7.0 8.0 18.0 5.0
2004 3.0 5.0 7.0 8.0 18.0 4.5
2005 3.0 5.0 7.0 8.0 18.0 4.5
2006 3.0 4.5 6.0 7.0 16.0 3.5
2007 3.0 4.5 6.0 7.0 16.0 3.5
2008 3.0 4.5 6.0 7.0 16.0 4.0
2009 3.5 5.0 6.0 7.0 16.0 4.0
2010 3.5 4.5 6.0 7.0 16.0 4.0
2011 3.5 4.5 6.0 6.0 16.0 3.5
2012 2.5 3.0 3.5 6.0 16.0 3.5
2013 2.5 3.0 3.5 6.0 15.0 4.0
β −0.1 −0.2 −0.4 −0.2 −0.2 −0.1
P value .03 .001 <.001 <.001 .28 <.001
Chain C
1996 2.5 4.0 5.0 6.0 10.0 1.5
1997 2.0 3.0 3.5 6.0 10.5 1.5
1998 2.0 3.5 4.0 6.0 10.5 1.5
1999 2.0 3.5 4.0 6.0 10.5 1.5
2000 2.0 3.5 4.0 6.0 10.5 1.5
2001 2.0 3.0 3.5 6.0 10.5 1.5
2002 2.0 3.0 3.5 5.0 10.5 1.5
2003 2.0 3.0 3.5 6.0 10.5 1.5
2004 2.0 3.0 3.5 6.0 10.5 1.5
2005 2.5 3.5 4.0 6.0 10.5 1.5
2006 2.5 3.0 4.0 6.0 10.5 1.5
2007 2.5 3.0 3.5 5.0 10.5 1.5
2008 2.5 3.0 4.0 5.0 10.5 1.5
2009 3.0 4.0 5.0 5.0 11.5 1.5
2010 3.0 3.5 4.5 5.0 11.5 1.5
2011 3.0 4.0 5.0 5.0 12.0 1.5
2012 3.0 4.0 5.0 6.0 16.0 3.5
2013 3.0 3.5 4.5 6.5 13.0 1.5
β 0.1 <0.1 0.1 <−0.1 0.2 <0.1
P value <.001 .33 .06 .06 .002 .15
Chain comparison P value ≤.001 <.001^a <.001^a <.001^a <.001^a <.001

Chain/Year	French Fries	Cheeseburger	Grilled Chicken Sandwich
Chain A
1996	1.5	4.0	4.5	6.0	13.0
1997	1.5	4.0	4.5	6.0	13.0	3.0
1998	1.5	4.0	4.5	6.0	13.0	3.0
1999	1.5	4.0	4.5	6.0	13.0	3.0
2000	1.5	4.0	4.5	6.0	13.0	3.0
2001	1.5	4.0	4.5	6.0	13.0	3.0
2002	1.5	4.0	4.5	6.0	13.0	3.0
2003	1.5	4.0	4.5	6.0	13.0	3.0
2004	2.0	3.0	4.5	6.0	13.0	3.0
2005	2.0	3.0	5.0	6.0	12.0	2.0
2006	2.5	4.0	6.0	6.0	12.0	2.0
2007	2.5	4.0	6.0	6.0	12.0	2.0
2008	1.5	2.5	3.5	6.0	12.0	2.0
2009	1.5	2.5	3.5	6.0	12.0	2.0
2010	1.5	2.5	3.5	6.0	12.0	2.0
2011	1.5	2.5	3.5	6.0	12.0	2.0
2012	1.5	2.5	3.5	6.0	12.0	2.0
2013	1.5	2.5	3.5	6.0	12.0	2.0
β	<0.1	−0.1	−0.1	NC	−0.1	−0.1
P value	.61	<.001	.08	NS	<.001	<.001
Chain B
1996	—	—		—	—	—
1997	—	5.0		9.0	16.0	6.0
1998	—	—		—	—	—
1999	5.0	8.0	12.0	9.0	17.0	5.0
2000	5.0	8.0	12.0	9.0	17.0	5.0
2001	3.0	5.0	7.0	9.0	17.0	5.0
2002	3.0	5.0	7.0	8.0	30.0	5.0
2003	3.0	5.0	7.0	8.0	18.0	5.0
2004	3.0	5.0	7.0	8.0	18.0	4.5
2005	3.0	5.0	7.0	8.0	18.0	4.5
2006	3.0	4.5	6.0	7.0	16.0	3.5
2007	3.0	4.5	6.0	7.0	16.0	3.5
2008	3.0	4.5	6.0	7.0	16.0	4.0
2009	3.5	5.0	6.0	7.0	16.0	4.0
2010	3.5	4.5	6.0	7.0	16.0	4.0
2011	3.5	4.5	6.0	6.0	16.0	3.5
2012	2.5	3.0	3.5	6.0	16.0	3.5
2013	2.5	3.0	3.5	6.0	15.0	4.0
β	−0.1	−0.2	−0.4	−0.2	−0.2	−0.1
P value	.03	.001	<.001	<.001	.28	<.001
Chain C
1996	2.5	4.0	5.0	6.0	10.0	1.5
1997	2.0	3.0	3.5	6.0	10.5	1.5
1998	2.0	3.5	4.0	6.0	10.5	1.5
1999	2.0	3.5	4.0	6.0	10.5	1.5
2000	2.0	3.5	4.0	6.0	10.5	1.5
2001	2.0	3.0	3.5	6.0	10.5	1.5
2002	2.0	3.0	3.5	5.0	10.5	1.5
2003	2.0	3.0	3.5	6.0	10.5	1.5
2004	2.0	3.0	3.5	6.0	10.5	1.5
2005	2.5	3.5	4.0	6.0	10.5	1.5
2006	2.5	3.0	4.0	6.0	10.5	1.5
2007	2.5	3.0	3.5	5.0	10.5	1.5
2008	2.5	3.0	4.0	5.0	10.5	1.5
2009	3.0	4.0	5.0	5.0	11.5	1.5
2010	3.0	3.5	4.5	5.0	11.5	1.5
2011	3.0	4.0	5.0	5.0	12.0	1.5
2012	3.0	4.0	5.0	6.0	16.0	3.5
2013	3.0	3.5	4.5	6.5	13.0	1.5
β	0.1	<0.1	0.1	<−0.1	0.2	<0.1
P value	<.001	.33	.06	.06	.002	.15
Chain comparison P value	≤.001	<.001^a	<.001^a	<.001^a	<.001^a	<.001

Data for trans fat became available in 2001. The trans fat content of French fries declined to undetectable levels between 2006 and 2009 (Figure 4).

Figure 4

Trans fat content (g per portion) for popular menu items at 3 large, national fast-food chains. Trans fat content per serving for 3 sizes of French fries (small, medium, large), 2 sizes of cheeseburgers (2 oz, 4 oz), and 1 size of grilled chicken sandwich from Chains A, B, and C from 2001 through 2013. β estimates and P values derived from individual simple linear models; chain comparison P values derived from ANOVA (analysis of variance) models, comparing mean values between restaurants. Dashes indicate that data were not available; blank cells indicate that the item was not offered for the year(s). ^a Difference is between Chain C versus Chains A and B. Abbreviations: NS, nonsignificant; NC, no change.

Chain/Year French Fries
Cheeseburger
Grilled Chicken Sandwich
Small Medium Large 2 oz 4 oz

Trans Fat, g
Chain A
2001 — — — — — —
2002 — — — — — —
2003 — — — — — —
2004 — — — — — —
2005 2.5 4.0 6.0 1.0 1.5 0
2006 3.5 5.0 8.0 1.0 1.5 0
2007 3.5 5.0 8.0 0.5 1.5 0
2008 0 0 0 0.5 1.5 0
2009 0 0 0 0.5 1.5 0
2010 0 0 0 0.5 1.5 0
2011 0 0 0 0.5 1.5 0
2012 0 0 0 0.5 1.5 0
2013 0 0 0 0.5 1.5 0
β −0.5 −0.1 −1.1 −0.1 NC NC
P value .01 .01 .01 .03 NS NS
Chain B
2001 3.0 5.0 6.0 1.0 1.5 —
2002 3.0 4.7 6.4 0.7 1.5 0.5
2003 3.0 4.7 6.4 0.7 1.4 0.5
2004 3.0 4.5 6.0 0.5 1.5 0
2005 3.0 4.5 6.0 0.5 2.0 0
2006 3.0 4.5 6.0 0.5 1.5 0.5
2007 3.0 4.5 6.0 0.5 1.5 0.5
2008 3.0 4.5 6.0 0.5 1.5 0
2009 0 0 0 0.5 1.5 0
2010 0 0 0 0.5 1.5 0
2011 0 0 0 0 1.0 0
2012 0 0 0 0 1.0 0
2013 0 0 0 0 1.0 0
β −0.3 −0.5 −0.7 −0.1 <−0.1 <−0.1
P value <.001 <.001 <.001 <.001 .06 .03
Chain C
2001 — — — — — —
2002 — — — — — —
2003 3.0 4.5 5.0 0.5 1.0 0
2004 3.0 4.5 5.0 0.5 1.0 0
2005 3.5 5.0 6.0 0.5 1.0 0
2006 1.0 1.0 1.0 0.5 1.0 0
2007 0.5 1.0 1.0 0.5 1.0 0
2008 0 0 0 0.5 1.0 0
2009 0 0 0 0.5 1.0 0
2010 0 0 0 0.5 1.0 0
2011 0 0 0 0.5 1.5 0
2012 0 0 0 0.5 1.5 0
2013 0 0 0 0.5 1.5 0
β −0.4 −0.5 −0.6 NC 0.1 NC
P value .001 .001 .002 NS .005 NS
Chain comparison P value NS NS NS NS <.01^a NS

Chain/Year	French Fries	Cheeseburger	Grilled Chicken Sandwich
Chain A
2001	—	—	—	—	—	—
2002	—	—	—	—	—	—
2003	—	—	—	—	—	—
2004	—	—	—	—	—	—
2005	2.5	4.0	6.0	1.0	1.5	0
2006	3.5	5.0	8.0	1.0	1.5	0
2007	3.5	5.0	8.0	0.5	1.5	0
2008	0	0	0	0.5	1.5	0
2009	0	0	0	0.5	1.5	0
2010	0	0	0	0.5	1.5	0
2011	0	0	0	0.5	1.5	0
2012	0	0	0	0.5	1.5	0
2013	0	0	0	0.5	1.5	0
β	−0.5	−0.1	−1.1	−0.1	NC	NC
P value	.01	.01	.01	.03	NS	NS
Chain B
2001	3.0	5.0	6.0	1.0	1.5	—
2002	3.0	4.7	6.4	0.7	1.5	0.5
2003	3.0	4.7	6.4	0.7	1.4	0.5
2004	3.0	4.5	6.0	0.5	1.5	0
2005	3.0	4.5	6.0	0.5	2.0	0
2006	3.0	4.5	6.0	0.5	1.5	0.5
2007	3.0	4.5	6.0	0.5	1.5	0.5
2008	3.0	4.5	6.0	0.5	1.5	0
2009	0	0	0	0.5	1.5	0
2010	0	0	0	0.5	1.5	0
2011	0	0	0	0	1.0	0
2012	0	0	0	0	1.0	0
2013	0	0	0	0	1.0	0
β	−0.3	−0.5	−0.7	−0.1	<−0.1	<−0.1
P value	<.001	<.001	<.001	<.001	.06	.03
Chain C
2001	—	—	—	—	—	—
2002	—	—	—	—	—	—
2003	3.0	4.5	5.0	0.5	1.0	0
2004	3.0	4.5	5.0	0.5	1.0	0
2005	3.5	5.0	6.0	0.5	1.0	0
2006	1.0	1.0	1.0	0.5	1.0	0
2007	0.5	1.0	1.0	0.5	1.0	0
2008	0	0	0	0.5	1.0	0
2009	0	0	0	0.5	1.0	0
2010	0	0	0	0.5	1.0	0
2011	0	0	0	0.5	1.5	0
2012	0	0	0	0.5	1.5	0
2013	0	0	0	0.5	1.5	0
β	−0.4	−0.5	−0.6	NC	0.1	NC
P value	.001	.001	.002	NS	.005	NS
Chain comparison P value	NS	NS	NS	NS	<.01^a	NS

Meals

Over time the total energy content of the bundled meal varied inconsistently among the 3 chains (Figure 5). In 2013, the energy content of a large-sized bundled meal (cheeseburger, French fries, and regular cola) represented 65% to 80% of a 2,000-calorie-per-day diet, and sodium content represented 63% to 91% of the 2,300-mg-per-day recommendation and 97% to 139% of the 1,500-mg-per-day recommendation. We found a gradual downward trend in the sodium content of Chain A and Chain B and a gradual upward trend for Chain C. The saturated fat content of the meals exhibited little change for Chain A or Chain C, whereas it steadily declined for Chain B. The total trans fat content of the combination meals declined dramatically.

Figure 5

Comparison of energy, sodium, saturated fat, and trans fat content for popular menu items at 3 large, national fast-food chains. Energy (kcal), sodium (mg), saturated fat (g), and trans fat (g) content for 1999, 2003, 2008, and 2013 in popular small-sized (ie, 2-oz cheeseburger, small French fries, and small cola) and large-sized (ie, 4-oz cheeseburger, large French fries, and large cola) meals from chains A, B, and C. Trans fat data were not available for 1999. Dashes indicate that data were not available. Abbreviation: NA, not applicable.

Year/Item Chain A Chain B Chain C
Energy, kcal (% Total meal kcal)
1999
2-oz Cheeseburger 320 (47) 360 (44) 320 (47)
Small French fries 210 (31) 250 (31) 270 (40)
Small cola 150 (22) 204 (25) 90 (13)
Total small meal 680 (100) 814 (100) 680 (100)
4-oz Cheeseburger 530 (38) 760 (43) 490 (40)
Large French fries 540 (39) 590 (34) 570 (46)
Large cola 310 (22) 407 (23) 180 (15)
Total large meal 1,380 (100) 1,757 (100) 1,240 (100)
2003
2-oz Cheeseburger 330 (48) 360 (48) 310 (46)
Small French fries 210 (30) 230 (31) 250 (37)
Small cola 150 (22) 160 (21) 112 (17)
Total small meal 690 (100) 750 (100) 672 (100)
4-oz Cheeseburger 530 (38) 800 (49) 480 (42)
Large French fries 540 (39) 500 (31) 440 (38)
Large cola 310 (22) 330 (20) 224 (20)
Total large meal 1,380 (100) 1,630 (100) 1,144 (100)
2008
2-oz Cheeseburger 300 (44) 340 (48) 260 (35)
Small French fries 230 (34) 230 (32) 340 (46)
Small cola 150 (22) 140 (20) 140 (19)
Total small meal 680 (100) 710 (100) 740 (100)
4-oz Cheeseburger 510 (39) 770 (49) 500 (38)
Large French fries 500 (38) 500 (32) 550 (41)
Large cola 310 (23) 290 (19) 280 (21)
Total large meal 1,320 (100) 1,560 (100) 1,330 (100)
2013
2-oz Cheeseburger 300 (45) 288 (35) 290 (38)
Small French fries 230 (34) 340 (42) 310 (41)
Small cola 140 (21) 190 (23) 160 (21)
Total small meal 670 (100) 818 (100) 760 (100)
4-oz Cheeseburger 520 (40) 710 (45) 600 (42)
Large French fries 500 (38) 500 (31) 500 (35)
Large cola 280 (22) 380 (24) 320 (23)
Total large meal 1,300 (100) 1,590 (100) 1,420 (100)
Sodium, mg (% of total meal)
1999
2-oz Cheeseburger 820 (86) 760 (58) 830 (91)
Small French fries 135 (14) 550 (42) 85 (9)
Total small meal 955 (100) 1,310 (100) 915 (100)
4-oz Cheeseburger 1,290 (79) 1,380 (54) 1,240 (87)
Large French fries 350 (21) 1,180 (46) 180 (13)
Total large meal 1,640 (100) 2,560 (100) 1,420 (100)
2003
2-oz Cheeseburger 800 (86) 790 (66) 820 (79)
Small French fries 135 (14) 410 (34) 220 (21)
Total small meal 935 (100) 1,200 (100) 1,040 (100)
4-oz Cheeseburger 1,250 (78) 1,420 (62) 1,230 (76)
Large French fries 350 (22) 880 (38) 380 (24)
Total large meal 1,600 (100) 2,300 (100) 1,610 (100)
2008
2-oz Cheeseburger 750 (82) 780 (67) 690 (70)
Small French fries 160 (18) 380 (33) 290 (30)
Total small meal                               910 (100) 1,160 (100) 980 (100)
4-oz Cheeseburger 1,190 (77) 1450 (64) 1,190 (71)
Large French fries 350 (23) 820 (36) 480 (29)
Total large meal 1,540 (100) 2,270 (100) 1,670 (100)
2013
2-oz Cheeseburger 680 (81)                     690 (59) 600 (65)
Small French fries 160 (19) 480 (41) 330 (35)
Total small meal 840 (100) 1,170 (100) 930 (100)
4-oz Cheeseburger 1,100 (76) 1,380 (66) 1,220 (69)
Large French fries 350 (24) 710 (34) 540 (31)
Total large meal 1,450 (100) 2,090 (100) 1,760 (100)
Saturated fat, g (% total meal)
1999
2-oz Cheeseburger 6 (80) 9 (64) 6 (75)
Small French fries 1.5 (20) 5 (36) 2 (25)
Total small meal 7.5 (100) 14 (100) 8 (100)
4-oz Cheeseburger 13 (74) 17 (59) 10.5 (72)
Large French fries 4.5 (26) 12 (41) 4 (28)
Total large meal 17.5 (100) 29 (100) 14.5 (100)
2003
2-oz Cheeseburger 6 (80) 8 (73) 6 (75)
Small French fries 1.5 (20) 3 (27) 2 (25)
Total small meal 7.5 (100) 11 (100) 8 (100)
4-oz Cheeseburger 13 (74) 18 (72) 10.5 (75)
Large French fries 4.5 (26) 7 (28) 3.5 (25)
Total large meal 17.5 (100) 25 (100) 14 (100)
2008
2-oz Cheeseburger 6 (80) 7 (70) 5 (67)
Small French fries 1.5 (20) 3 (30) 2.5 (33)
Total small meal 7.5 (100) 10 (100) 7.5 (100)
4-oz Cheeseburger 12 (77) 16 (73) 10.5 (72)
Large French fries 3.5 (23) 6 (27) 4 (28)
Total large meal 15.5 (100) 22 (100) 14.5 (100)
2013
2-oz Cheeseburger 6 (80)                               6 (71) 4 (57)
Small French fries 1.5 (20) 2.5 (29) 3 (43)
Total small meal 7.5 (100) 8.5 (100) 7 (100)
4-oz Cheeseburger 12 (77) 10 (74) 13 (74)
Large French fries 3.5 (23) 3.5 (26) 4.5 (26)
Total large meal 15.5 (100) 13.5 (100) 17.5 (100)
Trans fat, g (% total meal)
2003
2-oz Cheeseburger — 0.7 (19) 0.5 (14)
Small French fries — 3 (81) 3 (86)
Total small meal — 3.7 (100) 3.5 (100)
4-oz Cheeseburger — 1.4 (18) 1 (17)
Large French fries — 6.4 (82) 5 (83)
Total large meal — 7.8 (100) 6 (100)
2008
2-oz Cheeseburger 0.5 (100) 0.5 (14) 0.5 (100)
Small French fries 0 3 (86) 0
Total small meal 0.5 (100) 3.5 (100) 0.5 (100)
4-oz Cheeseburger 1.5 (100) 1.5 (20) 1 (100)
Large French fries 0 6 (80) 0
Total large meal 1.5 (100) 7.5 (100) 1 (100)
2013
2-oz Cheeseburger 0.5 (100) 0 0.5 (100)
Small French fries 0 0 0
Total small meal 0.5 (100) 0 0.5 (100)
4-oz Cheeseburger 1.5 (100) 1 (100) 1.5 (100)
Large French fries 0 0 0
Total large meal 1.5 (100) 1 (100) 1.5 (100)

Year/Item	Chain A	Chain B	Chain C
Energy, kcal (% Total meal kcal)
1999
2-oz Cheeseburger	320 (47)	360 (44)	320 (47)
Small French fries	210 (31)	250 (31)	270 (40)
Small cola	150 (22)	204 (25)	90 (13)
Total small meal	680 (100)	814 (100)	680 (100)
4-oz Cheeseburger	530 (38)	760 (43)	490 (40)
Large French fries	540 (39)	590 (34)	570 (46)
Large cola	310 (22)	407 (23)	180 (15)
Total large meal	1,380 (100)	1,757 (100)	1,240 (100)
2003
2-oz Cheeseburger	330 (48)	360 (48)	310 (46)
Small French fries	210 (30)	230 (31)	250 (37)
Small cola	150 (22)	160 (21)	112 (17)
Total small meal	690 (100)	750 (100)	672 (100)
4-oz Cheeseburger	530 (38)	800 (49)	480 (42)
Large French fries	540 (39)	500 (31)	440 (38)
Large cola	310 (22)	330 (20)	224 (20)
Total large meal	1,380 (100)	1,630 (100)	1,144 (100)
2008
2-oz Cheeseburger	300 (44)	340 (48)	260 (35)
Small French fries	230 (34)	230 (32)	340 (46)
Small cola	150 (22)	140 (20)	140 (19)
Total small meal	680 (100)	710 (100)	740 (100)
4-oz Cheeseburger	510 (39)	770 (49)	500 (38)
Large French fries	500 (38)	500 (32)	550 (41)
Large cola	310 (23)	290 (19)	280 (21)
Total large meal	1,320 (100)	1,560 (100)	1,330 (100)
2013
2-oz Cheeseburger	300 (45)	288 (35)	290 (38)
Small French fries	230 (34)	340 (42)	310 (41)
Small cola	140 (21)	190 (23)	160 (21)
Total small meal	670 (100)	818 (100)	760 (100)
4-oz Cheeseburger	520 (40)	710 (45)	600 (42)
Large French fries	500 (38)	500 (31)	500 (35)
Large cola	280 (22)	380 (24)	320 (23)
Total large meal	1,300 (100)	1,590 (100)	1,420 (100)
Sodium, mg (% of total meal)
1999
2-oz Cheeseburger	820 (86)	760 (58)	830 (91)
Small French fries	135 (14)	550 (42)	85 (9)
Total small meal	955 (100)	1,310 (100)	915 (100)
4-oz Cheeseburger	1,290 (79)	1,380 (54)	1,240 (87)
Large French fries	350 (21)	1,180 (46)	180 (13)
Total large meal	1,640 (100)	2,560 (100)	1,420 (100)
2003
2-oz Cheeseburger	800 (86)	790 (66)	820 (79)
Small French fries	135 (14)	410 (34)	220 (21)
Total small meal	935 (100)	1,200 (100)	1,040 (100)
4-oz Cheeseburger	1,250 (78)	1,420 (62)	1,230 (76)
Large French fries	350 (22)	880 (38)	380 (24)
Total large meal	1,600 (100)	2,300 (100)	1,610 (100)
2008
2-oz Cheeseburger	750 (82)	780 (67)	690 (70)
Small French fries	160 (18)	380 (33)	290 (30)
Total small meal	910 (100)	1,160 (100)	980 (100)
4-oz Cheeseburger	1,190 (77)	1450 (64)	1,190 (71)
Large French fries	350 (23)	820 (36)	480 (29)
Total large meal	1,540 (100)	2,270 (100)	1,670 (100)
2013
2-oz Cheeseburger	680 (81)	690 (59)	600 (65)
Small French fries	160 (19)	480 (41)	330 (35)
Total small meal	840 (100)	1,170 (100)	930 (100)
4-oz Cheeseburger	1,100 (76)	1,380 (66)	1,220 (69)
Large French fries	350 (24)	710 (34)	540 (31)
Total large meal	1,450 (100)	2,090 (100)	1,760 (100)
Saturated fat, g (% total meal)
1999
2-oz Cheeseburger	6 (80)	9 (64)	6 (75)
Small French fries	1.5 (20)	5 (36)	2 (25)
Total small meal	7.5 (100)	14 (100)	8 (100)
4-oz Cheeseburger	13 (74)	17 (59)	10.5 (72)
Large French fries	4.5 (26)	12 (41)	4 (28)
Total large meal	17.5 (100)	29 (100)	14.5 (100)
2003
2-oz Cheeseburger	6 (80)	8 (73)	6 (75)
Small French fries	1.5 (20)	3 (27)	2 (25)
Total small meal	7.5 (100)	11 (100)	8 (100)
4-oz Cheeseburger	13 (74)	18 (72)	10.5 (75)
Large French fries	4.5 (26)	7 (28)	3.5 (25)
Total large meal	17.5 (100)	25 (100)	14 (100)
2008
2-oz Cheeseburger	6 (80)	7 (70)	5 (67)
Small French fries	1.5 (20)	3 (30)	2.5 (33)
Total small meal	7.5 (100)	10 (100)	7.5 (100)
4-oz Cheeseburger	12 (77)	16 (73)	10.5 (72)
Large French fries	3.5 (23)	6 (27)	4 (28)
Total large meal	15.5 (100)	22 (100)	14.5 (100)
2013
2-oz Cheeseburger	6 (80)	6 (71)	4 (57)
Small French fries	1.5 (20)	2.5 (29)	3 (43)
Total small meal	7.5 (100)	8.5 (100)	7 (100)
4-oz Cheeseburger	12 (77)	10 (74)	13 (74)
Large French fries	3.5 (23)	3.5 (26)	4.5 (26)
Total large meal	15.5 (100)	13.5 (100)	17.5 (100)
Trans fat, g (% total meal)
2003
2-oz Cheeseburger	—	0.7 (19)	0.5 (14)
Small French fries	—	3 (81)	3 (86)
Total small meal	—	3.7 (100)	3.5 (100)
4-oz Cheeseburger	—	1.4 (18)	1 (17)
Large French fries	—	6.4 (82)	5 (83)
Total large meal	—	7.8 (100)	6 (100)
2008
2-oz Cheeseburger	0.5 (100)	0.5 (14)	0.5 (100)
Small French fries	0	3 (86)	0
Total small meal	0.5 (100)	3.5 (100)	0.5 (100)
4-oz Cheeseburger	1.5 (100)	1.5 (20)	1 (100)
Large French fries	0	6 (80)	0
Total large meal	1.5 (100)	7.5 (100)	1 (100)
2013
2-oz Cheeseburger	0.5 (100)	0	0.5 (100)
Small French fries	0	0	0
Total small meal	0.5 (100)	0	0.5 (100)
4-oz Cheeseburger	1.5 (100)	1 (100)	1.5 (100)
Large French fries	0	0	0
Total large meal	1.5 (100)	1 (100)	1.5 (100)

Discussion

Despite concern that portion sizes have increased over time, contributing to the obesity epidemic and high rates of cardiometabolic disorders, among the 3 fast-food chain restaurants surveyed and menu items selected, no clear temporal trends were observed. Nevertheless, the energy, sodium, and saturated fat contents were high relative to recommendations (1).

Although there appeared to be an upward trend in portion size of the fast-food restaurant items through 2002 (13), our data and recently published data (17) indicate that this trend appears to have abated. Changes did vary substantially among the 3 chains, and portion sizes remain large. For example, in 2013, large-sized fries, regardless of chain, represented 25% of the daily energy needs of an adult, assuming an energy requirement of 2,000 kcal per day. A large-sized bundled meal composed of a large cheeseburger, large French fries, and regular cola beverage represented 65% to 80% of a 2,000 calorie diet.

Although the sodium content of some menu items decreased, sodium levels mostly remain high and in some cases they increased. The Dietary Guidelines for Americans recommends a sodium limit of 2,300 mg per day for the general population and 1,500 mg per day for some subpopulations (1). For all 3 chains, the sodium content of a 4-oz cheeseburger approached or exceeded half the 2,300-mg-per-day target and 75% of the 1,500-mg-per-day target (1). For the large-sized meal, the sodium content was 63% to 91% of a 2,300-mg-per-day recommendation and 97% to 139% of a 1,500-mg-per-day recommendation.

The saturated fat content of the items surveyed was consistent, with the exception of a decrease in 1 chain’s French fries, presumably due to a change in frying fat (from beef tallow to partially hydrogenated fat). Nevertheless, the saturated fat content of the large-sized meal in 2013 was 61% to 80% of the recommended 10% of energy upper limit (22 g/2,000 kcal) (1) and 104% and 135% of the recommended 6% of energy upper limit (13 g/2,000 kcal)(6).

Of the menu items assessed, French fries historically contributed most of the trans fat. More recently, the trans fat content of French fries decreased because of a shift away from the use of partially hydrogenated fat. This change was prompted by local legislative mandates and public pressure (16). Our findings are consistent with those recently generated for foods purchased from 11 fast-food chains in New York City (18). The changes are an example of how reformulation had a positive effect on overall intake (19). The American Heart Association recommends trans fat intake be less than 1% of energy (20). The trans fat content of the large bundled meal that includes a cheeseburger represents 50% to 75% of the current recommendation, although the trans fat content of cheeseburgers comes from that naturally present in ruminant fat.

A noteworthy finding was that the energy, sodium, and saturated fat content of similarly labeled menu items differed considerably among the 3 fast-food chains. This has implications for counseling individuals on approaches to reduce intakes. Although the most straightforward approach is to provide dietary counseling on the basis of portion size (eg, always order the smallest size), findings of our study indicate that without information tailored to each food venue, the counseling is not likely to achieve the intended goal. To illustrate, an order of small French fries at Chain B provides 110 kcal and 320 mg sodium more than the same item at Chain A. It is unlikely that consumers are aware of the differences among chain restaurants. However, the implications of these data are striking. An extra 100 kcal per day without compensation translates to a 6 to 7 kg weight gain per year (21–23).

The data in this study were restricted to 3 fast-food chain restaurants; therefore, trends observed may not be generalizable to other venues. Of note, the 3 fast-food chain restaurants chosen account for approximately 34% of sales dollars of the top fast-food restaurants in the Untied States (14). Additionally, fast-food chain restaurant foods and beverages accounted for approximately 40% of total away-from-home energy intake in 2008 (24). Consumption of foods and beverages from fast-food restaurants is positively associated with body fatness and coronary heart disease mortality (25–28). Not captured in this study was the potential effect of recent “healthier” items offered by fast-food restaurants on the choice of the more frequently ordered items that were the focus of this study.

Most of the data used for this study were derived from the Wayback Machine website. When possible, these data were independently validated using current data from company websites. In all cases, the Wayback Machine website data were accurate. This website is unbiased because it is an independent website archival system. We cannot rule out the possibility that small variations in nutrient values from year to year may have resulted from analytical variability or shifts in analytical methods. The study was limited to 3 chain restaurants, 3 food items, 1 beverage, and 1 bundled meal. These items and this meal combination were chosen because they were most commonly ordered in the 3 chain restaurants (15). An alternate approach would have been to choose different restaurants on the basis of single items, for example, chicken sandwiches. Although trends for other food items or other types of fast-food items could be different, there are no data to suggest this to be the case. An unanswered question is whether, were a fast-food chain to change its portion sizes or reduce sodium content, consumers would compensate by modifying their order, switching to another chain, or altering another dietary component.

Our findings suggest that efforts to promote reductions in energy, sodium, saturated fat, and trans fat intakes need to be shifted from emphasizing portion size labels (eg, small, medium, large). When developing strategies that help consumers better control their energy intakes and intakes of other nutrients, additional factors — such as total caloric intake, frequency of eating occasions, number of items eaten at any occasion, specific menu choices, and limiting energy-containing beverages — should be addressed. People should be encouraged to take advantage of the point-of-purchase menu labeling provided at fast-food establishments and should consult websites that contain nutrition information.

Acknowledgments

This work was supported by the US Department of Agriculture under agreement nos. 58-1950-0-0014 and 1950-51000-072-02S with Tufts University. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the US Department of Agriculture. The authors thank Ashley Equi for her help with data acquisition.

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions.

Suggested citation for this article: Urban LE, Roberts SB, Fierstein JL, Gary CE, Lichtenstein AH. Temporal Trends in Fast-Food Restaurant Energy, Sodium, Saturated Fat, and Trans Fat Content, United States, 1996–2013. Prev Chronic Dis 2014;11:140202. DOI: http://dx.doi.org/10.5888/pcd11.140202.

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22753304

Chain/Year	French Fries, kcal			Cheeseburger, kcal		Grilled Chicken Sandwich, kcal	Cola, kcal
Chain/Year	S	M	L	2 oz	4 oz	Grilled Chicken Sandwich, kcal	S	M	L
Chain A
1996	210	450	540	320	530		150	—	—
1997	210	450	540	320	530	440	150	—	—
1998	210	450	540	320	530	440	150	—	—
1999	210	450	540	320	530	440	150	210	310
2000	210	450	540	320	530	450	150	210	310
2001	210	450	540	330	530	450	150	210	310
2002	210	450	540	330	530	450	150	210	310
2003	210	450	540	330	530	400	150	210	310
2004	220	350	520	330	540	400	150	210	310
2005	230	350	520	310	510	420	150	210	310
2006	250	380	570	310	510	420	150	210	310
2007	250	380	570	300	510	420	150	210	310
2008	230	380	500	300	510	420	150	210	310
2009	230	380	500	300	510	420	150	210	310
2010	230	380	500	300	510	420	150	210	310
2011	230	380	500	300	510	350	150	210	310
2012	230	380	500	300	520	350	150	210	310
2013	230	380	500	300	520	350	140	200	280
β	1.8	−0.6	−2.7	−1.8	−1.4	−5.5	−0.2	−0.3	−0.8
P value	<.001	<.001	.007	<.001	.002	<.001	.10	.11	.11
Chain B
1996	—	—		—	—	—	—	—	—
1997	—	370		380	730	550	204	280	—
1998	—	—		—	—	—	—	—	—
1999	250	400	590	360	760	530	204	280	407
2000	250	400	590	360	760	530	204	280	407
2001	230	360	500	370	780	550	—	—	—
2002	230	360	500	360	850	580	160	230	330
2003	230	360	500	360	800	580	160	230	330
2004	230	360	500	350	800	570	160	200	330
2005	230	360	500	350	800	570	140	200	290
2006	230	360	500	330	760	510	140	200	290
2007	230	360	500	330	760	510	140	200	290
2008	230	360	500	340	770	490	140	210	290
2009	340	480	580	340	770	490	210	290	390
2010	340	440	540	310	770	490	210	290	390
2011	340	440	540	300	760	470	190	290	380
2012	340	410	500	280	760	470	190	290	380
2013	340	410	500	288	710	510	190	290	380
β	8.9	3.9	−2.0	−5.8	−1.7	−5.5	−0.1	1.5	0.6
P value	.001	.05	.36	<.001	.39	.002	.97	.52	.85
Chain C
1996	260	380	460	320	490	310	90	108	180
1997	270	390	470	320	490	310	90	108	180
1998	270	470	570	320	490	310	90	108	180
1999	270	470	570	320	490	310	90	108	180
2000	270	470	570	320	490	310	90	108	180
2001	270	420	470	310	480	300	104	130	208
2002	250	390	440	310	480	300	112	140	224
2003	250	390	440	310	480	300	112	140	224
2004	250	390	440	310	480	360	112	140	224
2005	280	440	490	320	490	360	112	140	224
2006	370	420	540	320	490	370	140	224	294
2007	330	420	520	320	500	320	140	224	294
2008	340	430	550	260	500	320	140	210	280
2009	330	420	540	270	540	350	160	240	320
2010	330	410	540	270	540	340	160	240	320
2011	320	420	530	270	550	360	160	240	320
2012	320	420	530	290	620	390	160	—	—
2013	310	410	500	290	600	390	160	240	320
β	4.9	−0.5	1.8	−3.0	6.1	4.5	5.2	10.3	10.6
P value	.001	.73	.40	<.001	<.001	<.001	<.001	<.001	<.001
Chain comparison P value	≤.002	.04^a	NS	≤.008^b	<.001^b	<.001	≤.01	≤.02	<.001^b

Chain/Year	French Fries			Cheeseburger		Grilled Chicken Sandwich
	Small	Medium	Large	2 oz	4 oz	Grilled Chicken Sandwich
	Sodium, mg
Chain A
1996	135	290	350	770	1,200
1997	135	290	350	820	1,290	1,040
1998	135	290	350	820	1,290	1,040
1999	135	290	350	820	1,290	1,040
2000	135	290	350	830	1,310	970
2001	135	290	350	830	1,310	970
2002	135	290	350	830	1,310	970
2003	135	290	350	800	1,250	890
2004	150	220	340	790	1,240	1,020
2005	140	220	330	740	1,150	1,240
2006	140	220	330	740	1,150	1,240
2007	140	220	330	750	1,190	1,190
2008	160	270	350	750	1,190	1,190
2009	160	270	350	750	1,190	1,190
2010	160	270	350	750	1,190	1,190
2011	160	270	350	750	1,190	820
2012	160	270	350	680	1,100	820
2013	160	270	350	680	1,100	820
β	1.9	−2.1	−0.2	−7.5	−10.2	−2.8
P value	<.001	.10	.63	<.001	<.001	.71
Chain B
1996	—	—		—	—	—
1997	—	240		770	1,350	480
1998	—	—		—	—	—
1999	550	820	1,180	760	1,380	1,060
2000	550	820	1,180	760	1,380	1,060
2001	630	690	940	750	1,390	1,110
2002	410	640	880	790	1,430	1,370
2003	410	640	880	790	1,420	1,370
2004	410	640	880	770	1,450	1,410
2005	410	640	880	770	1,450	1,410
2006	380	590	820	780	1,450	1,180
2007	380	590	820	780	1,450	1,180
2008	380	590	820	780	1,450	1,250
2009	590	820	990	770	1,450	1,220
2010	530	670	830	740	1,450	1,220
2011	530	670	830	710	1,410	1,100
2012	480	570	710	690	1,410	1,330
2013	480	570	710	690	1,240	1,350
β	−1.7	2.1	−24.0	−4.1	<0.1	23.7
P value	.75	.79	<.001	.01	.99	.04
Chain C
1996	85	120	150	770	1,130	780
1997	85	120	150	830	1,240	790
1998	85	150	180	830	1,240	790
1999	85	150	180	830	1,240	790
2000	85	150	180	830	1,240	790
2001	85	130	150	800	1,180	740
2002	220	340	380	820	1,210	740
2003	220	340	380	820	1,230	730
2004	220	340	380	820	1,230	1,100
2005	270	430	480	820	1,220	1,100
2006	380	430	550	810	1,200	1,070
2007	340	430	550	800	1,220	950
2008	290	370	480	690	1,190	950
2009	300	380	500	700	1,260	1,000
2010	280	350	460	730	1,290	1,030
2011	350	460	570	670	1,270	1,110
2012	350	460	570	820	1,440	880
2013	330	440	540	800	1,220	1,000
β	18.8	22.0	29.6	−4.7	5.9	17.9
P value	<.001	<.001	<.001	.05	.03	.002
Chain comparison P value	≤.01	<.001^a	<.001^a	NS	<.001^a	≤.001^a