Meals consumed from both full-service and fast-food restaurants account for a substantial proportion of daily energy intake. Yet, the overall actual dietary quality of different restaurant meals and related trends have not been well established. To examine these issues, Junxiu Liu and Dariush Mozaffarian (Friedman School of Nutrition Science and Policy at Tufts University) and colleagues assessed nutritional quality of meals of full-service and fast-food restaurants consumed by US adults over a 14-year period, including the trends associated with socio-demographic disparities, in a nationally representative sample.

The National Health and Nutrition Examination Survey, known as NHANES, is a program designed to assess the health and nutritional status of adults and children in the US. Nationally representative samples totaling 35,015 adults aged > 20 y from 7 NHANES cycles 2003-2016 were utilized for this study. Dietary information based on 24-h dietary recalls was analyzed to assess patterns and nutritional quality. The American Heart Association diet score, which is predictive of cardiovascular and metabolic outcomes in diverse populations, was utilized to assess full-service and fast-food meal quality. Based on 50 possible points, diet quality scores were defined as follows: poor < 20, intermediate 20-39.9, or as ideal > 40.

Between 2003 and 2016, approximately 21 percent of total caloric intake by American adults came from restaurants. In 2015-2016, diet quality of most full-service and fast-food meals consumed was low, with mean American Heart Association diet scores of 31.6 and 27.6, respectively. Modest improvements in dietary quality were observed in fast-food meals, but the average quality of both full-service and fast-food meals remained low and with persistent or growing socio-demographic disparities. As restaurant meals continue to provide a substantial portion of calories for US adults, these findings highlight the need for strategies to improve the nutritional quality of U.S. restaurant meals. A corresponding editorial by Vivica Kraak (Virginia Tech) emphasizes that the US restaurant sector can play an important role in this transformation by encouraging customers to make healthy choices. “If chain restaurants are not part of the solution, they remain part of the problem that contributes to obesity and chronic disease rates.”

This study is a part of the Food Policy Review and Intervention Cost-Effectiveness (Food-PRICE) research initiative, a National Institutes of Health-funded collaboration led by researchers at the Friedman School working to identify cost-effective nutrition strategies to improve population health in the United States. The work was supported by awards from the National Institutes of Health’s National Heart, Lung, and Blood Institute (R01HL130735) and a postdoctoral fellowship from the American Heart Association.”

References Liu J, Rehm CD, Micha R, Mozaffarian D. Quality of Meals Consumed by US Adults at Full-Service and Fast-Food Restaurants, 2003-2016: Persistent Low Quality and Widening Disparities. J Nutr. 2020 Jan 29 (Epub ahead of print; DOI: 

Kraak VI. The US Chain Restaurant Industry Must Transform Its Business Model to Market Healthy Menus Items to Americans to Reduce Obesity and Chronic Disease Risks. J Nutr. 2019 Jun, DOI:

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