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

Susan B Roberts* (Corresponding Author), Sai Krupa Das, Vivian Marques Miguel Suen, Jussi Pihlajamäki, Rebecca Kuriyan, Matilda Steiner-Asiedu, Amy Taetzsch, Alex K Anderson, Rachel E Silver, Kathryn Barger, Amy Krauss, Leila Karhunen, Xueying Zhang, Catherine Hambly, Ursula Schwab, Andresa de Toledo Triffoni-Melo, Salima F Taylor, Christina Economos, Anura V Kurpad, John R Speakman* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Citations (Scopus)
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OBJECTIVE: To measure the energy content of frequently ordered meals from full service and fast food restaurants in five countries and compare values with US data.

DESIGN: Cross sectional survey.

SETTING: 223 meals from 111 randomly selected full service and fast food restaurants serving popular cuisines in Brazil, China, Finland, Ghana, and India were the primary sampling unit; 10 meals from five worksite canteens were also studied in Finland. The observational unit was frequently ordered meals in selected restaurants.

MAIN OUTCOME MEASURE: Meal energy content, measured by bomb calorimetry.

RESULTS: Compared with the US, weighted mean energy of restaurant meals was lower only in China (719 (95% confidence interval 646 to 799) kcal versus 1088 (1002 to 1181) kcal; P<0.001). In analysis of variance models, fast food contained 33% less energy than full service meals (P<0.001). In Finland, worksite canteens provided 25% less energy than full service and fast food restaurants (mean 880 (SD 156) versus 1166 (298); P=0.009). Country, restaurant type, number of meal components, and meal weight predicted meal energy in a factorial analysis of variance (R2=0.62, P<0.001). Ninety four per cent of full service meals and 72% of fast food meals contained at least 600 kcal. Modeling indicated that, except in China, consuming current servings of a full service and a fast food meal daily would supply between 70% and 120% of the daily energy requirements for a sedentary woman, without additional meals, drinks, snacks, appetizers, or desserts.

CONCLUSION: Very high dietary energy content of both full service and fast food restaurant meals is a widespread phenomenon that is probably supporting global obesity and provides a valid intervention target.

Original languageEnglish
Article numberk4864
JournalBMJ (Clinical research ed.)
Publication statusPublished - 12 Dec 2018

Bibliographical note

Funding: This work was supported in part by the US Department of Agriculture under agreement no. 58-1950-4-003 with Tufts University and a Tufts University Provost award to SBR. The study had additional funding in Brazil from FAPESP grants 2013/18520-0 and 2013/14489-1 to VS; in China from the National Science Foundation of China grant No 91431102 to JRS and International Partnership Program of Chinese Academy of Sciences grant No GJHZ1660 to JRS; in Finland from internal funding by the University of Eastern Finland to JP; in Ghana from the University of Georgia Global Research Collaborative Grant Program to AKA. The views expressed are those of the authors. The sponsors had no role in the design, undertaking, or reporting of the study.


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