Abstract EP24: Menu Calorie Label Use Is Associated With Healthier Diet Quality In Americans

Abstract

Background: Unhealthy diet quality is a risk factor for cardiometabolic diseases. The Affordable Care Act mandated menu calorie labeling in many food service businesses to promote healthy food choices, but evidence is limited on whether label use affects dietary intake. Hypothesis: We studied the hypothesis that menu calorie label use is associated with healthier diet quality in a nationally representative dataset. Methods: We included individuals age≥16 years from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 who reported buying food from a fast food, sit-down, or buffet restaurant or coffee shop in the past year (n=3,823). The exposure, menu calorie label use, was dichotomized to participants who used labels vs. those who did not use labels at any of the mentioned food service sites using the Consumer Behavior Phone Follow-up Module survey data. The primary outcome was diet quality measured by the Healthy Eating Index 2015 (HEI-2015; range 0-100) using two days of 24-hour diet recall data (n=3,809). Secondary outcomes included certain HEI components (added sugars, saturated fats, fruits, vegetables) and total daily calories. We used multiple linear regression to measure the association between label use and outcomes, accounting for the complex survey design of NHANES and adjusting for demographic, socioeconomic, and comorbidity factors. Results: Of 3,806 participants (representing 224,305,985 Americans), 903 (26.9 weighted %) used menu calorie labels. Those who used menu calorie labels were more likely to be younger (μ=43.3 years, SE 0.58), female (60.8%), and with higher educational attainment (college degree or higher 44.6%), and less likely to be low-income (≤200% of federal poverty level 19.5%) compared to those who did not use them (age μ=47.1 years, SE 0.79; female 49.7%; college degree or higher 26.9%; ≤200% FPL 33.6%). Compared to participants who did not use calorie labels, those who used menu calorie labels had HEI-2015 scores that were 3.95 points (95% CI 2.28, 5.63) higher and consumed less calories (β=-240.4 kcal, 95% CI -384.3, -96.5). Of the HEI-2015 components, participants who used menu calorie labels ate more vegetables (β=0.41 points, 95% CI 0.20, 0.62) and less added sugars (β=0.74 points, 95% CI 0.24, 1.24). No differences were seen in saturated fat or fruit intake. Conclusions: Individuals who used menu calorie labels had significantly healthier dietary intake and consumed less calories compared to those who did not use labels, suggesting that providing caloric information may influence healthy food decisions. Those who did not use labels had lower education level and family income. Further research is needed to explore how people use label information to make food choices and why individuals may not use calorie labels to improve utility and effectiveness of point-of-purchase nutrition information without amplifying health disparities.