National Fast-food Chain Research Articles

Menu Labeling and Calories Purchased in Restaurants in a US National Fast Food Chain

Menu labeling has been implemented in restaurants in some US jurisdictions as early as 2008, but the extent to which menu labeling is associated with calories purchased is unclear. To estimate the association of menu labeling with calories and nutrients purchased and assess geographic variation in results. A cohort study was conducted with a quasi-experimental design using actual transaction data from Taco Bell restaurants from calendar years 2007 to 2014 US restaurants with menu labeling matched to comparison restaurants using synthetic control methods. Data were analyzed from May to October 2023. Menu labeling policies in 6 US jurisdictions. The primary outcome was calories per transaction. Secondary outcomes included total and saturated fat, carbohydrates, protein, sugar, fiber, and sodium. The final sample included 2329 restaurants, with menu labeling in 474 (31 468 restaurant-month observations). Most restaurants (94.3%) were located in California. Difference-in-differences model results indicated that customers purchased 24.7 (95% CI, 23.6-25.7) fewer calories per transaction from restaurants in the menu labeling group in the 3- to 24-month follow-up period vs the comparison group, including 21.9 (95% CI, 20.9-22.9) fewer calories in the 3- to 12-month follow-up period and 25.0 (95% CI, 24.0-26.1) fewer calories in the 13- to 24-month follow-up period. Changes in the nutrient content of transactions were consistent with calorie estimates. Findings in California were similar to overall estimates in magnitude and direction; yet, among restaurants outside of California, no association was observed in the 3- to 24-month period. The outcome of menu labeling also differed by item category and time of day, with a larger decrease in the number of tacos vs other items purchased and a larger decrease in calories purchased during breakfast vs other times of the day in the 3- to 24-month period. In this quasi-experimental cohort study, fewer calories were purchased in restaurants with calorie labels compared with those with no labels, suggesting that consumers are sensitive to calorie information on menu boards, although associations differed by location.

Notes from the Field: Multistate Outbreak of Escherichia coli O157:H7 Infections Linked to a National Fast-Food Chain - United States, 2022.

Notes from the Field: Multistate Outbreak of Escherichia coli O157:H7 Infections Linked to a National Fast-Food Chain - United States, 2022.

Sociodemographic Disparities among Fast-Food Restaurant Customers Who Notice and Use Calorie Menu Labels

BackgroundAs part of the recently passed Patient Protection and Affordable Care Act, chain restaurants with 20 or more locations nationwide will soon be required to post calorie information on menus with the aim of helping customers make healthier food choices. To be effective, this policy must affect all customers, especially those most at risk for poor health and diet outcomes. ObjectiveTo determine whether noticing or using calorie menu labels was associated with demographic characteristics of customers at a national fast-food chain currently implementing calorie menu labeling. DesignCross-sectional analysis. Participants/settingCustomer receipts and survey data were collected from 329 participants using street-intercept survey methodology at 29 McDonald's restaurant locations in low- and high-income neighborhoods throughout the Phoenix, AZ, metropolitan area. Outcome measuresCalorie menu labeling awareness and use were assessed. The total number of calories purchased was evaluated using participants’ itemized receipts. Statistical analysesMultivariate logistic regression analyses were used to calculate the odds of customers noticing or using calorie menu labels. ResultsApproximately 60% of participants noticed calorie menu labels, whereas only 16% reported using the information for food or beverage purchases. Higher-income individuals had twice the odds of noticing calorie labels (P=0.029) and three times the odds of using them (P=0.004). Significant positive associations were found between individuals with a bachelor’s degree or higher and use of calorie menu labels (odds ratio 3.25; P=0.023). Noticing calorie menu labels was not associated with purchasing fewer calories; however, those who reported using calorie information purchased 146 fewer calories than those who did not (P=0.001). ConclusionsUsing calorie menu labels is associated with purchasing fewer calories. However, there are significant socioeconomic disparities among customers who notice and use calorie menu labels. Targeted education campaigns are needed to improve the use of menu labeling across all sociodemographic groups.

The Autopsy of Chicken Nuggets Reads “Chicken Little”

PurposeTo determine the contents of chicken nuggets from 2 national food chains. BackgroundChicken nuggets have become a major component of the American diet. We sought to determine the current composition of this highly processed food. MethodsRandomly selected nuggets from 2 different national fast food chains were fixed in formalin, sectioned and stained for microscopic analysis. ResultsStriated muscle (chicken meat) was not the predominate component in either nugget. Fat was present in equal or greater quantities along with epithelium, bone, nerve, and connective tissue. ConclusionChicken nuggets are mostly fat, and their name is a misnomer.

Communicating nutrition information: Usability and usefulness of the interactive menus of national fast food chain restaurants

Unhealthy dietary habits, such as fast food consumption, have been identified as one of the major factors linked with the co-morbidity of obesity, diabetes, and hypertension. Nutrition facts displayed on nutrition labels are aimed at providing the public easy access to nutrition information to facilitate better nutrition behavior and dietary habits. The empirical evidence, however, has demonstrated that consumers either under used or lacked the ability to accurately use the nutrition facts provided on these labels. This project tested the usability and usefulness of the nutrition facts posted on the interactive menus from three national fast food chains. The results show that the interactive menus provided by the fast food chains were highly usable but not necessarily useful, with users encountering a relatively high degree of difficulty in constructing meal plans that could comply with the recommended nutrient-intake quantities. The major lesson learned from this case study suggests that the restaurant industry should continue to improve the nutrition values of their products and provide interactive menus for their consumers to make good dietary choices that could help prevent the co-morbidity epidemic of obesity, diabetes, and hypertension in this country.

Multistate outbreak of Escherichia coli O157:H7 infections associated with a national fast-food chain, 2006: a study incorporating epidemiological and food source traceback results.

A multistate outbreak of Escherichia coli O157:H7 infections occurred in the USA in November-December 2006 in patrons of restaurant chain A. We identified 77 cases with chain A exposure in four states - Delaware, New Jersey, New York, and Pennsylvania. Fifty-one (66%) patients were hospitalized, and seven (9%) developed haemolytic uraemic syndrome; none died. In a matched analysis controlling for age in 31 cases and 55 controls, illness was associated with consumption of shredded iceberg lettuce [matched odds ratio (mOR) 8·0, 95% confidence interval (CI) 1·1-348·1] and shredded cheddar cheese (mOR 6·2, CI 1·7-33·7). Lettuce, an uncooked ingredient, was more commonly consumed (97% of patients) than cheddar cheese (84%) and a single source supplied all affected restaurants. A single source of cheese could not explain the regional distribution of outbreak cases. The outbreak highlights challenges in conducting rapid multistate investigations and the importance of incorporating epidemiological study results with other investigative findings.

Risk factors for and prevention of sporadic infections with vero cytotoxin (shiga toxin) producing Escherichia coli 0157

Recent outbreaks of vero cytotoxin (shiga toxin) producing Escherichia coli O157 (VTEC O157) infection have stimulated debate on food safety. However, 90% of cases in England and Wales are sporadic. We report a case-control study of sporadic VTEC O157 infection. We compared 85 sporadic cases of VTEC O157 infection, identified through population surveillance, with 142 controls, randomly selected from general practitioners' lists. We matched cases and controls for age, sex, and family doctor's practice. Exposures to foods, water, animals, farms, and environmental factors were recorded. We visited the premises concerned when cases had eaten beefburgers or cooked sliced meats from caterers or had had contact with a farm. Consumption of a beefburger from a catering premises other than from a fast-food chain A (a national chain) and consumption of cold cooked sliced meat (eg, in a salad or sandwich) from caterers, but not butchers, was associated with VTEC O157 infection (odds ratios 4.63 [95% CI 1.33-30.14] and 3.36 [1.04-12.74], respectively). Policies for ensuring thorough cooking of burgers by one national fast-food chain differed from the other catering premises we visited. There was evidence of person-to-person spread and transmission of VTEC O157 infection from animals. Local inspection of catering establishments that serve cooked meats together with public education to prevent spread on farms and in houses would reduce the burden of VTEC O157 infection by about 10% for each risk factor.