Advertisement

Trends in Sodium Content of Menu Items in Large Chain Restaurants in the U.S.

Published:October 19, 2017DOI:https://doi.org/10.1016/j.amepre.2017.08.018

      Introduction

      Consuming too much sodium is associated with increased risk for cardiovascular disease, and restaurant foods are a primary source of sodium. This study assessed recent trends in sodium content of menu items in U.S. chain restaurants.

      Methods

      Data from 21,557 menu items in 66 top-earning chain restaurants available from 2012 to 2016 were obtained from the MenuStat project and analyzed in 2017. Generalized linear models were used to examine changes in calorie-adjusted, per-item sodium content of menu items offered in all years (2012–2016) and items offered in 2012 only compared with items newly introduced in 2013, 2014, 2015, and 2016.

      Results

      Overall, calorie-adjusted sodium content in newly introduced menu items declined by 104 mg from 2012 to 2016 (p<0.02). However, the magnitude and direction of these changes varied by menu category and restaurant type; sodium content, particularly for main course items, was high. Sodium declined by 83 mg in fast food restaurants, 19 mg in fast casual restaurants, and 163 mg in full service restaurants. Sodium in appetizer and side items newly introduced in 2016 increased by 266 mg compared with items on the menu in 2012 only (p<0.01). Sodium in main courses newly introduced in 2016 declined by 124 mg compared with items on the menu in 2012 only (p=0.01), with the greatest decline, 207 mg (p=0.03), among salads.

      Conclusions

      Average, adjusted, per-item sodium content was lower in newly introduced items in large chain restaurants. However, sodium content of core and new menu items remain high, and reductions are inconsistent across menu categories and restaurant types.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • National Academy of Medicine
        Sodium Intake in Populations: Assessment of Evidence.
        The National Academies Press, Washington, DC2013https://doi.org/10.17226/18311
      1. National Center for Health Statistics. Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD: National Center for Health Statistics; 2016.

      2. U.S. DHHS, U.S. Department of Agriculture. 2015−2020 Dietary Guidelines for Americans. 8th ed. http://health.gov/dietaryguidelines/2015/guidelines/. Published December 2015. Accessed August 30, 2017.

        • Jackson S.L.
        • Coleman King S.M.
        • Zhao L.
        • Cogswell M.E.
        Prevalence of excess sodium intake in the United States—NHANES, 2009–2012.
        MMWR Morb Mortal Wkly Rep. 2016; 64: 1393-1397https://doi.org/10.15585/mmwr.mm6452a1
        • Bibbins-Domingo K.
        • Chertow G.M.
        • Coxson P.G.
        • et al.
        Projected effect of dietary salt reductions on future cardiovascular disease.
        N Engl J Med. 2010; 362: 590-599https://doi.org/10.1056/NEJMoa0907355
        • Mattes R.D.
        • Donnelly D.
        Relative contributions of dietary sodium sources.
        J Am Coll Nutr. 1991; 10: 383-393https://doi.org/10.1080/07315724.1991.10718167
        • Harnack L.J.
        • Cogswell M.E.
        • Shikany J.M.
        • et al.
        Sources of sodium in U.S. adults from 3 geographic regions.
        Circulation. 2017; 135: 1775-1783https://doi.org/10.1161/CIRCULATIONAHA.116.024446
        • Ahuja J.K.C.
        • Wasswa-Kintu S.
        • Haytowitz D.B.
        • et al.
        Sodium content of popular commercially processed and restaurant foods in the United States.
        Prev Med Rep. 2015; 2: 962-967https://doi.org/10.1016/j.pmedr.2015.11.003
        • An R.
        Fast-food and full-service restaurant consumption and daily energy and nutrient intakes in U.S. adults.
        Eur J Clin Nutr. 2016; 70: 97-103https://doi.org/10.1038/ejcn.2015.104
        • Drewnowski A.
        • Rehm C.D.
        Sodium intakes of U.S. children and adults from foods and beverages by location of origin and by specific food source.
        Nutrients. 2013; 5: 1840-1855https://doi.org/10.3390/nu5061840
        • Nguyen B.T.
        • Powell L.M.
        The impact of restaurant consumption among U.S. adults: effects on energy and nutrient intakes.
        Public Health Nutr. 2013; 17: 2445-2452https://doi.org/10.1017/S1368980014001153
        • Wu H.W.
        • Sturm R.
        Changes in the energy and sodium content of main entrées in U.S. chain restaurants from 2010 to 2011.
        J Acad Nutr Diet. 2014; 114: 209-219https://doi.org/10.1016/j.jand.2013.07.035
        • Powell L.M.
        • Nguyen B.T.
        • Han E.
        Energy intake from restaurants: demographics and socioeconomics, 2003–2008.
        Am J Prev Med. 2012; 43: 498-504https://doi.org/10.1016/j.amepre.2012.07.041
      3. Economic Research Service. Table 10: Food away from home as a share of food expenditures. www.ers.usda.gov/data-products/food-expenditures.aspx. Published 2014. Accessed March 28, 2017.

        • Patel S.M.
        • Gunn J.P.
        • Tong X.
        • Cogswell M.E.
        Consumer sentiment on actions reducing sodium in processed and restaurant foods, ConsumerStyles 2010.
        Am J Prev Med. 2014; 46: 516-524https://doi.org/10.1016/j.amepre.2013.12.012
        • Jacobson M.F.
        • Havas S.
        • McCarter R.
        Changes in sodium levels in processed and restaurant foods, 2005 to 2011.
        JAMA Intern Med. 2013; 173: 1285-1291https://doi.org/10.1001/jamainternmed.2013.6154
        • Scourboutakos M.J.
        • Semnani-Azad Z.
        • L’Abbe M.R.
        Restaurant meals: Almost a full day’s worth of calories, fats, and sodium.
        JAMA Intern Med. 2013; 173: 1373-1374https://doi.org/10.1001/jamainternmed.2013.6159
      4. New York City Department of Health. National Salt Reduction Initiative. www1.nyc.gov/site/doh/health/health-topics/salt-initiative-restaurantfood.page. Accessed March 17, 2017.

        • Curtis C.J.
        • Clapp J.
        • Niederman S.A.
        • Ng S.W.
        • Angell S.Y.
        U.S. food industry progress during the national salt reduction initiative: 2009–2014.
        Am J Public Health. 2016; 106: 1815-1819https://doi.org/10.2105/AJPH.2016.303397
      5. New York City Department of Health. National Salt Reduction Initiative Sodium Reformulation in Top U.S. Chain Restaurant Foods: 2009−2014. www1.nyc.gov/assets/doh/downloads/pdf/cardio/nsri-restaurant-report-poster.pdf. Accessed March 17, 2017.

      6. U.S. Food and Drug Administration. Draft Guidance for Industry: Voluntary Sodium Reduction Goals: Target Mean and Upper Bound Concentrations for Sodium in Commercially Processed, Packaged, and Prepared Foods. www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/ucm494732.htm. Published June 2016. Accessed March 28, 2017.

        • Bleich S.N.
        • Wolfson J.A.
        • Jarlenski M.P.
        Calorie changes in large chain restaurants: declines in new menu items but room for improvement.
        Am J Prev Med. 2016; 50: e1-e8https://doi.org/10.1016/j.amepre.2015.05.007
        • Bleich S.N.
        • Wolfson J.A.
        • Jarlenski M.P.
        Calorie changes in chain restaurant menu items: implications for obesity and evaluations of menu labeling.
        Am J Prev Med. 2015; 48: 70-75https://doi.org/10.1016/j.amepre.2014.08.026
        • Bleich S.N.
        • Wolfson J.A.
        • Jarlenski M.P.
        • Block J.P.
        Restaurants with calories displayed on menus had lower calorie counts compared to restaurants without such labels.
        Health Aff (Millwood). 2015; 34: 1877-1884https://doi.org/10.1377/hlthaff.2015.0512
        • Jarlenski M.P.
        • Wolfson J.A.
        • Bleich S.N.
        Macronutrient composition of menu offerings in fast food restaurants in the U.S..
        Am J Prev Med. 2016; 51: e91-e97https://doi.org/10.1016/j.amepre.2016.03.023
      7. The MenuStat Project. http://menustat.org/. Accessed June 9, 2016.

      8. The MenuStat Project Methods. http://menustat.org/Content/assets/pdfFile/MenuStat%20Methods%20and%20Codebook.pdf. Accessed June 8, 2016.

      9. What exactly is fast casual. Franchise Times. January 1, 2008. http://www.franchisetimes.com/January-2008/What-exactly-is-fast-casual/. Accessed May 23, 2017.

        • Auchincloss A.H.
        • Leonberg B.L.
        • Glanz K.
        • Bellitz S.
        • Ricchezza A.
        • Jervis A.
        Nutritional value of meals at full-service restaurant chains.
        J Nutr Educ Behav. 2014; 46: 75-81https://doi.org/10.1016/j.jneb.2013.10.008
        • Johnson C.M.
        • Angell S.Y.
        • Lederer A.
        • et al.
        Sodium content of lunchtime fast food purchases at major U.S. chains.
        Arch Intern Med. 2010; 170: 732-734https://doi.org/10.1001/archinternmed.2010.72
        • Maalouf J.
        • Cogswell M.E.
        • Gunn J.P.
        • et al.
        Monitoring the sodium content of restaurant foods: public health challenges and opportunities.
        Am J Public Health. 2013; 103: e21-e30https://doi.org/10.2105/AJPH.2013.301442
        • Moran A.J.
        • Block J.P.
        • Goshev S.G.
        • Bleich S.N.
        • Roberto C.A.
        Trends in nutrient content of children’s menu items in U.S. chain restaurants.
        Am J Prev Med. 2017; 52: 284-291https://doi.org/10.1016/j.amepre.2016.11.007
        • Deierlein A.L.
        • Peat K.
        • Claudio L.
        Comparison of the nutrient content of children’s menu items at U.S. restaurant chains, 2010–2014.
        Nutr J. 2015; 14: 80https://doi.org/10.1186/s12937-015-0066-4
        • Hearst M.O.
        • Harnack L.J.
        • Bauer K.W.
        • Earnest A.A.
        • French S.A.
        • Michael Oakes J.
        Nutritional quality at eight U.S. fast-food chains: 14-year trends.
        Am J Prev Med. 2013; 44: 589-594https://doi.org/10.1016/j.amepre.2013.01.028
        • Rudelt A.
        • French S.
        • Harnack L.
        Fourteen-year trends in sodium content of menu offerings at eight leading fast-food restaurants in the USA.
        Public Health Nutr. 2014; 17: 1682-1688https://doi.org/10.1017/S136898001300236X
        • Urban L.E.
        • Roberts S.B.
        • Fierstein J.L.
        • Gary C.E.
        • Lichtenstein A.H.
        Temporal trends in fast-food restaurant energy, sodium, saturated fat, and trans fat content, United States, 1996–2013.
        Prev Chronic Dis. 2014; 11: E229https://doi.org/10.5888/pcd11.140202
        • Moran A.J.
        • Ramirez M.
        • Block J.P.
        Consumer underestimation of sodium in fast food restaurant meals: results from a cross-sectional observational study.
        Appetite. 2017; 113: 155-161https://doi.org/10.1016/j.appet.2017.02.028
      10. New York City Department of Health. Sodium Warning Label for Chain Restaurants. www1.nyc.gov/site/doh/health/health-topics/national-salt-reduction-initiative.page. Accessed March 19, 2017.

      11. National Restaurant Association v New York City Department of Health and Mental Hygiene, 2017 1140 (NY Appellate Div, 1st Dept 2017).
        • Cantor J.
        • Torres A.
        • Abrams C.
        • Elbel B.
        Five years later: awareness of New York City’s calorie labels declined, with no changes in calories purchased.
        Health Affairs (Millwood). 2015; 34: 1893-1900https://doi.org/10.1377/hlthaff.2015.0623
        • Breck A.
        • Cantor J.
        • Martinez O.
        • Elbel B.
        Who reports noticing and using calorie information posted on fast food restaurant menus?.
        Appetite. 2014; 81: 30-36https://doi.org/10.1016/j.appet.2014.05.027
        • Dumanovsky T.
        • Huang C.Y.
        • Bassett M.T.
        • Silver L.D.
        Consumer awareness of fast-food calorie information in New York City after implementation of a menu labeling regulation.
        Am J Public Health. 2010; 100: 2520-2525https://doi.org/10.2105/AJPH.2010.191908
        • U.S. DHHS, U.S. Department of Agriculture
        Food labeling: nutrition labeling of standard menu items in restaurants and similar retail food establishments; extension of compliance date; request for comments. 21 CFR Parts 11 and 101. Docket no. FDA-2011-F-0172.
        Fed Reg. 82. 2017: 20825-20829

      Linked Article