Association Between Restaurant Menu Item Descriptions and Their Nutrient Content


      Item descriptions on restaurant menus often include claims about health and other attributes, and these are much less regulated than the language on packaged food labels. This study tests whether menu items with claims have different nutritional content from items without claims.


      Investigators compiled a data set of menu items, their claims, and their nutrition content using MenuStat. Data included 84,788 item-year observations at up to 96 of the top-selling restaurant chains from 2012 to 2018. Items were identified with general health, health-related ingredients, nutrient content, product sourcing, and vegan or vegetarian claims through a matching algorithm. Mixed-effects models were used to examine the effect of claims on calories, nutrients to limit (e.g., saturated fat and sodium), and other nutrients by dish types (sides, main dishes, desserts).


      Most dishes with claims were lower in calories; however, items with claims were not consistently lower in other nutrients to limit (sodium, saturated fat, sugar, or trans fat). Vegan or vegetarian desserts had 128 mg (95% CI=20.9, 235.1) more sodium than desserts without this claim. Main and side dishes with claims had equivalent or higher sugar content than items without claims. Many items with claims were lower in saturated fat, especially main dishes with a nutrient content claim (−2.8 percentage points, 95% CI= −3.4, −2.2).


      Items with claims were high in nutrients to limit. Additional efforts to increase transparency around excessive ingredients, such as the sodium warning labels, could be implemented by the restaurant industry.
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        • Shangguan S
        • Afshin A
        • Shulkin M
        • et al.
        A meta-analysis of food labeling effects on consumer diet behaviors and industry practices.
        Am J Prev Med. 2019; 56: 300-314
        • Kozup JC
        • Creyer EH
        • Burton S
        Making healthful food choices: the influence of health claims and nutrition information on consumers’ evaluations of packaged food products and restaurant menu items.
        J Mark. 2003; 67: 19-34
        • Huang Y
        • Pomeranz JL
        • Cash SB
        Effective national menu labeling requires accuracy and enforcement.
        J Acad Nutr Diet. 2018; 118: 989-993
        • U.S. Government Publishing Office
        21 CFR §101.11-nutrition labeling of standard menu items in covered establishments.
        U.S. Government Publishing Office, Washington, DCPublished April 1, 2015 (Accessed December 1, 2019)
        • Cleveland LP
        • Simon D
        • Block JP
        Federal calorie labelling compliance at U.S. chain restaurants.
        Obes Sci Pract. 2020; 6: 207-214
        • Hughner RS
        • McDonagh P
        • Prothero A
        • Shultz CJ
        • Stanton J
        Who are organic food consumers? A compilation and review of why people purchase organic food.
        J Consum Behav. 2007; 6: 94-110
        • Schuldt JP
        • Muller D
        • Schwarz N
        The “fair trade” effect: health halos from social ethics claims.
        Soc Psychol Personal Sci. 2012; 3: 581-589
        • Chandon P
        • Wansink B.
        The biasing health halos of fast‐food restaurant health claims: lower calorie estimates and higher side‐dish consumption intentions.
        J Consum Res. 2007; 34: 301-314
        • Finaret AB
        • Masters WA
        Beyond calories: the new economics of nutrition.
        Annu Rev Resour Econ. 2019; 11: 237-259
        • Kaur A
        • Scarborough P
        • Hieke S
        • et al.
        The nutritional quality of foods carrying health-related claims in Germany, The Netherlands, Spain, Slovenia and the United Kingdom [published correction appears in Eur J Clin Nutr. 2016;70(12):1462].
        Eur J Clin Nutr. 2016; 70: 1388-1395
        • Wansink B
        • Chandon P
        Can “low-fat” nutrition labels lead to obesity.
        J Mark Res. 2006; 43: 605-617
        • Colby JJ
        • Elder JP
        • Peterson G
        • Knisley PM
        • Carleton RA
        Promoting the selection of healthy food through menu item description in a family-style restaurant.
        Am J Prev Med. 1987; 3: 171-177
        • Howlett EA
        • Burton S
        • Bates K
        • Huggins K
        Coming to a restaurant near you? Potential consumer responses to nutrition information disclosure on menus.
        J Consum Res. 2009; 36: 494-503
        • Green JE
        • Brown AG
        • Ohri-Vachaspati P
        Sociodemographic disparities among fast-food restaurant customers who notice and use calorie menu labels.
        J Acad Nutr Diet. 2015; 115: 1093-1101
        • Dumoitier A
        • Abbo V
        • Neuhofer ZT
        • McFadden BR
        A review of nutrition labeling and food choice in the United States.
        Obes Sci Pract. 2019; 5: 581-591
        • Paeratakul S
        • Ferdinand DP
        • Champagne CM
        • Ryan DH
        • Bray GA
        Fast-food consumption among U.S. adults and children: dietary and nutrient intake profile.
        J Am Diet Assoc. 2003; 103: 1332-1338
        • Vikraman S
        • Fryar CD
        • Ogden CL
        Caloric intake from fast food among children and adolescents in the United States, 2011-2012.
        NCHS Data Brief. 2015; (Accessed September 19, 2019): 1-8
        • Bleich SN
        • Moran AJ
        • Jarlenski MP
        • Wolfson JA
        Higher-calorie menu items eliminated in large chain restaurants.
        Am J Prev Med. 2018; 54: 214-220
        • Moran AJ
        • Block JP
        • Goshev SG
        • Bleich SN
        • Roberto CA
        Trends in nutrient content of children's menu items in U.S. chain restaurants.
        Am J Prev Med. 2017; 52: 284-291
        • Bleich SN
        • Wolfson JA
        • Jarlenski MP
        • Block JP
        Restaurants with calories displayed on menus had lower calorie counts compared to restaurants without such labels.
        Health Aff (Millwood). 2015; 34: 1877-1884
        • Mueller MP
        • Wilde P
        • Folta SC
        • Anzman-Frasca S
        • Economos CD
        Availability of healthier children's menu items in the top selling quick service restaurant chains (2004-2015).
        Am J Public Health. 2019; 109: 267-269
        • Bleich SN
        • Soto MJ
        • Dunn CG
        • Moran AJ
        • Block JP
        Calorie and nutrient trends in large U.S. chain restaurants, 2012-2018.
        PLoS One. 2020; 15e0228891
        • Bleich SN
        • Wolfson JA
        • Jarlenski MP
        Calorie changes in chain restaurant menu items: implications for obesity and evaluations of menu labeling.
        Am J Prev Med. 2015; 48: 70-75
        • Merrill AL
        • Watt BK
        Energy value of foods... basis and derivation. Agriculture handbook no. 74.
        U.S. Department of Agriculture, Washington, DCPublished February 1973 (Accessed June 1, 2020)
        • HHS, U.S. Department of Agriculture
        Dietary guidelines for Americans 2015-2020: eighth edition.
        HHS, U.S. Department of Agriculture, Washington, DCPublished December 2015
        • Mozaffarian D
        • Rosenberg I
        • Uauy R
        History of modern nutrition science-implications for current research, dietary guidelines, and food policy.
        BMJ. 2018; 361: k2392
      1. HHS, U.S. Department of Agriculture. Shifts needed to align with healthy eating patterns: a closer look at current intakes and recommended shifts. Washington, DC: HHS, U.S. Department of Agriculture. Published January 7, 2016. Accessed October 15, 2019.

        • McCall M
        • Lynn A.
        The effects of restaurant menu item descriptions on perceptions of quality, price, and purchase intention.
        J Foodserv Bus Res. 2008; 11: 439-445
        • Tuso PJ
        • Ismail MH
        • Ha BP
        • Bartolotto C
        Nutritional update for physicians: plant-based diets.
        Perm J. 2013; 17: 61-66
        • Rayner M
        • Wood A
        • Lawrence M
        • et al.
        Monitoring the health-related labelling of foods and non-alcoholic beverages in retail settings.
        Obes Rev. 2013; 14: 70-81
        • Cleveland LP
        • Simon D
        • Block JP
        Compliance in 2017 with federal calorie labeling in 90 chain restaurants and 10 retail food outlets prior to required implementation.
        Am J Public Health. 2018; 108: 1099-1102
        • Zoellner J
        • You W
        • Connell C
        • et al.
        Health literacy is associated with healthy eating index scores and sugar-sweetened beverage intake: findings from the rural Lower Mississippi Delta.
        J Am Diet Assoc. 2011; 111: 1012-1020
        • Carbone ET
        • Zoellner JM
        Nutrition and health literacy: a systematic review to inform nutrition research and practice.
        J Acad Nutr Diet. 2012; 112: 254-265
        • Rikard RV
        • Thompson MS
        • McKinney J
        • Beauchamp A
        Examining health literacy disparities in the United States: a third look at the National Assessment of Adult Literacy (NAAL).
        BMC Public Health. 2016; 16: 975
        • Gibbs HD
        • Kennett AR
        • Kerling EH
        • et al.
        Assessing the nutrition literacy of parents and its relationship with child diet quality.
        J Nutr Educ Behav. 2016; 48: 505-509.e1
        • Gibbs HD
        • Ellerbeck EF
        • Gajewski B
        • Zhang C
        • Sullivan DK
        The nutrition literacy assessment instrument is a valid and reliable measure of nutrition literacy in adults with chronic disease.
        J Nutr Educ Behav. 2018; 50: 247-257.e1
        • Alexander E
        • Rutkow L
        • Gudzune KA
        • Cohen JE
        • McGinty EE
        Healthiness of U.S. chain restaurant meals in 2017.
        J Acad Nutr Diet. 2020; 120: 1359-1367
        • Benjamin EJ
        • Muntner P
        • Alonso A
        • et al.
        Heart disease and stroke statistics-2019 update: a report from the American Heart Association [published correction appears in Circulation. 2020;141(2):e33].
        Circulation. 2019; 139: e56-e528
        • Rowley WR
        • Bezold C
        • Arikan Y
        • Byrne E
        • Krohe S
        Diabetes 2030: insights from yesterday, today, and future trends.
        Popul Health Manag. 2017; 20: 6-12
        • Lin J
        • Thompson TJ
        • Cheng YJ
        • et al.
        Projection of the future diabetes burden in the United States through 2060.
        Popul Health Metr. 2018; 16: 9
        • Sallam T
        • Watson KE
        Predictors of cardiovascular risk in women.
        Womens Health (Lond). 2013; 9: 491-498
        • Restaurants and gluten-free menu claims
        Gluten Free Watchdog.
        Published May 22, 2017
      2. Sodium initiatives. NYC health. Updated September 9, 2015. Accessed June 1, 2020.

      3. Final determination regarding partially hydrogenated oils.
        Fed Regist. 2018; 83 (Accessed May 25, 2020): 23358-23359