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Preventing Chronic Disease | Temporal Trends in Fast-Food Restaurant Energy, Sodium, Saturated Fat, and Trans Fat Content, United States, 1996–2013 - CDC


Preventing Chronic Disease | Temporal Trends in Fast-Food Restaurant Energy, Sodium, Saturated Fat, and Trans Fat Content, United States, 1996–2013 - CDC

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Temporal Trends in Fast-Food Restaurant Energy, Sodium, Saturated Fat, and Trans Fat Content, United States, 1996–2013

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The fast food facts from this article are broken down in this easy-to-read infographic Adobe PDF file[PDF – 376 KB].

Lorien E. Urban, PhD; Susan B. Roberts, PhD; Jamie L. Fierstein, MS; Christine E. Gary, MS; Alice H. Lichtenstein, DSc

Suggested citation for this article: Urban LE, Roberts SB, Fierstein JL, Gary CE, Lichtenstein AH. Temporal Trends in Fast-Food Restaurant Energy, Sodium, Saturated Fat, and Trans Fat Content, United States, 1996–2013. Prev Chronic Dis 2014;11:140202. DOI:http://dx.doi.org/10.5888/pcd11.140202External Web Site Icon.


Excess intakes of energy, sodium, saturated fat, and trans fat are associated with increased risk for cardiometabolic syndrome. Trends in fast-food restaurant portion sizes can inform policy decisions. We examined the variability of popular food items in 3 fast-food restaurants in the United States by portion size during the past 18 years.
Items from 3 national fast-food chains were selected: French fries, cheeseburgers, grilled chicken sandwich, and regular cola. Data on energy, sodium, saturated fat, and trans fat content were collated from 1996 through 2013 using an archival website. Time trends were assessed using simple linear regression models, using energy or a nutrient component as the dependent variable and the year as the independent variable.
For most items, energy content per serving differed among chain restaurants for all menu items (P ≤ .04); energy content of 56% of items decreased (β range, −0.1 to −5.8 kcal) and the content of 44% increased (β range, 0.6–10.6 kcal). For sodium, the content of 18% of the items significantly decreased (β range, −4.1 to −24.0 mg) and the content for 33% increased (β range, 1.9–29.6 mg). Absolute differences were modest. The saturated and trans fat content, post-2009, was modest for French fries. In 2013, the energy content of a large-sized bundled meal (cheeseburger, French fries, and regular cola) represented 65% to 80% of a 2,000-calorie-per-day diet, and sodium content represented 63% to 91% of the 2,300-mg-per-day recommendation and 97% to 139% of the 1,500-mg-per-day recommendation.
Findings suggest that efforts to promote reductions in energy, sodium, saturated fat, and trans fat intakes need to be shifted from emphasizing portion-size labels to additional factors such as total calories, frequency of eating, number of items ordered, menu choices, and energy-containing beverages.


Excess intakes of energy, sodium, saturated fat, and trans fat are associated with elevated risk for cardiometabolic disorders (1–3). For this reason, Dietary Guidelines for Americans (1) and health advocacy organizations (4–6) recommend limiting intakes and maintaining a healthy weight. Nevertheless, intakes of these nutrients exceed recommendations (1–7).
The contribution of away-from-home foods to total energy has nearly doubled in the past 30 years, rising from 18% in 1977 to 33% in 2010 (8,9), and fast food in particular has historically contributed a disproportional amount of dietary sodium, saturated fat, and trans fat (10–12), making these foods a target for modification. Although there has been progress in this area, including an increase in the number of “healthier” offerings, sales for the most frequently ordered items from fast-food restaurants remain strong (15).
One area that has gained attention is the portion size (ie, amount served to customer) of frequently ordered items. Between 1998 and 2006, fast-food retailers attempted to minimize publicizing the issue of changing portion sizes by redesignating sizing (eg, medium renamed small), which resulted in an increase of portion sizes in absolute terms (13). Little information exists for trends in the energy content of fast-food items since 2006 or trends in the amounts of sodium, saturated fat, and trans fat in fast-food menu items over time. These data are important because, in addition to changes in menu options, they can be used as an indicator of whether foods as served outside the home have been modified to be consistent with population-wide dietary guidance. They also provide a basis on which to evaluate industry trends and provide data to inform public health campaigns and clinical programs designed to promote improvements in dietary patterns.

Our aim was to collate available data for energy, saturated fat, trans fat, and sodium for some of the most frequently ordered fast-food items from 3 national fast-food chains by portion size and describe trends over a 18-year period from 1996 through 2013.


This work was supported by the US Department of Agriculture under agreement nos. 58-1950-0-0014 and 1950-51000-072-02S with Tufts University. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the US Department of Agriculture. The authors thank Ashley Equi for her help with data acquisition.

Author Information

Corresponding Author: Alice H. Lichtenstein, DSc, Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St, Boston, MA 02111. Telephone: 617-556-3127. E-mail: alice.lichtenstein@tufts.edu.
Author Affiliations: Lorien E. Urban, Susan B. Roberts, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; Jamie L. Fierstein, Christine E. Gary, Freidman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.


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