What's on the menu? A review of the energy and nutritional content of US chain restaurant menus

OBJECTIVE: The present study aimed to (i) describe the availability of nutrition information in major chain restaurants, (ii) document the energy and nutrient levels of menu items, (iii) evaluate relationships with restaurant characteristics, menu labelling and trans fat laws, and nutrition information accessibility, and (iv) compare energy and nutrient levels against industry-sponsored and government-issued nutrition criteria. DESIGN: Descriptive statistics and multivariate regression analysis of the energy, total fat, saturated fat, trans fat, sodium, carbohydrate and protein levels of 29 531 regular and 1392 children's menu items [corrected]. SETTING: Energy and nutrition information provided on restaurant websites or upon request, and secondary databases on restaurant characteristics. SUBJECTS: The top 400 US chain restaurants by sales, based on the 2009 list of the Restaurants & Institutions magazine. RESULTS: Complete nutrition information was reported for 245 (61 %) restaurants. Appetizers had more energy, fat and sodium than all other item types. Children's menu specialty beverages had more fat, saturated fat and carbohydrates than comparable regular menu beverages. The majority of main entrées fell below one-third of the US Department of Agriculture's estimated daily energy needs, but as few as 3 % were also within limits for sodium, fat and saturated fat. Main entrées had significantly more energy, fat and saturated fat in family-style restaurants than in fast-food restaurants. Restaurants that made nutrition information easily accessible on websites had significantly lower energy, fat and sodium contents across menu offerings than those providing information only upon request. CONCLUSIONS: The paper provides a comprehensive view of chain restaurant menu nutrition prior to nationwide labelling laws. It offers baseline data to evaluate how restaurants respond after laws are implemented.