title: Temporal trends in fast-food restaurant energy, sodium, saturated fat, and trans fat content, United States, 1996-2013.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
authors.forename: Lorien E
authors.initials: LE
authors.lastname: Urban
authors.affiliation: Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
authors.forename: Susan B
authors.initials: SB
authors.lastname: Roberts
authors.affiliation: Freidman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Fierstein
authors.affiliation: Freidman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Gary
authors.affiliation: , Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St, Boston, MA 02111. E-mail: alice.lichtenstein@tufts.edu.
authors.forename: Alice H
authors.initials: AH
authors.lastname: Lichtenstein
mesh_terms: D031204:Caloric Restriction / Q000592:standards; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002149:Energy Intake; D057140:Fast Foods / Q000706:statistics & numerical data*; D005227:Fatty Acids / Q000032:analysis; D005504:Food Analysis / Q000592:standards / Q000706:statistics & numerical data*; D005515:Food Labeling / Q000639:trends*; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D012147:Restaurants / Q000592:standards / Q000706:statistics & numerical data*; D012982:Sodium, Dietary / Q000032:analysis; D044242:Trans Fatty Acids / Q000032:analysis; D014481:United States
chemical_list: D005227:Fatty Acids; D012982:Sodium, Dietary; D044242:Trans Fatty Acids