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Differences in energy and nutrient content of menu items served by large chain restaurants in the USA and the UK in 2018.

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OBJECTIVE: To quantify the sector-wide energy and nutritional differences of both adult and children's restaurant menu items in the UK and the USA in 2018. DESIGN: Cross-sectional study. SETTING: Energy and nutritional information provided on restaurant websites. PARTICIPANTS: Menu items (n 40 902) served by forty-two large UK chains and ninety-six large USA chains. RESULTS: Mean absolute energy, fat and saturated fat values were higher in USA menu items. For example, the mean adjusted per-item differences of adult menu items between the USA and the UK were 45·6 kcal for energy and 3·2 g for fat. Comparable figures for children's menu items were 43·7 kcal and 4 g. Compared with UK menu items, USA adult menu items also had higher sugar content (3·2 g, 95 % CI (0·5, 6)), and children's menu items had higher Na content (181·1 mg, 95 % CI (108·4, 253·7)). Overall, 96·8 % of UK and 95·8 % of USA menu items exceeded recommended levels for at least one of Na, fat, saturated fat or sugars. CONCLUSIONS: Menu items served by large chain restaurants had higher mean absolute levels of energy, fat and saturated fat in the USA compared with the UK. UK adult menu items were also lower in sugars compared with the USA ones and children's items lower in Na. As more than 95 % of all items were considered to have high levels of at least one nutrient of public health concern in the USA and the UK, improvements in restaurant menu items are needed in both countries.



Chain restaurants, Childhood obesity, Cross-country comparison, Energy, Nutrients, Restaurant food environment

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Public Health Nutr

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Cambridge University Press (CUP)
MRC (MC_UU_00006/7)
Department of Health (via National Institute for Health Research (NIHR)) (PD-SPH-2015-10029 BH154142)
This work was supported by the Medical Research Council (grant number MC_UU_00006/7). YH is supported through a Gates Cambridge Scholarship. DT is supported by a PhD studentship awarded by the National Institute for Health Research (NIHR), School for Public Health Research (Grant No. PD‐SPH‐2015‐10025). No funders had any role in the study design; collection, analysis and interpretation of data; the writing of the manuscript; or the decision to submit the manuscript for publication.