Nutritional quality at fast-food restaurants still needs improvement

More than 25 percent of American adults chow down on fast food two or more times each week. Known for menu items containing high amounts of fat, sugar, and salt, fast-food restaurants have contributed to America's poor diets and increased risk of diet-related chronic diseases, like heart disease and diabetes. A new study funded by the Robert Wood Johnson Foundation's Healthy Eating Research program and published in the American Journal of Preventive Medicine presents results from a 14-year study indicating that fast food restaurant menus have only modestly increased nutritious offerings, and much improvement is still needed.

"Despite qualitative evidence that the fast-food industry is making improvements to the nutritional quality of at least some of their menu items, a quantitative evaluation of trends in the nutritional quality of fast food available in the marketplace was lacking," says lead investigator Mary Hearst, PhD, MPH, Associate Professor of Public Health at St. Catherine University in St. Paul, Minnesota. "This is the first study to quantitatively evaluate whether fast-food restaurant chains have improved the nutritional quality of their U.S. menu offerings over a period of time during which they have been encouraged to do so by governmental and nongovernmental agencies."

Hearst and the study team set out to examine trends at eight fast-food restaurants using data from 1997/1998 to 2009/2010 culled from the University of Minnesota Nutrition Coordinating Center Food and Nutrient Database, which houses menus from 22 fast-food restaurants. The investigators selected eight restaurants:

McDonald's
Burger King
Wendy's
Taco Bell
Kentucky Fried Chicken (KFC)
Arby's
Jack in the Box
Dairy Queen

Three criteria determined restaurant selection: Inclusion in the database since 1997; offering a defined set of menu items (i.e., not offering a kind of "create your own meal"); and inclusion of all standard menu items in the database.

To evaluate nutritional quality, researchers relied on the Healthy Eating Index (HEI)-2005, a metric developed by the U.S. Department of Agriculture and used for quantifying nutritional quality. The team expected index scores would fall below the score for the American food supply - 60 points of 100 - due to high fat and sugar and low fruit and vegetable content. It also expected to find an increase in HEI-2005 scores among these restaurants over the 14-year period.

Across the eight restaurants, the HEI-2005 score increased over the 14-year period. However, the increase was modest, from 45 in 1997/1998 to 48 in 2009/2010. KFC showed the greatest improvement with a nine-point increase and Jack in the Box, the second greatest with a seven-point increase.