Research Original Research| Volume 112, ISSUE 8, P1169-1176, August 2012

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Energy, Saturated Fat, and Sodium Were Lower in Entrées at Chain Restaurants at 18 Months Compared with 6 Months Following the Implementation of Mandatory Menu Labeling Regulation in King County, Washington



      Policies on menu labeling have been proposed as a method to improve the food environment. However, there is little information on the nutrient content of chain restaurant menu items and changes over time.


      To evaluate the energy, saturated fat, and sodium content of entrées 6 and 18 months post-implementation of restaurant menu labeling in King County of Washington State for items that were on the menu at both time periods, and across all items at 6 and 18 months and to compare energy content to recommendations provided by the 2005 Dietary Guidelines for Americans.


      Eligible restaurants included sit-down and quick-service chains (eg, burgers, pizza, sandwiches/subs, and Tex-Mex) subject to King County regulations with four or more establishments. One establishment per chain was audited at each time period.

      Statistical analyses

      Hypothesis one examined entrées that were on the menu at both time periods using a paired t test and hypothesis two compared quartiles at 6 months to the distribution at 18 months using a Mantel-Haentzel odds ratios and 95% CIs, and a Cochrane-Armitage test for trend. The content of entrées at 18 months was compared with one-third (assuming three meals per day) of the nutrient intake recommendations for adults provided by the 2005 Dietary Guidelines for Americans.


      The audit included 37 eligible chains of 92 regulated chains. Energy contents were lower (all chains −41, sit down −73, and quick service −19; paired t tests P<0.0001) for entrées that were on the menu at both time periods. There was a significant trend across quartiles for a decrease in energy, saturated fat, and sodium for all entrées at sit-down chains only. At 18 months entrées not designated for children exceeded 56%, 77%, and 89% of the energy, saturated fat, and sodium guidelines, respectively.


      Modest improvements in the nutrient content of sit-down and quick-service restaurant entrées occurred but overall levels for energy, saturated fat, and sodium are excessive.


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      B. Bruemmer is a senior lecturer emeritus, Program in Nutritional Sciences, School of Public Health, University of Washington, Seattle.


      J. Krieger is chief, Epidemiology and Planning Unit, Chronic Disease and Injury Prevention Department, Public Health-Seattle and King County, Seattle, WA.


      N. Chan is assistant chief, Assessment Policy Development, and Evaluation Department, Public Health-Seattle and King County, Seattle, WA.


      B. E. Saelens is an associate professor of child health, behavior, and development, Department of Pediatrics, Seattle Children's Research Institute, Seattle, WA.