Christmas 2018: Food For Thought∣Measured energy content of frequently purchased restaurant meals: multi-country cross sectional study [2018年圣诞特刊：思想之飨∣经常购买的餐厅中膳食能量测量：多国横断面研究]

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BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4864 (Published 12 December 2018)
Cite this as: BMJ 2018;363:k4864

Authors
Susan B Roberts, Sai Krupa Das, Vivian Marques Miguel Suen, Jussi Pihlajamäki, Rebecca Kuriyan, Matilda Steiner-Asiedu, Amy Taetzsch, Alex K Anderson, Rachel E Silver, Kathryn Barger, Amy Krauss, Leila Karhunen, Xueying Zhang, Catherine Hambly, Ursula Schwab, Andresa de Toledo Triffoni-Melo, Priscila Giacomo Fassini, Salima F Taylor, Christina Economos, Anura V Kurpad, John R Speakman

Abstract
Objective To measure the energy content of frequently ordered meals from full service and fast food restaurants in five countries and compare values with US data.

Design Cross sectional survey.

Setting 223 meals from 111 randomly selected full service and fast food restaurants serving popular cuisines in Brazil, China, Finland, Ghana, and India were the primary sampling unit; 10 meals from five worksite canteens were also studied in Finland. The observational unit was frequently ordered meals in selected restaurants.

Main outcome measure Meal energy content, measured by bomb calorimetry.

Results Compared with the US, weighted mean energy of restaurant meals was lower only in China (719 (95% confidence interval 646 to 799) kcal versus 1088 (1002 to 1181) kcal; P<0.001). In analysis of variance models, fast food contained 33% less energy than full service meals (P<0.001). In Finland, worksite canteens provided 25% less energy than full service and fast food restaurants (mean 880 (SD 156) versus 1166 (298); P=0.009). Country, restaurant type, number of meal components, and meal weight predicted meal energy in a factorial analysis of variance (R2=0.62, P<0.001). Ninety four per cent of full service meals and 72% of fast food meals contained at least 600 kcal. Modeling indicated that, except in China, consuming current servings of a full service and a fast food meal daily would supply between 70% and 120% of the daily energy requirements for a sedentary woman, without additional meals, drinks, snacks, appetizers, or desserts.

Conclusion Very high dietary energy content of both full service and fast food restaurant meals is a widespread phenomenon that is probably supporting global obesity and provides a valid intervention target.