Availability and Nutrient Composition of Vegetarian Items at US Fast-Food Restaurants

Nutrient composition of plant-based fast-food meals and their omnivore counterparts: A cross-sectional analysis of e-menus

OBJECTIVES

Fast food chains have introduced many plant-based meals to their menus. We aimed to compare the nutrient composition and allergenic content of plant-based (vegan or vegetarian) meals in fast food chains with their animal-based equivalents.

METHODS

E-menus from 50 fast food chains across 5 countries (Australia, Canada, Poland, the UK, and the US) were analyzed. Data on meal type, weight, calories, macronutrients, sodium, fiber, and allergen presence were gathered. Plant-based meals were matched with meat counterparts, where the latter shared the same meal type, originated from the same country and chain, and showed a weight difference of less than 10%. Multivariate logistic regression analysis was performed.

RESULTS

From n = 2455 records, n = 1868 unique meals were matched. Plant-based meals showed lower odds ratios (OR) for protein (OR, 0.10; 95% confidence interval [CI], 0.08-0.14) and sodium (OR, 0.70; 95% CI, 0.55-0.90) and higher odds for carbohydrates (OR, 1.87; 95% CI, 1.41-2.49), sugar (OR, 1.43; 95% CI, 1.12-1.82), and fiber (OR, 4.87; 95% CI, 3.60-6.63) compared with omnivorous meals, adjusted for country, meal type, and meal weight. Notably, plant-based and omnivorous meals were not associated with total caloric content. Separate analyses of vegetarian and vegan meals yielded similar results. Omnivorous meals more frequently contained allergens such as dairy, eggs, fish, shellfish, and mustard, whereas plant-based meals more likely contained allergens such as sesame, seeds, and nuts.

CONCLUSIONS

Plant-based fast food meals were more likely to contain more carbohydrates, sugar, and fiber and less protein and sodium than their animal-based counterparts. These findings emphasize the importance of informed food choices in the fast food context.

Systematic review and meta-analysis of iodine nutrition in modern vegan and vegetarian diets

Vegan and vegetarian diets are widely supported and adopted, but individuals following such diets remain at greater risk of iodine deficiency. This systematic review and meta-analysis was conducted to assess the iodine intake and status in adults following a vegan or vegetarian diet in the modern day. A systematic review and quality assessment were conducted from October 2020 to December 2022 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidance. Studies were identified in Ovid MEDLINE, Web of Science, PubMed, and Scopus. Eleven articles were eligible for review containing 4421 adults (aged ≥ 18 years). Vegan groups had the lowest median urinary iodine concentration (mUIC) (12·2/l). None of the dietary groups had mUIC within the optimal range for iodine status (100-200 µg/l) (WHO). Vegan diets had the poorest iodine intake (17·3 µg/d) and were strongly associated with lower iodine intake (P = < 0·001) compared with omnivorous diets. Lower intake in vegan diets was influenced by sex (P = 0·007), the presence of voluntary or absence of Universal Salt Iodisation (USI) programmes (P = 0·01 & P = < 0·001), and living in a country with adequate iodine nutrition (P = < 0·001). Vegetarians and particularly vegans living in countries with no current USI programme continue to have increased risk of low iodine status, iodine deficiency and inadequate iodine intake. Further research into the usefulness of mandatory fortification of vegan appropriate foods is required.

Effect of Climate Change Impact Menu Labels on Fast Food Ordering Choices Among US Adults: A Randomized Clinical Trial

IMPORTANCE

There is increasing interest in strategies to encourage more environmentally sustainable food choices in US restaurants through the use of menu labels that indicate an item's potential impact on the world's climate. Data are lacking on the ideal design of such labels to effectively encourage sustainable choices.

OBJECTIVE

To test the effects of positive and negative climate impact menu labels on the environmental sustainability and healthfulness of food choices compared with a control label.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial used an online national US survey conducted March 30 to April 13, 2022, among a nationally representative sample of adults (aged ≥18 years) from the AmeriSpeak panel. Data were analyzed in June to October 2022.

INTERVENTIONS

Participants were shown a fast food menu and prompted to select 1 item they would like to order for dinner. Participants were randomized to view menus with 1 of 3 label conditions: a quick response code label on all items (control group); green low-climate impact label on chicken, fish, or vegetarian items (positive framing); or red high-climate impact label on red meat items (negative framing).

MAIN OUTCOMES AND MEASURES

The main outcome was an indicator of selecting a sustainable item (ie, one without red meat). Secondary outcomes included participant health perceptions of the selected item and the Nutrition Profile Index (NPI) score of healthfulness.

RESULTS

Among 5049 participants (2444 female [51.6%]; 789 aged 18-29 years [20.3%], 1532 aged 30-44 years [25.9%], 1089 aged 45-59 years [23.5%], and 1639 aged ≥60 years [30.4%]; 142 Asian [5.3%], 611 Black [12.1%], and 3197 White [63.3%]; 866 Hispanic [17.2%]), high- and low-climate impact labels were effective at encouraging sustainable selections from the menu. Compared with participants in the control group, 23.5% more participants (95% CI, 13.7%-34.0%; P < .001) selected a sustainable menu item when menus displayed high-climate impact labels and 9.9% more participants (95% CI, 1.0%-19.8%; P = .03) selected a sustainable menu item when menus displayed low-climate impact labels. Across experimental conditions, participants who selected a sustainable item rated their order as healthier than those who selected an unsustainable item, according to mean perceived healthfulness score (control label: 3.4 points; 95% CI, 3.2-3.5 points vs 2.5 points; 95% CI, 2.4-2.6 points; P < .001; low-impact label: 3.7 points; 95% CI, 3.5-3.8 points vs 2.6 points; 95% CI, 2.5-2.7 points; P < .001; high-impact label: 3.5 points; 95% CI, 3.3-3.6 points vs 2.7 points; 95% CI, 2.6-2.9 points; P < .001). Participants in the high-climate impact label group selected healthier items according to mean (SE) NPI score (54.3 [0.2] points) compared with those in the low-climate impact (53.2 [0.2] points; P < .001) and control (52.9 [0.3] points; P < .001) label groups.

CONCLUSIONS AND RELEVANCE

This randomized clinical trial's findings suggest that climate impact menu labels, especially negatively framed labels highlighting high-climate impact items (ie, red meat), were an effective strategy to reduce red meat selections and encourage more sustainable choices.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05482204.

Cooking at Home, Fast Food, Meat Consumption, and Dietary Carbon Footprint among US Adults

Shifting consumer behavior towards more sustainable diets can benefit environmental sustainability and human health. Although more frequent home cooking is associated with a better diet quality and fast-food consumption with worse diet quality, the environmental impact of diets based on frequency of cooking or eating fast food is not well understood. The objective of this study was to investigate whether the frequency of cooking dinner at home or eating fast food is associated with dietary greenhouse gas emissions (GHGE). We linked 24-h dietary recall data from adult respondents in the 2007-2010 National Health and Nutrition Examination Survey (NHANES) (N = 11,469) to a database of GHGE factors to obtain a measure of dietary GHGE (kgCO2-eq/2000 kcal) (the sum of emissions released in the production of food for an individual's diet), adjusted by energy intake (kgCO2-eq/2000 kcal). We examined associations between frequency of cooking dinner (the only meal for which cooking frequency was measured), frequency of eating fast food, and dietary GHGE and protein sources (beef, pork, poultry, other meat, and fish and seafood (g/2000 kcal)) using generalized linearized regression models that controlled for age, sex, and other socio-economic characteristics. Greater cooking frequency was associated with higher dietary GHGE. In fully adjusted models, cooking 5-6 times/week was associated with an additional 0.058 kgCO2-eq/2000 kcal (SE 0.033) and cooking 7 times/week was associated with an additional 0.057 kgCO2-eq/2000 kcal (SE 0.027) when compared to cooking 0-2 times/week. Individuals in households who cooked dinner more frequently consumed significantly more meat, poultry, and fish (cooking 7 times/week: 148.7 g/2000 kcal vs. cooking 0-2 times/week: 135.4 g/2000 kcal, p-trend = 0.005), which could explain the association with a higher carbon footprint diet. There were few associations of note between fast-food frequency and GHGE. Policies and interventions that reduce consumption of meat and increase consumption of plants when both cooking meals at home and eating meals out are needed to shift toward diets that will be beneficial for both human health and the health of the planet.