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108 International Journal of Ch ild Health and Nutrition, 2014, 3, 108-11 3
E-ISSN: 1929-4247/14 © 2014 Lifescience G lobal
Analysis of the Caloric and Macronutrient Content of Meal Options
Offered to Children at Popular Restaurant Chains
Andrea L. Deierlein*, Kelley Coffman and Luz Claudio
One Gustave L. Levy Place Box 1057, New York, NY 10029, USA
Abstract: Background: Previous research suggests that consumption of foods from restaurants is associated with poor
dietary quality an d adverse health outcomes. There are few studies that examine the nutri ent content of children’s meal
options of fered at both sit-down and fast- food chain restaurants. The ma in objective was to describe the average energy
and nutrient profi les of meal options on chi ldren’s menus at chain r estaurants in the Unite d States (US) and compare
them to the Dietary Guidelines for Americans.
Methods: The samp le consisted of 13 sit-down and 16 fast-food restaurants ranked within th e top 50 US restaurant
chains in 2009 (meal nutrient content was accessed in 2010). Ther e were 421 and 275 meal options listed on children’s
menus from sit-down and fast-food restaurants, respectiv ely. D escriptive statistics are presented for calories, fat,
saturated fat, pr otein, carbohydrates, fiber, and sodium.
Results: In general, nutrient cont ents of c hildre n’s meal options at sit-dow n and fast-food restaurants wer e similar. Meal
options accounted for large percent ages of the recommended d aily intakes of calor ies, fa t, saturated fat, and sodium an d
small percentages of the recommended daily intakes of fiber, carbohydrate, and pr otein for children. More than half of
children’s meals at these restaurants exceeded recommenda tions f or fat and saturated fat.
Conclusions: Children’s meal options at sit-down and fast-food restaur ant chai ns that complied with the US Dietary
Guidelines were li mited. The majority of t he meal options had fat, saturated fat and sodium contents that exceed
recommen dations, while providing low amounts of fiber.
Keywords: Children, restaurant, nutrition, chain, meal.
INTRODUCTION
Foods prepared away from home account for
approximately one quarter of daily meals and snacks
and one third of total caloric intakes for individuals ages
2 years and older [1]. Consumption of foods from
restaurants is associated with less healthy dietary
quality in children [2]. Among children ages 4-19 years,
approximately 23-43% report eating fast-food on a
typical day, resulting in a greater average daily caloric
intake of 187 calories compared to non-consumers [3].
In adolescents, fast-food consumption is associated
with high calorie and fat intakes [4] and increased
weight and waist circumference, as well as adverse
metabolic outcomes [5,6].
Despite the large focus in the literature on dietary
patterns and health outcomes, there are few studies
that examine the nutrient content meal options offered
to children at fast-food and sit-down restaurant chains,
especially with respect to fiber and sodium content.
Fiber and sodium have been the targets of recent
public health campaigns. Fiber is a main constituent of
fruits, vegetables, and whole grains and is associated
with a lower risk of disease development, including
diabetes, obesity, and coronary heart disease [7]. In
*Address correspondence to this author at the One Gustave L. Levy Place Box
1057, New York, NY 10029, USA; Tel: 212-824-7044; Fax : 212-996-0407;
E-mail: andrea.deierlein@mssm.edu
contrast, sodium is added to the majority of processed
foods and is linked to increased risk of hypertension
and cardiovascular disease [8].
The main objective of this study was to describe
and compare the average energy and nutrient profiles
of meal options available on children’s menus at
popular sit-down and fast-food restaurant chains in the
United States (US), focusing on calories,
macronutrients, sodium, and fiber. We also compared
these profiles to current dietary recommendations
based on the 2010 Dietary Guidelines for Americans
issued by the US Department of Agriculture and the US
Department of Health and Human Services [9].
METHODS
The sample consisted of restaurants ranked within
the top 50 restaurant chains in the US in 2009 [10].
Rankings were based on restaurants’ total sales in
2008. The sample consisted of restaurants that offered
entrees as part of meal options for children.
Restaurants that offered only buffets, pizza, or
convenience/snack options (ice cream, pastries, coffee,
and other convenience items) were excluded (n=11).
Since the objective of this study was to describe the
nutrient profiles of meal options on children’s menus,
restaurants that only provided one menu (presumably
an adult menu) were excluded (n=4). Lastly,
restaurants that did not provide nutritional information
Analysis of the Caloric and Macronutrient Content of Meal Options International Journal of Child Health and Nutrition, 2014, Vol. 3, No. 2 109
for the meals (accessed June-July 2010) were
excluded (n=6). The remaining 29 restaurants were
then classified as sit-down restaurants (n=13) and fast-
food restaurants (n=16). Sit-down restaurants were
defined as restaurants with wait-staff service and fast-
food restaurants were defined as restaurants offering
self-service or carry out without wait-staff service [11].
The total sample of 29 restaurants represented over
$184 billion in total sales for 2008, with fast-food
restaurants accounting for approximately $157 billion of
the sales (85%).
In order to determine the average nutrient profiles of
meals available to children at fast-food and sit-down
restaurant chains, the nutrition information for all meals
offered on the menus was calculated using all possible
combinations of entrées and side options, including all
size/portion options and all dressing/sauce options if
provided. The following items were excluded from the
analysis: meals that were not offered as part of
restaurants’ daily menus; meals on breakfast and
lunch-specific menus; seasonal or region-specific
offers; gluten-free or special diet meals; side salads or
soups not labeled as a main “entrée” or not offered as
part of a meal by the restaurant; desserts; additional
sauces and toppings that were not specifically
indicated for the meal; and unlimited meal offers, such
as buffets. All beverages were also excluded.
Statistical Analyses
For children’s menus, there were 421 possible meal
combinations available at sit-down restaurants and 275
meal options available at fast-food restaurants.
Nutrition information for all meal combinations was
entered into an Excel database and Stata 11.0 was
used for statistical analyses. Descriptive statistics were
computed for total calories, fat (g), percent calories
from fat, total saturated fat (g), percent calories from
saturated fat, protein (g), percent calories from protein,
total carbohydrates (g), percent calories from
carbohydrates, fiber (g), and sodium (mg). The values
for sodium represented sodium that was either
naturally occurring in the food or was added during
processing or preparation, not sodium from table salt
added by the customer. Average nutrient information
for children’s meals was compared to
recommendations provided by the 2010 Dietary
Guidelines for Americans [9]. The percentages of
calories from macronutrients within meals were
calculated assuming 4 calories per gram of
carbohydrates and protein and 9 calories per gram of
fat and saturated fat. The percentage of calories from
each macronutrient was compared to the
recommended macronutrient ranges suggested in the
Guidelines as follows: 45-65% carbohydrates; 10-30%
protein; 25-35% fat; and less than 10% saturated fat
[9]. The Guidelines’ recommendations for sodium and
fiber are age and gender-specific. For these analyses,
we used reference daily intakes of 1500 mg of sodium
(1500 mg/day is the Adequate Intake recommended for
individuals ages 9 years and older and no more than
2200 mg/day is recommended for children ages 9-13
years) and 25 g of fiber (22 g/day and 25 g/day are
recommended for girls and boys, respectively, ages 9-
13 years).
RESULTS
In general, children’s meal options at sit-down and
fast-food restaurants exceeded the daily recommended
intakes of fat, saturated fat, and sodium while they
were within or below the recommendations for
carbohydrates, protein, and fiber. The mean (standard
deviation, SD), median, and ranges for: total calories
(kcal), total fat (g), percent of calories from fat (%),
saturated fat (g), percent of calories from saturated fat
(%), protein (g), percent of calories from protein (%),
carbohydrates (g), percent of calories from
carbohydrates (%), sodium (mg), and fiber (g) are
shown in Table 1 for children’s meal options at sit-down
and fast-food restaurants. The frequencies (%) of meal
options at sit-down and fast-food restaurants that
exceeded the 2010 Dietary Guidelines recommended
daily intakes of percent of calories from fat, percent of
calories from saturated fat, and sodium are displayed in
Figure 1.
Sit-Down Restaurants
The average sit-down restaurant meal provided a
mean energy intake of 537.7 (SD=202.1) calories. Over
one third of these calories were from fat with 12.1%
(SD=7.5) of calories from saturated fat. Children’s
meals contained a mean of 1118.9 mg (SD=587.2) of
sodium, which is three quarters of the Adequate Intake
(and over half the recommended limit of daily intake),
and 4.6 g (SD=2.7) of fiber, which is 18.4% of the
recommended daily intake (Table 1). The majority of
children’s meal options from sit-down restaurants
exceeded the recommended daily intakes of percent of
calories from fat or saturated fat and one-fifth contained
more than 1500 mg of sodium (Figure 1). A total of
14.3% of children’s meal options at sit-down
restaurants exceeded the recommendations for all
three of the selected nutrients.
110 International Journal of Child Health and Nutritio n, 2014, Vol. 3, No. 2
Deierlein et al.
Fast-Food Restaurants
The average fast-food restaurant children’s meal
provided a mean energy intake of 529.5 (SD=162.7)
calories. More than one third of these calories were
from fat with 14.7% (SD=5.5) from saturated fat.
Children’s meals contained a mean of 999.8 mg
(SD=299.3) of sodium, which is two thirds of the
Adequate Intake (and almost half the recommended
limit of daily intake), and 3.6 (SD=1.7) g of fiber, which
is 14.4% of the recommended intake (Table 1).
Approximately 72% of children’s meal options from
fast-food restaurants exceeded the recommended daily
intake of percent of calories from fat; 79% exceeded
the recommended daily intake of percent of calories
from saturated fat; and 3% of meals contained more
than 1500 mg of sodium (Figure 1).
DISCUSSION
The purpose of this study was to describe the
average nutrient information of meal options available
on children’s menus at popular US sit-down and fast-
food restaurant chains and to compare this information
to the 2010 Dietary Guidelines for Americans [9]. The
results show that meals offered at these restaurants,
on average, accounted for large percentages of the
recommended daily intakes of calories, fat, saturated
fat, and sodium and small percentages of the
recommended daily intakes of fiber, carbohydrates,
and protein for children. More than half of children’s
meals at sit-down and fast-food restaurants exceeded
the recommendations for fat and saturated fat.
Our study adds valuable information to the relatively
sparse literature regarding the average nutrient profiles
of meal options available to children at popular US
restaurant chains. The average percent of calories from
fat in children’s meals ranged from approximately 38-
50% and the average percent of calories from
saturated fat ranged from approximately 12-16%,
exceeding national recommendations for children.
Despite somewhat similar percent calorie distributions
of macronutrients, children’s meals at sit-down
restaurants had higher average amounts of calories,
fat, saturated fat, and sodium compared to meals at
fast-food restaurants. These differences are likely due
to larger portion sizes at sit-down restaurants
compared to fast-food restaurants [12]. This finding is
important because children consume larger quantities
of energy-dense foods (such as those offered at fast-
food and sit-down restaurants) as portion sizes
increase and, consequently consume increased
amounts of calories, fat, and other nutrients [13].
The average amounts of sodium in meals were
particularly alarming, accounting for approximately half
of the limited daily intake for children (based on a
recommended intake of no more than 2200 mg/day).
Table 1: Descriptive Nutrition Information for Meal Options on Adults’ and Children’s Menus at Sit-Down (n=13) and
Fast-Food (n=16) Chain Restaurants Ranked within the Top 50 Chain Restaurants in the United States
Sit-Down Restaurants (n=13) Fast-food Restaurants (n=16)
N Mean ± SD Median Range N Mean ± SD Median Range
Children 421 275
Calories (kcal) 421 537.7 ± 202.1 510.0 125.0-1268.3 275 529.5 ± 162.7 530.0 140.0-850.0
Total Fat (g) 421 24.8 ± 15.4 23.0 0.0-78.4 275 23.2 ± 9.1 23.0 1.5-45.0
Percent Calories fr om
Fat (%) 421 38.3 ± 15.1 39.8 0.0-77.5 275 38.7 ± 8.4 39.1 7.3-5 6.5
Saturated Fat (g) 296 8.4 ± 7.0 6.0 0.0-32.1 275 9.2 ± 5.1 8.5 0.0-20.0
Percent Calories fr om
Saturated Fat (%) 296 12.1 ± 7.5 10.9 0.0-34.6 275 15.1 ± 6.3 13.0 7.1-48.6
Carbohydrates ( g) 408 55.0 ± 24.9 53.0 6.0-145.4 275 60.1 ± 20. 5 63.0 4.0-9 2.0
Percent Calories fr om
Carbohydrates ( %) 408 42.0 ± 15. 9 40.5 4.4-92.0 275 45.3 ± 8.7 45.8 11.4-84.3
Protein (g) 316 24.2 ± 9.4 24.0 5.0-49.0 275 18.3 ± 4. 5 18.0 6.0-30.0
Percent Calories fr om
Protein (%) 316 19.3 ± 10. 9 16.0 6.0-61.7 275 15. 1 ± 6.3 13. 0 7.1-48.6
Sodium (mg) 421 1118.9 ± 587.2 1045.0 50.0-4398.0 275 999.8 ± 299.3 997.0 270.0-1890.0
Fiber (g) 337 4.6 ± 2.7 4.0 0.0-14.8 275 3.6 ± 1.7 3.0 0.0- 12.0
Analysis of the Caloric and Macronutrient Content of Meal Options International Journal of Child Health and Nutrition, 2014, Vol. 3, No. 2 111
Excess dietary sodium contributes to the later
development of hypertension, which is a known risk
factor for adverse cardiovascular events and kidney
disease [14,15]. Reductions in dietary sodium are
associated with decreased systolic and diastolic blood
pressure in children [16]. In contrast to sodium, the
average amounts of fiber in meals were low, providing
less than one fifth of the recommended intake for
children. In adults, dietary fiber is positively associated
with satiety and acts to decrease hunger, thereby
playing an important role in body weight regulation and
the prevention of obesity, as well as the related co-
morbidites, such as diabetes [17-19]. Though evidence
for such health benefits of dietary fiber among children
is currently not established, it is likely that fiber plays an
important role in children’s health [17].
Previous studies have described the nutrient
profiles of fast-food and/or chain restaurant meal
options, using varying methodologies, and the results
are consistent with and complement the results of the
current study [20,21]. Higher intakes of calories, fat,
and added sugars are reported when children consume
foods at fast-food and other restaurants [3,12,22,23]. In
a cross-sectional study of participants in the Continuing
Survey of Food Intakes by Individuals (1994-1998),
fast-food use was reported by 42% of children.
Children with reported fast-food consumption on a
given day had higher calorie, fat, saturated fat, sodium,
and soft drink intakes and lower vitamin, fruit,
vegetable, and milk intakes compared to a day when
fast-food was not consumed and compared to non-
consumers of fast-food [24]. Only 3% of fast-food kids’
meals offered at major fast-food restaurant chains met
all of the criteria of the National School Lunch Program
[23]. In a comparison of children’s meals at fast-food
and non-fast-food restaurants, the overall mean
percentages of calories from fat were similar (37.5% at
fast-food vs. 40.5% at non-fast-food restaurants) and
there were no significant differences in macronutrient
content when evaluating meals with the highest calorie
side item at the two types of restaurants [12]. However,
similar to the findings in the current study, children’s
meals at fast-food restaurants were smaller, contained
less calories, fat, saturated fat, protein, carbohydrates,
and fiber, and included lower calorie side options
compared to meals at non-fast-food restaurants [12].
The results of this study should be considered
within the context of its limitations. This is a descriptive
study reporting the average nutrient profiles of
children’s meal options from menus posted on
restaurants’ websites in 2010; therefore, we cannot
comment on recent menu changes, regional
differences in meal options, or consumer purchasing
behaviors of meals. We used nutrition information that
was provided by restaurants rather than an
independent source. Previous studies suggest that
Figure 1: Frequency of children’s meal options on menus at sit-down and fast-food chain restaurants that exceeded the 2010
Dietary Guidelines recommendations for daily intakes of percent of calories from fat, percent of calories from saturated fat, and
sodiuma.
aAmong sit-down restaurants (n=13), there were 421 meals with available nutrition information for calories from fat; 296 meals
for calories from saturated fat; and 421 meals for sodium. Among fast-food restaurants (n=16), there were 275 meals with
available nutrition information for calories from fat, calories from saturated fat, and sodium.
112 International Journal of Child Health and Nutritio n, 2014, Vol. 3, No. 2 Deierlein et al.
some of this nutrient information may be under-
reported [25], which would likely underestimate the
reported average meal nutrient values. Also, by design
of our study, we were unable to account for any
condiments, sauces, or salt added (or subtracted)
during or after food preparation and any beverages
consumed with the meals. Such additions to meals
would likely account for substantial increases in
calories, macronutrients, and sodium. Overall, these
limitations suggest that the reported nutrient content of
meals is lower than what is actually being consumed by
children.
CONCLUSIONS
Sit-down and fast-food chain restaurants offer
convenient, affordable, and quick meal options for
children [26]; however, evidence from this study and
others [3,12,20-23] show that the majority of these
meals are high in calories, fat, and sodium and low in
fiber. Meals at sit-down chain restaurants may be of
particular concern because of large portion sizes.
Public health initiatives to increase consumer
knowledge and awareness by providing nutrition
information on menus in chain restaurants may help
guide consumers to make healthier choices [27,28],
especially for children [29], but are likely inadequate to
prevent excessive dietary intakes [28,30]. Alterations to
restaurant meals that favor low calorie options, reduce
portion sizes [31], and include fruits, vegetables, and
whole grains are necessary to decrease calories, fat,
and sodium and increase fiber intakes among child
consumers.
COMPETING INTERESTS
The authors declare that they have no competing
interests. All authors were involved in the
implementation of the study as well as read and
approved the final manuscript.
ACKNOWLEDGEMENTS
This work was supported by the Research Training
Program in Environmental Pediatrics (T32HD049311)
and the Short-term Training Programs for Minority
Students (R25 HL108857 and T35 ES007298). The
authors would like to thank Brenda Vazquez for her
assistance in gathering restaurant information and
participating in data entry.
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Received on 21-02-2014 Accepted on 24-04-2014 Published on 30-05-2014
http://dx.doi.or g/10.6000/1929-4247. 2014.03.02.6
© 2014 Deierlein et al.; Licensee Lifescience Global.
This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License
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