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Fast-food consumption among US adults and children:
Dietary and nutrient intake profile
SAHASPORN PAERATAKUL, MBBS, PhD; DAPHNE P. FERDINAND, MN, RN; CATHERINE M. CHAMPAGNE, RD, PhD;
DONNA H. RYAN, MD; GEORGE A. BRAY, MD
ABSTRACT
Objective To examine the dietary profile associated with
fast-food use. To compare the dietary intake of individuals on
the day that they ate fast food with the day that fast food was
not eaten.
Design Cross-sectional study design. The dietary intake of
individuals who reported eating fast food on one or both
survey days was compared with those who did not report
eating fast food. Among the individuals who reported eat-
ing fast food, dietary intake on the day when fast food was
eaten was compared with the day when fast food was not
eaten. Weighted comparison of mean intakes and pairwise
t-test were used in the statistical analysis.
Subjects/setting Data from 17,370 adults and children
who participated in the 1994-1996 and 1998 Continuing
Survey of Food Intakes by Individuals. Dietary intake data
were collected by 2 non-consecutive 24-hour dietary re-
calls.
Results Fast-food use was reported by 37% of the adults
and 42% of the children. Adults and children who reported
eating fast food had higher intake of energy, fat, saturated
fat, sodium, carbonated soft drink, and lower intake of vi-
tamins A and C, milk, fruits and vegetables than those who
did not reported eating fast food (P⬍.001). Similar differ-
ences were observed among individuals between the day
when fast food was eaten and the day when fast food was
not eaten.
Conclusions Consumers should be aware that consumption
of high-fat fast food may contribute to higher energy and fat
intake, and lower intake of healthful nutrients. J Am Diet
Assoc. 2003;103:1332-1338.
Fast food is a growing component of the American diet, and
the frequency of fast-food use has increased dramatically
since the early 1970s (1). The number of fast-food outlets
increased from about 30,000 in 1970 to 140,000 in 1980,
and fast-food sales increased by about 300% (1). More recent
estimates show that in 2001, there were about 222,000 fast-
food locations in the United States, generating sales of more
than $125 billion. The number is projected to increase by 4.1%
in 2002, with estimated sales of $130.1 billion (2). The same
report also indicated that three of 10 consumers agreed that
meals at a restaurant or fast-food establishment are essential to
the way they live, and three of five consumers reported that
they plan to eat at fast-food restaurants in 2002 about as often
as they did in 2001.
Fast food is especially popular among adolescents, who on
average visit a fast-food outlet twice per week (3,4). A survey of
4,746 students 11 to 18 years of age reported that about 75%
ate at a fast-food restaurant during the week before the survey
(5). The same survey showed that fast-food use was associated
with higher intake of fried potato, hamburger, pizza, and soft
drink, and lower intake of fruits, vegetables, and milk. Fast food
is high in fat and energy, and although fast-food restaurants
have diversified to include a broader range of foods, hamburg-
ers and french fries continue to be leaders in terms of sales
volume (1). A small order of french fries typically contains
about 200 calories and 10 g of fat, and a large hamburger con-
tains nearly 600 calories and 35 g of fat. Consequently, many
people have raised concerns about the nutritional quality of
S. Paeratakul is an instructor, C. M. Champagne is a
research professor, D. H. Ryan is a professor, and G. A.
Bray is the Boyd Professor at the Pennington Biomedical
Research Center, Louisiana State University, Baton
Rouge. D. P. Ferdinand is a doctoral candidate at the
Southern University and A&M College School of Nursing,
Baton Rouge, LA.
Address correspondence to Sahasporn Paeratakul, Nu-
tritional Epidemiology, Pennington Biomedical Research
Center, 6400 Perkins Rd, Baton Rouge, LA 70808. E-mail:
paerats@pbrc.edu
Copyright © 2003 by the American Dietetic Association.
0002-8223/03/10310-0012$30.00/0
doi: 10.1053/S0002-8223(03)01086-1
RESEARCH
1332 / October 2003 Volume 103 Number 10
fast food, not only for children and adolescents but also for
adults (4-8). Previous studies have shown that despite its high
fat content, fast food provides an adequate intake of protein
and carbohydrate. However, these studies have focused on the
fat and energy derived from fast food and have not assessed the
broader impact that fast food might have on the overall diet.
This study used the data from a representative sample of US
adults and children to examine the cross-sectional association
between fast-food consumption and diet quality. It was based
on three hypotheses. First, the sociodemographic factors may
be associated with fast-food use. In particular, fast-food use is
common among children and adolescents, young adults, and
people with higher income. Second, individuals who reported
eating fast food on a given day may have a less favorable dietary
and nutrient intake profile compared with those who did not
report eating fast food. Third, the dietary intake profile on the
days when individuals reported eating fast food may be less
favorable compared with the days when these individuals did
not eat fast food.
SUBJECTS AND METHODS
The 1994-1996, 1998 Continuing Survey of Food Intakes by
Individuals (CSFII) was conducted in a nationally representa-
tive sample of the civilian population in the United States using
a stratified, multistage, area probability sample design. The
details of the survey design and methods are available else-
where (9). Briefly, the in-person interview was used to collect a
wide range of sociodemographic, dietary, and health data from
the survey participants. In 1994-1996, the total of 20,126 adults
and children were selected into the sample. Of these, 16,103
individuals (80%) completed the interview. An additional rep-
resentative sample of 6,413 children 9 years of age or younger
was added to the survey in 1998, using the same design and
methodology.
Data used in this study include sociodemographic data
(age, gender, race, income, education, and household size)
and the dietary intake data. Four racial/ethnic groups were
defined: non-Hispanic white (n⫽12,188), non-Hispanic
black (n⫽2,227), Hispanic (n⫽2,182), and other ethnicities
including Asians, Pacific Islanders, American Indians and
Alaska natives (n⫽773). Income was classified into three
categories: less than 100%, 101% to 299%, and more than
300% of the Federal poverty guidelines based on household
size and income (10). Education level was ascertained by the
actual number of years of schooling completed. This was
classified into four categories: less than high school educa-
tion, high school education, some college education, and 4 or
more years of college education. Household size was classi-
fied as households with three or fewer members and those
with four members or more.
Dietary data were collected by two nonconsecutive 24-hour
dietary recalls using multiple-pass methodology, whereby the
survey respondents were systematically interviewed to provide
as complete information as possible. The two dietary recalls
were conducted 3 to 10 days apart, but not on the same day of
the week. Proxy interview of an adult household member was
used in children less than 6 years of age, although those 6 to 11
years of age (6 to 9 years of age in CSFII 1998) were asked to
provide their own food intake data, assisted by an adult.
The interviewer used a food instruction booklet to probe
for a complete description of every food and the amount
eaten. Fast-food intake, if any, was specifically queried re-
garding the place where the food was obtained (fast-food
place, pizza place). The names of several fast-food establish-
ments as well as the commercial names of fast-food items
were also provided. This study did not focus on the other
foods that were eaten away from home (eg, at restaurants
with table service and school cafeterias). From the total
18,081 adults and children 2 years of age or older who com-
pleted the two 24-hour dietary recalls, 17,370 (96%) pro-
vided complete data for analysis.
STATISTICAL ANALYSIS
The appropriate sampling weights were used in the analyses to
compensate for variable probabilities of selection, differential
nonresponse rates, and possible deficiencies in the sampling
frame (9). The proportion of individuals who reported eating
fast food on one or both survey days was calculated, and was
stratified by age group, gender, race/ethnicity, income, educa-
tion, and household size. The intake of selected foods and nu-
trients among individuals who reported eating fast food on one
or both survey days was compared with those who did not eat
fast food on either day. Separate analyses for men and women
showed similar results, so they were combined together. The
results from younger children (eg, less than 5 or less than 10
years old) also showed a pattern similar to that of older chil-
dren and adolescents, so they were analyzed as a single group.
The comparison of proportions was made by using
2
statistics
corrected for the survey design, and comparison of means was
made by using the linearization method. Among the 6,858 indi-
viduals who reported eating fast food, the diet on the day that
fast food was eaten and the diet on the day that fast food was
not eaten (excluding 1,475 individuals who ate fast food on
both survey days) were compared. In this comparison
(n⫽5383), the unweighted results were presented because the
sampling weights were different for each survey day, and the
paired t-test was used to compare the diet on the day when fast
food was eaten with the day when fast food was not eaten.
Because this was the within-individual comparison, data from
adults and children were combined in this analysis. Separate
analyses for adults and children showed similar results. All
analyses were performed using Stata (version 7.0, 2001, Stata
Corporation, College Station, TX) and SAS (version 8.1, 1999-
2000, SAS Institute Inc, Cary, NC).
RESULTS
Table 1 presents the sociodemographic characteristics of the
adults and children who reported eating fast food on one or
both survey days. The percentage of individuals who reported
eating fast food was higher among those 10 to 39 years of age
and declined in older individuals. Men reported more frequent
use of fast food than women, as did people with high school and
some college education, individuals with higher income, and
households with four or more members. The reported use of
fast food was lowest among people 60 years of age and older
and among people with a household income of 100% of the
poverty threshold or less.
The food and nutrient intake profile of children and adults
who reported eating fast food and those who did not report
eating fast food on either survey day is shown in Tables 2 and 3.
The children and adolescents who reported eating fast food
had a significantly lower intake of bread and cereals. They also
consumed fewer dark green vegetables and other vegetables,
but significantly more fried potato. The intake of other (non-
citrus) fruits and juices, milk, and legumes was lower compared
with the intake of those who did not report eating fast food.
RESEARCH
Journal of THE AMERICAN DIETETIC ASSOCIATION / 1333
They also reported higher intake of chicken, meat mixture
(dishes that consist mainly of meat), and carbonated soft
drinks. In terms of energy and nutrients, the children who re-
ported eating fast food had a significantly higher intake of total
energy and fat, and a lower intake of protein, vitamin A, and
beta carotene compared with children who did not report eat-
ing fast food.
The adults who reported eating fast food had a signifi-
cantly lower intake of bread, cereals, grains, milk, and le-
gumes. The intake of all fruits and vegetables was lower,
except for fried potato, which was more than twice higher
than the intake of those who did not report eating fast food.
Individuals who reported eating fast food also consumed
more chicken, meat mixture, and grain mixture (dishes that
consist mainly of grain, including pizza and lasagna). Car-
bonated soft drink intake was more than doubled compared
with that of those who did not report eating fast food. The
intake of total energy, fat, cholesterol, sodium, and calcium
was significantly higher, whereas the intake of carbohydrate,
protein, dietary fiber, vitamin A, vitamin C, and beta caro-
tene was significantly lower in the adults who reported eat-
ing fast food compared with those who did not report eating
fast food.
Among 5,383 adults and children who reported eating fast
food on one of the two survey days (excluding those who ate
fast food on both days), the diet on the day that fast food was
eaten was compared with the diet on the day that fast food was
not eaten. This is shown in Table 4. On the day that fast food
was eaten, the subjects consumed less grains, cereals, fruits,
vegetables, milk, and legumes compared with the day that fast
food was not eaten. They also consumed more grain mixture,
meat mixture, chicken, fried potato, and carbonated soft
drinks. On the day that fast food was eaten, the intake of en-
ergy, fat, saturated fat, calcium, and sodium was higher, and
the intake of carbohydrate, protein, dietary fiber, vitamin A,
vitamin C, and beta carotene was lower compared with the day
that fast food was not eaten.
DISCUSSION
Because of time constraints, convenience, and lifestyle, fast
food has become an increasingly important part of the Ameri-
can diet. In 1970, money spent on foods eaten away from home
accounted for 25% of total food spending; by 1999 it had
reached a record 47% of total food spending (11,12). This
study shows that fast food, not including other foods eaten
away from home (eg, at school cafeterias), may contribute to
high intake of energy, fat, sodium, carbonated soft drinks, and
fried potato, and low intake of milk, fruits, vegetables, dietary
fiber, and some vitamins. The previous studies of fast food and
diet quality are limited, but it has been suggested that fast food
may encourage soft drink consumption and may be associated
with low intake of fruits, vegetables, and milk in both adults and
children (1,5).
Results from this study show that fast-food use varied with
sociodemographic factors, being higher among children and
adolescents, young adults, and people with higher income com-
pared with other groups. These findings are consistent with the
available data. Whether education may influence fast-food use
is not known, but the results from this study suggest that more
education may be associated with fast-food consumption. How-
ever, fast-food use may decline at the highest levels of educa-
tion. In this sample, people with 4 or more years of college
education reported lower fast-food consumption compared
with those with high school or some college education. In con-
trast to previous studies, however, the household size was pos-
itively associated with fast-food use.
It is generally believed that fast food contributes to a poor
diet (13,14), although the evidence is limited and previous
studies focused mainly on energy and fat derived from fast
food. Results from this study are similar to those reported in
the studies of fast-food consumption among women and stu-
dents in grades 7 to 12, where fast-food intake was associated
with higher intake of fried potato and soft drinks and lower
intake of fruits, vegetables, and milk (1,5). In contrast to pre-
vious studies, these results show that fast-food use was associ-
ated with higher calcium intake among the adults. This may
reflect the trend for increasing cheese consumption in the
United States, which is at a record level, perhaps because of the
popularity of foods such as cheeseburgers, pizzas, and tacos
(11).
The 1994-1996 and 1998 CSFII data provide detailed de-
scriptions of every food, where it was obtained, and the amount
eaten. In addition, the two nonconsecutive dietary recalls en-
abled us to compare the diets of the same individuals on the day
that fast food was eaten and the day that fast food was not
eaten. Such within-person difference has not been previously
reported in the general population of the United States or else-
where. Again, fast-food use was associated with a less favorable
dietary profile, suggesting that individuals may eat differently
Table 1
Sociodemographic characteristics of the study population and the
percentage of individuals who reported eating fast food on one or
both survey days*
Sample
size
Reported
fast food
intake (%)
P
†
Total sample 17,370 42.2
Age (y)
2 to 9 6,754 41.7
10 to 19 1,796 50.3
20 to 39 2,701 52.0
40 to 59 3,203 40.5
60 and over 2,916 20.1 ⬍.001
Gender
Male 8,658 44.4
Female 8,712 40.2 ⬍.001
Race/ethnicity
White 12,188 42.0
Black 2,227 45.8
Hispanic 2,182 40.5
Others
‡
773 38.5 .2
Education
§
Less than high school 2,374 36.6
High school 3,145 43.3
Some college 1,849 46.0
Four or more years of college 2,061 41.7 ⬍.001
Household income (percent of poverty)
⬍100 3,285 32.1
101 to 299 7,254 41.3
300 and over 6,831 45.5 ⬍.001
Household size
3 or fewer 8,131 39.4
4 or more 9,239 45.6 ⬍.001
*Weighted estimates.
†
Pvalue for the difference in reported fast food use, based on the
2
test of
statistical independence within each sociodemographic group.
‡
Including Asian, Pacific Islander, American Indian, and Alaska native.
§
Data available from survey respondents 15 years and older.
RESEARCH
1334 / October 2003 Volume 103 Number 10
Table 2
Food intake of children and adolescents (n⫽8,307) and adults (n⫽9,063) who reported eating fast food on one or both survey days
compared with those who did not report eating fast food*
Children and adolescents
(g/day)
Reported eating fast food P
†
Yes (nⴝ3,508) No (nⴝ4,799)
Grains and cereals
Bread, roll 39 (1) 43 (1) .006
Cereal, rice, pasta 57 (3) 77 (3) ⬍.001
Grain mixture 114 (5) 110 (4) .5
Other grain products 67 (2) 67 (1) .8
Fruits
Citrus fruits and juices 66 (5) 70 (5) .5
Other fruits and juices 103 (4) 130 (4) ⬍.001
Vegetables
Dark green/deep yellow vegetables 9 (1) 12 (1) ⬍.001
Fried potato 35 (1) 17 (1) ⬍.001
Other vegetables 71 (3) 90 (3) ⬍.001
Legumes, nuts, seeds 14 (1) 19 (1) .001
Milk and milk products
Fluid milk 260 (8) 308 (9) ⬍.001
Cheese 13 (1) 14 (1) .5
Milk dessert 28 (1) 24 (1) .03
Other milk products 54 (3) 49 (2) .2
Meat and meat products
Beef 17 (1) 17 (1) .9
Pork 6 (0.5) 7 (1) .1
Chicken 23 (1) 17 (1) ⬍.001
Fish and shellfish 5 (1) 6 (1) .4
Other meat 24 (1) 28 (1) .006
Meat mixture 81 (4) 64 (3) .001
Egg 12 (1) 13 (1) .7
Fats, oils, sugars
Fats and oils 7 (0.5) 8 (0.5) .1
Sugars and sweets 37 (2) 32 (1) .04
Beverages
Fruit drinks 139 (8) 141 (6) .8
Carbonated soft drinks 358 (14) 179 (7) ⬍.001
Adults
(g/day)
Reported eating fast food P
†
Yes (n⫽3,350) No (n⫽5,713)
Grains and cereals
Bread, roll 48 (1) 54 (1) ⬍.001
Cereal, rice, pasta 56 (3) 83 (3) ⬍.001
Grain mixture 109 (4) 93 (3) ⬍.001
Other grain products 61 (2) 64 (1) .2
Fruits
Citrus fruits and juices 57 (3) 72 (3) ⬍.001
Other fruits and juices 67 (3) 106 (3) ⬍.001
Vegetables
Dark green/deep yellow vegetables 17 (1) 26 (1) ⬍.001
Fried potato 31 (1) 13 (1) ⬍.001
Other vegetables 137 (3) 178 (4) ⬍.001
Legumes, nuts, seeds 19 (1) 33 (2) ⬍.001
Milk and milk products
Fluid milk 126 (4) 149 (5) ⬍.001
Cheese 15 (1) 16 (1) .3
Milk dessert 25 (1) 24 (1) .4
Other milk products 26 (2) 24 (1) .3
Meat and meat products
Beef 25 (1) 25 (1) .7
Pork 9 (1) 12 (1) ⬍.001
Chicken 26 (1) 20 (1) ⬍.001
Fish and shellfish 11 (1) 12 (1) .3
Other meat 29 (1) 31 (1) .3
Meat mixture 128 (4) 88 (3) ⬍.001
Egg 19 (1) 17 (1) .07
Fats, oils, sugars
Fats and oils 15 (1) 16 (0.5) .03
Sugars and sweets 19 (1) 21 (1) .06
Beverages
Coffee, tea 479 (12) 508 (13) .03
Fruit drinks 70 (3) 64 (3) .07
Carbonated soft drinks 459 (12) 239 (9) ⬍.001
Alcoholic beverages 137 (12) 96 (7) .004
*Weighted estimates. Data are presented as mean (standard error).
†
Pvalue for the difference in intake between individuals who reported eating fast food and those who did not report eating fast food.
RESEARCH
Journal of THE AMERICAN DIETETIC ASSOCIATION / 1335
Table 3
Intake of energy and selected nutrients of children and adolescents (n⫽8,307) and adults (n⫽9,063) who reported eating fast food on one
or both survey days compared with those who did not report eating fast food*
Children and adolescents Reported eating fast food P
†
Yes (nⴝ3,508) No (nⴝ4,799)
Total energy (kcal) 1,971 (21) 1,816 (18) ⬍.001
Carbohydrate (% total energy) 53.9 (0.2) 54.1 (0.2) .5
Protein (% total energy) 13.7 (0.1) 14.3 (0.1) ⬍.001
Fat (% total energy) 32.4 (0.1) 31.6 (0.1) ⬍.001
Saturated fat (% total energy) 11.8 (0.1) 11.5 (0.1) .003
Total fat (g) 71 (1) 64 (1) ⬍.001
Saturated fat (g) 26 (0.5) 23 (0.5) ⬍.001
Cholesterol (mg) 214 (4) 213 (4) .9
Dietary fiber (g) 12 (0.2) 13 (0.2) .05
Vitamin A (retinol equivalent) 787 (21) 905 (19) ⬍.001
Vitamin C (mg) 92 (3) 100 (2) .02
Vitamin E (mg) 6 (0.1) 6 (0.1) .6
Beta carotene (retinol equivalent) 269 (13) 344 (11) ⬍.001
Sodium (mg) 3,001 (35) 2,900 (36) .02
Calcium (mg) 875 (15) 868 (14) .7
Potassium (mg) 2,244 (27) 2,253 (26) .8
Iron (mg) 14 (0.3) 14 (0.2) .3
Adults Reported eating fast food P
†
Yes (nⴝ3,350) No (nⴝ5,713)
Total energy (kcal) 1,973 (14) 1,768 (12) ⬍.001
Carbohydrate (% total energy) 49.9 (0.2) 51.4 (0.2) ⬍.001
Protein (% total energy) 15.7 (0.1) 16.4 (0.1) ⬍.001
Fat (% total energy) 34.4 (0.2) 32.2 (0.2) ⬍.001
Saturated fat (% total energy) 11.6 (0.1) 10.6 (0.1) ⬍.001
Total fat (g) 76 (1) 64 (1) ⬍.001
Saturated fat (g) 26 (0.2) 21 (0.2) ⬍.001
Cholesterol (mg) 263 (4) 243 (4) ⬍.001
Dietary fiber (g) 14 (0.2) 16 (0.2) ⬍.001
Vitamin A (retinol equivalent) 823 (18) 1,048 (23) ⬍.001
Vitamin C (mg) 82 (2) 99 (2) ⬍.001
Vitamin E (mg) 8 (0.1) 8 (0.1) .3
Beta carotene (retinol equivalent) 399 (11) 571 (18) ⬍.001
Sodium (mg) 3,309 (31) 3,060 (31) ⬍.001
Calcium (mg) 725 (10) 689 (7) .001
Potassium (mg) 2,512 (20) 2,584 (21) .008
Iron 15 (0.2) 14 (0.2) .5
Caffeine (mg) 226 (5) 214 (5) .04
Alcohol (g) 6.9 (0.5) 5.1 (0.4) .004
*Weighted estimates. Data are presented as mean (standard error).
†
Pvalue for the difference in intake between individuals who reported eating fast food and those who did not report eating fast food.
RESEARCH
1336 / October 2003 Volume 103 Number 10
Table 4
Comparison of the food intake, energy, and nutrient intake of 5,383 adults and children on the day when fast food was eaten with the day
when fast food was not eaten*
Food intake
(g/day)
Day reported eating fast food P
†
Yes (nⴝ5,383) No (nⴝ5,383)
Grains and cereals
Bread, roll 37 (1) 46 (1) ⬍.001
Cereal, rice, pasta 50 (1) 65 (2) ⬍.001
Grain mixture 104 (2) 97 (2) .03
Other grain products 57 (1) 65 (1) ⬍.001
Fruits
Citrus fruits and juices 56 (2) 59 (2) .1
Other fruits and juices 96 (2) 128 (3) ⬍.001
Vegetables
Dark green/deep yellow vegetables 9 (0.5) 17 (1) ⬍.001
Fried potato 39 (1) 15 (1) ⬍.001
Other vegetables 88 (2) 120 (2) ⬍.001
Legumes, nuts, seeds 15 (1) 22 (1) ⬍.001
Milk and milk products
Total 278 (4) 306 (4) ⬍.001
Fluid milk 202 (3) 233 (4) ⬍.001
Cheese 12 (0.4) 15 (0.5) ⬍.001
Milk dessert 27 (1) 25 (1) .1
Other milk products 37 (1) 33 (1) .007
Meat and meat products
Beef 16 (1) 21 (1) ⬍.001
Pork 6 (0.4) 10 (0.4) ⬍.001
Chicken 26 (1) 19 (1) ⬍.001
Fish and shellfish 7 (0.5) 9 (0.6) .003
Other meat 22 (1) 30 (1) ⬍.001
Meat mixture 101 (2) 71 (2) ⬍.001
Egg 17 (1) 16 (0.5) .4
Fats, oils, sugars
Fats and oils 9 (0.3) 11 (0.3) ⬍.001
Sugars and sweets 26 (1) 26 (1) .9
Beverages
Fruit drinks 106 (4) 110 (4) .2
Carbonated soft drinks 359 (6) 228 (5) ⬍.001
Energy and nutrient intake Day reported eating fast food P
†
Yes (nⴝ5,383) No (nⴝ5,383)
Total energy (kcal) 1,881 (10) 1,772 (10) ⬍.001
Carbohydrate (% total energy) 51.9 (0.1) 52.6 (0.1) ⬍.001
Protein (% total energy) 14.4 (0.1) 15.1 (0.1) ⬍.001
Fat (% total energy) 33.7 (0.1) 32.3 (0.1) ⬍.001
Saturated fat (% total energy) 12 (0.05) 11.4 (0.1) ⬍.001
Total fat (g) 71 (0.5) 65 (0.5) ⬍.001
Saturated fat (g) 25 (0.2) 23 (0.2) ⬍.001
Cholesterol (mg) 228 (2) 234 (3) .05
Dietary fiber (g) 12 (0.1) 13 (0.1) ⬍.001
Vitamin A (retinol equivalent) 741 (12) 903 (15) ⬍.001
Vitamin C (mg) 84 (1) 96 (1) ⬍.001
Vitamin E (mg) 7 (0.1) 7 (0.1) .6
Beta-carotene (retinol equivalent) 287 (8) 409 (12) ⬍.001
Sodium (mg) 2,956 (19) 2,923 (20) .2
Calcium (mg) 787 (6) 770 (6) .02
Potassium (mg) 2,298 (14) 2,327 (15) .07
Iron 14 (0.1) 14 (0.1) .7
*Unweighted estimates. Data are presented as mean (standard error), and exclude 1,475 individuals who reported eating fast food on both survey days.
†
Pvalue for the difference in intake between the day when fast food was eaten with the day when fast food was not eaten, paired t-test.
RESEARCH
Journal of THE AMERICAN DIETETIC ASSOCIATION / 1337
and may eat fewer other foods on the day that fast food is
consumed.
Fast-food use is not a dietary habit per se, and people eat fast
food for reasons such as convenience and a busy lifestyle.
Therefore, the increase in fast-food consumption in the United
States is likely to continue. A strong criticism of the fast-food
industry (15) was met by an equally strong rebuttal from the
fast-food industry (16). Many fast-food enterprises have ex-
panded the range of options to include healthful foods. How-
ever, it is questionable whether foods such as fruits and vege-
tables would be selected if offered at fast-food restaurants
because this choice may reflect the perceived lack of taste
rather than lack of availability. Based on the available evidence,
it is concluded that if it is necessary to eat fast food, then
choosing the lower-fat items that are available at many fast-
food locations may help with reducing the excess energy intake
associated with high-fat items. In addition, as with other high-
fat foods, the highly palatable high-fat fast foods may result in
an excessive energy intake. Again this may be avoided by
choosing lower-fat items.
This study has limitations. First, the cross-sectional study
design does not provide evidence of the causal relationship
between fast-food consumption and diet quality. Second, di-
etary data collected from the population are subject to mea-
surement error and bias, particularly those caused by the un-
derreporting of intake by overweight and obese individuals.
Although we believe that the CSFII dietary data are of good
quality, the effect of such bias on our results cannot be as-
sessed.
APPLICATIONS
■Fast food has become an important part of the American diet,
and the increase in fast-food use in the United States is likely to
continue. The excess energy intake associated with eating fast
food may be avoided by choosing lower-fat items and avoiding
the side items, such as french fries and soft drinks. The wide-
spread use of fast food among children and adolescents is of
concern because the high fat and energy intake may contribute
to childhood and subsequent adult obesity. However, addi-
tional data, especially the longitudinal data, are needed to ex-
amine this relationship.
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RESEARCH
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