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

J Acad Nutr Diet. 2012 Aug;112(8):1169-76. doi: 10.1016/j.jand.2012.04.019. Epub 2012 Jun 15.


Background: 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.

Objective: 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.

Setting: 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.

Results: 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.

Conclusions: 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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Dietary Fats / administration & dosage
  • Dietary Fats / analysis*
  • Energy Intake*
  • Food Analysis / standards
  • Food Labeling* / standards
  • Food Labeling* / statistics & numerical data
  • Guideline Adherence
  • Humans
  • Menu Planning / standards*
  • Nutrition Policy
  • Nutritive Value
  • Restaurants / legislation & jurisprudence
  • Restaurants / standards
  • Restaurants / statistics & numerical data*
  • Sodium, Dietary / administration & dosage
  • Sodium, Dietary / analysis*
  • Time Factors
  • Washington


  • Dietary Fats
  • Sodium, Dietary