Differences in energy and nutrient content of menu items served by large chain restaurants in the USA and the UK in 2018

Objective: To quantify the sector-wide energy and nutritional differences of both adult and children's restaurant menu items in the UK and the USA in 2018. Design: Cross-sectional study. Setting: Energy and nutritional information provided on restaurant websites. Participants: Menu items (n 40 902) served by forty-two large UK chains and ninety-six large USA chains. Results: Mean absolute energy, fat and saturated fat values were higher in USA menu items. For example, the mean adjusted per-item differences of adult menu items between the USA and the UK were 45 center dot 6 kcal for energy and 3 center dot 2 g for fat. Comparable figures for children's menu items were 43 center dot 7 kcal and 4 g. Compared with UK menu items, USA adult menu items also had higher sugar content (3 center dot 2 g, 95 % CI (0 center dot 5, 6)), and children's menu items had higher Na content (181 center dot 1 mg, 95 % CI (108 center dot 4, 253 center dot 7)). Overall, 96 center dot 8 % of UK and 95 center dot 8 % of USA menu items exceeded recommended levels for at least one of Na, fat, saturated fat or sugars. Conclusions: Menu items served by large chain restaurants had higher mean absolute levels of energy, fat and saturated fat in the USA compared with the UK. UK adult menu items were also lower in sugars compared with the USA ones and children's items lower in Na. As more than 95 % of all items were considered to have high levels of at least one nutrient of public health concern in the USA and the UK, improvements in restaurant menu items are needed in both countries.