TABLE 3.
Trends in American Heart Association scores and adjusted quantities of American Heart Association dietary components consumed from full-service and fast-food restaurants among US adults, 2003–2016
| Survey-weighted mean ± SE1,2 | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Dietary targets3 | 2003–2004 (n1 = 1405; n2 = 2010) | 2005–2006 (n1 = 1375; n2 = 2122) | 2007–2008 (n1 = 1566; n2 = 2374) | 2009–2010 (n1 = 1631; n2 = 2408) | 2011–2012 (n1 = 1465; n2 = 2401) | 2013–2014 (n1 = 1546; n2 = 2607) | 2015–2016 (n1 = 1460; n2 = 2342) | P-trend | Mean change4 from 2003–2004 to 2015–2016 | Percent change4 from 2003–2004 to 2015–2016 |
| AHA scores | ||||||||||
| Primary (range: 0–50)5 | ||||||||||
| Full-service restaurant | 17.8 ± 0.24 | 17.8 ± 0.20 | 17.5 ± 0.21 | 17.6 ± 0.24 | 17.9 ± 0.27 | 17.9 ± 0.28 | 17.3 ± 0.40 | 0.52 | — | — |
| Fast-food restaurant | 14.9 ± 0.18 | 14.7 ± 0.19 | 14.5 ± 0.15 | 14.2 ± 0.23 | 14.9 ± 0.21 | 15.2 ± 0.23 | 14.7 ± 0.23 | 0.58 | — | — |
| Secondary (range: 0–80)6 | ||||||||||
| Full-service restaurant | 32.2 ± 0.45 | 32.1 ± 0.39 | 31.4 ± 0.30 | 31.6 ± 0.49 | 32.8 ± 0.44 | 33.1 ± 0.51 | 31.6 ± 0.48 | 0.45 | — | — |
| Fast-food restaurant | 26.5 ± 0.28 | 26.4 ± 0.31 | 26.3 ± 0.26 | 26.6 ± 0.40 | 27.3 ± 0.41 | 27.6 ± 0.28 | 27.6 ± 0.44 | <0.001 | — | — |
| AHA Primary Component Goals | ||||||||||
| Fruits and vegetables (adjusted servings/d) | ||||||||||
| Full-service restaurant | 2.77 ± 0.13 | 2.69 ± 0.11 | 2.45 ± 0.08 | 2.64 ± 0.15 | 2.66 ± 0.12 | 2.38 ± 0.08 | 2.18 ± 0.14 | 0.001 | −0.59 (−0.96, −0.21) | −21.2 (−33.4, −8.94) |
| Fast-food restaurant | 1.76 ± 0.04 | 1.81 ± 0.08 | 1.51 ± 0.03 | 1.56 ± 0.06 | 1.47 ± 0.05 | 1.48 ± 0.05 | 1.47 ± 0.06 | <0.001 | −0.29 (−0.43, −0.15) | −16.4 (−23.9, −8.99) |
| Whole grains (adjusted servings/d) | ||||||||||
| Full-service restaurant | 0.22 ± 0.03 | 0.19 ± 0.02 | 0.25 ± 0.03 | 0.23 ± 0.02 | 0.34 ± 0.04 | 0.36 ± 0.04 | 0.49 ± 0.09 | <0.001 | 0.27 (0.08, 0.47) | 125 (18.68, 231) |
| Fast-food restaurant | 0.08 ± 0.01 | 0.16 ± 0.03 | 0.12 ± 0.02 | 0.11 ± 0.02 | 0.28 ± 0.06 | 0.30 ± 0.04 | 0.31 ± 0.05 | <0.001 | 0.23 (0.13, 0.33) | 305 (113, 497) |
| Fish and shellfish (adjusted servings/d) | ||||||||||
| Full-service restaurant | 0.37 ± 0.06 | 0.42 ± 0.04 | 0.39 ± 0.04 | 0.48 ± 0.05 | 0.40 ± 0.05 | 0.46 ± 0.05 | 0.53 ± 0.09 | 0.09 | 0.16 (−0.04, 0.37) | 44.2 (−20.1, 108) |
| Fast-food restaurant | 0.10 ± 0.01 | 0.08 ± 0.007 | 0.11 ± 0.01 | 0.15 ± 0.05 | 0.11 ± 0.03 | 0.10 ± 0.01 | 0.09 ± 0.01 | 0.73 | −0.008 (−0.04, 0.02) | −8.12 (−36.2, 20.0) |
| Sugar-sweetened beverages (adjusted servings/d) | ||||||||||
| Full-service restaurant | 1.10 ± 0.08 | 0.90 ± 0.11 | 0.91 ± 0.12 | 0.84 ± 0.06 | 0.83 ± 0.07 | 0.62 ± 0.05 | 0.72 ± 0.10 | <0.001 | −0.33 (−0.58, −0.07) | −31.3 (−52.5, −10.0) |
| Fast-food restaurant | 1.47 ± 0.09 | 1.25 ± 0.09 | 1.18 ± 0.07 | 1.22 ± 0.09 | 1.28 ± 0.09 | 1.07 ± 0.08 | 1.21 ± 0.08 | 0.02 | −0.26 (−0.50, −0.02) | −17.6 (−32.1, −3.01) |
| Sodium (adjusted g/d) | ||||||||||
| Full-service restaurant | 4.34 ± 0.10 | 4.38 ± 0.09 | 4.42 ± 0.09 | 4.55 ± 0.11 | 4.41 ± 0.06 | 4.31 ± 0.06 | 4.40 ± 0.07 | 0.98 | 0.06 (−0.18, 0.30) | 1.36 (−4.14, 6.85) |
| Fast-food restaurant | 3.82 ± 0.06 | 3.97 ± 0.04 | 3.91 ± 0.05 | 4.03 ± 0.08 | 3.70 ± 0.10 | 3.74 ± 0.05 | 3.77 ± 0.30 | 0.003 | −0.05 (−0.19, 0.10) | −1.21 (−4.86, 2.44) |
| AHA Secondary Component Goals | ||||||||||
| Nuts, seeds, and legumes (adjusted servings/d) | ||||||||||
| Full-service restaurant | 0.17 ± 0.03 | 0.16 ± 0.02 | 0.16 ± 0.02 | 0.16 ± 0.03 | 0.16 ± 0.02 | 0.26 ± 0.05 | 0.25 ± 0.04 | 0.03 | 0.07 (−0.03,0.18) | 40.9 (−27.5, 109) |
| Fast-food restaurant | 0.07 ± 0.01 | 0.09 ± 0.02 | 0.10 ± 0.02 | 0.07 ± 0.01 | 0.12 ± 0.02 | 0.14 ± 0.01 | 0.15 ± 0.02 | <0.001 | 0.08 (0.03, 0.13) | 122 (21.8, 223) |
| Processed meat (adjusted servings/d) | ||||||||||
| Full-service restaurant | 0.22 ± 0.03 | 0.22 ± 0.02 | 0.23 ± 0.03 | 0.24 ± 0.03 | 0.27 ± 0.03 | 0.20 ± 0.02 | 0.21 ± 0.04 | 0.94 | −0.003 (−0.10, 0.1) | −1.20 (−47.8, 45.4) |
| Fast-food restaurant | 0.32 ± 0.03 | 0.32 ± 0.03 | 0.29 ± 0.02 | 0.30 ± 0.03 | 0.32 ± 0.04 | 0.32 ± 0.03 | 0.27 ± 0.02 | 0.53 | −0.05 (−0.12, 0.02) | −14.8 (−34.9, 5.28) |
| Saturated fat (% of energy) | ||||||||||
| Full-service restaurant | 11.8 ± 0.20 | 12.0 ± 0.17 | 12.2 ± 0.17 | 11.8 ± 0.30 | 11.1 ± 0.18 | 11.1 ± 0.20 | 12.2 ± 0.35 | 0.19 | 0.39 (−0.41, 1.2) | 3.31 (−3.44, 10.1) |
| Fast-food restaurant | 13.4 ± 0.14 | 13.6 ± 0.15 | 13.7 ± 0.16 | 12.8 ± 0.13 | 13.2 ± 0.20 | 13.1 ± 0.22 | 13.1 ± 0.25 | 0.03 | −0.30 (−0.87, 0.27) | −2.24 (−6.44, 1.97) |
The majority of means were adjusted for energy to 2000 kcal/d by scaling. The means for saturated fat were adjusted as percentage of corresponding total energy from full-service restaurants or fast-food restaurants. Supplemental Tables 7 and 8 provide additional data.
To account for varying serving sizes and amounts as well as facilitate interpretation of the contents of these foods and nutrients in different FS and FF meals and as compared to national dietary recommendations, all intakes were adjusted to 2000 kcal/d. The sample sizes for full-service restaurants and fast-food restaurants were indicated by n1 and n2, respectively.
Serving sizes were derived based on the standards from the USDA's Food Pattern Equivalent Database, which has no direct conversion and details were reported elsewhere (23).
Values represent means or proportions (95% CIs).
The primary total diet score is the sum of the scores for the 5 dietary components included in the primary score.
The secondary total diet score is the sum of the scores for all 8 components included in the primary and secondary scores.
AHA, American Heart Association.