Availability and nutrient composition of vegetarian items at U.S. fast food restaurants

Background: Consumer demand for vegetarian options is growing. Fast food restaurants have responded by adding high-profile vegetarian offerings but little is known about the overall availability or nutrient profile of vegetarian options at these establishments, or how these items compare to non-vegetarian items. Objective: The purpose of this study was to quantify trends in the availability and nutrient profile of vegetarian items in U.S. fast food restaurants from 2012-2018. Design: This study was a longitudinal analysis of secondary data. We used nutrient data from the MenuStat database for menu offerings at 36 large U.S. fast food chain restaurants (2012 to 2018). Vegetarian items were identified through automated key-word searches and item description hand-coding. Outcome Measures: Annual counts and proportions of vegetarian and non-vegetarian items by category, and annual trends and differences in predicted mean calories; saturated, unsaturated, and trans fat; sugar; non-sugar carbohydrates; protein; sodium between and within vegetarian and non-vegetarian items. Statistical analysis performed: We report counts and proportions of vegetarian items by menu category, then use tobit regression models to examine annual trends and differences in predicted mean nutrients between and within vegetarian and non-vegetarian items. Sensitivity analyses were calorie-adjusted. Results: The annual proportion of vegetarian items remained consistent (~20%), while counts increased (2012, n=601; 2018, n=713). Vegetarian items had significantly fewer calories (2018: -95 kcals) and, even after adjustment for calories, lower saturated fat (-1.6g), unsaturated fat (-1.8g), protein (-3.8g), and sodium (-62mg) annually (p’s <0.05) compared to non-vegetarian items. Vegetarian items were significantly higher in sugar (2018: +2.0g, p<0.01) and non-sugar carbohydrates (2018: +9.7g, p<0.01), after calorie adjustment, compared to non-vegetarian items. Conclusions: Vegetarian items were generally lower in several overconsumed nutrients of public health concern (e.g., sodium, saturated fat) than non-vegetarian items, but nutrient changes suggest surveillance remains important as vegetarian options increase in popularity.