1. Journal Club 埼玉医科大学 総合医療センター 内分泌・糖尿病内科 Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University 松田 昌文 Matsuda, Masafumi 2011 年 8 月 4 日 8:30-8:55 ８階 医局 Urban LE, McCrory MA, Dallal GE, Das SK, Saltzman E, Weber JL, Roberts SB. Accuracy of stated energy contents of restaurant foods. JAMA. 2011 Jul 20;306(3):287-93. Dumanovsky T, Huang CY, Nonas CA, Matte TD, Bassett MT, Silver LD. Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: cross sectional customer surveys. BMJ. 2011 Jul 26;343:d4464. doi: 10.1136/bmj.d4464.

2. Federal Food, Drug, and Cosmetic Act Nutrition Labeling and Education Act of 1990 The Nutrition Labeling and Education Act (NLEA) (Public Law 101-535) is a 1990 United States Federal law. It was signed into law on November 8, 1990 by President George H. W. Bush. The law gives the Food and Drug Administration (FDA) authority to require nutrition labeling of most foods regulated by the Agency; and to require that all nutrient content claims (for example, 'high fiber', 'low fat', etc.) and health claims meet FDA regulations. The act did not require restaurants to comply to the same standards. In January 2008 New York City fully implemented a regulation requiring chain restaurants to provide calorie information prominently for all items on menus and menu boards

3. JAMA. 2011;306(3):287-293 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts (Drs Urban, Dallal, Das, Saltzman, and Roberts); Department of Foods and Nutrition, Department of Psychological Sciences and the Ingestive Behavior Research Center, Purdue University, West Lafayette, Indiana (Dr McCrory); and Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock (Dr Weber).

4. Context National recommendations for the prevention and treatment of obesity emphasize reducing energy intake. Foods purchased in restaurants provide approximately 35% of the daily energy intake in US individuals but the accuracy of the energy contents listed for these foods is unknown. Objective To examine the accuracy of stated energy contents of foods purchased in restaurants.

5. Design and Setting A validated bomb calorimetry technique was used to measure dietary energy in food from 42 restaurants, comprising 269 total food items and 242 unique foods. The restaurants and foods were randomly selected from quick- serve and sit-down restaurants in Massachusetts, Arkansas, and Indiana between January and June 2010. Main Outcome Measure The difference between restaurant-stated and laboratorymeasured energy contents, which were corrected for standard metabolizable energy conversion factors.

6. Low-stated energy foods had less than 600 kcal/ portion and high-stated energy foods had 600 kcal/ portion or higher as stated on the restaurant Web site per entire served portion. Four foods were unavailable for resampling and therefore could not be included in the resampling analysis. Figure 1. Sampling Plan

10. Results The absolute stated energy contents were not significantly different from the absolute measured energy contents overall (difference of 10 kcal/portion; 95% confidence interval [CI], −15 to 34 kcal/portion; P=.52); however, the stated energy contents of individual foods were variable relative to the measured energy contents. Of the 269 food items, 50 (19%) contained measured energy contents of at least 100 kcal/portion more than the stated energy contents. Of the 10% of foods with the highest excess energy in the initial sampling, 13 of 17 were available for a second sampling. In the first analysis, these foods contained average measured energy contents of 289 kcal/portion (95% CI, 186 to 392 kcal/portion) more than the stated energy contents; in the second analysis, these foods contained average measured energy contents of 258 kcal/portion (95% CI, 154 to 361 kcal/portion) more than the stated energy contents (P<.001 for each vs 0 kcal/portion difference). In addition, foods with lower stated energy contents contained higher measured energy contents than stated, while foods with higher stated energy contents contained lower measured energy contents (P<.001).

11. Conclusions Stated energy contents of restaurant foods were accurate overall. However, there was substantial inaccuracy for some individual foods, with understated energy contents for those with lower energy contents.

12. Message/Comments 無作為抽出した飲食店 42 軒を対象に、料理 のエネルギー表示の正確さを調査。全般的 に表示量と測定量の絶対値に有意差は見ら れなかった（差異 1 人前あたり 10kcal ）。 269 品目中 50 品目では測定量の方が高かっ た。また、表示量の低い食事ほど測定量が 高く、表示量の高い食事ほど測定量が低い 傾向にあった（ P ＜ 0.001 ）。

14. BMJ 2011;343:d4464 doi: 10.1136/bmj.d4464

15. Objective To assess the impact of fast food restaurants adding calorie labelling to menu items on the energy content of individual purchases.

16. Design Cross sectional surveys in spring 2007 and spring 2009 (one year before and nine months after full implementation of regulation requiring chain restaurants’ menus to contain details of the energy content of all menu items). Setting 168 randomly selected locations of the top 11 fast food chains in New York City during lunchtime hours. Participants 7309 adult customers interviewed in 2007 and 8489 in 2009. Main outcome measures Energy content of individual purchases, based on customers’ register receipts and on calorie information provided for all items in menus.

24. Results For the full sample, mean calories purchased did not change from before to after regulation (828 v 846 kcal, P=0.22), though a modest decrease was shown in a regression model adjusted for restaurant chain, poverty level for the store location, sex of customers, type of purchase, and inflation adjusted cost (847 v 827 kcal, P=0.01). Three major chains, which accounted for 42% of customers surveyed, showed significant reductions in mean energy per purchase (McDonald’s 829 v 785 kcal, P=0.02; Au Bon Pain 555 v 475 kcal, P<0.001; KFC 927 v 868 kcal, P<0.01), while mean energy content increased for one chain (Subway 749 v 882 kcal, P<0.001). In the 2009 survey, 15% (1288/8489) of customers reported using the calorie information, and these customers purchased 106 fewer kilocalories than customers who did not see or use the calorie information (757 v 863 kcal, P<0.001).

25. Conclusion Although no overall decline in calories purchased was observed for the full sample, several major chains saw significant reductions. After regulation, one in six lunchtime customers used the calorie information provided, and these customers made lower calorie choices.

26. Message/Comments ニューヨーク市の 11 のファストフード チェーン 168 店で昼食をとった成人を対象 に、カロリー表示義務化前後での、購入 1 回あたりのカロリー量の変化を横断的顧客 調査で比較。全般的なカロリー量は義務化 前後で変化はなかったが、ファストフード チェーン 3 社では有意な低下が見られた。 また、 6 人に 1 人は表示を参考に低カロリー 食を選択していた。