2.2.2. Fast-Food Combo Meals

The nutrient composition of meal combos in the database was calculated by combining per product nutrient values for existing individual products. A combination of products was considered a meal combo if: (i) it offered two or more products, one of which may be a beverage; (ii) the meals were considered a main meal (e.g., burger, fries, soft drink) rather than a snack (e.g., muffin and coffee) and; (iii) the combo was promoted as a meal to be shared between a specific number of people (e.g., contained four burgers and four beverages). Some 'party packs' and pizza deals were not considered meals as it was not obvious how many people they would feed (e.g., three large pizzas, two large fries and 1.5 L soft drink).

Meal combos were then categorized by type based on the presence of key common products e.g., burger, chicken, pie, sandwich, etc. Many of the combos offered the consumer a choice for one or more of the products within. When this occurred, an option offered with the lowest energy choice (e.g., artificially sweetened beverage (ASB), lowest calorie sandwich filling) and an option with the highest energy choice (e.g., sugar sweetened beverage (SSB), highest calorie sandwich filling) were created.

**Figure 1.** Flow-chart indicating the reasons and number of fast-food products excluded and included in the analyses, New Zealand, 2020. \* Asian—Chinese, juice, beverages other, tea/coffee/hot chocolate, water, breakfast sweet, dressings/condiments sweet, other, seafood, soups.

In total, 176 meal combos from nine fast-food chains were identified, which were allocated to one of 20 combo categories. The number of combos within a category ranged from three (5 categories) to 20 (4 categories).

#### Outcomes

A range of indicators were chosen to benchmark the healthiness of fast-food items and meal combos in relation to existing relevant targets and daily population recommendations for energy, sodium, added sugar and saturated fat intakes [24,25]

Serving size and nutritional composition/serving: The average amount of energy (kilojoules-kJ), sodium (mg), sugar (g) and saturated fat (g) per serving was calculated and described as medians (interquartile range); and minimum and maximum values. We calculated medians for these metrics because for some of the fast-food categories and combos, the nutrient contents were not normally distributed.

Percentage of adult daily recommendations/serving: The percentage contribution that each product and combo meal made to daily population Nutrient Reference Values (NRVs) [24] for energy, sodium, sugar and saturated fat was calculated. New Zealand and Australia share the same NRVs so we used the same energy benchmark as an Australian fast-food supply analysis of 8700 kJ [26]. We applied the recommended upper limit for sodium (2000 mg) [24] which is also the WHO upper limit [27], saturated and trans-fat (≤10% of energy/day, 23 g for 8700 kJ diet) [24] and sugar (WHO recommendation for free sugars intake ≤10% of energy/day, 51 g for 8700 kJ diet) [25]. The free sugars content of fast foods is not available and intrinsic sugars are present in few fast foods in NZ, therefore total sugars were used as a proxy.

Proportion of products exceeding the UK sodium targets: UK sodium targets (2024 targets published in 2020) were used as there are no targets available for NZ. UK sodium targets are set per serving (or slice for pizza) for the takeaway sector [23] and per 100 g for other categories (used for 'cakes, muffins and pastry'), and were assessed for seven of 16 categories included in this study.

Proportion of sugar-sweetened beverages exceeding sugar thresholds for the UK soft drinks industry levy: The UK SDIL [16] is based on total sugar content of beverages per 100 mL. The UK soft drinks levy thresholds (>5 g and ≤8 g/100 mL and >8 g/100 mL) were used as NZ does not have sugar targets for beverages.

#### Analysis

All analyses were performed using SPSS software (version 25, IBM SPSS Statistics).

## **3. Results**

## *3.1. Fast-Food Categories and Products*

Table 1 presents the median (interquartile range) serving size, energy and nutrients/serving (sodium, total sugar, saturated fat), and percent contribution to daily recommendations by fast-food category. Table S1 (Supplementary Material) presents, for each fast-food category, the minimum and maximum values for energy and nutrient contents and for percent contributions of energy and nutrients to daily recommendations.

The categories with the highest median energy per serving and percentage contribution to recommended daily energy intake (8700 kJ) were Burgers (2585 kJ, 29.7%, respectively), followed by Fries (2010 kJ, 23.1%) and Asian meals (2015 kJ, 23.2.0%). Half of the Pastry, savory, Cakes, muffins and pastries and Milkshakes/smoothies, considered to be snack items, contributed, respectively, at least, 22.0%, 22.4% and 18.6%/serving to the daily recommended energy intake for a NZ adult (Table 1).

The categories with the highest median sodium per serving and percentage contribution to maximum recommended daily sodium intake (2000 mg) intake were Burgers (1090.6 mg, 54.5%, respectively), followed by Breakfast, savory (1075 mg, 53.8%,) and Sandwiches and wraps (900 mg, 45.0%).) The categories with the highest median total sugar per serving and percentage contribution to maximum recommended daily free sugar intake (51 g) were Milkshakes/smoothies (49.0 g, 96.0%, respectively) followed by sugar-sweetened soft drinks, (33.8 g, 66.3%) and Cakes/muffins/pastries (32.8 g, 64.3%). The highest median values of saturated fat per serving and percentage contribution to maximum daily recommended intake (23 g) were observed for Pastry, savory (13.0 g, 56.8%, respectively) followed by Breakfast, savory (9.5 g, 41.3%) and Burgers (9.2 g, 40.0%) (Table 1).

Analysis involving all products showed that most (n = 1562; 89.1%) contributed 30% or less/serving to the daily recommended energy intake for an average NZ adult. In total, 235 products (13.4%) contributed 50% or more/serving of the maximum daily recommended sodium intake. Twenty-three products (1.3%) exceeded the maximum recommended daily sodium intake (data not shown in table).

Figure 2 shows the proportions of products above the UK sodium target [24] among the fast-food categories where a target existed. Overall, almost half the products (46.5%) exceeded the target/serving. The categories with the largest percentage of products exceeding the UK sodium target were Fries (100% of products), Pizzas (57.1%) and Pastries, savory (52.6%). The categories with the lowest percentage exceeding the UK sodium target were Sandwiches and wraps (38.1%), Burgers (36.5%) and Cakes, muffins and sweet pastry products (35.8%).

Of the 73 sugar-sweetened soft drinks assessed, the majority (n = 67; 91.8%) exceeded the UK-SDIL thresholds [16], where 58 (74.5%) had a sugar content >8 g/100 mL and 9 (12.3%) had a sugar content >5 g & ≤8 g/100 mL (data not shown).

*Nutrients* **2021**, *13*, 4010 **Table 1.** NZ fast food supply 2020, by food category: Median (interquartile ranges) for: total energy, sodium, sugar and saturated fat content by serving size and percent energy, sodium, sugar and saturated fat contributions to recommended daily intakes.


Sides, other (7); sweetened (0);

Dressings/condiments-savory

Breakfast-savory

Dressings/condiments-savory

 (0);

 (0).

 (39). Missing (n) Nutrient content and % of daily

Pastry-savory

 (0); Cakes, muffins and pastry (0); Desserts (0); Burgers (0); Chicken (6); Pizza (1); Salads (0); Sandwiches

recommendation:

 Asian (11); Milkshakes, smoothies (0); Soft drinks-sugar

 sweetened (1); Soft

 and wraps (0); Fries (0); Sides, other (0);

drinks-artificially

**Figure 2.** Proportions of products above the 2024 UK sodium targets for the respective food category.
