**1. Introduction**

New Zealand (NZ) has high rates of non-communicable disease with two of three adults and one in four children overweight or obese [1], and in 2017 unhealthy diets accounted for nearly 20% of illness and early death [2]. The average NZ diet is low in fruit, vegetables, wholegrains, legumes, nuts and seeds and contains an excess of foods high in sugar and sodium [1,2].

Fast-food is heavily marketed, cheap in comparison to other restaurant foods, convenient, accessible and palatable [3,4]. Fast-food has been independently associated with increased energy intakes and accelerating rates of weight gain and obesity [5,6]. In the United States, fast-food consumption has been associated with an additional 814 kJ of dietary energy per day and higher intakes of saturated fat and sodium [7]. Fast-food meals are generally characterized by large portion sizes, low levels of health-promoting nutrients such as fibre, and high levels of energy and adverse nutrients including saturated fat, added sugar and sodium [8]. Many chains offer combination meals (meal combos) in

**Citation:** Mackay, S.; Gontijo de Castro, T.; Young, L.; Shaw, G.; Ni Mhurchu, C.; Eyles, H. Energy, Sodium, Sugar and Saturated Fat Content of New Zealand Fast-Food Products and Meal Combos in 2020. *Nutrients* **2021**, *13*, 4010. https:// doi.org/10.3390/nu13114010

Academic Editors: Alessandra Durazzo and Massimo Lucarini

Received: 8 October 2021 Accepted: 8 November 2021 Published: 10 November 2021

**Publisher's Note:** MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

addition to individual items. These bundle unhealthy food options for a cheaper price and are a common tool used by the fast food industry to increase consumption [9].

In NZ, the percentage of the household food budget spent on restaurants and takeaways increased from 22% in 2000 to 27% in 2020 [10], and in 2019, 53% of adults bought a takeout meal from a fast-food or takeaway shop at least once a week [11]. Euromonitor trends for NZ from 2015 to 2020 show a 3.5% increase in foodservice value growth for limited-service restaurants with sales, and the number of fast-food outlets is forecast to continue to grow [12]. A previous assessment of the energy, serving size and sodium content of the NZ fast-food supply [13] reported an increase in the serving size of fast-food items from 2012 to 2016 and an increase in sodium and energy per serving, although there was no increase in product sodium or energy density.

Internationally there is a lack of agreed guidelines for portion or serving sizes or nutrients for fast-foods, and there is wide variation in serving sizes and nutrient contents of fast foods within and across countries [14]. However, the United Kingdom (UK) has government-led programs to reduce the energy, salt and sugar content in the "out-of-home" food sector [15]. The voluntary targets aim to reduce the levels of salt and sugar in the foods that contribute most to dietary intakes for UK adults. The mandatory UK "Soft Drinks Industry Levy" was introduced in 2018 to incentivize the industry to reduce the sugar content of soft drinks or pay a variable levy depending on the sugar content of the drink [16].

There are no government regulations in NZ related to fast-food composition targets, menu labeling of energy or nutrients [17], or to limit density of outlets. There is little nutrition information provided at the point of purchase to assist customers to purchase healthier options [18]. The NZ Government has not set food composition targets for any foods. The Heart Foundation has a voluntary HeartSAFE program focused on reducing sodium and sugar in low-cost, high-volume processed foods [19] but only four of 38 food categories have targets for foods that are consumed away from the home. In 2018, the NZ Ministers of Health and Primary Industries requested that the food industry convene a Food Industry Taskforce to show how they could contribute to obesity reduction. The resulting voluntary recommendations of the Taskforce related to fast food were to develop serving size ranges, best-practice portion guidance, education, providing nutrition information and to consider voluntary menu labeling [18] but there has been no indication of implementation. Annual cross-sectional surveys of all food and beverage products available for sale at fast-food chains in NZ are undertaken as part of data collection for the Nutritrack database [20]. Fast-food chains were defined according to Fleischhacker et al. [21] as restaurants providing food which is generally cheap, requires minimal preparation, and where no table service is provided.

This paper aims to benchmark the healthiness of products and combo meals available in the NZ fast-food supply in 2020 to provide recent evidence to inform effective policies and actions regarding reformulation and consumer information. To achieve this we: (i) assessed the sugar, salt, saturated fat and energy content of key fast-food product categories and meal combos and compared their nutrient content to national and international daily recommended intakes and; (ii) benchmarked selected fast-food product categories against accepted sodium and sugar targets. This is also the first study in NZ to assess the healthiness of meal combos provided by fast-food chains.

#### **2. Materials and Methods**
