![]() ![]() Yet, two recent systematic reviews found no statistically significant association among adults’ geographic access to fast-food or QSR chains, socioeconomic status, and weight. Some evidence suggests that one’s biological preferences for energy-dense and nutrient-poor foods high in calories, fats, sugars, and sodium may interact with cultural, economic, lifestyle, and sociodemographic factors (i.e., age, race, ethnicity, and gender) to increase the demand for QSR foods. Cross-sectional studies found associations among the consumption of food and beverage products high in energy (kilocalories (kcal) or kilojoules (kJ)) fats (i.e., total, saturated, and trans fats) sodium and added sugars poor diet quality unhealthy lifestyle behaviors and obesity or diet-related NCD risks among populations in high- and middle-income countries. Transnational restaurant chains created a lucrative global market demand for energy-dense, nutrient-poor processed food and beverage products linked to obesity and non-communicable diseases (NCDs), including type 2 diabetes, cardiovascular diseases, and certain cancers. While QSR chains contributed to economic development by creating jobs, businesses often pay workers below the minimum wage and provide limited benefits that precipitate food and economic insecurity. Technical innovation and trade liberalization enabled the international expansion of restaurant franchise businesses worldwide since the 1960s that generated some economic benefits but also many health consequences. Fast-food meals and sugary beverages marketed by transnational QSR chains are perceived to be a symbol of Western culture, capitalism, and the globalization of the food supply. Quick-service, fast-casual, and full-service restaurant (QSR, FCR, and FSR) chains offer a variety of inexpensive and convenient food and beverage products to customers on the premises, as takeaway, or delivered at home, work, or other locations. These results may inform future research and encourage transnational chain restaurants to offer healthy product profiles and standardized portions to reduce obesity and NCD risks worldwide. There was wide variation within and across countries, regions, firms, and chains to reduce energy, saturated and trans fats, sodium, and standardized portions. The systematic review results showed no standardized assessment methods or metrics to evaluate transnational chain restaurants’ practices to improve menu offerings. The scoping review found a few expert-recommended targets for restaurants to improve offerings, but no internationally accepted standard for portions or serving sizes. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, identified 179 records, and included 50 studies conducted in 30 countries across six regions. Thirdly, we describe a systematic review of five electronic databases (2000–2018) to identify studies on nutrient profile and portion size changes made by transnational restaurants over 18 years. ![]() Secondly, we summarize results from a scoping review of healthy dietary guidelines for restaurants. Firstly, we describe the transnational restaurant industry structure and eating trends. This study examined whether transnational restaurant chains reformulated products and standardized portions aligned with healthy dietary guidelines and criteria. Transnational restaurant chains sell food and beverage products in 75 to 139 countries worldwide linked to obesity and non-communicable diseases (NCDs).
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