McDonald's reported quarterly revenue that missed analysts' estimates and warned that global comparable sales for October are expected to be relatively flat.
Sales at stores opened for at least 12 months rose 0.9% in the third quarter, missing analysts' expectations of a 1% rise, according to Consensus Metrix.
A recent survey from Goldman Sachs suggested that McDonald's, which lately has lagged rivals in introducing popular new menu items, might be losing favour with consumers.
In the US, comparable sales increased 0.7%, but missed the average 0.9% rise analysts had expected. Comparable sales in its Asia/Pacific, Middle East and Africa business declined a steeper than expected 1.4%.
The company is fighting to accelerate sales in the US after smaller rivals such as Wendy's and Burger King Worldwide rolled out new menu items and limited-time offers.
McDonald's previously got a sales bump from new products such as oatmeal, sandwich wraps and lattes, but its more complicated menu has slowed service at its drive-thru outlets.
The world's biggest restaurant chain by revenue said net income rose to $1.52 billion, or $1.52 per share, for the third quarter ended September 30, from $1.46 billion, or $1.43 per share, a year earlier. Revenue rose 2.4% to $7.32 billion.
Analysts on average had expected earnings of $1.51 per share on revenue of $7.34 billion, according to Thomson Reuters. Restaurant margins at both franchised and company-operated stores slipped in the quarter, the company said.