CONTEXT: Consumption of high-energy food has increased globally, thereby leading to an increase in many diseases. One strategy for addressing this is to make people aware of their energy intake through energy and fat labels. However, the effectiveness of this remains debatable.
OBJECTIVE: This review aims to pool the mixed outcomes of recent studies assessing the effect of energy and fat content labeling on food consumption pattern.
DATA SOURCES: Google Scholar, MEDLINE, and Cochrane Library databases were searched. Randomized controlled and quasi-experimental controlled trials published from 2014 to 2019 were included.
DATA EXTRACTION: Two reviewers screened 413 abstracts independently. Qualitative and quantitative data was extracted from 10 articles; meta-analysis was carried out on 6 of those studies.
RESULTS: The majority of the included papers were conducted in the regions of America, the Western Pacific, and Europe. Overall, the 6 studies claimed that labeling did not reduce the consumption of energy or fat. However, meta-analysis showed that fat and energy content labeling of food had a statistically significant effect on consumption. Subgroup analysis showed no difference with respect to types of labels, ie, context labeling vs traffic-light labeling, but energy content labels seemed to be more effective than fat content labels in influencing healthy food choices.
CONCLUSION: Energy and fat content labeling were shown to reduce the consumption of each significantly. However, the outcome was influenced by the study setting and the population concerned. There is a need for research in other regions in order to assess the global effectiveness of nutrition labels on food consumption.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42020172675.
BACKGROUND: Nutritional labelling is advocated as a means to promote healthier food purchasing and consumption, including lower energy intake. Internationally, many different nutritional labelling schemes have been introduced. There is no consensus on whether such labelling is effective in promoting healthier behaviour.
OBJECTIVES: To assess the impact of nutritional labelling for food and non-alcoholic drinks on purchasing and consumption of healthier items. Our secondary objective was to explore possible effect moderators of nutritional labelling on purchasing and consumption.
SEARCH METHODS: We searched 13 electronic databases including CENTRAL, MEDLINE and Embase to 26 April 2017. We also handsearched references and citations and sought unpublished studies through websites and trials registries.
SELECTION CRITERIA: Eligible studies: were randomised or quasi-randomised controlled trials (RCTs/Q-RCTs), controlled before-and-after studies, or interrupted time series (ITS) studies; compared a labelled product (with information on nutrients or energy) with the same product without a nutritional label; assessed objectively measured purchasing or consumption of foods or non-alcoholic drinks in real-world or laboratory settings.
DATA COLLECTION AND ANALYSIS: Two authors independently selected studies for inclusion and extracted study data. We applied the Cochrane 'Risk of bias' tool and GRADE to assess the quality of evidence. We pooled studies that evaluated similar interventions and outcomes using a random-effects meta-analysis, and we synthesised data from other studies in a narrative summary.
MAIN RESULTS: We included 28 studies, comprising 17 RCTs, 5 Q-RCTs and 6 ITS studies. Most (21/28) took place in the USA, and 19 took place in university settings, 14 of which mainly involved university students or staff. Most (20/28) studies assessed the impact of labelling on menus or menu boards, or nutritional labelling placed on, or adjacent to, a range of foods or drinks from which participants could choose. Eight studies provided participants with only one labelled food or drink option (in which labelling was present on a container or packaging, adjacent to the food or on a display board) and measured the amount consumed. The most frequently assessed labelling type was energy (i.e. calorie) information (12/28).Eleven studies assessed the impact of nutritional labelling on purchasing food or drink options in real-world settings, including purchases from vending machines (one cluster-RCT), grocery stores (one ITS), or restaurants, cafeterias or coffee shops (three RCTs, one Q-RCT and five ITS). Findings on vending machines and grocery stores were not interpretable, and were rated as very low quality. A meta-analysis of the three RCTs, all of which assessed energy labelling on menus in restaurants, demonstrated a statistically significant reduction of 47 kcal in energy purchased (MD -46.72 kcal, 95% CI -78.35, -15.10, N = 1877). Assuming an average meal of 600 kcal, energy labelling on menus would reduce energy purchased per meal by 7.8% (95% CI 2.5% to 13.1%). The quality of the evidence for these three studies was rated as low, so our confidence in the effect estimate is limited and may change with further studies. Of the remaining six studies, only two (both ITS studies involving energy labels on menus or menus boards in a coffee shop or cafeteria) were at low risk of bias, and their results support the meta-analysis. The results of the other four studies which were conducted in a restaurant, cafeterias (2 studies) or a coffee shop, were not clearly reported and were at high risk of bias.Seventeen studies assessed the impact of nutritional labels on consumption in artificial settings or scenarios (henceforth referred to as laboratory studies or settings). Of these, eight (all RCTs) assessed the effect of labels on menus or placed on a range of food options. A meta-analysis of these studies did not conclusively demonstrate a reduction in energy consumed during a meal (MD -50 kcal, 95% CI -104.41, 3.88, N = 1705). We rated the quality of the evidence as low, so our confidence in the effect estimate is limited and may change with further studies.Six laboratory studies (four RCTs and two Q-RCTs) assessed the impact of labelling a single food or drink option (such as chocolate, pasta or soft drinks) on energy consumed during a snack or meal. A meta-analysis of these studies did not demonstrate a statistically significant difference in energy (kcal) consumed (SMD 0.05, 95% CI -0.17 to 0.27, N = 732). However, the confidence intervals were wide, suggesting uncertainty in the true effect size. We rated the quality of the evidence as low, so our confidence in the effect estimate is limited and may change with further studies.There was no evidence that nutritional labelling had the unintended harm of increasing energy purchased or consumed. Indirect evidence came from five laboratory studies that involved mislabelling single nutrient content (i.e. placing low energy or low fat labels on high-energy foods) during a snack or meal. A meta-analysis of these studies did not demonstrate a statistically significant increase in energy (kcal) consumed (SMD 0.19, 95% CI -0.14to 0.51, N = 718). The effect was small and the confidence intervals wide, suggesting uncertainty in the true effect size. We rated the quality of the evidence from these studies as very low, providing very little confidence in the effect estimate.
AUTHORS' CONCLUSIONS: Findings from a small body of low-quality evidence suggest that nutritional labelling comprising energy information on menus may reduce energy purchased in restaurants. The evidence assessing the impact on consumption of energy information on menus or on a range of food options in laboratory settings suggests a similar effect to that observed for purchasing, although the evidence is less definite and also of low quality.Accordingly, and in the absence of observed harms, we tentatively suggest that nutritional labelling on menus in restaurants could be used as part of a wider set of measures to tackle obesity. Additional high-quality research in real-world settings is needed to enable more certain conclusions.Further high-quality research is also needed to address the dearth of evidence from grocery stores and vending machines and to assess potential moderators of the intervention effect, including socioeconomic status.
CONTEXT: College students are at an elevated risk of poor nutrition and eating habits.
OBJECTIVE: The aim of this systematic review was to examine and quantify the effect of nutrition labels on diet quality in college students.
DATA SOURCES: Literature searches were conducted in 4 electronic databases.
STUDY SELECTION: Peer-reviewed publications that assessed the effect of nutrition label use on food choice or dietary intake in college students were included.
DATA EXTRACTION: Twenty-two randomized controlled trials, cohort studies, and pre-post studies were identified.
RESULTS: Sixteen studies found label exposure to be associated with improved diet. Of the 13 studies reporting calories selected or consumed, 8 found that posting labels at the point of purchase decreased calories, 4 found no effect, and 1 found that calories consumed increased after posting labels. Nine of the 12 studies assessing noncaloric measures found that nutrition labels positively affected diet quality. Meta-analysis of pre-post studies found a decrease of 36 kcal (P < 0.05) with label exposure.
CONCLUSIONS: Nutrition labels had a moderate but positive effect on dietary intake of college students.
CONTEXTO: falta evidência de que a rotulação do menu influencie as escolhas alimentares nas configurações da vida real. Os comentários geralmente se concentram nas contagens de calorias sem abordar questões mais amplas relacionadas à alimentação saudável. OBJETIVO: Esta revisão sistemática avaliou a influência de diversos formatos de rotulagem de menu sobre escolhas alimentares em configurações da vida real. FUÍAS DE DADOS: Foram pesquisadas várias bases de dados: Cochrane Library, Scopus, MEDLINE, Web of Science, Science Science e Technology Abstracts, Biological Abstracts, CAB Abstracts, EconLit, SciELO e LILACS. SELEÇÃO DE ESTUDO: dois revisores selecionaram cegamente os artigos que relatam experiências, quase-experimentos e estudos observacionais usando grupos de controle ou pré-intervenção. EXTRACÇÃO DE DADOS: os dados foram extraídos usando um formulário padrão. Análises diferenciadas entre os tipos de serviços alimentares. A qualidade dos 38 estudos incluídos foi avaliada cegamente por dois revisores. ANÁLISE DE DADOS: os resultados foram misturados, mas uma influência parcial da rotulagem do menu em escolhas alimentares foi mais freqüente do que uma influência geral ou nenhuma influência. A rotulagem do menu foi mais eficaz nas cafeterias do que nos restaurantes. Informações qualitativas, como símbolos de alimentos saudáveis e rotulagem de semáforos, foram mais eficazes na promoção de uma alimentação saudável. Em geral, os estudos foram de qualidade moderada e não utilizaram grupos de controle. CONCLUSÕES: A rotulagem de calorias nos menus não é eficaz para promover escolhas alimentares mais saudáveis. Outras pesquisas em configurações da vida real com grupos de controle devem testar diversas informações qualitativas na rotulagem de menu.
Consumption of high-energy food has increased globally, thereby leading to an increase in many diseases. One strategy for addressing this is to make people aware of their energy intake through energy and fat labels. However, the effectiveness of this remains debatable.
OBJECTIVE:
This review aims to pool the mixed outcomes of recent studies assessing the effect of energy and fat content labeling on food consumption pattern.
DATA SOURCES:
Google Scholar, MEDLINE, and Cochrane Library databases were searched. Randomized controlled and quasi-experimental controlled trials published from 2014 to 2019 were included.
DATA EXTRACTION:
Two reviewers screened 413 abstracts independently. Qualitative and quantitative data was extracted from 10 articles; meta-analysis was carried out on 6 of those studies.
RESULTS:
The majority of the included papers were conducted in the regions of America, the Western Pacific, and Europe. Overall, the 6 studies claimed that labeling did not reduce the consumption of energy or fat. However, meta-analysis showed that fat and energy content labeling of food had a statistically significant effect on consumption. Subgroup analysis showed no difference with respect to types of labels, ie, context labeling vs traffic-light labeling, but energy content labels seemed to be more effective than fat content labels in influencing healthy food choices.
CONCLUSION:
Energy and fat content labeling were shown to reduce the consumption of each significantly. However, the outcome was influenced by the study setting and the population concerned. There is a need for research in other regions in order to assess the global effectiveness of nutrition labels on food consumption.