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: There is limited evidence that nutritional labelling on food/drinks is changing eating behaviours. Physical activity calorie equivalent (PACE) food labelling aims to provide the public with information about the amount of physical activity required to expend the number of kilocalories in food/drinks (eg, calories in this pizza requires 45 min of running to burn), to encourage healthier food choices and reduce disease.
OBJECTIVE: We aimed to systematically search for randomised controlled trials and experimental studies of the effects of PACE food labelling on the selection, purchase or consumption of food/drinks.
METHODS: PACE food labelling was compared with any other type of food labelling or no labelling (comparator). Reports were identified by searching electronic databases, websites and social media platforms. Inverse variance meta-analysis was used to summarise evidence. Weighted mean differences (WMD) and 95% CIs were used to describe between-group differences using a random effects model.
RESULTS: 15 studies were eligible for inclusion. When PACE labelling was displayed on food/drinks and menus, significantly fewer calories were selected, relative to comparator labelling (WMD=-64.9 kcal, 95% CI -103.2 to -26.6, p=0.009, n=4606). Presenting participants with PACE food labelling results in the consumption of significantly fewer calories (WMD=-80.4 kcal, 95% CI-136.7 to -24.2, p=0.005, n=486) relative to comparator food labelling.
CONCLUSION: Based on current evidence PACE food labelling may reduce the number of kilocalories selected from menus and decrease the number of kilocalories/grams of food consumed by the public, compared with other types of food labelling/no labelling.
TRIAL REGISTRATION NUMBER: CRD42018088567.
CONTEXT: The influence of food and beverage labeling (food labeling) on consumer behaviors, industry responses, and health outcomes is not well established.
EVIDENCE ACQUISITION: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Ten databases were searched in 2014 for studies published after 1990 evaluating food labeling and consumer purchases/orders, intakes, metabolic risk factors, and industry responses. Data extractions were performed independently and in duplicate. Studies were pooled using inverse-variance random effects meta-analysis. Heterogeneity was explored with I2, stratified analyses, and meta-regression; and publication bias was assessed with funnel plots, Begg's tests, and Egger's tests. Analyses were completed in 2017.
EVIDENCE SYNTHESIS: From 6,232 articles, a total of 60 studies were identified, including 2 million observations across 111 intervention arms in 11 countries. Food labeling decreased consumer intakes of energy by 6.6% (95% CI= -8.8%, -4.4%, n=31), total fat by 10.6% (95% CI= -17.7%, -3.5%, n=13), and other unhealthy dietary options by 13.0% (95% CI= -25.7%, -0.2%, n=16), while increasing vegetable consumption by 13.5% (95% CI=2.4%, 24.6%, n=5). Evaluating industry responses, labeling decreased product contents of sodium by 8.9% (95% CI= -17.3%, -0.6%, n=4) and artificial trans fat by 64.3% (95% CI= -91.1%, -37.5%, n=3). No significant heterogeneity was identified by label placement or type, duration, labeled product, region, population, voluntary or legislative approaches, combined intervention components, study design, or quality. Evidence for publication bias was not identified.
CONCLUSIONS: From reviewing 60 intervention studies, food labeling reduces consumer dietary intake of selected nutrients and influences industry practices to reduce product contents of sodium and artificial trans fat.
BACKGROUND: Many countries are trying to identify strategies to control obesity. Nutrition labeling is a policy that could lead to healthy food choices by providing information to consumers. Calorie labeling, for example, could lead to consumers choosing lower calorie foods. However, its effectiveness has been limited. Recently, physical activity equivalent labeling (i.e., displaying calories in terms of estimated amount of physical activity to burn calories) has been proposed as an alternative to the calorie-only label. The aim of this review was to identify and evaluate the published literature comparing effects on health behavior between physical activity equivalent labeling and calorie-only labeling.
METHOD: We searched the following databases: Pubmed/medline, Scopus, Web of science, Agris, Cochrane library, Google Scholar. We also searched along with reference lists of included articles. Articles that were published between 1 January 2000 and 31 October 2016 were eligible for inclusion provided they reported on studies that examined the effects of both types of labeling and included at least one outcome of interest. Mean and standard deviations of the included results were combined using a fixed-effect model. The difference in calories purchased between people exposed to physical activity labeling and calorie-only labeling was calculated as weighted mean difference by using a fixed-effect model.
RESULT: The difference of calories ordered between physical activity label and calorie label groups was not statistically significant (SMD: -0.03; 95% CI: -0.13, 0.07). The difference of calories ordered between physical activity label and calorie label according to real vs unreal (e.g. web-based) condition was 65 Kcal fewer in real-world settings.
CONCLUSION: Physical activity calorie equivalent labeling in minutes does not significantly reduce calories ordered compared to calorie-only labeling.
BACKGROUND: Obesity has a serious impact on public health. Sugar-sweetened beverages (SSBs) are implicated in the obesity epidemic. Regulation has been suggested as one approach to limit consumption.
OBJECTIVE: The aim of this study was to synthesize existing evidence related to the impact of taxes on the consumption, purchase, or sales of SSBs.
DESIGN: A systematic review was conducted by using MEDLINE through PubMed (https://www.ncbi.nlm.nih.gov/pubmed), the Cochrane Library (http://www.cochranelibrary.com/), the Web of Science (https://login.webofknowledge.com/error/Error?PathInfo=%2F&Error=IPError), and Scopus (https://www.scopus.com/search/form.uri?display=basic) in the period 2011-2017 for studies that analyzed the impact of fiscal regulatory measures on the consumption, purchase, or sales of SSBs. The quality of evidence was assessed according to the CONSORT (Consolidated Standards of Reporting Trials) and the TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) statements.
RESULTS: Of the 17 studies, 5 (29.4%) evaluated the impact of a tax on SSBs in naturalistic experiments by county or city in the United States and in Mexico. Findings indicated that purchases or sales of SSBs decreased significantly with taxation amounts of 8% (Berkeley, CA) and 10% (Mexico). One study found no effect on sales of SSBs in 2 states that enacted a 5.5% tax on sodas. Twelve (70.6%) studies were based on virtual or experimental conditions evaluating either purchasing behavior or sales (6 studies; 50.0%) or behavioral intent (6 studies; 50.0%), resulting in a decrease in either purchasing behavior or sales or intent behavior with heterogeneity according to the tax rate.
CONCLUSIONS: Taxation significantly influences planned purchases and increases the probability of the purchase of healthy beverages. SSB taxes have the potential to reduce calorie and sugar intake, but further research is needed to evaluate effects on diet quality.
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.
CONTEXT: In recent decades, portion sizes have increased significantly. Although previous research indicates that food labels impact on product choice and healthiness perception, their impact on portion sizes consumed is less clear.
OBJECTIVE: This systematic review examined whether food label information influenced portion size consumption.
DATA SOURCES: A search of 7 major electronic databases for studies published from 1980 to April 2016 was conducted.
DATA EXTRACTION: Two reviewers independently screened 11 128 abstracts. Data were extracted from 32 articles (comprising 36 studies).
RESULTS: Based on the test food used, the overall effects were found to be: no effect, a positive effect, or a negative effect. Labels displaying energy content (n = 15 studies, 17 effects) and fat content information (n = 13 studies, 14 effects) were evaluated most commonly, with exercise equivalent labels evaluated least (n = 2 studies, 2 effects).
CONCLUSIONS: Nutrition and health information presented on food labels has varying impacts on portion sizes consumed, from increased to decreased intake. Recommendations for future research include evaluating more recent food label types and achieving more consistent reporting standards.
BACKGROUND: This systematic review (PROSPERO: CRD42015025276) employs a realist approach to investigate the effect of "real-world" policies targeting different aspects of the food environment that shape individual and collective nutrition.
OBJECTIVES: We were interested in assessing intermediate outcomes along the assumed causal pathway to "policy success", in addition to the final outcome of changed consumption patterns.
DATA SOURCES: We performed a search of 16 databases through October 2015, with no initial restriction by language.
STUDY ELIGIBILITY CRITERIA: We included all publications that reported the effect of statutory provisions aimed at reducing the consumption of energy-dense foods and beverages in the general population. We allowed all methodological approaches that contained some measure of comparison, including studies of implementation progress.
STUDY APPRAISAL AND SYNTHESIS METHODS: We reviewed included studies using the appraisal tools for pre-post and observational studies developed by the National Heart, Lung, and Blood Institute. Given the considerable heterogeneity in interventions assessed, study designs employed, and outcome measures reported, we opted for a narrative synthesis of results.
RESULTS AND IMPLICATIONS: Results drawn from 36 peer-reviewed articles and grey literature reports demonstrated that isolated regulatory interventions can improve intermediate outcomes, but fail to affect consumption at clinically significant levels. The included literature covered six different types of interventions, with 19 studies reporting on calorie posting on chain restaurant menus. The large majority of the identified interventions were conducted in the US. Early results from recent taxation measures were published after the review cut-off date but these suggested more favorable effects on consumption levels. Nevertheless, the evidence assessed in this review suggests that current policies are generally falling short of anticipated health impacts.
INTRODUÇÃO: a obesidade infantil é uma preocupação séria em matéria de saúde pública a nível internacional e são necessárias intervenções a nível populacional para apoiar escolhas alimentares saudáveis. As avaliações existentes da rotulagem do menu se concentraram predominantemente em adultos. No entanto, a infância e a adolescência são períodos distintos de desenvolvimento durante os quais são estabelecidos comportamentos alimentares e preferências alimentares a longo prazo. Embora alguns estudos tenham examinado o efeito da rotulagem do menu entre crianças e adolescentes, nenhuma revisão sintetizou essa evidência. OBJETIVO: Avaliar se a rotulagem do menu influencia a quantidade de calorias ordenadas por crianças e adolescentes (ou pais em nome da juventude) nos estabelecimentos alimentares, incluindo restaurantes e cafeterias. MÉTODOS: pesquisas bibliográficas abrangentes foram realizadas nos bancos de dados Medline, Scopus, PsycINFO, CINAHL, SocINDEX e Embase. Foram identificados onze estudos relevantes a partir de uma pesquisa inicial com 1.682 resultados. Os estudos foram avaliados utilizando uma ferramenta de avaliação de qualidade validada. RESULTADOS: Os exames de compras hipotéticas de alimentos em ambientes artificiais sugerem que a rotulagem do menu pode ser eficaz na redução de calorias compradas para ou por crianças e adolescentes. Estudos do mundo real são menos favoráveis, embora os estudos baseados na escola sejam geralmente positivos. Não está claro se os formatos contextuais ou interpretativos de rotulagem de menu são mais eficazes em comparação com a informação de calorias numéricas sozinho. CONCLUSÃO: Evidências que apoiem o impacto da rotulagem do menu na redução do conteúdo energético das escolhas alimentares para restaurantes e cafeterias feitas para crianças ou adolescentes são limitadas. Existe uma necessidade de estudos de alta qualidade realizados em configurações do mundo real.
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.
