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.
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.
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.
