Review Article
A Meta-Analysis of Food Labeling Effects on Consumer Diet Behaviors and Industry Practices

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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.

Section snippets

CONTEXT

Poor diet, as a risk factor of obesity and noncommunicable disease, is a leading cause of poor health in the U.S. and globally.1, 2 Effective strategies are needed to improve both consumer choices and industry formulations. Food and beverage labeling (food labeling) is being implemented increasingly. Examples include the Nutrition Facts panel3; menu calorie labels4, 5, 6; “traffic light” labels7, 8; logos such as “Green Keyhole,”9 “Choice,”10 and “Heart-Check”11; and nutrition- or

EVIDENCE ACQUISITION

The authors followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines during all stages of design, implementation, and reporting.35 The study objective, search strategy, and selection criteria were specified in the study protocol (Appendix, available online). This study was not registered in the International Prospective Register of Systematic Reviews (PROSPERO) database.

Study Characteristics

From 5,378 identified abstracts, 668 U.S. Department of Agriculture Economic Research Service websites, and 186 full-text articles identified from hand searching of reference lists and related articles in PubMed, 60 studies from 59 articles met inclusion criteria, comprising 2,078,043 unique observations (consumers, receipts, purchases) across 111 intervention arms (Figure 1). These included 16 randomized49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64 and 44 nonrandomized45,65, 66

DISCUSSION

In this systematic review and meta-analysis of 60 studies, including 111 intervention arms and more than 2 million observations across 11 countries, food labeling reduced consumer consumption of total energy and total fat, while increasing consumption of vegetables. Food labeling did not significantly alter consumer intakes of other dietary targets, including sodium, total carbohydrate, protein, saturated fat, fruits, or whole grains. This meta-analysis also found that food labeling altered

CONCLUSIONS

From the results of 60 intervention studies, food labeling effectively reduces consumer intakes of total energy and total fat, while increasing intake of vegetables. Food labeling also influences industry responses related to product contents of sodium and artificial trans fat. More studies are needed to assess the effects of labeling on other dietary targets, disease risk factors, and clinical endpoints.

ACKNOWLEDGMENTS

The authors thank all of the collaborators and advisory groups in the Food-PRICE (Policy Review and Intervention Cost-Effectiveness) project.

Author contributions were as follows: SS, AA, and DMo conceived and designed the experiments. SS, MS, WM, JS, MK, and DMa extracted the data. SS, DMo, FI, PS, RM, and DMa analyzed the data. SS and DMo wrote the first draft of the manuscript. SS, FI, and DMo contributed to the writing of the manuscript. All authors agree with the results and conclusions and

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