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