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.
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REFERENCES
- The Global Burden of Disease Study and the preventable burden of NCD.Glob Heart. 2016; 11: 393-397
- Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States.JAMA. 2017; 317: 912-924
- Changes to the Nutrition Facts label.www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm(Published)Date: 2018Date accessed: June 18, 2018
- Food labeling; nutrition labeling of standard menu items in restaurants and similar retail food establishments. Final rule.Fed Regist. 2014; 79: 71155-71259
- Menu-labeling policy in King County, Washington.Am J Prev Med. 2012; 43: S130-S135
- New menu labeling requirements: academy advocacy expands opportunities.J Acad Nutr Diet. 2015; 115: 707-708
- Comprehension and use of UK nutrition signpost labelling schemes: scientific rationale and design.http://webarchive.nationalarchives.gov.uk/20120403230459/http://www.food.gov.uk/multimedia/pdfs/quantrationale.pdf(Published)Date: 2008Date accessed: September 30, 2018
- Guide to creating a front of pack (FoP) nutrition label for pre-packed products sold through retail outlets.https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/566251/FoP_Nutrition_labelling_UK_guidance.pdf(Published)Date: 2016Date accessed: September 30, 2018
- The Keyhole.2015www.livsmedelsverket.se/en/food-and-content/labelling/nyckelhalet/(Published)Date accessed: June 18, 2018
- The Choices programme: a simple, front-of-pack stamp making healthy choices easy.Asia Pac J Clin Nutr. 2008; 17: 383-386
- Heart-Check food certification program nutrition requirements.www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Heart-CheckMarkCertification/Heart-Check-Food-Certification-Program-Nutrition-Requirements_UCM_300914_Article.jsp(Published)Date: 2018Date accessed: June 18, 2018
- Consumer awareness of fast-food calorie information in New York City after implementation of a menu labeling regulation.Am J Public Health. 2010; 100: 2520-2525
- Front-of-pack nutrition labels. Their effect on attention and choices when consumers have varying goals and time constraints.Appetite. 2011; 57: 148-160
- Making healthy food choices using nutrition facts panels. The roles of knowledge, motivation, dietary modifications goals, and age.Appetite. 2012; 59: 129-139
- Food labelling to advance better education for life.Eur J Clin Nutr. 2010; 64: S14-S19
- Behavioural effects of directive cues on front-of-package nutrition information: the combination matters!.Public Health Nutr. 2014; 17: 2115-2121
- Examination of Front-of-Package Nutrition Rating Systems and Symbols: Phase 1 Report.The National Academies Press, Washington, DC2010
- Influence of relative fat content information on responses to three foods.Appetite. 1997; 28: 49-62
- Consumer knowledge and attitudes to salt intake and labelled salt information.Appetite. 2009; 53: 189-194
- Use and understanding of nutrition information on food labels in six European countries.J Public Health. 2010; 18: 261-277
- Food label use and awareness of nutritional information and recommendations among persons with chronic disease.Am J Clin Nutr. 2009; 90: 1351-1357
- Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association.Circulation. 2012; 126: 1514-1563
- CVD prevention through policy: a review of mass media, food/menu labeling, taxation/subsidies, built environment, school procurement, worksite wellness, and marketing standards to improve diet.Curr Cardiol Rep. 2015; 17: 98
- Impact of nutrition environmental interventions on point-of-purchase behavior in adults: a review.Prev Med. 2004; 39: S108-S136
- The effectiveness of policies for reducing dietary trans fat: a systematic review of the evidence.Bull World Health Organ. 2013; 91: 262-269
- Nutrition labels on pre-packaged foods: a systematic review.Public Health Nutr. 2011; 14: 1496-1506
- Calorie menu labeling on quick-service restaurant menus: an updated systematic review of the literature.Int J Behav Nutr Phys Act. 2011; 8: 135
- Front-of-package nutrition labelling policy: global progress and future directions.Public Health Nutr. 2018; 21: 1399-1408
- The influence of menu labeling on calories selected or consumed: a systematic review and meta-analysis.J Acad Nutr Diet. 2014; 114: 1375-1388
- Systematic review and meta-analysis of the impact of restaurant menu calorie labeling.Am J Public Health. 2015; 105: e11-e24
- A systematic review, and meta-analyses, of the impact of health-related claims on dietary choices.Int J Behav Nutr Phys Act. 2017; 14: 93
- 2013 FAO/WHO workshop presentation: IOM report on front-of-package nutrition rating systems and symbols.www.who.int/nutrition/events/2013_FAO_WHO_workshop_frontofpack_nutritionlabelling_presentation_Lichtenstein.pdf(Published)Date: 2013Date accessed: February 26, 2017
- NICE Guidance: cardiovascular disease prevention.(Published)
- Food reformulations to reduce trans fatty acids.N Engl J Med. 2010; 362: 2037-2039
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.BMJ. 2009; 339: b2535
- Promoting healthy choices: information versus convenience.Am Econ J Appl Econ. 2010; 2: 164-178
- Looking at the label and beyond: the effects of calorie labels, health consciousness, and demographics on caloric intake in restaurants.Int J Behav Nutr Phys Act. 2013; 10: 21
- The impact of menu labeling on fast-food purchases for children and parents.Am J Prev Med. 2011; 41: 434-438
- Calorie labeling and food choices: a first look at the effects on low-income people in New York City.Health Aff (Millwood). 2009; 28: w1110-w1121
- Calorie labeling, fast food purchasing and restaurant visits.Obesity (Silver Spring). 2013; 21: 2172-2179
- Calorie posting in chain restaurants.Am Econ J Econ Policy. 2011; 3: 91-128
- Effect of different children's menu labeling designs on family purchases.Appetite. 2013; 62: 198-202
- Evaluation of a voluntary menu-labeling program in full-service restaurants.Am J Public Health. 2010; 100: 1035-1039
- Mandatory menu labeling in one fast-food chain in King County, Washington.Am J Prev Med. 2011; 40: 122-127
- Customer responses to mandatory menu labeling at full-service restaurants.Am J Prev Med. 2013; 45: 710-719
- Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis.Am J Clin Nutr. 2014; 100: 278-288
- The prospective impact of food pricing on improving dietary consumption: a systematic review and meta-analysis.PLoS One. 2017; 12e0172277
- Effectiveness of school food environment policies on children's dietary behaviors: a systematic review and meta-analysis.PLoS One. 2018; 13e0194555
- Menu labels displaying the kilocalorie content or the exercise equivalent: effects on energy ordered and consumed in young adults.Am J Health Promot. 2015; 29: 294-302
- An intervention study targeting energy and nutrient intake in worksite cafeterias.Eat Behav. 2010; 11: 144-151
- The impact of educational and environmental interventions in Dutch worksite cafeterias.Health Promot Int. 2004; 19: 335-343
- The influence of recipe modification and nutritional information on restaurant food acceptance and macronutrient intakes.Public Health Nutr. 2000; 3: 201-209
- The effectiveness of nutrition education and labeling in Dutch supermarkets.Am J Health Promot. 2004; 18: 221-224
- Effects of energy-content labels and motivational posters on sales of sugar-sweetened beverages: stimulating sales of diet drinks among adults study.J Am Diet Assoc. 2006; 106: 1866-1869
- The Smart Choices front-of-package nutrition label. Influence on perceptions and intake of cereal.Appetite. 2012; 58: 651-657
- Evaluating the impact of menu labeling on food choices and intake.Am J Public Health. 2010; 100: 312-318
- Effects of calorie labeling and value size pricing on fast food meal choices: results from an experimental trial.Int J Behav Nutr Phys Act. 2008; 5: 63
- The impact of adding front-of-package sodium content labels to grocery products: an experimental study.Public Health Nutr. 2013; 16: 383-391
- Influence of simplified nutrition labeling and taxation on laboratory energy intake in adults.Appetite. 2011; 56: 184-192
- Effect of fat-free potato chips with and without nutrition labels on fat and energy intakes.Am J Clin Nutr. 1998; 68: 282-290
- A randomized trial of calorie labeling on menus.Prev Med. 2013; 57: 860-866
- “Healthy,” “diet,” or “hedonic”. How nutrition claims affect food-related perceptions and intake?.Appetite. 2012; 59: 877-884
- The effects of using a nutrition logo on consumption and product evaluation of a sweet pastry.Appetite. 2010; 55: 707-709
- Effects of warning and information labels on consumption of full-fat, reduced-fat, and no-fat products.J Appl Psychol. 1998; 83: 97-101
- Effectiveness of offering keyhole labelled meals in improving the nutritional quality of lunch meals eaten in worksite canteens.Ann Nutr Metab. 2013; 63: 954
- A 2-phase labeling and choice architecture intervention to improve healthy food and beverage choices.Am J Public Health. 2012; 102: 527-533
- Pilot study of a cafeteria program relying primarily on symbols to promote healthy choices.J Nutr Educ. 1996; 28: 282-285
- Does nutrition information on menus impact food choice? Comparisons across two hospital cafeterias.Public Health Nutr. 2014; 17: 1393-1402
- A nutrition intervention with a main focus on vegetables and bread consumption among young men in the Norwegian National Guard.Food Nutr Res. 2013; : 57
- Paradoxical effect of a nutrition labelling scheme in a student cafeteria.Nutr Res. 1995; 15: 1251-1261
- Environmental intervention in carryout restaurants increases sales of healthy menu items in a low-income urban setting.Am J Health Promot. 2015; 29: 357-364
- Predictors of total calories purchased at fast-food restaurants: restaurant characteristics, calorie awareness, and use of calorie information.J Nutr Educ Behav. 2013; 45: 404-411
- Exploratory analysis of fast-food chain restaurant menus before and after implementation of local calorie-labeling policies, 2005–2011.Prev Chronic Dis. 2013; 10: E101
- Nutrition-labeling regulation impacts on restaurant environments.Am J Prev Med. 2012; 43: 505-511
- Child and adolescent fast-food choice and the influence of calorie labeling: a natural experiment.Int J Obes (Lond). 2011; 35: 493-500
- Consumer purchasing patterns in response to calorie labeling legislation in New York City.Int J Behav Nutr Phys Act. 2011; 8: 51
- Purchasing behavior and calorie information at fast-food chains in New York City, 2007.Am J Public Health. 2008; 98: 1457-1459
- An urban food store intervention positively affects food-related psychosocial variables and food behaviors.Health Educ Behav. 2010; 37: 390-402
- Evaluation of a supermarket intervention: the NCI-Giant food eat for health study.Eval Rev. 1992; 16: 464-490
- Nutritional quality of Australian breakfast cereals. Are they improving?.Appetite. 2012; 59: 464-470
- Point-of-purchase health information encourages customers to purchase vegetables: objective analysis by using a point-of-sales system.Environ Health Prev Med. 2011; 16: 239-246
- View the label before you view the movie: a field experiment into the impact of portion size and Guideline Daily Amounts labelling on soft drinks in cinemas.BMC Public Health. 2011; 11: 438
- Does nutrition information about the energy density of meals affect food intake in normal-weight women?.Appetite. 2002; 39: 137-145
- Information about the fat content of preloads influences energy intake in healthy women.J Am Diet Assoc. 1995; 95: 993-998
- Changing social patterns of risk factors for cardiovascular disease in a Swedish community intervention programme.Int J Epidemiol. 1993; 22: 1026-1037
- Food label effects on customer purchases in a hospital cafeteria in Northern California.J Foodserv Bus Res. 2013; 16: 155-168
- A traffic light food labeling intervention increases consumer awareness of health and healthy choices at the point-of-purchase.Prev Med. 2013; 57: 253-257
- Point-of-selection nutrition information influences choice of portion size in an all-you-can-eat university dining hall.J Foodserv Bus Res. 2011; 14: 86-98
- Posting point-of-purchase nutrition information in university canteens does not influence meal choice and nutrient intake.Am J Clin Nutr. 2011; 94: 562-570
- Menu labeling regulations and calories purchased at chain restaurants.Am J Prev Med. 2013; 44: 595-604
- Changes in the energy and sodium content of main entrees in U.S. chain restaurants from 2010 to 2011.J Acad Nutr Diet. 2014; 114: 209-219
- Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: cross sectional customer surveys.BMJ. 2011; 343: d4464
- Comparison of price change and health message interventions in promoting healthy food choices.Health Psychol. 2002; 21: 505-512
- Menu calorie labelling in a fine dining restaurant: will it make a difference?.J Qual Assur Hosp Tour. 2013; 14: 281-293
- Does easily accessible nutritional labelling increase consumption of healthy meals away from home? A field experiment measuring the impact of a point-of-purchase healthy symbol on lunch sales.Acta Agricult Scand C Food Econ. 2011; 8: 200-207
- Healthier choices in an Australian health service: a pre-post audit of an intervention to improve the nutritional value of foods and drinks in vending machines and food outlets.BMC Health Serv Res. 2013; 13: 492
- Trans fatty acids content and fatty acid profiles in the selected food products from Korea between 2005 and 2008.J Food Sci. 2010; 75: C647-C652
- A comparison of the fat composition and prices of margarines between 2002 and 2006, when new Canadian labelling regulations came into effect.Public Health Nutr. 2009; 12: 1270-1275
- Reducing sugar-sweetened beverage consumption by providing caloric information: how black adolescents alter their purchases and whether the effects persist.Am J Public Health. 2014; 104: 2417-2424
- Reduction in purchases of sugar-sweetened beverages among low-income black adolescents after exposure to caloric information.Am J Public Health. 2012; 102: 329-335
- Using traffic light labels to improve food selection in recreation and sport facility eating environments.Appetite. 2015; 91: 329-335
- Can nutrition information increase sales of healthful vended snacks?.J Sch Health. 1993; 63: 386-390
- Trans fatty acids in human milk in Canada declined with the introduction of trans fat food labeling.J Nutr. 2006; 136: 2558-2561
- Levels of plasma trans-fatty acids in non-Hispanic white adults in the United States in 2000 and 2009.JAMA. 2012; 307: 562-563
- Health claims in food marketing: evidence on knowledge and behavior in the cereal market.J Public Policy Mark. 1991; 10: 15-32
- Front-of-pack nutrition label stimulates healthier product development: a quantitative analysis.Int J Behav Nutr Phys Act. 2010; 7: 65
- Label claims for conventional foods and dietary supplements.(Published)
- Guidance for Industry: food labeling guide.www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm2006828.htm(Published)Date: 1994. Revised 2013Date accessed: September 30, 2018
- Swedish students’ interpretations of food symbols and their perceptions of healthy eating. An exploratory study.Appetite. 2014; 82: 29-35
- Snacks with nutrition labels: tastiness perception, healthiness perception, and willingness to pay by Norwegian adolescents.J Nutr Educ Behav. 2016; 48: 104-111.e1
- The ‘Green Keyhole’ revisited: nutritional knowledge may influence food selection.Eur J Clin Nutr. 1999; 53: 776-780
- Sweden to investigate low uptake of Keyhole logo.www.foodnavigator.com/Article/2018/04/09/Sweden-to-investigate-low-uptake-of-Keyhole-logo(Published April 9,)Date: 2018Date accessed: July 21, 2018
- Choices International Foundation/Choices Programme.http://ec.europa.eu/health//sites/health/files/nutrition_physical_activity/docs/ev20130926_co04_en.pdf(Published)Date: 2013Date accessed: June 18, 2018
- A front-of-pack nutrition logo: a quantitative and qualitative process evaluation in the Netherlands.J Health Commun. 2009; 14: 631-645
- Choices Programme.2018www.choicesprogramme.org/(Published)Date accessed: June 18, 2018
- Dutch industry-backed nutrition label ticked off with mounting criticism.www.foodnavigator.com/Article/2016/04/22/Dutch-industry-backed-nutrition-label-ticked-off-with-mounting-criticism(Published April 21,)Date: 2016Date accessed: July 21, 2018
- Dutch ditch healthy eating logo for an app.www.foodnavigator.com/Article/2016/10/25/Dutch-ditch-healthy-eating-logo-for-an-app(Published October 24,)Date: 2016Date accessed: July 21, 2018
- Impact of front-of-pack “traffic-light” nutrition labeling on consumer food purchases in the UK.Health Promot Int. 2009; 24: 344-352
- Chile's black STOP sign for foods high in fat, salt or sugar.Eur J Risk Regul. 2015; 6: 622-628
- The Heart symbol: a new food labelling system in Finland.Nutr Bull. 2000; 25: 335-339
- About Health Star ratings.http://healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/Content/About+the+Health+Star+Rating+System(Published December 6,)Date: 2014Date accessed: July 21, 2018
- The National Heart Foundation of Australia Pick the Tick Program.Med J Aust. 1992; 157: 569
- Impact of the Pick the Tick food information programme on the salt content of food in New Zealand.Health Promot Int. 2002; 17: 13-19
- Performance characteristics of NuVal and the Overall Nutritional Quality Index (ONQI).Am J Clin Nutr. 2010; 91: 1102s-1108s
- Guiding stars: the effect of a nutrition navigation program on consumer purchases at the supermarket.Am J Clin Nutr. 2010; 91: 1090s-1094s
- The Smart Choices front-of-package nutrition labeling program: rationale and development of the nutrition criteria.Am J Clin Nutr. 2010; 91: 1078s-1089s
- How the Heart-Check Food Certification Program Works.www.heart.org/en/healthy-living/company-collaboration/heart-check-certification/how-the-heart-check-food-certification-program-works(Published)Date: 2016Date accessed: March 17, 2017
New York City Department of Health and Mental Hygiene. Intention to Repeal and Reenact Sec 81.50 of the New York City Health Code; 2007.
- Calorie-labelling: does it impact on calorie purchase in catering outlets and the views of young adults?.Int J Obes (Lond). 2015; 39: 542-545
- Menu labelling is effective in reducing energy ordered and consumed: a systematic review and meta-analysis of recent studies.Public Health Nutr. 2016; 19: 2106-2121
- Impact of food labelling systems on food choices and eating behaviours: a systematic review and meta-analysis of randomized studies.Obes Rev. 2016; 17: 201-210
- A meta-analysis to determine the impact of restaurant menu labeling on calories and nutrients (ordered or consumed) in U.S. adults.Nutrients. 2017; 9: 1088
- Nutritional labelling for healthier food or non-alcoholic drink purchasing and consumption.Cochrane Database Syst Rev. 2018; 2CD009315
- Eye tracking and nutrition label use: a review of the literature and recommendations for label enhancement.Food Policy. 2012; 37: 378-382
- Factors affecting use and understanding of nutrition information on food labels: evidences from consumers.Agricult Econ Rev. 2012; 13: 103-116
- Consumer attitudes and understanding of low-sodium claims on food: an analysis of healthy and hypertensive individuals.Am J Clin Nutr. 2013; 97: 1288-1298
- Consumer testing of the acceptability and effectiveness of front-of-pack food labelling systems for the Australian grocery market.Health Promot Int. 2009; 24: 120-129
- What factors determine the use of the nutrition information on the food label when female consumers from Pietermaritzburg select and purchase fat spreads?.South Afr J Clin Nutr. 2009; 22: 69-73
- Consumers’ health-related motive orientations and reactions to claims about dietary calcium.Nutrients. 2013; 5: 82-96
- The motivational and informational basis of attitudes toward foods with health claims.Appetite. 2012; 59: 960-967
- Information technology and lifestyle: a systematic evaluation of internet and mobile interventions for improving diet, physical activity, obesity, tobacco, and alcohol use.J Am Heart Assoc. 2016; 5e003058
- Food-intake patterns assessed by using front-of-pack labeling program criteria associated with better diet quality and lower cardiometabolic risk.Am J Clin Nutr. 2014; 99: 454-462
- Effects of different types of front-of-pack labelling information on the healthiness of food purchases-a randomised controlled trial.Nutrients. 2017; 9: 1284
- Sources of sodium in U.S. adults from 3 geographic regions.Circulation. 2017; 135: 1775-1783
- Relative contributions of dietary sodium sources.J Am Coll Nutr. 1991; 10: 383-393
- Trans fat intake and its dietary sources in general populations worldwide: a systematic review.Nutrients. 2017; 9: 840
- Using natural experiments to evaluate population health interventions: new Medical Research Council guidance.J Epidemiol Community Health. 2012; 66: 1182-1186
- Effects of a voluntary front-of-pack nutrition labelling system on packaged food reformulation: the Health Star Rating System in New Zealand.Nutrients. 2017; 9: 918
- The impact of price and nutrition labelling on sugary drink purchases: results from an experimental marketplace study.Appetite. 2018; 121: 129-137
- Effects of interpretive nutrition labels on consumer food purchases: the Starlight randomized controlled trial.Am J Clin Nutr. 2017; 105: 695-704
- Perception of different formats of front-of-pack nutrition labels according to sociodemographic, lifestyle and dietary factors in a French population: cross-sectional study among the NutriNet-Sante cohort participants.BMJ Open. 2017; 7e016108
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Published online: December 17, 2018
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© 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
