Abstract
Front of pack labelling (FOPL) provides visible nutritional information and appears to influence knowledge and reformulation. However, a recent Cochrane review found limited and inconsistent evidence for behaviour change. The present review aimed to examine studies published subsequent the Cochrane review, focusing on prepackaged foods, examining the impact of FOPL on purchasing and consumption. Controlled experimental/intervention and interrupted time series (ITS) studies were included, with no age/geography restrictions. Exposures were FOPL with objectively measured consumption/purchasing outcomes. Thirteen databases were searched (January 2017 to April 2019) and forward citation searching was undertaken on the included studies. Purchasing data from experimental studies were meta-analysed. Two series of meta-analyses were undertaken; combined FOPL versus no-FOPL and specific FOPL scheme versus no-FOPL. Outcomes were sugar (g 100g-1 ), calories (kcal 100g-1 ), saturated fat (g 100g-1 ) and sodium (mg 100g-1 ). We identified 14 studies, reporting consumption (experimental; n=3) and purchasing (n=8, experimental; n=3, ITS). Meta-analysis of experimental studies showed sugar and sodium content of purchases was lower for combined FOPL versus no-FOPL (-0.40g sugar 100g-1 , P<0.01; -24.482mg sodium 100g-1 , P=0.012), with a trend for lower energy and saturated fat (-2.03 kcal 100g-1 , P=0.08; -0.154g saturated fat 100g-1 , P=0.091). For specific FOPL, products purchased by 'high in' FOPL groups had lower sugar (-0.67g sugar 100g-1 , P≤0.01), calories (-4.43 kcal 100g-1 , P<0.05), sodium (-33.78mg 100g-1 , P=0.01) versus no-FOPL; Multiple Traffic Light had lower sodium (-34.94mg 100g-1 , P<0.01) versus no-FOPL. Findings regarding consumption were limited and inconsistent. FOPL resulted in healthier purchasing in ITS studies. This review provides evidence from experimental and 'real-life' studies indicating that FOPL encourages healthier food purchasing. PROSPERO CRD42019135743.
Highlights
Poor diet is a major contributing factor to excess weight gain and risk of obesity, as well as ill health in general.Food environments are a key focus for policy-makers, given that they influence our health-related behavior and can encourage poor diets and over-consumption (1,2).Small-scale environments include food packaging, the a 2020 The Authors
Screening on title and abstract resulted in 246 records that were screened on full text and assessed for eligibility
This supports our meta-analyses findings, in that ‘high in’ systems are effective at reducing consumption of energy, sugar and sodium. These findings suggest that overall, labels had an impact on behaviour, this was stronger for purchasing behavior, as opposed to consumption, and there appeared to be less evidence to support ‘straight up’ nutrition information
Summary
Poor diet is a major contributing factor to excess weight gain and risk of obesity, as well as ill health in general.Food environments are a key focus for policy-makers, given that they influence our health-related behavior and can encourage poor diets and over-consumption (1,2).Small-scale environments include food packaging, the a 2020 The Authors. Front of pack labelling (FOPL) provides key nutritional information, typically relating to the fat, sugar, salt or calorie content of foods. The World Health Organization recommends FOPL as a policy strategy to aid healthier food choices by providing clearly visible nutritional information, in addition to eliciting change in food production and supply, including product reformulation (4). Meta-analysis of experimental studies showed sugar and sodium content of purchases was lower for combined FOPL versus no-FOPL (À0.40 g sugar 100 gÀ1, P < 0.01; À24.482 mg sodium 100 gÀ1, P = 0.012), with a trend for lower energy and saturated fat (À2.03 kcal 100 gÀ1, P = 0.08; À0.154 g saturated fat 100 gÀ1, P = 0.091). Conclusions: This review provides evidence from experimental and ‘reallife’ studies indicating that FOPL encourages healthier food purchasing.
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