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Cochrane Database of Systematic Reviews

Etiquetas con información nutricional para la compra y el consumo de bebidas no alcohólicas y alimentos más saludables

Información

DOI:
https://doi.org/10.1002/14651858.CD009315.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 27 febrero 2018see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Salud pública

Copyright:
  1. Copyright © 2018 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.
  2. This is an open access article under the terms of the Creative Commons Attribution-Non-Commercial Licence , which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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Autores

  • Rachel A Crocketta

    Division of Psychology, University of Stirling, Stirling, UK

    Crockett, King and Marteau have contributed equally to this review, thus should be considered joint first authors.

  • Sarah E King

    Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK

  • Theresa M Marteau

    Correspondencia a: Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK

    [email protected]

  • A T Prevost

    School of Public Health, Imperial College London, London, UK

  • Giacomo Bignardi

    Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK

  • Nia W Roberts

    Bodleian Health Care Libraries, University of Oxford, Oxford, UK

  • Brendon Stubbs

    Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK

  • Gareth J Hollandsa

    Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

    Hollands and Jebb contributed equally to this review.

  • Susan A Jebb

    Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

Contributions of authors

Writing the protocol: RAC, GJH, SAJ, TMM.

Searching for studies: NR, RAC.

Selecting studies: RAC, SEK, BS, GB.

Extracting data from studies: RAC, SEK, BS, GB.

Entering data into RevMan: SEK, RAC.

Analysing data: SEK, RAC, ATP.

Interpreting the analysis: SEK, ATP, SAJ, GJH, TMM.

Drafting final review: all.

Updating the review: all.

Sources of support

Internal sources

  • King's College London, UK

    Provides support and resources for two authors (RAC, TMM)

  • University of Cambridge, UK

    Provides support for three authors (GJH, TMM, SAJ)

  • University of Stirling, UK

    Provides support and resources for one author (RAC)

External sources

  • National Institutes for Health Research, UK

    Postdoctoral Research Fellowship (RAC)

    National Institute of Health Research Senior Investigator Award (NF‐SI‐0513‐10101) (TM)

Declarations of interest

Rachel Crockett: none known.
Sarah King: none known.
Theresa Marteau: none known.
AT Prevost: none known.
Giacomo Bignardi: none known.
Nia Roberts: none known.
Brendon Stubbs: none known.
Gareth Hollands: none known.
Susan Jebb: Chaired the Public Health Responsibility Deal Food Network (2011‐2015) which encouraged the adoption of front of pack nutritional labelling and energy labelling on menus.

Acknowledgements

Emma Norris, Ocean Blue and Chandrika Cyril worked as research assistants on the review, assisting with the search and selection of studies as well as data entry.

Joana Vasconcelos was the second assessor for one of papers and assisted with addressing some reviewers comments.

Stephan Dombrowski and Mike Rayner gave helpful feedback on an early draft of the review.

Version history

Published

Title

Stage

Authors

Version

2018 Feb 27

Nutritional labelling for healthier food or non‐alcoholic drink purchasing and consumption

Review

Rachel A Crockett, Sarah E King, Theresa M Marteau, A T Prevost, Giacomo Bignardi, Nia W Roberts, Brendon Stubbs, Gareth J Hollands, Susan A Jebb

https://doi.org/10.1002/14651858.CD009315.pub2

2011 Sep 07

Nutritional labelling for promoting healthier food purchasing and consumption

Protocol

Rachel A Crockett, Gareth J Hollands, Susan A Jebb, Theresa M Marteau

https://doi.org/10.1002/14651858.CD009315

Differences between protocol and review

Title: We altered the title to include non‐alcoholic drinks as well as food because relevant studies rarely evaluated food and drink separately. As a consequence, it was not possible to isolate the effect of labelling for these different products and to restrict the inclusion criteria to food only would have let to the exclusion of several potentially relevant studies. We also altered our inclusion criteria to reflect this change.

Background: we made small changes to the Background to bring the review up‐to‐date, including the addition of more recent references, notably Rayner 2013.

Types of studies: the protocol and review state, "Based on Cochrane recommendations, [ITS] studies that reported only a simple pre and post‐intervention comparisons were not included in the review analysis unless a valid justification for their inclusion could be made or a re‐analysis of the data could enable data from multiple observations in the pre and post periods to be analysed using repeated measures methods" (Cochrane Public Health Review Group 2010; EPOC 2015). We added the following sentence to clarify that studies that either presented appropriate data in graphs, or did not present data in graphs, but did present other types of statistical tests (i.e. other than t‐tests) could be eligible for inclusion: "Authors had to present these data within a graph and/or at the very least analyse them using regression analysis, preferably using segmented regression."

Types of interventions: the protocol stated that a label could be compared to a group in which participants see the same food product presented without a label or with an incomplete label. As we found a number of papers in the search that compared two or more types of labels, we added the following text for clarity: "As noted above, the intervention labelling group had to be compared with a no‐labelling (or incomplete) control group. Thus, we excluded studies that only compared two or more different types of labelling schemes without a control group."

Primary outcomes: the protocol specified purchasing or consumption of foods only, but we also included studies that evaluated the effect of labelling on purchasing of non‐alcoholic drinks (for the reasons stated above). We also added the following sentence to this section of the review for clarity: "We excluded studies that evaluated intention to purchase or intention to consume without an objectively assessed measure of the behaviour."

We also clarified that purchasing had to involve payment with money, as we found some studies in the evidence base that evaluated choices in the settings of interest (e.g. grocery stores), but did not involve purchasing per se.

Food consumption: the protocol specified that where the food consumed was heterogeneous (e.g. a meal comprising various elements with different nutritional content), the amount of each separate element consumed within the meal needed to be assessed for the study to be included. However, this approach would have excluded a number of otherwise good‐quality studies. Thus, we ended up including studies that evaluated multiple food elements and consumption by weighing the meal before and after consumption.

Search methods for identification of studies: we also searched for trials in progress, which was an additional source not specified in the study protocol.

Selection of studies: the protocol stated that "[w]here studies are excluded only on the basis of an incomplete label, the details of these studies will be tabulated separately." We did not identify any incomplete labels, so there was no need to tabulate any details separately.

Data extraction and management: we planned to extract data on any measures relating to the process of implementing the intervention, including data on cost of implementing the intervention in any of the included studies. We did not do this in the final review due to lack of data.

Assessment of risk of bias in included studies:

We added detection bias to this section, which we had omitted. We also removed the risk of bias domain of outcome measurement assessment, as objective outcome measurement was an inclusion criterion for the review. Moreover, we added information to the review regarding how we determined an overall assessment of risk of bias for each study (which we had not specified in the protocol).

The protocol specified that we would use the Quality Assessment Tool for Quantitative Studies (EPHPP 2009) to estimate the risk of bias in controlled before‐and‐after studies and to compare the risk between different types of studies. We did not end up using this tool because we did not identify any eligible controlled before‐and‐after studies.

In addition to the quality assessment strategies specified in the protocol, we conducted a GRADE assessment of the evidence for each outcome according to Cochrane guidance.

Measures of treatment effect: we added the following two paragraphs to the review, which we did not present in the protocol. We added the first paragraph to help quantify the results, and the second because many of the ITS studies were of poor quality, so we considered re‐analysis of the data to be of limited value:

"In order to re‐express effect sizes using a more familiar metric, we calculated the percentage reduction in energy consumed over a typical meal, using an average of 600 kcal as a baseline. This amount was based on mean daily energy intake across the UK population of 1727 kcal or 7226 kJ (standard deviation (SD) 537 kcal or 2247 kJ, using data from the UK National Diet and Nutrition Survey (National Centre for Social Research 2012). Our approach to re‐expressing effect sizes was based on Hollands 2015.

"For ITS studies, we aimed to present statistical comparisons of time trends before and after the intervention (EPOC 2015). In all of the ITS studies, we present the results as described by the study authors, typically as regression analyses. When studies also presented data graphically, we did not attempt any re‐analysis using segmented time series regression techniques if the data were already appropriately analysed by the study authors or if we did not consider the study to be of sufficient quality to warrant re‐analysis. We considered one ITS study to be at low risk of bias (Bollinger 2011), but we could not re‐analyse the data presented graphically due to a lack of information. The figures presented weekly calories per transaction, but there were no data on the number of transactions per week; this means that the absolute and relative variability of each point was unknown and could not be modelled with time series to provide unbiased estimates."

Unit of analysis issues: we updated this section to reflect current methodology. This section now states, "For eligible cluster‐randomised trials, we planned to adjust the data to account for clustering if the study authors had not already done so. However, we only included one cluster‐RCT in the review, and the appropriate data needed to report and adjust the results were not available."

Assessment of heterogeneity: we added a sentence to the review regarding how we would deal with non‐statistical heterogeneity as well as statistical heterogeneity (the protocol only described the latter).

Assessment of reporting biases: the protocol stated that we would use funnel plots to assess reporting biases. However, we could not do this because none of the meta‐analyses included more than 10 studies.

Data synthesis: the protocol stated, "[W]e will only include studies considered to be at lower risk of bias in the meta‐analysis". We included all available evidence in one meta‐analysis but also did a separate sensitivity analysis for studies considered to be at lower risk of bias. We did this in order to present a comprehensive overview of all of the evidence and because we considered very few studies to be at low risk of bias.

A number of unanticipated data synthesis challenges emerged once we identified the included papers. In order to describe how we dealt with these, we added the following text to the review:

  1. "For included studies with more than one eligible intervention arm, we combined data when studies contained information about the same product characteristic (e.g. energy), albeit in multiple ways (e.g. varying in whether presented as numbers, colour coded, activity‐equivalents, and whether presented with recommended daily energy intake).

  2. "Where studies assessed the impact of nutritional labelling adjacent to a range of food products and it was not possible to extract an effect summary for the range of food products, we included the data for the product representing the most complete meal, for example, sales of entrées (as opposed to sales of a side dish) (e.g. Dubbert 1984). If no products represented more or less complete meals, we extracted data for products containing the greatest amount of energy.

  3. "Where studies reported a number of outcomes, such as consumption of a range of different nutrients, we used the most frequently reported outcome among the included studies (e.g. Harnack 2008a). Had outcomes been reported in the same study that related to both increased consumption of healthier foods and decreased consumption of less healthy foods, we would have prioritised the latter."

In addition, after examination of the included studies, we decided to conduct separate analyses for laboratory studies that offered multiple and single food options (which we did not specify in the protocol). We added the following text to the section on data synthesis to describe our rationale: "In the process of conducting the review, it became apparent that the studies also differed in terms of how many labelled options participants had to choose from and what kind(s) of nutritional content the labels described. Participants had to make absolute judgments when given only one labelled option and relative judgments when provided with a myriad of options labelled differently. Thus, we analysed these studies separately."

The exploration of effect modifiers: the protocol specified exploration of 10 possible effect moderators of nutritional labelling using subgroup analysis.

  1. Body weight: overweight (> BMI 25 kg/m²) or not overweight (< BMI 25 kg/m²).

  2. Dietary restraint in individuals intending to diet: restrained eater or unrestrained eater.

  3. Gender: male or female.

  4. Label amount formats: relative amounts or absolute amounts of the nutrient or energy.

  5. Label signposting: signposting present or absent.

  6. The national context in which food was purchased or consumed. Initial examination of the literature indicated that a large proportion of the current research originates in the USA. Thus we compared the effects of nutritional labelling in the USA versus other countries. If there were sufficient variation in the country of study, we would make comparisons between countries.

  7. Socioeconomic status: more socially deprived or less socially deprived.

  8. Expectations of the taste the food: tastes bad or tastes good.

  9. Price of the food: more expensive or less expensive.

  10. Immediate context in which food is: purchased in a fast food restaurant or non‐fast food restaurant; or consumed in a real‐world or laboratory setting.

There were sufficient data to analyse only two of these effects (dietary restraint and country). Further, the protocol described the procedure for analysing moderating effects for both continuous and dichotomous outcomes. Given that all data included in the meta‐analysis were continuous, we removed the information about the analysis of dichotomous outcomes and added information about the analysis of the continuous outcomes.

Assessment of heterogeneity: the protocol considers three potential sources of heterogeneity for exploration in subgroup analysis.

  1. The impact of the positioning of the label, comparing those that appear on the food package with those appearing in another location, such as on a supermarket shelf.

  2. The impact of the information given on the label. First, we planned to compare labels giving information about a range of nutrients versus those giving information about one nutrient. Second, as labels most frequently give energy information, we planned to compare the impact of labels giving information about energy content with labels giving information about other nutrients.

  3. The impact of the definitions of healthy purchasing and healthy consumption used in this review. More healthy purchasing is considered to be decreased purchasing of less healthy foods or increased purchasing of more healthy foods, but these may be two separate behaviours. We planned to use subgroup analysis to identify whether they were separate behaviours and this a source of heterogeneity. Similarly, we planned to investigate possible heterogeneity as a consequence of defining more healthy consumption as either decreased consumption of less healthy foods or increased consumption of healthier foods.

Due to lack of information (e.g. many studies did not report on the positioning of the label) and/or lack of differences in label format between the studies, we did not conduct these planned subgroup analyses. Also, given that there were only four studies at low risk of bias, various further subgroup analyses were not possible.

Sensitivity analysis: the protocol stated, "Sensitivity analyses will be conducted to explore the impact of missing data comparing results from available‐case and ITT analysis. Sensitivity analyses will also be used to assess the effects of nutritional labelling on behaviour across studies at both high and low risk of bias, specifically the meta‐analyses will be re‐run including all studies regardless of their risk of bias. Additionally, the impact of the definition of nutritional labels used in this review will be explored. The meta‐analyses will be re‐run including the studies excluded from the main analyses due to the presentation of an incomplete label rather than a complete label (as described in the 'Description of the intervention')."

We did not conduct these analyses because only four studies at low risk of bias were available for analysis, which is not enough to enable comparison in the above variables.

Notes

From the author team, 10 October, 2018, in response to recent retraction of several studies by Brian Wansink

On the 19th September 2018, JAMA, JAMA Internal Medicine and JAMA Pediatrics retracted six articles on which Brian Wansink (John Dyson Professor of Marketing at Cornell University), was an author (https://media.jamanetwork.com/news-item/jama-network-retracts-6-articles-that-included-dr-brian-wansink-as-author/). Given seven previous retractions, this means that 13 of his articles have been retracted as of 10th October 2018 (http://retractiondatabase.org/RetractionSearch.aspx#?auth%3dWansink). The retracted articles are listed at the end of this note.

None of the 13 retracted articles authored by Wansink were included in this Cochrane review. The results and conclusions of the review are therefore not affected.

Other articles on which Wansink is an author, and which have not been retracted, were included in this review. It includes 28 studies, of which two studies were authored by Wansink.

The effects reported in this review are uncertain, attributable in part to evidence that is at significant risk of bias with, at best, GRADE ratings of ‘low’ (meaning that further research is very likely to have an important impact on our confidence in estimated effects). These retractions do, however, introduce additional uncertainty regarding the veracity of other studies Wansink has authored, including those contributing to this review. Should any study included in this review be retracted, we will withdraw that study’s data from updated meta‐analyses conducted as part of future updates of this Cochrane review.
Gareth Hollands and Theresa Marteau, on behalf of the author team

Retracted studies (as of 10th October 2018)

Wansink B, Tal A, Shimizu M (2012). First foods most: after 18‐hour fast, people drawn to starches first and vegetables last. Arch Intern Med. 172(12): 961‐963.

Tal A, Wansink B (2013). Fattening fasting: hungry grocery shoppers buy more calories, not more food. JAMA Intern Med. 173(12): 1146‐1148.

Tal A, Zuckerman S, Wansink B (2014). Watch what you eat: action‐related television content increases food intake. JAMA Intern Med. 174(11): 1842‐1843.

Wansink B, Cheney MM (2005). Super Bowls: serving bowl size and food consumption. JAMA. 293(14): 1727‐1728.

Wansink B, Payne C, Werle C (2008). Consequences of belonging to the “clean plate club”. Arch Pediatr Adolesc Med. 162(10): 994‐995.

Hanks AS, Just DR, Wansink B (2013). Preordering school lunch encourages better food choices by children. JAMA Pediatr. 167(7): 673‐674.

Vuorinen A‐L, Strahilevitz MA, Wansink B, Safer DL (2017). Shifts in the Enjoyment of Healthy and Unhealthy Behaviors Affect Short‐ and Long‐Term Postbariatric Weight Loss. Bariatric Surgical Practice and Patient Care. 12(1): 35–42.

Wansink B, Just DR, Payne CR, Klinger MZ (2012). Attractive names sustain increased vegetable intake in schools. Prev Med. 55(4):330‐332.

Wansink B, Westgren R (2003). Profiling taste‐motivated segments. Appetite. 41(3): 323‐7.

Sigirci O, Rockmore M, Wansink B (2016). How Traumatic Violence Permanently Changes Shopping Behavior. Front. Psychol. 7:1298.

Sigirci O, Wansink B (2015). Low prices and high regret: how pricing influences regret at all‐you‐can‐eat buffets. BMC Nutrition 1:36.

Wansink B, Park S‐B (2002). Sensory Suggestiveness and Labeling: Do Soy Labels Bias Taste? Journal of Sensory Studies. 17(5): 483‐491.

Wansink B, Just DR, Payne CR (2012). Can Branding Improve School Lunches? Arch Pediatr Adolesc Med. 166(10): 967‐968.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Examples of nutritional labels used in practice

Figuras y tablas -
Figure 1

Examples of nutritional labels used in practice

Logic model of the process by which nutritional labelling may have an impact on diets and health

Figuras y tablas -
Figure 2

Logic model of the process by which nutritional labelling may have an impact on diets and health

Study flow diagram

Figuras y tablas -
Figure 3

Study flow diagram

Risk of bias summary

Figuras y tablas -
Figure 4

Risk of bias summary

Forest plot of comparison: Labelling on menus vs no labelling in restaurants, and energy (kcal) of food purchased

Figuras y tablas -
Figure 5

Forest plot of comparison: Labelling on menus vs no labelling in restaurants, and energy (kcal) of food purchased

Forest plot of comparison: Labelling on menus or placed on a range of food options vs. no labelling in laboratory settings, and energy (kcal) consumed

Figuras y tablas -
Figure 6

Forest plot of comparison: Labelling on menus or placed on a range of food options vs. no labelling in laboratory settings, and energy (kcal) consumed

Comparison 1: Labelling on menus vs no labelling in restaurants, Outcome 1: Energy (kcal) of food purchased

Figuras y tablas -
Analysis 1.1

Comparison 1: Labelling on menus vs no labelling in restaurants, Outcome 1: Energy (kcal) of food purchased

Comparison 2: Labelling on menus or placed on a range of food options vs no labelling in laboratory settings, Outcome 1: Energy (kcal) consumed during a meal

Figuras y tablas -
Analysis 2.1

Comparison 2: Labelling on menus or placed on a range of food options vs no labelling in laboratory settings, Outcome 1: Energy (kcal) consumed during a meal

Comparison 3: Labelling on menus vs no labelling in laboratory settings (studies with a low risk of bias), Outcome 1: Energy (kcal) consumed during a meal

Figuras y tablas -
Analysis 3.1

Comparison 3: Labelling on menus vs no labelling in laboratory settings (studies with a low risk of bias), Outcome 1: Energy (kcal) consumed during a meal

Comparison 4: Labelling of a single food or drink option vs no labelling in laboratory settings, Outcome 1: Energy (kcal) consumption

Figuras y tablas -
Analysis 4.1

Comparison 4: Labelling of a single food or drink option vs no labelling in laboratory settings, Outcome 1: Energy (kcal) consumption

Comparison 5: Labelling of a single food or drink option vs no labelling in laboratory settings (studies at low risk of bias), Outcome 1: Energy (kcal) consumption

Figuras y tablas -
Analysis 5.1

Comparison 5: Labelling of a single food or drink option vs no labelling in laboratory settings (studies at low risk of bias), Outcome 1: Energy (kcal) consumption

Comparison 6: Consumption in laboratory settings: subgroup analysis by dietary restraint (studies providing a range of food options), Outcome 1: Energy (kcal) consumed during a meal

Figuras y tablas -
Analysis 6.1

Comparison 6: Consumption in laboratory settings: subgroup analysis by dietary restraint (studies providing a range of food options), Outcome 1: Energy (kcal) consumed during a meal

Comparison 7: Consumption in laboratory settings: subgroup analysis by dietary restraint (study providing a single food option), Outcome 1: Energy (kcal) consumed during a snack

Figuras y tablas -
Analysis 7.1

Comparison 7: Consumption in laboratory settings: subgroup analysis by dietary restraint (study providing a single food option), Outcome 1: Energy (kcal) consumed during a snack

Comparison 8: Consumption in laboratory settings: subgroup analysis by study country (studies providing a range of food options), Outcome 1: Energy (kcal) consumed during a snack/meal

Figuras y tablas -
Analysis 8.1

Comparison 8: Consumption in laboratory settings: subgroup analysis by study country (studies providing a range of food options), Outcome 1: Energy (kcal) consumed during a snack/meal

Comparison 9: Consumption in laboratory settings: subgroup analysis by study country (studies providing single food option), Outcome 1: Energy (kcal) consumed during a snack/meal

Figuras y tablas -
Analysis 9.1

Comparison 9: Consumption in laboratory settings: subgroup analysis by study country (studies providing single food option), Outcome 1: Energy (kcal) consumed during a snack/meal

Comparison 10: Low fat (or energy) labelling vs no labelling on high‐energy foods, Outcome 1: Energy (kcal) consumed during a snack/meal in laboratory settings

Figuras y tablas -
Analysis 10.1

Comparison 10: Low fat (or energy) labelling vs no labelling on high‐energy foods, Outcome 1: Energy (kcal) consumed during a snack/meal in laboratory settings

Summary of findings 1. Summary of findings table

Nutritional labelling compared to no labelling for healthier food purchasing and consumption

Patient or population: university students/staff and general consumers
Setting: real‐world and laboratory settings
Intervention: nutritional labelling
Comparison: no labelling

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with no labelling

Risk with nutritional labelling

Food purchased from vending machines
assessed with: diet soda beverages/week
Follow‐up: 5 weeks a

Although more beverages were purchased in the labelling group, large baseline imbalances arising from a small number of randomised units meant that an accurate effect size could not be calculated.

(1 RCT)

⊕⊝⊝⊝
Very lowb

Sample size unknown (population purchasing from 3 intervention and 2 control public vending machines)

Food purchased from a grocery store
assessed with: calorie‐healthy foods as % of sales
Follow‐up: 94 months

Sales performance decreased after labelling was introduced in this interrupted time series study, although this was difficult to interpret because results were measured as health foods as a proportion of overall foods, rather than directly measuring the number of products purchased.

(1 ITS study)

⊕⊝⊝⊝
Very lowc

Sample size unknown (population purchasing from a large chain of grocery stores)

Food purchased in restaurants (labels on menus) assessed with: kcal
Follow‐up: range 2 weeks to 19 weeks

The median food purchased in restaurants was 746 kcald

MD 46.72 kcal fewer (78.35 fewer to 15.10 fewer)e

1877
(3 RCTs)

⊕⊕⊝⊝
Lowf

Six additional studies (one Q‐RCT and 5 ITS studies which took place in a restaurant, cafeterias or coffee shops) also measured purchasing, 2 of which were ITS studies at low risk of bias (which assessed energy labels on menus/menu boards in a coffee shop or cafeteria) and found results consistent with this meta‐analysis.

Food consumed in laboratory settings (labels on menus or labels placed on a range of food options)
assessed with: kcal

The median food consumed in laboratory settings was 796.4 kcald

MD 50.27 kcal fewer (104.41 fewer to 3.88 more)

1705
(8 RCTs)

⊕⊕⊝⊝
Lowg

Food consumed in laboratory settings (single snack food or drink option)
assessed with: kcal

The median food consumed in laboratory settings was 316.975 kcald

SMD 0.05 (95% CI −0.17 to 0.27), P = 0.67

732
(6 RCTs)

⊕⊕⊝⊝
Lowh

An SMD of 0.05 represents a small effect (Cohen 1988).

Potential harms (high‐energy snack foods consumed with misleading low fat/energy labels in laboratory settings)
assessed with: kcal

The median food consumed with misleading low fat/energy labels in laboratory settings was 190 kcald

SMD of 0.19 (95% CI −0.14to 0.51), P = 0.25

831
(5 RCTs)

⊕⊝⊝⊝
Very lowi

An SMD of 0.19 represents a small effect (Cohen 1988).

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio; OR: odds ratio.

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

aAll outcomes measuring immediate purchasing or consumption decisions at the point of exposure to the label, although returning customers in non‐laboratory settings may have experienced repeat exposure during the study period.
bDowngraded by two levels for very serious risk of bias and one level for a high degree of imprecision given no useful effect estimate could be calculated.
cRating begins at 'low' as this is an observational study. Downgraded by one level for serious risk of bias, and one level for indirectness, as outcome was measured as a proportion of overall purchasing rather than directly measured.
dMedian value among the control groups in the included studies.
e Assuming this result applied consistently to a population average meal of 600 kcal, this would represent a reduction of 7.8% (95% CI 2.5% to 13.1%).
f Downgraded by two levels for very serious risk of bias.
g Downgraded by one level for imprecision, as the 95% confidence interval included the possibility of no effect and of a meaningful decrease, and by one level for indirectness, as behaviour observed in a laboratory setting may not be applicable to real‐world settings. Although five of the included studies were at unclear risk of bias, we did not downgrade for risk of bias.
hDowngraded by one level for serious risk of bias and one level for indirectness, as behaviour observed in a laboratory setting may not be applicable to real‐world settings.
iDowngraded one level for serious risk of bias, one level for heterogeneity, one level for indirectness (as behaviour observed in a laboratory setting may not be applicable to real‐world settings) and one level for imprecision (as the 95% confidence interval included the possibility of a meaningful decrease or increase).

Figuras y tablas -
Summary of findings 1. Summary of findings table
Table 1. Study that assessed labelling vs no labelling on drinks purchased from vending machines

Reference and study design

Participants and Setting

Intervention/Comparison (sample sizes)

Outcome

Results

Summary effect

Bergen 2006

Cluster‐RCT

Students and employees at a university

Real‐world setting

Brightly coloured '0 calories, 0 carbs' labels (n = 3 vending machines) vs no labels (n = 2 vending machines)a

Mean number of diet soda beverages (with '0 calories, 0 carbs') purchased from vending machines (weekly)

Mean 54.40 beverages (SD 16.69) vs 48.90 beverages (SD 1.84)

The methods used to analyse the data were not clearly reported and an accurate effect size and confidence intervals could not be calculated.b

aThe authors also evaluated another intervention ('0 calorie, 0 carbs' plus a motivational poster encouraging the purchase of water and non‐energy‐containing soft drinks) that was not eligible for inclusion in this review.
bThere were baseline differences between the groups. In addition, we could not provide a standardised effect due to the impact of small randomised units (vending machines) on estimates of standard deviation.

Figuras y tablas -
Table 1. Study that assessed labelling vs no labelling on drinks purchased from vending machines
Table 2. Study that assessed labelling vs no labelling on food or drinks purchased from a grocery store

Reference and study design

Participants and setting

Intervention/comparison (sample sizes)

Outcome

Results

Summary effect

Balasubramanian 2002

Interrupted time series

Customers at a major grocery store chain

Real‐world setting

'Low calorie', 'diet' 'light' label on front of package vs no label (sample sizes not clear)a

Share (%) of sales of different food categories

"Regression models featuring calorie‐healthy foods consistently show [that] the relative sales performance of such items decreased after the onset of [mandatory labelling]": 'low calorie/diet/light' bottled juices = −1.538 (SE 0.191); 'light' frozen entrées = −2.601 (SE 0.373); 'light' frozen dinners = −4.507 (SE 0.963)b

Regression P values of < 0.001 indicated fewer foods with 'calorie healthy' descriptors were purchased.

aThe authors also evaluated 'vitamin C fortified' bottled juices, 'plus calcium/calcium added' juices, and 'low fat/reduced fat/fat free' cheese and cookies. These data were not eligible for inclusion in this review.
bGraphs were not presented for the foods or beverages of interest, so that re‐analysis of the data was not possible from the published paper.

Figuras y tablas -
Table 2. Study that assessed labelling vs no labelling on food or drinks purchased from a grocery store
Table 3. Studies that assessed labelling vs no labelling on food or drinks purchased in restaurants, cafeterias or coffee shops

Reference and study design

Participants and setting

Intervention/comparison (sample sizes)

Outcome

Results

Summary effect

Allan 2015

Q‐RCT

Coffee shop customers at academic hospital

Real‐world setting

Energy content of all food and drinks available on point of purchase signs vs. no information (N = 20,516 items purchased)

Proportion of high energy food and drinks purchased (as a percentage of total drinks and snacks sold)

The proportion of high energy snacks purchased was 41% in the intervention and 45% the control group (P = 0.04); the proportion of high energy drinks purchased was 46% in the intervention group and 50% in the control group (P = 0.15).

Effect size and confidence intervals could not be calculated.

Bollinger 2011

Interrupted time series

Coffee shop customers

Real‐world setting

Energy content on menu and menu boards vs no information (N = 118,480 transactions reported)

Mean kcal of food and drinks purchased per transaction

"Estimates of the effect of calorie posting (calories per transaction): log (beverages and food) = −0.060 (0.001)a–representing a ... decrease in average calories per transaction, equivalent to 14.4 calories"

Regression P value < 0.01

Chu 2009

Interrupted time series

Customers at a university dining centre

Real‐world setting

Nutrition facts information on menu board (N = 14,199 entrées sold) vs no label (pre‐intervention: N = 13,951 entrées sold; post‐intervention N = 14,020 entrées sold)

Mean kcal content of entrées purchased per day

Mean energy content of entrées sold at start of the pre‐intervention period: 646.5 kcal with a slope of 0.094 kcal per day. The difference in energy content of entrées sold between the pre‐treatment last day and treatment first day was −12.4 kcal (P = 0.007). Following this reduction, the difference in slope pre‐intervention to intervention was −0.298 kcal per day, and the difference in slope intervention to post‐intervention was 1.512 kcal per day. This means that the average energy content of entrées purchased reduced immediately after the intervention, and gradually increased when the intervention was removed.

Regression P values were 0.56 (pre‐intervention to intervention slope), and 0.013 (intervention to post‐intervention slope).

Cioffi 2015

Interrupted time series

Customers at a university dining centre

Real‐world setting

Nutrition facts label on pre‐packaged meals and snacks vs no label (sample sizes not reported)

Mean kcal purchased per week from meals and snacks

"Mean [energy] purchased decreased significantly across the 3 [time points] of the pre‐labelling period. However, no such trend was observed in the post‐labelling period." (data compared over 3 time points)."After labelling, the mean energy content of the items purchased per week decreased significantly from 476.2 (SD 8.7) kcals to 445.3 (SD 8.1) kcals per week (p<0.001)."

A statistical comparison of time trends (i.e. slope) before and after the intervention was not reported, so that the overall effectiveness of the intervention is not clear.

Dubbert 1984

Interrupted time series

Customers at a public cafeteria

Real‐world setting

'Lower calorie' label on green paper with a red dot on right‐hand corner beside food item vs no label (sample sizes of foods purchased is not clear)

Probability of choosing low energy entrées, vegetables, or salads

"The probability of choosing a low [energy] entrée did not differ from baseline." The probability of purchasing lower‐energy vegetables and salads significantly increased compared to the no label baseline conditions (P < 0.001).

A statistical comparison of time trends before and after the intervention was not clearly reported, so that the overall effectiveness of the intervention is not clear.

Ellison 2013

RCT

Customers at a restaurant

Real‐world setting

1. Energy content on menu (n = 54)

2. Menu with energy content using traffic light format (n = 54)

3. No label (n = 30)

Mean kcal purchased per meal (including entrées, desserts and drinks)

756.5 kcal (SD 338.5)b vs 765 kcal (SD 368.0)

MD −8.50 kcal (95% CI −154.85 to 137.85)

Ellison 2014a

RCT

Customers at a restaurant

Real‐world setting

1. Energy content on menu (n = 469)

2. Menu with energy content using traffic light format (n = 591)

3. No label (n = 472)

Mean kcal purchased per meal (entrées only)

705.6 kcal (SD 334.7)c vs. 746 kcal (SD 368.0)

MD −40.38 kcal (95% CI −79.21 to −1.55)

Holmes 2013

Interrupted time series

Families at a restaurant

Real‐world setting

Children's menu with energy and fat content label vs no label (N = 1275 meals)d

Mean kcal purchased per meal

"The calorie and fat menu had the biggest change in calories compared to the control menu (−9.54), but it was not significant."

A statistical comparison of time trends before and after the intervention was not reported, so that the overall effectiveness of the intervention is not clear.

VanEpps 2016

RCT

Employees at large company buying lunch online

Real‐world setting

1. Energy content on menu (n = 38)

2. Menu with energy content using traffic light format (n = 46)

3. No label (n = 123)e

Mean kcal purchased per meal

537.9 kcal (SD 203.9)f vs. 605.3 kcal (SD 222.5)

MD −67.38 kcal (95% CI −126.09 to −8.66)

aAccounting for effects of week, day of week and weather.
bSDs were calculated from P values reported in the text; means and SDs for both intervention groups were combined (intervention 1: 817 kcal (SD 334.6); intervention 2: 696 kcal (SD 334.6)).
cSDs were based on Ellison 2013; means and SDs for both intervention groups were combined (intervention 1: 719 kcal (SD 334.6); intervention 2: 695 kcal (SD 334.6)).
dThe authors also evaluated two other labelling interventions (a healthy (apple) symbol, and a 'Nutrition Bargain Price') that were not eligible for inclusion in this review.
eThe authors also evaluated one other labelling interventions (traffic light labels without energy information) that was not eligible for inclusion in this review.
fMeans and SDs (obtained from the study authors) for both intervention groups were combined (intervention 1: 543.8 (SD 180); intervention 2: 533.1 (SD 223.6)).

Figuras y tablas -
Table 3. Studies that assessed labelling vs no labelling on food or drinks purchased in restaurants, cafeterias or coffee shops
Table 4. Studies that assessed labelling vs no labelling on food or drinks consumed in laboratory settings

Reference and study design

Participants and setting

Intervention/comparison (sample sizes)

Outcome

Results

Summary effect

Labelling on menus or placed on a range of food options on energy consumed during a meal

Girz 2012 ‐ study 2

RCT

University students

Experimental (laboratory) study at a university

Energy content on menu plus information on recommended daily energy intake for women and men (n = 60) vs no label (n = 66)a

Mean kcal consumed during a meal (salad and pasta)

608.2 kcal (SD 350.8)b vs 631.3 kcal (SD 324.0)

MD −23.02 kcal (95% CI −141.28 to 95.24)

Girz ongoing

RCT

University students

Experimental (laboratory) study at a university

Energy content on menu (n = 24) vs no label (n = 25)

Mean kcal consumed during a meal

433.1 kcal (SD 260.2) vs 426.5 kcal (SD 237.4)c

MD 6.60 kcal (95% CI −133.02 to 146.22)

Hammond 2013

RCT

Adults

Experimental (laboratory) study at a university

1. Energy content on menu (n = 165)

2. Menu with energy content using a traffic light format (n = 156)

3. Menu with energy, fat, salt, and sugar content using traffic light format (n = 152) vs no label (n = 162)

Mean kcal consumed during a fast food meal

761.6 kcal (SD 348.9)d vs 839.6 kcal (SD 318.8)

MD −78.00 kcal (95% CI −136.29 to −19.70)

Harnack 2008a

RCT

Adolescents and adults

Experimental study conducted in hotel conference rooms/church hall

Energy content on menu plus information on recommended daily energy intake for women and men (n = 151) vs no label (n = 150)e

Mean kcal consumed during a fast food meal

804.7 kcal (SD 423.9) vs 739.0 kcal (SD 358.2)

MD 65.70 kcal (95% CI −22.94 to 154.34)

James 2015

RCT

Adults, including university students

Experimental study at a university

Energy content on menu plus information on recommended daily energy intake for women and men (n = 99) vs no label (n = 99)f

Mean kcal consumed during a meal

722.0 kcal (SD 271.6)g vs 770.0 (SD 269.1)

MD −48.00 kcal (95% CI −123.31 to 27.31)

Platkin 2014

RCT

Female university students

Experimental (laboratory) study at a university

1. Energy content on menu (n = 20)

2. Menu with energy content and exercise equivalents (n = 20) vs no label (n = 22)

Mean kcal consumed during a fast food meal

870.1 kcal (SD 375.9)h vs 995.4 (SD 429.4)

MD −125.33 kcal (95% CI −339.26 to 88.59)

Roberto 2010

RCT

Adults from the community

Experimental (classroom) study at a university

1. Energy content on menu (n = 92)

2. Menu with energy content plus information on recommended daily intake (n = 103) vs no label (n = 92)

Mean kcal consumed during a meal

1293.3 kcal (SD 656.8)i vs 1458.9 kcal (SD 724.6)

MD −165.58 kcal (95% CI −340.01 to 8.84)

Temple 2010

RCT

Adults

Experimental (laboratory) study at a university

Nutrition facts label on foods (n = 23) vs no label (n = 24)

Mean kcal consumed during a meal

620.4 kcal (SD 203.6) vs 822.8 kcal (SD 408.7)j

MD −202.40 kcal (SD −385.86 to −18.94)

Labelling of a single food or drink option on energy consumed during a snack or meal

Cavanagh 2014

RCT

Female university students

Experimental (laboratory) study at a university

Energy label on chocolate cookie (130 kcal) (n = 62) vs no label (n = 62)k

Mean grams consumed from snack of chocolate chip cookies

45.1 g (SD 21.50) vs 33.1 g (SD 21.57)l

SMD 0.55 (95% CI 0.19 to 0.91)

Crockett 2014

RCT

Adults

Experimental study at a cinema

Red 'high fat' label on side of popcorn container (n = 96) vs no label (n = 88)m

Mean kcal consumed from snack of toffee or salted popcorn (high‐fat snack)

413.5 kcal (SD 307.6)n vs 468.1 kcal (SD 361.9)

SMD −0.16 (95% CI −0.45 to 0.13)

Ebneter 2013

RCT

Female university students

Experimental study at a university

Energy label ('new colours of regular M&M's, 240 calories per serving"') on glass container containing M&M's (n = 41) vs no energy content label ('new colours of regular M&M's') (n = 38)o

Mean kcal consumed during snack of M&M's (high‐fat snack)

157.2 kcal (SD 98.5) vs165.9 kcal (SD 141.5)

SMD −0.07 (95% CI −0.51 to 0.37)

Kral 2002

Q‐RCT

Females

Experimental (laboratory) study at a university

Energy label plus 'colour‐coded' information on level of energy density on an entrée (n = 20) vs no label (n = 20)

Mean kcal consumed from an entrée at breakfast, lunch and dinner

1534.0 kcal (SD 451.7) vs 1569.0 kcal (SD 335.4)

SMD −0.09 (95% CI −0.71 to 0.53)

Roberto 2012

RCT

Adults

Experimental (laboratory) study at a university

1. Smart choices label on cereal box (n = 76 analysed)

2. Modified smart choices label (n = 71) vs no label (n = 69)

Mean grams of high‐sugar breakfast cereal and milk consumed

225.7 g (SD 138.2)p vs 219.9 g (SD 127.1)

SMD 0.04 (95% CI −0.24 to 0.33)

Vermeer 2011

Q‐RCT

Adults

Experimental study at a cinema

Portion size and energy content label (display board) (n = 48) vs no label (n = 41)

Mean millilitres of soft drink consumed

376.3 mL (SD 125.4) vs 382.14 mL (SD 147.6)q

SMD −0.04 (95% CI−0.46 to 0.37)

aTwo other interventions were combined by the study authors as a 'calorie only' intervention (400 kcal salad and 1200 kcal pasta, and 1200 kcal salad and 400 kcal pasta (although both salad and pasta contained 1200 kcal)). We did not include this data in the above analysis as it involved mislabelling some of the foods (data were not reported separately for consumption of foods that were accurately labelled).
bMeans and SDs were reported separately for men and women by the study authors; we have combined these data.
cData were obtained from the study authors (Girz ongoing).
dMean and SDs for all three intervention groups were combined (intervention 1: 744.2 kcal (SD 368.1); intervention 2: 776.8 kcal (SD 350.9); intervention 3: 764.9 (SD 326.2)).
eThe authors also evaluated other labelling interventions (energy information and daily recommended intake plus price modification, and price modification alone) that were not eligible for inclusion in this review.
fThe authors also evaluated another intervention (exercise label describing the number of minutes of brisk walking required to burn the energy for each food item), but as this intervention did not present energy content information, it was not eligible for inclusion in this review.
gSDs were calculated from confidence intervals.
hSDs were calculated from standard errors. Means and SDs for both intervention groups were combined (intervention 1: 898.82 kcal (SD 392); intervention 2: 841.31 kcal (SD 82.07)).
iMeans and SDs for both intervention groups were combined (intervention 1: 1334.72 kcal (SD 621); intervention 2: 1256.37 kcal (SD 689)).
jData were obtained from the study authors (Temple 2010).
kThe authors also evaluated another labelling intervention (high energy label on a low energy cookie) that was not eligible for inclusion in this review.
lThese data were converted kcal using formula presented in DeGroot 2012.
mThe authors also evaluated another labelling intervention (green 'low fat' label on high fat popcorn) that is not reported here (see Table 5).
nMeans and SDs for two types of popcorn (toffee and salted), reported separately in the paper, were combined.
oThe authors also evaluated two other labelling interventions (low fat label with and without energy information on high fat snacks) that is not reported here (see Table 5).
pMeans and SDs for both intervention groups were combined (intervention 1: 219.21 (SD 133); intervention 2: 232.61 (SD 144)). These data were then converted kcal using formula presented in DeGroot 2012.
qThese data were converted kcal using formula presented in DeGroot 2012.

Figuras y tablas -
Table 4. Studies that assessed labelling vs no labelling on food or drinks consumed in laboratory settings
Table 5. Studies that assessed potential harms (indirectly): 'low fat' or low energy labels on high‐energy snacks

Reference and study design

Participants and setting

Intervention/comparison (sample sizes)

Outcome

Results

Summary effect

Crockett 2014

RCT

Adults

Experimental study at a cinema

Green 'low fat' label on side of container containing high‐fat popcorn (n = 103) vs no label (n = 88)

Mean kcal consumed from snack of popcorn

402.44 kcal (SD 288.68) vs 468.07 kcal (SD 361.93)

SMD −0.20 (95% CI −0.48 to 0.08)

Ebneter 2013

RCT

Female university students

Experimental study at a university

Low fat label ('new low fat M&M's') on glass container containing M&M's (n = 49) vs no energy information label ('new colours of regular M&M's') (n = 38)

Mean kcal consumed during snack of M&M's

192.34 kcal (SD 145.53) vs165.88 kcal (SD 141.5)

SMD 0.18 (95% CI−0.25 to 0.61)

Girz 2012 ‐ study 1

RCT

Female university students

Experimental (laboratory) study at a university

Lower energy label (600 kcal) on high‐energy salad and pasta (actually 1200 kcal) (n = 56) vs no label (n = 49)a

Mean kcal consumed during a meal (salad and pasta)

400.26 kcal (SD 199.8) vs 420.19 kcal (SD 233.69)

SMD −0.09 (95% CI −0.47 to 0.29)

Wansink 2006 ‐ study 1

Q‐RCT

Students and their families

Experimental study at a university

Low fat label ('new low fat M&M's') on glass container containing M&M's vs no energy information label ('new colours of regular M&M's') (n = 269 overall (n by group not reported))

Mean kcal consumed from snack of M&M's

Mean 244 kcal (SD not reported) vs 190 kcal (SD not reported)

SMD 0.44 (95% CI 0.20 to 0.68)b

Wansink 2006 ‐ study 3

Q‐RCT

University staff, graduates and undergraduates

Experimental study at a university

Low fat label ('Low‐Fat Rocky Mountain Granola') on zip lock bag vs no label ('Regular Rocky Mountain Granola') (n = 66 overall (n by group not reported))

Mean kcal consumed from snack of granola

Mean 249 kcal (SD not reported) vs 165 kcal (SD not reported)

SMD 0.69 (95% CI 0.20 to 1.18)c

aData were extracted for those who chose pasta or salad when it was inaccurately as '600 calories'.
bSMD was calculated based on F‐test data reported in the text.
cSMD was calculated based on F‐test data reported in the text.

Figuras y tablas -
Table 5. Studies that assessed potential harms (indirectly): 'low fat' or low energy labels on high‐energy snacks
Comparison 1. Labelling on menus vs no labelling in restaurants

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Energy (kcal) of food purchased Show forest plot

3

1877

Mean Difference (IV, Random, 95% CI)

‐46.72 [‐78.35, ‐15.10]

Figuras y tablas -
Comparison 1. Labelling on menus vs no labelling in restaurants
Comparison 2. Labelling on menus or placed on a range of food options vs no labelling in laboratory settings

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Energy (kcal) consumed during a meal Show forest plot

8

1705

Mean Difference (IV, Random, 95% CI)

‐50.27 [‐104.41, 3.88]

Figuras y tablas -
Comparison 2. Labelling on menus or placed on a range of food options vs no labelling in laboratory settings
Comparison 3. Labelling on menus vs no labelling in laboratory settings (studies with a low risk of bias)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

3.1 Energy (kcal) consumed during a meal Show forest plot

3

547

Mean Difference (IV, Random, 95% CI)

‐72.04 [‐137.84, ‐6.25]

Figuras y tablas -
Comparison 3. Labelling on menus vs no labelling in laboratory settings (studies with a low risk of bias)
Comparison 4. Labelling of a single food or drink option vs no labelling in laboratory settings

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4.1 Energy (kcal) consumption Show forest plot

6

732

Std. Mean Difference (IV, Random, 95% CI)

0.05 [‐0.17, 0.27]

Figuras y tablas -
Comparison 4. Labelling of a single food or drink option vs no labelling in laboratory settings
Comparison 5. Labelling of a single food or drink option vs no labelling in laboratory settings (studies at low risk of bias)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

5.1 Energy (kcal) consumption Show forest plot

2

400

Std. Mean Difference (IV, Random, 95% CI)

‐0.06 [‐0.26, 0.15]

Figuras y tablas -
Comparison 5. Labelling of a single food or drink option vs no labelling in laboratory settings (studies at low risk of bias)
Comparison 6. Consumption in laboratory settings: subgroup analysis by dietary restraint (studies providing a range of food options)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

6.1 Energy (kcal) consumed during a meal Show forest plot

2

267

Mean Difference (IV, Random, 95% CI)

15.48 [‐20.08, 51.04]

6.1.1 Restrained eaters

2

129

Mean Difference (IV, Random, 95% CI)

20.87 [‐37.44, 79.18]

6.1.2 Unrestrained eaters

2

138

Mean Difference (IV, Random, 95% CI)

10.98 [‐38.85, 60.81]

Figuras y tablas -
Comparison 6. Consumption in laboratory settings: subgroup analysis by dietary restraint (studies providing a range of food options)
Comparison 7. Consumption in laboratory settings: subgroup analysis by dietary restraint (study providing a single food option)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

7.1 Energy (kcal) consumed during a snack Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

‐0.17 [‐0.63, 0.28]

7.1.1 Restrained eaters

1

Std. Mean Difference (IV, Random, 95% CI)

‐0.44 [‐0.94, 0.05]

7.1.2 Urestrained eaters

1

Std. Mean Difference (IV, Random, 95% CI)

0.03 [‐0.34, 0.39]

Figuras y tablas -
Comparison 7. Consumption in laboratory settings: subgroup analysis by dietary restraint (study providing a single food option)
Comparison 8. Consumption in laboratory settings: subgroup analysis by study country (studies providing a range of food options)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

8.1 Energy (kcal) consumed during a snack/meal Show forest plot

8

1705

Mean Difference (IV, Random, 95% CI)

‐50.28 [‐104.42, 3.87]

8.1.1 Studies conducted in the USA

5

895

Mean Difference (IV, Random, 95% CI)

‐70.57 [‐167.65, 26.52]

8.1.2 Studies conducted in other countries

3

810

Mean Difference (IV, Random, 95% CI)

‐58.18 [‐107.15, ‐9.21]

Figuras y tablas -
Comparison 8. Consumption in laboratory settings: subgroup analysis by study country (studies providing a range of food options)
Comparison 9. Consumption in laboratory settings: subgroup analysis by study country (studies providing single food option)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

9.1 Energy (kcal) consumed during a snack/meal Show forest plot

6

732

Std. Mean Difference (IV, Random, 95% CI)

0.05 [‐0.17, 0.27]

9.1.1 Studies conducted in the USA

4

459

Std. Mean Difference (IV, Random, 95% CI)

0.14 [‐0.17, 0.45]

9.1.2 Studies conducted in other countries

2

273

Std. Mean Difference (IV, Random, 95% CI)

‐0.12 [‐0.36, 0.11]

Figuras y tablas -
Comparison 9. Consumption in laboratory settings: subgroup analysis by study country (studies providing single food option)
Comparison 10. Low fat (or energy) labelling vs no labelling on high‐energy foods

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

10.1 Energy (kcal) consumed during a snack/meal in laboratory settings Show forest plot

5

718

Std. Mean Difference (IV, Random, 95% CI)

0.19 [‐0.14, 0.51]

Figuras y tablas -
Comparison 10. Low fat (or energy) labelling vs no labelling on high‐energy foods