Background
Nutritional labelling is advocated as a means to promote healthier food purchasing and consumption, including lower energy intake. Internationally, many different nutritional labelling schemes have been introduced. There is no consensus on whether such labelling is effective in promoting healthier behaviour.
Objectives
To assess the impact of nutritional labelling for food and non‐alcoholic drinks on purchasing and consumption of healthier items. Our secondary objective was to explore possible effect moderators of nutritional labelling on purchasing and consumption.
Search methods
We searched 13 electronic databases including CENTRAL, MEDLINE and Embase to 26 April 2017. We also handsearched references and citations and sought unpublished studies through websites and trials registries.
Selection criteria
Eligible studies: were randomised or quasi‐randomised controlled trials (RCTs/Q‐RCTs), controlled before‐and‐after studies, or interrupted time series (ITS) studies; compared a labelled product (with information on nutrients or energy) with the same product without a nutritional label; assessed objectively measured purchasing or consumption of foods or non‐alcoholic drinks in real‐world or laboratory settings.
Data collection and analysis
Two authors independently selected studies for inclusion and extracted study data. We applied the Cochrane 'Risk of bias' tool and GRADE to assess the quality of evidence. We pooled studies that evaluated similar interventions and outcomes using a random‐effects meta‐analysis, and we synthesised data from other studies in a narrative summary.
Main results
We included 28 studies, comprising 17 RCTs, 5 Q‐RCTs and 6 ITS studies. Most (21/28) took place in the USA, and 19 took place in university settings, 14 of which mainly involved university students or staff. Most (20/28) studies assessed the impact of labelling on menus or menu boards, or nutritional labelling placed on, or adjacent to, a range of foods or drinks from which participants could choose. Eight studies provided participants with only one labelled food or drink option (in which labelling was present on a container or packaging, adjacent to the food or on a display board) and measured the amount consumed. The most frequently assessed labelling type was energy (i.e. calorie) information (12/28).
Eleven studies assessed the impact of nutritional labelling on purchasing food or drink options in real‐world settings, including purchases from vending machines (one cluster‐RCT), grocery stores (one ITS), or restaurants, cafeterias or coffee shops (three RCTs, one Q‐RCT and five ITS). Findings on vending machines and grocery stores were not interpretable, and were rated as very low quality. A meta‐analysis of the three RCTs, all of which assessed energy labelling on menus in restaurants, demonstrated a statistically signific...