Influence of the nutrition and health information presented on food labels on portion size consumed: a systematic review

The Relation between Consumer Perception and Objective Understanding of Front-of-Package Nutrition Labels (FOPNLs); Results from an Online Representative Survey

BACKGROUND

This study investigates the efficacy of Front-of-Pack Nutrition Labels (FOPNLs) as a cost-effective tool for improving dietary choices among Greek consumers. The purpose of the study was to investigate Greek customers' preferences and comprehension of commonly used European FOPNL schemes.

METHODS

The Hellenic Food Authority and the Agricultural University of Athens performed a representative online survey in March 2022, titled "The Role of Nutritional Labelling in Public Perception and Food Procurement." Consumers responded to a questionnaire separated into two parts. Part one included (i) personal, sociodemographic information, and (ii) subjective opinions on the FOPNL schemes, and part two comprised (iii) an objective understanding of NutriScore and NutrInform Battery, using 15 different foods. Participants were randomly allocated to these groups, and general mixed models were used for analysis.

RESULTS

A total of 1389 adults completed the first part of the survey, and 74.8% completed the second part. The Multiple Traffic Lights scheme was the preferred FOPNL, chosen by 48.4% of respondents, compared to 19.7% for NutrInform Battery and 12.3% for NutriScore. However, the mean objective assessment score was highest for NutriScore (5.8 ± 2.3) compared to NutrInform Battery (5.4 ± 1.9).

CONCLUSION

The results highlight the necessity for comprehensive nutrition education programs by showing a considerable gap between subjective preferences and an objective understanding of nutrition labels.

The neural model of front-of-package label processing

Front-of-package (FOP) labels have been adopted in many countries to battle the obesity pandemic and its serious health consequences by providing clearer and easier-to-understand nutrition and health information. The effectiveness of FOP labels has been generally confirmed, with some contextual and individual factors modifying their effectiveness. Existing theories (eg, the dual-process theory) and shifting priorities for self-control, provide some explanations for the FOP label effect. However, the cognitive and neural mechanisms underlying the processing of FOP labels remain unknown. Here, a new model, namely, the neural model of FOP label processing, has been proposed to fill this gap by providing an integrated account of FOP label processing while simultaneously considering multiple important situational and individual factors in the same framework. This neural model is built on the core eating network (ie, the ventral reward pathway and the dorsal control pathway) for food cue processing and actual food consumption. The new model explains how FOP labels may facilitate attention, influence the core eating network, and thus alter food choices. It also demonstrates how motivation may modify FOP label processing in 2 ways: affecting attention (the indirect way) and changing the process of evaluating the food (the direct way). It further explains how some contextual and individual factors (eg, ego depletion, time pressure, and health knowledge) influence the process. Thus, the neural model integrates evidence from behavioral, eye-tracking, and neuroimaging studies into a single, integrated account, deepening understanding of the cognitive and neural mechanisms of FOP label processing. This model might facilitate consensus on the most successful FOP label. Moreover, it could provide insights for consumers, food industries, and policy makers and encourage healthy eating behaviors.

On-the-Pack Voluntary Well-Being Messaging for Milks Targeting Chinese Older Adults: A Content Analysis

China is experiencing severe population aging. Given that milks targeting older adults are one of the most popular foods designed for Chinese older adults (COA), this study investigated on-the-pack (OTP) voluntary well-being messaging (VWM, ways of communicating a product's broad well-being benefits through information on food content or statements linked to favourable components, functions, or well-being outcomes) for milk targeting COA. Over 200 products identified from two sources (JD.com and Mintel's global new products database), were analysed for type, content, and VWM frequency for different brand origins and milk sources of various animal species, nutrition claim regulation compliance and alignment with nutrition facts. The results suggested: (1) different brand origins (domestic vs. international) and milk source (cow vs. goat) highlighted different well-being aspects of products, (2) three products failed to comply with government regulations made for nutrition labelling of pre-packed foods (GB 28050-2011), but (3) excepting fat, all 'contains' claims and most 'high' claims did not reflect significantly greater levels of nutrients, compared to products with no claims. The findings create a comprehensive picture of OTP VWM for milks targeting older adults in China, providing useful information for consumer, domestic, and international dairy industries, and policymakers.

The effects of nutrition and health claims on the nutrient composition of single and subsequent meal servings

Nutrition and health claims (NHCs) can help individuals make better food choices. While NHCs have been found to influence consumer perceptions and consumption, there has been less focus on how claims influence the nutritional composition of servings. There has also been little attention paid to longer term or compensatory effects of claims on subsequent food selection. This manuscript details two studies considering these matters. Study 1 (n = 60) was a within-subjects experiment to measure the impact of NHCs on food selection and nutritional composition at single meal servings. Participants served from three fake food buffet meal stations (breakfast, hot meal, snacks) with NHCs present or absent. Study 2 (n = 55) was a within-subjects experiment to examine the impact of NHCs on food selection and nutritional composition at a subsequent meal. Participants served from a fake food buffet breakfast with or without NHCs followed by a lunch without NHCs. In study 1, while results varied for different meals, the presence of claims was found to significantly reduce the amount of energy, fat, saturated fat, sugar, carbohydrates, and sodium, and increase the amount of protein in meals that were served. Results for fibre were mixed. In addition, NHCs increased the quantity of food served in the snacks condition. There was no evidence of claims at breakfast impacting the nutritional composition of subsequent lunch servings in study 2. Despite claims potentially increasing serving quantities, the nutritional composition of chosen servings was more encouraging and claims may help individuals to meet recommended nutritional daily guidelines. These findings have wider implications in terms of government policy, food reformulation, and the continuing debate around the use of nutrient profiling regulations for products carrying claims.

Nutrition and Health Claims: Consumer Use and Evolving Regulation

Purpose of Review

The value of nutrition and health claims (N&HC) depends on how consumers use them and the regulatory framework that enables them. This paper aims to explore the impact of claims on consumer behaviour and identify evolving regulatory challenges, using the Australian experience as a reference point.

Recent Findings

N&HC can influence consumer food purchasing and consumption, but how consumers interpret and act on specific claims is less well understood, and regulatory frameworks are evolving. In the last 10 years, changes to the Australian regulatory framework have exposed greater opportunities for promoting foods, albeit with challenges regarding self-substantiation of claims.

Summary

N&HC can play a significant role in driving consumer choices towards a healthier food supply. The Australian experience demonstrates how N&HC can continue to evolve, reflecting developments in methodologies and a fundamental appreciation of the relationship between food and health.

Does labelling a food as 'light' vs. 'filling' influence intake and sensory-specific satiation?

Although several studies have investigated the influence of nutrition labelling on food intake, the effect of labels indicating a food's satiating power on food intake and sensory-specific satiation (SSS) is poorly understood. We investigated whether providing information about the satiating power of a meal affects intake and SSS. Participants (19 men and 18 women) consumed the same test meal of pasta salad ad libitum on two occasions, once described as 'light' and once as 'filling'. SSS was determined as the change in liking of the flavor and desire to eat the test meal before and after consumption, compared to seven uneaten foods. As hypothesized, intake increased by a mean (±SD) of 31 ± 59 g and 42 ± 81 kcal when the meal was labelled 'light' as opposed to 'filling' (p < 0.01). After eating, ratings for both liking and desire to eat decreased significantly more for the test meal than for the uneaten control foods (p < 0.001), demonstrating SSS. These relative changes in liking and desire to eat did not differ between the label conditions, despite differences in intake. Furthermore, accounting for amount consumed, the magnitude of SSS did not differ between the label conditions, which suggests that it did not explain the effect of the labels on intake. This study shows that labels indicating the satiating power of a meal can affect intake, warranting caution in the use of such labels on products intended to reduce intake.

Well-being Messaging for Mammalian Milks: A Scoping Review

Having a holistic understanding of research on well-being messaging for milk is vital to allow the optimal communication of the association between milk consumption and various nutritional, physical, and psychological benefits to the consumer. This work is a unique interdisciplinary, scoping review of existing research on well-being messaging for milk. Well-being messages are ways to communicate the broad well-being benefits of specific products to the consumer through information on food content or statements that link a product with favourable components, functions, or well-being outcomes. Leveraging this broad definition, and by proposing a guiding theoretical model that considers well-being messaging as a form of communication, milk well-being messaging literature has been mapped across time, geographical locations, disciplines, and product types. Two hundred forty-six were records included in this review, of which 177 were empirical studies. Studies were disseminated between 1954 and 2019, with 54.9% published after 2011. Food, Agriculture, and Biological Sciences (N = 109), Nutrition and Dietetics (N = 78), and Medicine, Public Health, and Health Professions (N = 69) disciplines have attracted the most publications, with numbers generally increasing in most recent years. The majority of included non-empirical records (69.6%) provide lists of commercially available products carrying well-being messaging and/or regulations on the use of particular well-being messages for milk according to various legislative authorities. Most of the empirical studies were conducted in North America (N = 71), West Europe (N = 52), and Oceania (N = 22), and on plain (i.e., unflavoured) milk (N = 152). Whereas, most studied elements of well-being messaging for milk across time, i.e., message (N = 169), product (N = 141), receiver (N = 101), and context (N = 72) have seen an increasing number of studies in recent years; sender (N = 51) and medium (N = 27) have been even less studied in the past four years. A more detailed analysis of research trends in each element of well-being messaging is reported. The research highlights immediate and strategic knowledge gaps that need further attention from researchers and/or policymakers in order to improve the “messaging” of well-being benefits of milk consumption to the consumer.

Impact of color-coded and warning nutrition labelling schemes: A systematic review and network meta-analysis

BACKGROUND

Suboptimal diets are a leading risk factor for death and disability. Nutrition labelling is a potential method to encourage consumers to improve dietary behaviour. This systematic review and network meta-analysis (NMA) summarises evidence on the impact of colour-coded interpretive labels and warning labels on changing consumers' purchasing behaviour.

METHODS AND FINDINGS

We conducted a literature review of peer-reviewed articles published between 1 January 1990 and 24 May 2021 in PubMed, Embase via Ovid, Cochrane Central Register of Controlled Trials, and SCOPUS. Randomised controlled trials (RCTs) and quasi-experimental studies were included for the primary outcomes (measures of changes in consumers' purchasing and consuming behaviour). A frequentist NMA method was applied to pool the results. A total of 156 studies (including 101 RCTs and 55 non-RCTs) nested in 138 articles were incorporated into the systematic review, of which 134 studies in 120 articles were eligible for meta-analysis. We found that the traffic light labelling system (TLS), nutrient warning (NW), and health warning (HW) were associated with an increased probability of selecting more healthful products (odds ratios [ORs] and 95% confidence intervals [CIs]: TLS, 1.5 [1.2, 1.87]; NW, 3.61 [2.82, 4.63]; HW, 1.65 [1.32, 2.06]). Nutri-Score (NS) and warning labels appeared effective in reducing consumers' probability of selecting less healthful products (NS, 0.66 [0.53, 0.82]; NW,0.65 [0.54, 0.77]; HW,0.64 [0.53, 0.76]). NS and NW were associated with an increased overall healthfulness (healthfulness ratings of products purchased using models such as FSAm-NPS/HCSP) by 7.9% and 26%, respectively. TLS, NS, and NW were associated with a reduced energy (total energy: TLS, -6.5%; NS, -6%; NW, -12.9%; energy per 100 g/ml: TLS, -3%; NS, -3.5%; NW, -3.8%), sodium (total sodium/salt: TLS, -6.4%; sodium/salt per 100 g/ml: NS: -7.8%), fat (total fat: NS, -15.7%; fat per 100 g/ml: TLS: -2.6%; NS: -3.2%), and total saturated fat (TLS, -12.9%; NS: -17.1%; NW: -16.3%) content of purchases. The impact of TLS, NS, and NW on purchasing behaviour could be explained by improved understanding of the nutrition information, which further elicits negative perception towards unhealthful products or positive attitudes towards healthful foods. Comparisons across label types suggested that colour-coded labels performed better in nudging consumers towards the purchase of more healthful products (NS versus NW: 1.51 [1.08, 2.11]), while warning labels have the advantage in discouraging unhealthful purchasing behaviour (NW versus TLS: 0.81 [0.67, 0.98]; HW versus TLS: 0.8 [0.63, 1]). Study limitations included high heterogeneity and inconsistency in the comparisons across different label types, limited number of real-world studies (95% were laboratory studies), and lack of long-term impact assessments.

CONCLUSIONS

Our systematic review provided comprehensive evidence for the impact of colour-coded labels and warnings in nudging consumers' purchasing behaviour towards more healthful products and the underlying psychological mechanism of behavioural change. Each type of label had different attributes, which should be taken into consideration when making front-of-package nutrition labelling (FOPL) policies according to local contexts. Our study supported mandatory front-of-pack labelling policies in directing consumers' choice and encouraging the food industry to reformulate their products.

PROTOCOL REGISTRY

PROSPERO (CRD42020161877).

Breakfast Cereals Carrying Fibre-Related Claims: Do They Have a Better Nutritional Composition Than Those without Such Claims? Results from the Food Labelling of Italian Products (FLIP) Study

Nutrition claims (NCs) on food packaging are, from one side, an informative tool about the nutritional characteristics of the product. From another side, they could bias the consumer in perceiving such products as healthier than those without claims. In order to investigate whether products with NCs have a better nutritional composition that those without claims, the present study aimed to compare the nutrition facts of 376 breakfast cereals, with and without fibre-related NCs, available in 13 Italian retailer online stores. Among these products, 73 items claimed to be a "source of fibre" and 109 "high in fibre". In addition to a higher fibre content, products "high in fibre" showed higher protein and fat contents but lower carbohydrate, sugar and salt contents compared to both "source of fibre" and without fibre-related NC items. Overall, a high variability in nutritional values was also observed within products with the same type of fibre-related NC. In conclusion, the results suggested that fibre-related NCs should not be considered as a marker of a better nutritional composition of breakfast cereals, and thus consumers should be educated to carefully read the entire nutritional information reported in the food labelling.

The impact of the nutri-score on food choice: A choice experiment in a Dutch supermarket

Front-of-package (FOP) nutrition labels are placed on products to help consumers make healthy food choices. A lab-in-field experiment was conducted to test the effectiveness of two FOP labels in promoting healthy food choices among Dutch consumers, and to examine whether dieters and health conscious shoppers are more likely to use the FOP labels. In addition, it was examined whether the placement of relatively "good" FOP label scores on products might inadvertently lead to increases in serving sizes. Participants (N = 300) consisted of Dutch consumers shopping for groceries in a local supermarket. They were randomly assigned to one of three conditions (Nutri-score, Multiple Traffic Light (MTL) label, or no label control condition), presented with six different (labeled) cereals, and asked to make a choice. Next, participants were shown a product with a relatively good label score and selected their desired serving size. The results show that the Nutri-score promotes choice of the healthiest cereal. Dieting behaviour and health conscious shopping did not moderate this effect, and the labels did not affect serving size selection. Overall, the study provides evidence for the Nutri-score to promote healthy food choices among Dutch consumers.

The effect of energy and fat content labeling on food consumption pattern: a systematic review and meta-analysis

CONTEXT

Consumption of high-energy food has increased globally, thereby leading to an increase in many diseases. One strategy for addressing this is to make people aware of their energy intake through energy and fat labels. However, the effectiveness of this remains debatable.

OBJECTIVE

This review aims to pool the mixed outcomes of recent studies assessing the effect of energy and fat content labeling on food consumption pattern.

DATA SOURCES

Google Scholar, MEDLINE, and Cochrane Library databases were searched. Randomized controlled and quasi-experimental controlled trials published from 2014 to 2019 were included.

DATA EXTRACTION

Two reviewers screened 413 abstracts independently. Qualitative and quantitative data was extracted from 10 articles; meta-analysis was carried out on 6 of those studies.

RESULTS

The majority of the included papers were conducted in the regions of America, the Western Pacific, and Europe. Overall, the 6 studies claimed that labeling did not reduce the consumption of energy or fat. However, meta-analysis showed that fat and energy content labeling of food had a statistically significant effect on consumption. Subgroup analysis showed no difference with respect to types of labels, ie, context labeling vs traffic-light labeling, but energy content labels seemed to be more effective than fat content labels in influencing healthy food choices.

CONCLUSION

Energy and fat content labeling were shown to reduce the consumption of each significantly. However, the outcome was influenced by the study setting and the population concerned. There is a need for research in other regions in order to assess the global effectiveness of nutrition labels on food consumption.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020172675.

Fatty Acids Quality in Middle Eastern Traditional Dishes, Arabic Sweets and Market Foods Frequently Consumed in Lebanon

The prevalence of diet-related non-communicable diseases is on the rise in the countries of the Eastern Mediterranean, including Lebanon. This study aimed to provide data on fatty acid profiles and ratios of Lebanese composite dishes, Arabic sweets, and market foods. Methods: Thirty types of traditional dishes, collected from five different Lebanese governorates, thirty-seven types of Arabic sweets and forty-six market food products were considered for analysis. Food samples were chemically analyzed for total, unsaturated and saturated fatty acids. The range of total fatty acids in composite dishes, Arabic sweets, and market food products was between 1.2-11.7 g/100 g, 5.3-25.8 g/100 g, and 0.5-100 g/100 g, respectively. Additionally, the range of saturated fatty acids in composite dishes, Arabic sweets, and market food products was between 0.5-4.9 g/100 g, 2.5-23.6 g/100 g and 0.1-56.4 g/100 g, respectively. Furthermore, about 75% of these foods were poor in unsaturated fatty acids. Regarding saturated fatty acid, the polyunsaturated to monounsaturated (P.M.S) ratio was lower than the recommended ratio of 1:1:1 in 96% of samples. To conclude, there is a need to prioritize fat content in foods and consider processing modifications in the food production system with the aim of achieving a higher P:M:S ratio intake among the population.

Nutrition Claims Frequency and Compliance in a Food Sample of the Spanish Market: The BADALI Study

Nutrition claims (NCs) have been shown to affect customers' perceptions and behaviour. In Europe, they are regulated by Regulation (EC) No 1924/2006. The aim of this work was to analyse the prevalence and compliance of NCs according to this regulation in Spain. For this purpose, we used the BADALI database, which included 3197 foods present in the Spanish market. Our results show that 36.1% of all foods carried NCs, at a rate of 3.3 NCs/food. The prevalence was very heterogeneous among food groups. Nuts and seeds, legumes and non-alcoholic beverages were the groups with the highest prevalence. Micronutrients, fat, fibre and sugars were the nutrients most referred to in NCs. Overall, the compliance was low, with 49.2% NCs correct. Fibre and proteins were the nutrients with most correct NCs. Vegetables and non-alcoholic beverages were the food groups with the highest proportion of correct NCs. The main reason for incorrect NCs was because the amount of the nutrient was not stated in the label. The results of our study reveal that the aim of the European Commission to ensure a high level of protection for consumers regarding NCs has not been fulfilled. Therefore, we consider it crucial that European institutions invest in guaranteeing regulation compliance.

Awareness of product-related information, health messages and warnings on alcohol packaging among adolescents: a cross-sectional survey in the United Kingdom

BACKGROUND

Alcohol packaging can be used to communicate product-related information, health messages and health warnings to consumers. We examined awareness and recall of such information and messaging among adolescents in the United Kingdom.

METHOD

A cross-sectional survey was conducted with 11-19 year olds in the United Kingdom (n = 3399), with participants asked if they had seen any information, health messages or warnings on alcohol packaging in the past month (Yes/No) and, if so, what they recalled. We also assessed higher-risk drinking among current drinkers (≥5 Alcohol Use Disorders Identification Test-Consumption) and susceptibility to consume among never-drinkers.

RESULTS

One-third (32%) of participants had seen information, health messages or warnings on alcohol packaging. Chi-Square tests showed awareness was greater for current drinkers than non-drinkers (46% vs. 19%; P < 0.001), higher-risk drinkers than lower-risk drinkers (55% vs. 39%; P < 0.001), and susceptible never-drinkers than non-susceptible never-drinkers (21% vs. 16%; P = 0.01). Ten messages were recalled, with drinking responsibly (18%) and not drinking during pregnancy (13%) most recalled.

CONCLUSION

Most young drinkers, including almost half of higher-risk drinkers, did not recall seeing any information, health messages or warnings on alcohol packaging in the past month, suggesting that current labelling is failing to reach this key audience.

Using Sensory Cues to Optimise the Satiety Value of a Reduced-Calorie Product Labelled 'Healthier Choice'

Reformulation strategies to reduce the energy density of commonly consumed foods and beverages are intended to support weight management, but expectations generated by labelling these as 'healthier' alternatives can have unintended effects on the product's sensory evaluations and consumption behaviours. We compared the impact of four different strategies for presenting a lower-calorie beverage to consumers on product perceptions, short-term appetite and energy intake. Participants (N = 112) consumed higher- (211 kcal/portion) and lower-calorie (98 kcal/portion) fixed-portion soymilks in the morning across two test days, with the lower-calorie version presented in one of four contexts varying in label information and sensory quality: (1) sensory-matched/unlabelled, (2) sensory-matched/labelled, (3) sensory-reduced (less sweet and creamy)/labelled, and (4) sensory-enhanced (sweeter and creamier)/labelled. The label was Singapore's Healthier Choice Symbol, which also highlighted that the soymilk was lower calorie. Changes in reported appetite, ad libitum lunch intake, and self-reported intake for the rest of the text day were recorded. Results indicated that total energy intake was consistently lower on the days the lower calorie beverages were consumed, regardless of how they were presented. However, the 'healthier choice' label increased hunger prior to lunch and reduced the soymilks' perceived thickness and sweetness compared to the same unlabelled version. Increasing the product's sensory intensity successfully maintained liking, experienced sensory quality and appetite. Results suggest that food companies wanting to explicitly label product reformulations could combine messages of 'lower calorie' and 'healthier choice' with appropriate taste and texture enhancements to maintain acceptance and avoid negative effects on appetite.

Systematic review of the impact of nutrition claims related to fat, sugar and energy content on food choices and energy intake

Background

As part of efforts to address high levels of overweight and obesity, the provision of nutrition information (e.g., through nutrition labels and nutrition claims) on food packages has increasingly become an important policy option. This study aimed to assess the influence of nutrition claims relating to fat, sugar, and energy content on product packaging on several aspects of food choices to understand how they contribute to the prevention of overweight and obesity.

Methods

A systematic literature review was conducted using the online databases EBSCOhost Global Health, EBSCOhost Medline, ScienceDirect, Scopus, PsycINFO and Embase. Studies were included if they measured the influence of nutrition claims relating to fat, sugar, and energy content on outcomes related to body weight, and were published between January 2003 and April 2018.

Results

Eleven studies were included in the review. Results showed that nutrition claims can influence the knowledge of consumers with respect to perceived healthfulness of products, as well as expected and experienced tastiness of food products – making food products with nutrition claims seem healthier and less tasty. Nutrition claims can make the appropriate portion size appear to be larger and lead to an underestimation of the energy content of food products. Nutrition claims can also influence food purchase intentions, moderated by the perceived healthfulness of the relevant food products and the health consciousness of individuals. Nutrition claims were also found to have an impact on food purchases, to influence ‘consumption guilt’ (i.e., feeling of guilt associated with eating), and to increase consumption, moderated by the weight status of individuals. These influences were shown to vary depending on the type of claim and food carrying the claim.

Conclusions

There is evidence that, while nutrition claims may lead some consumers to improve their nutrition knowledge and select healthier options, it may also lead consumers to increase food consumption and overall energy intake. This may run counter to efforts to address overweight and obesity.

A review of evidence supporting current strategies, challenges, and opportunities to reduce portion sizes

Although there is considerable evidence for the portion-size effect and its potential impact on health, much of this has not been successfully applied to help consumers reduce portion sizes. The objective of this review is to provide an update on the strength of evidence supporting strategies with potential to reduce portion sizes across individuals and eating contexts. Three levels of action are considered: food-level strategies (targeting commercial snack and meal portion sizes, packaging, food labels, tableware, and food sensory properties), individual-level strategies (targeting eating rate and bite size, portion norms, plate-cleaning tendencies, and cognitive processes), and population approaches (targeting the physical, social, and economic environment and health policy). Food- and individual-level strategies are associated with small to moderate effects; however, in isolation, none seem to have sufficient impact on food intake to reverse the portion-size effect and its consequences. Wider changes to the portion-size environment will be necessary to support individual- and food-level strategies leading to portion control.

[Effects of front-of-package nutritional labeling of food and beverages: synopsis of systematic reviewsEfeitos da rotulagem nutricional frontal de alimentos e bebidas: sumário de estudos de revisão sistemática]

Objetivos.

Sintetizar la información disponible sobre el efecto del etiquetado nutricional frontal en la elección, compra y consumo de alimentos y bebidas, y el estado nutricional de los consumidores, e identificar los factores que influyen en su efectividad.

Métodos.

Se realizó una sinopsis de revisiones sistemáticas (RS) conforme a las recomendaciones PRISMA. La búsqueda bibliográfica se realizó en Medline (Pubmed), The Cochrane Library, LILACS, EBSCOhost y Scopus, limitada a estudios publicados en español o inglés sin restricción por fecha de publicación. La calidad metodológica se evaluó utilizando la herramienta AMSTAR 2.

Resultados.

Se incluyeron siete RS. El etiquetado frontal facilitó la elección de alimentos saludables y tuvo un efecto variable sobre las dimensiones de consumo y compra. Ninguna RS evaluó el efecto sobre el estado nutricional. El costo y sabor, los hábitos alimentarios, el nivel educativo y los sistemas dominantes de procesamiento de información en el consumidor influyeron en su efectividad. La mayoría de RS mostraron limitaciones metodológicas y un nivel de confianza críticamente bajo.

Conclusiones.

El etiquetado frontal tuvo efecto positivo en la elección de alimentos saludables, con resultados variables en las dimensiones de compra y consumo. Se necesitan estudios locales con una adecuada calidad metodológica para identificar el formato de etiquetado más efectivo en cada país. Su implementación como política de salud pública debe acompañarse de estrategias para mejorar el acceso a alimentos saludables, promover la actividad física y brindar educación nutricional a los consumidores.

Potential moderators of the portion size effect

AIM

The robust effect of portion size on intake has led to growing interest in why individuals consume more food when served larger portions. A number of explanations have been proposed, and this review aims to provide insight into potential underlying factors by summarizing recent studies testing moderators of the portion size effect.

SUMMARY OF FINDINGS

Provision of portion size information, such as through labeling or training in portion control, failed to attenuate food intake in response to increasing meal size. This indicates that a lack of knowledge about appropriate portions may not be sufficient to explain the portion size effect. In contrast, there is evidence for a role of decision making in the response to large portions, with value being one consideration of importance. The portion size effect may be more closely related to the inherent value of food than monetary value, since provision of the opportunity to take away uneaten food after a meal, which can reduce food waste, attenuated the portion size effect but variations in pricing did not. A number of studies also support an influence of orosensory processing on the portion size effect; large portions have been shown to relate to increased bite size and faster eating rate. Reduced oral processing time when consuming large portions could contribute to the effect by delaying sensory-specific satiety. Findings from a recent study supported this by demonstrating that sensory-specific satiety did not differ between larger and smaller portions despite substantial differences in intake.

CONCLUSIONS

A number of moderators of the portion size effect have been identified, including factors related to the environment, the food, and the individual. It is likely that multiple variables contribute to the response to large portions. Future research should aim to determine the relative contribution of explanatory variables across different contexts and individuals.

Marketing Strategy, Serving Size, and Nutrition Information of Popular Children's Food Packages in Taiwan

A content analysis was used to investigate the marketing strategies, serving size, and nutrition quality in Taiwan popular children’s snacks and drinks. A total of 361 snacks and 246 drinks were collected. It was found that 38.6% of snacks and 25.3% of drinks were child-targeted (CT) foods, and 78.1% and 85.4% of the snacks and drinks had health and nutrition marketing (HNM). Serving size was significantly positively correlated to calories among different food categories in this study. Only the CT breads, ready-to-eat cereals, and fruit/vegetable juice had smaller serving sizes than did the corresponding non-CT products. These CT products had significantly fewer calories than did the corresponding non-CT products. Approximately 30% of snacks and 18% of drinks had both CT and HNM. Moreover, 82.7% of CT snacks and 100.0% of CT drinks with HNM were high in sugar. About 95% of foods with no added sugar claim were high sugar. CT foods are not necessarily healthier than non-CT foods, even the CT food with HNM. Health professionals should help parents assess the nutrition quality of the popular children’s foods. Further research was needed to investigate the effect of these marketing strategies and serving size on children’s food consumption.

Can front-of-pack labels influence portion size judgements for unhealthy foods?

OBJECTIVE

By clearly conveying the healthiness of a food, front-of-pack (FOP) labels have the potential to influence the portion size considered appropriate for consumption. The present study examined the how the Daily Intake Guide (DIG), Multiple Traffic Lights (MTL) and Health Star Rating (HSR) FOP labels affect judgements of appropriate portion sizes of unhealthy foods compared with when no FOP label is present.

DESIGN

Respondents viewed mock packages of unhealthy variations of pizzas, cookies, yoghurts and cornflakes featuring the DIG, MTL, HSR or no FOP label, and indicated the portion size they believed should be eaten of each food on a single occasion.

SETTING

The survey was completed on the respondent's personal computer.

SUBJECTS

A total of 1505 Australian adults provided 4166 ratings across 192 mock packages relating to four product categories: pizza, yoghurt, cornflakes and cookies.

RESULTS

Compared with no FOP label, the HSR resulted in a small but significant reduction in the portion size selected as appropriate for consumption of pizzas and cornflakes (P<0·05). The MTL resulted in smaller portions of cornflakes being selected compared with no FOP label (P<0·05).

CONCLUSIONS

Respondents perceived smaller portion sizes as appropriate for some, but not all, of the foods tested when FOP labels with more interpretative formats (HSR, MTL) appeared on-pack compared with no FOP label. No effect was found for the less interpretive FOP label (the DIG). Interpretive FOP labels may have the potential to influence portion size judgements, albeit at modest levels.