The Impact of Non-Fiscal Mandatory and Voluntary Policies and Interventions on the Reformulation of Food and Beverage Products: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Eligibility Criteria and Search Strategy
2.2. Quality Assessment
2.3. Data Extraction
2.4. Data Synthesis
3. Results
3.1. Study Selection
3.2. Study Descriptions
3.3. Vote Counting Results
3.4. Narrative Synthesis
3.5. Bias and Quality Assessment
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Primary Author, Year, Country | Design | Policy | Sector | Product | Nutrients | Overall Finding (Direction) | Study Quality |
---|---|---|---|---|---|---|---|
Mandatory | |||||||
Ale-Chilet (2022), Chile [39] | Pre-post | FOPL—WL; advertising | In + advertising | Cereal | Sugar, Calories, Sodium, SFA | Improvement | Low |
Barahona (2022), Chile [41] | Pre-post | FOPL—WL; advertising | In + advertising | Cereal | Sugar, Calories | Improvement | Low |
Bates (2020), US [42] | Cross-sectional | FOP—sodium health claims | In | Mixed processed food | Sodium | Improvement | Low |
Champion (2020), France [43] | Repeated cross-sectional | BOP nutrition label | In | Cereal | Fat, SFA, Sugars, Sodium, Fibre | Improvement | Low |
De Kock (2016), South Africa [44] | Repeated cross-sectional | Mandatory sodium limits | In | Stock cubes | Sodium | Improvement | Low |
Garsetti (2016), US [45] | Repeated cross-sectional | BOP trans-fat | In | Spreads | TFA | Improvement | Low |
Grummon (2021), US [46] | Pre-post | Menu labelling—calorie | OOH | Fast food | Calorie | Improvement | Low |
Jahn (2018), US [47] | Pre-post | School standards | In | Mixed processed food and beverages | Sodium, Energy, Total fat, SFA, Sugar, Fibre, Protein | Improvement | Low |
Martinovic (2020), France [48] | Repeated cross-sectional | BOP nutrition label | In | Sauces | Sugar, Calories, Sodium, SFA, protein | Improvement | Low |
Monge-Rojas (2017), Latin America [49] | Repeated cross-sectional | BOP TFA, TFA limits, prohibition of cooking method | Both | Mixed processed food | TFA | Improvement | Low |
Quintiliano (2020), Chile [50] | Pre-post | FOPL—WL; advertising | In + advertising | Mixed processed food | Sugar, Calories, Sodium, SFA, NNS | Improvement | Low |
Reyes (2020), Chile [51] | Repeated cross-sectional + pre-post | FOPL—WL; advertising | In + advertising | Mixed processed food and beverages | Sugar, Calories, Sodium, SFA | Improvement | Low |
Saavedra-Garcia (2022), Peru [52] | Pre-post | FOPL—WL | In | Mixed processed food | Sugar, Sodium, SFA, TFA, NNS | Improvement | Low |
Sisti (2023), US [53] | Pre-post | Menu warning—sodium | OOH | Fast food | Sodium | No change | Low |
Tran (2019), US [54] | Repeated cross-sectional | Menu labelling—calorie | OOH | Fast food | Calorie | Improvement | Low |
Wellard-Cole (2018), AUS [55] | Longitudinal observational | Menu labelling—calorie | OOH | Mixed processed food and beverages | Calorie | No change | Low |
Zancheta (2021), Chile [56] | Pre-post | FOPL—WL; advertising | In + advertising | Mixed processed food and beverages | Sugar, NNS | Improvement | Low |
Voluntary | |||||||
Arcand (2014), Canada [57] | Repeated cross-sectional | Government set nutrient reduction targets | Both | Fast food | TFA | Improvement | Low |
Bablani (2020), AUS + NZ [58] | Difference-in-differences | FOPL—HSR | In | Mixed processed food | Calories, sugars, SFA, Sodium, Protein, Fibre | Improvement | Moderate |
Bandy (2022), UK [59] | Repeated cross-sectional | Government set nutrient reduction targets | In | Mixed processed food | Sodium | Improvement | Low |
Bernstein (2020), Canada [60] | Longitudinal observational | BOP sugar labelling (transition period) | In | Mixed processed food and beverages | Calories, Sugars, SFA, Fat, Sodium, Protein, Fibre | Improvement | Low |
Brants (2017), The Netherlands [61] | Repeated cross-sectional | Government set nutrient reduction targets | In | Mixed processed food | Sodium, Sugar, SFA | Improvement | Low |
Christoforou (2013), AUS [62] | Repeated cross-sectional | NGO led reduction targets | In | Mixed processed food | Sodium | Improvement | Low |
Clapp (2018), US [63] | Pre-post | Government set nutrient reduction targets | In | Mixed processed food | Sodium, Calories | Improvement | Low |
Curtis (2016), US [64] | Repeated cross-sectional | Government set nutrient reduction targets | In | Mixed processed food | Sodium | Improvement | Low |
Eyles (2013), UK [65] | Repeated cross-sectional | Government set nutrient reduction targets | In | Mixed processed food | Sodium | Improvement | Low |
Eyles (2018), NZ [66] | Repeated cross-sectional | Government initiated industry pledges; FOPL—HSR | Both | Fast food | Calories, Sodium | Improvement | Low |
Fichera (2020), UK [67] | Difference-in-differences | FOPL—MTL | Both | Bread | Sodium | Improvement | Moderate |
Garcia (2020), UK, Mexico, Ecuador, and Guatemala [68] | Cross-sectional | Government set nutrient reduction targets | In | Mixed processed food | Calories, Sodium, SFA, Sugar | Improvement | Low |
Gressier (2021), UK [69] | Repeated cross-sectional | Government set nutrient reduction targets | In | Cereal + yogurt | Sugar | Improvement | Low |
Hashem (2019), UK [70] | Repeated cross-sectional | Government set nutrient reduction targets | In | Chocolate | Sugar | Worsened | Low |
He (2014), UK [71] | Repeated cross-sectional | Government set nutrient reduction targets | In | Mixed processed food and beverages | Sodium | Improvement | Low |
Health Canada (2018), Canada [72] | Pre-post | Government set nutrient reduction targets | In | Mixed processed food | Sodium | Improvement | Very low |
Jensen (2017), Denmark [73] | Longitudinal observational | Retailer led reformulation strategy | In | Mixed processed food | Sodium | Mixed | Low |
Kanter (2019), Chile [74] | Pre-post | FOPL—WL; advertising | In | Mixed processed food | Calories | Improvement | Low |
Levi (2018), AUS [75] | Repeated cross-sectional | Government set nutrient reduction targets | In + advertising | Mixed processed food and beverages | Calories, Sodium, SFA, Sugar | No change | Low |
Lowery (2020), Colombia [76] | Pre-post | Industry advertising and product pledges | In | Soup | Sodium | Improvement | Low |
Luger (2018), Austria [77] | Repeated cross-sectional | NGO led reduction targets | Both | Mixed processed food | Total fat, SFA, TFA, Sodium, Sugar, Energy Density, NNS | Improvement | Low |
McMenemy (2022), Ireland [78] | Repeated cross-sectional | Industry led reformulation strategy | Both | SSB | Sugar | Improvement | Low |
Ni Mhurchu (2017), NZ [79] | Repeated cross-sectional | FOPL—HSR | In | Mixed processed food | Energy, Protein, Total Fat, Carbohydrate, SFA, Sodium, Sugar, Fibre, Vitamin D/B12, Calcium, Iron | Mixed | Low |
Moore (2020), UK [80] | Repeated cross-sectional | Government set nutrient reduction targets | In | Mixed processed food and beverages | Energy, SFA, Sugar, Sodium, Protein, Fibre | Improvement | Low |
Moran (2022), US [81] | Repeated cross-sectional | Government set nutrient reduction targets | In | Yogurt | Sugar | Improvement | Low |
Morrison (2019), AUS [82] | Repeated cross-sectional | FOPL—HSR | In | Mixed processed food | Sodium | Improvement | Low |
Nilson (2017), Brazil [83] | Repeated cross-sectional | Government set nutrient reduction targets | In | Mixed processed food | Energy, SFA, Sugar, Sodium, Protein, Fibre | Improvement | Low |
Nilson (2017), Brazil [84] | Repeated cross-sectional | Government set nutrient reduction targets | In | Mixed processed food | Sodium | Improvement | Low |
Ning (2017), NZ [85] | Repeated cross-sectional | FOPL—Heart Tick | In | Mixed processed food | Sodium | Improvement | Low |
Park (2020), South Korea [86] | Repeated cross-sectional | Government set nutrient reduction targets | In | Mixed processed food | Sodium | Improvement | Low |
Pérez-Farinós (2016), Spain [87] | Repeated cross-sectional | Government set nutrient reduction targets | Both | Mixed processed food | Sodium | Improvement | Low |
Pérez-Farinós (2018), Spain [88] | Repeated cross-sectional | Government initiated industry pledges | In | Mixed processed food | TFA | Improvement | Low |
Pinho-Gomes (2023), AUS [89] | Repeated cross-sectional | Industry nutrient reduction pledges | In | Beverages | Sugar, NNS | No change | Low |
Pombo-Rodrigues (2017), UK [90] | Repeated cross-sectional | Government set nutrient reduction targets | In | Cereal | Sodium, Sugar | Improvement | Low |
Pravst (2017), Slovenia [91] | Repeated cross-sectional | Government set nutrient reduction targets | In | Mixed processed food | Sodium | Mixed | Low |
Russell (2021), AUS [92] | Repeated cross-sectional | FOPL—HSR | In | Mixed processed food and beverage | Sugar, NNS | Worsened | Low |
Savio (2013), AUS [93] | Pre-post | Government initiated industry pledges; FOPL—Heart Tick | In | Mixed processed food and beverage | Energy, Protein, Total Fat, SFA, Sugar, Fibre, Sodium | Improvement | Low |
Sparks (2018), AUS [94] | Repeated cross-sectional | Government initiated industry pledges | In | Processed meat | Sodium | Improvement | Low |
Spiteri (2018), France [95] | Repeated cross-sectional | Government set nutrient reduction targets | In | Grocery basket | Sugar, fats, SFA, fibre, sodium | Improvement | Low |
Spiteri (2018), AUS [96] | Cross-sectional | Industry nutrient reduction pledges | In | Mixed processed food and beverage | Energy, Protein, SFA, Carbohydrates, Sugar, Fibre, Sodium | Worsened | Low |
Tan (2019), UK + China [97] | Repeated cross-sectional | Government set nutrient reduction targets | In | Sauces | Sodium | Improvement | Low |
Tassy (2022), Global [98] | Repeated cross-sectional | WHO set nutrient reduction targets | In | Mixed processed food | Sugar, Sodium, SFA, Protein | Improvement | Very Low |
Theis (2019), UK [99] | Cross-sectional | Menu labelling | OOH | Fast food | Energy, Fat, SFA, Sugar, Sodium Carbohydrates, Protein | Improvement | Low |
Thomson (2016), NZ [100] | Repeated cross-sectional | FOPL—Heart Tick | In | Mixed processed food | Energy, TFA, SFA, Sodium, Calcium, Fibre | Improvement | Low |
Trevena (2014), AUS [101] | Repeated cross-sectional | Government set nutrient reduction targets | In | Mixed processed food | Sodium | Improvement | Low |
Trevena (2015), AUS [102] | Repeated cross-sectional | Government set nutrient reduction targets | In | Mixed processed food | Sodium | Improvement | Low |
Van Dam (2022), France [103] | Cross-sectional | Government set industry commitments AND FOPL—N-S | Both | Processed food and fast food | Overall product healthiness | No change | Low |
Van Der Bend (2020), The Netherlands [104] | Repeated cross-sectional | FOPL—Healthy Choices | In | Mixed processed food | Energy, TFA, SFA, Sodium, Fibre, Sugar | Improvement | Low |
Vergeer (2022), Canada [105] | Repeated cross-sectional | Industry nutrient reduction pledges | In | Mixed processed food and beverages | Calories, Sodium, SFA, TFA, Sugar | Mixed | Low |
Vermote (2020), Belgium [106] | Repeated cross-sectional | FOPL—N-S | In | Cereal | Calories, Sodium, SFA, Fat, Sugar, Fibre, Protein | Improvement | Low |
Vlassopoulos (2017), US + France [107] | Repeated cross-sectional | Industry nutrient reduction pledges | In | Mixed processed food and beverages | Calories, Sodium, SFA, Fat, Sugar | Improvement | Very low |
Yon (2014), US [108] | Pre-post | Industry led reformulation strategy | In | Milk | Sugar, Calories, Fat, Sugar | Improvement | Low |
Zupanič (2019), Slovenia [109] | Repeated cross-sectional | Government initiated industry pledges | In | Mixed processed food and beverage | Sugar | Mixed | Low |
Both | |||||||
Hooker (2014), US + Canada [110] | Repeated cross-sectional | Government set nutrient reduction targets (voluntary); BOP TFA & Mandatory FOP claims | In | Cookies | TFA | Improvement | Low |
Moz-Christofoletti (2021), 22 EU countries [111] | Repeated cross-sectional | Government set nutrient reduction targets; Mandatory ban on added sugars in juice & TFA content | In | Mixed processed food and beverage | Sugar, TFA, Salt, SFA | Mixed | Low |
Otite (2013), US [112] | Longitudinal observational | Retailer led reformulation strategy; Mandatory FOP claims | In | Mixed processed food | TFA | Improvement | Low |
Temme (2017), The Netherlands [113] | Repeated cross-sectional | Industry nutrient reduction pledges; Mandatory limits on salt in bread | In | Mixed processed food | Sodium | Improvement | Low |
Urban (2014), US [114] | Longitudinal observational | Government set nutrient reduction targets; Cooking regulations | OOH | Fast food | Sodium, SFA, TFA | Improvement | Low |
Wellard-Cole (2019), AUS [115] | Repeated cross-sectional | Menu calorie labelling; Industry advertising standards | OOH + advertising | Fast food | Sugar, Calories, Sodium, SFA | No change | Low |
Zganiacz (2017), AUS [116] | Repeated cross-sectional | BOP nutrition label; FOPL—Heart Tick; NGO reduction targets; Government set reduction targets | In | Mixed processed food | Sodium | Improvement | Low |
Intervention Type | Examples from Included Studies |
---|---|
Reduction targets | UK Sugar Reduction Programme; UK Salt Reduction Targets: Sugar Reduction Pledge by Australian Beverages Council |
Front of pack labels or claims | Chilean Warning Label; Australia-New Zealand Health Star Rating; UK Multiple Traffic Light |
Advertising standards | Chilean regulation relating to the advertising restrictions for any products classified as high in sugar, salt, saturated fat, or energy; “Responsible self-regulation” agreement to limit advertising and sales of unhealthy beverages in schools |
Back of pack nutrition information | Nutrient declarations on products and the inclusion of trans-fatty acid content |
Mandatory nutrient limits | Upper limit for trans-fatty acid content |
Prohibition of cooking methods | Banning the use of partially hydrogenated oil |
Menu labelling | Voluntary menu labelling of nutrients in restaurants |
Industry-led reformulation strategies | “Responsible self-regulation” agreement to limit advertising and sales of unhealthy beverages in schools |
School standards | Nutrition standards for snacks sold at school |
Implementation & Intervention Type (n = 77) | Improvement | Worsening | Mixed | No Change |
---|---|---|---|---|
Mandatory (n = 17) | ||||
Multi-pronged interventions * (n = 6) | 6 (100%) | - | - | - |
Front of pack labels or health claims (n = 2) | 2 (100%) | - | - | - |
Menu labelling (n = 4) | 2 (50%) | - | - | 2 (50%) |
Mandatory nutrient declaration (n = 3) | 3 (100%) | - | - | - |
School standards (n = 1) | 1 (100%) | - | - | - |
Mandatory limits (n = 1) | 1 (100%) | - | - | - |
Overall | 15 (88%) | - | - | 2 (12%) |
Voluntary (n = 53) | ||||
Government-set reduction targets (n = 27) | 22 (81%) | 1 (4%) | 3 (12%) | 1 (4%) |
Front of pack labels or health claims (n = 9) | 7 (78%) | 1 (11%) | 1 (11%) | - |
Industry–set reduction targets (n = 4) | 1 (25%) | 1 (25%) | 2 (50%) | - |
NGO/WHO reduction targets (n = 3) | 3 (100% | - | - | - |
Industry/retailer-led strategies (n = 3) | 2 (67%) | - | 1 (33%) | - |
Advertising standards (n = 1) | 1 (100%) | - | - | - |
Nutrient declaration (n = 1) | 1 (100%) | - | - | - |
Menu labelling (n = 1) | 1 (100%) | - | - | - |
Multi-pronged interventions ** (n = 4) | 3 (75%) | - | - | 1 (25%) |
Overall | 42 (79%) | 3 (6%) | 5 (9%) | 3 (6%) |
Both (n = 7) | ||||
Multi-pronged interventions *** (n = 7) | 5 (71%) | - | 1 (14%) | 1 (14%) |
Outcome Category | Improvement | Worsening | Mixed Results | No Change |
---|---|---|---|---|
Sector (n = 77) | ||||
In-home (n = 56) | 46 (82%) | 3 (5%) | 6 (11%) | 1 (2%) |
Out-of-home (n = 6) | 4 (67%) | - | - | 2 (33%) |
Mixed (n = 15) | 12 (80%) | - | - | 3 (20%) |
Nutrient (n = 166) | ||||
Sodium (n = 56) | 42 (75%) | 1 (2%) | 6 (11%) | 7 (13%) |
Sugar (n = 38) | 22 (58%) | 3 (8%) | 4 (11%) | 9 (24%) |
Energy (n = 30) | 15 (50%) | 1 (3%) | 2 (7%) | 12 (40%) |
Saturated fat (n = 29) | 14 (48%) | 1 (3%) | 3 (10%) | 11 (38%) |
Trans-fatty acids (n = 13) | 9 (69%) | - | 2 (15%) | 2 (15%) |
Product type (n = 77) | ||||
Mixed packaged * (n = 50) | 40 (80%) | 2 (4%) | 6 (12%) | 2 (4%) |
Breakfast cereals (n = 5) | 5 (100%) | - | - | - |
Fast food (n = 5) | 3 (60%) | - | - | 2 (40%) |
Ready meals (n = 5) | 4 (80%) | - | - | 1 (20%) |
Condiments/sauces (n = 4) | 4 (100%) | - | - | - |
Beverages (n = 3) | 2 (67%) | - | - | 1 (33%) |
Morning goods * (n = 3) | 3 (100%) | - | - | - |
Yoghurts (n = 1) | 1 (100%) | - | - | - |
Chocolate (n = 1) | - | 1 (100%) | - |
Study Findings (n = 77) | n | % | Significant |
---|---|---|---|
Improvements in nutritional quality | 62 | 81 (%) | 46 |
Decreases in unhealthy nutrients | 57 | ||
Decreases in unhealthy nutrients and increases in healthy nutrients | 5 | ||
Worsening in nutritional quality | 3 | (4%) | 2 |
Increases in unhealthy nutrients | 3 | ||
Decreases in healthy nutrients | 0 | ||
Studies that observed no-significant changes | 6 | (8%) | |
Studies that observed mixed changes | 6 | (8%) |
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Packer, J.; Michalopoulou, S.; Cruz, J.; Dhar, D.; Stansfield, C.; Kaczmarska, H.; Viner, R.M.; Mytton, O.; Russell, S.J. The Impact of Non-Fiscal Mandatory and Voluntary Policies and Interventions on the Reformulation of Food and Beverage Products: A Systematic Review. Nutrients 2024, 16, 3484. https://doi.org/10.3390/nu16203484
Packer J, Michalopoulou S, Cruz J, Dhar D, Stansfield C, Kaczmarska H, Viner RM, Mytton O, Russell SJ. The Impact of Non-Fiscal Mandatory and Voluntary Policies and Interventions on the Reformulation of Food and Beverage Products: A Systematic Review. Nutrients. 2024; 16(20):3484. https://doi.org/10.3390/nu16203484
Chicago/Turabian StylePacker, Jessica, Semina Michalopoulou, Joana Cruz, Disha Dhar, Claire Stansfield, Helena Kaczmarska, Russell M. Viner, Oliver Mytton, and Simon J. Russell. 2024. "The Impact of Non-Fiscal Mandatory and Voluntary Policies and Interventions on the Reformulation of Food and Beverage Products: A Systematic Review" Nutrients 16, no. 20: 3484. https://doi.org/10.3390/nu16203484