摘要：We conducted a systematic review and meta-analysis evaluating the relationship between menu calorie labeling and calories ordered or purchased in the PubMed, Web of Science, PolicyFile, and PAIS International databases through October 2013. Among 19 studies, menu calorie labeling was associated with a −18.13 kilocalorie reduction ordered per meal with significant heterogeneity across studies (95% confidence interval = −33.56, −2.70; P = .021; I 2 = 61.0%). However, among 6 controlled studies in restaurant settings, labeling was associated with a nonsignificant −7.63 kilocalorie reduction (95% confidence interval = −21.02, 5.76; P = .264; I 2 = 9.8%). Although current evidence does not support a significant impact on calories ordered, menu calorie labeling is a relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories. These findings are limited by significant heterogeneity among nonrestaurant studies and few studies conducted in restaurant settings. Consumption of fast food and food away from home has increased in the United States in recent decades. 1,2 In 2007–2008, fast-food and full-service restaurants accounted for an estimated 275 kilocalories (kcal) per day among children aged 2 to 11 years, 564 kcal per day among adolescents aged 12 to 19 years, and 599 kcal per day among adults aged 20 to 64 years, or 14% of total energy intake for children and 24% for adolescents and adults. 2 Furthermore, the consumption of fast food and food away from home has been associated with lower diet quality, greater energy intake, and higher body weight, making foods consumed away from home a possible target to counter the current obesity crisis. 3–5 Beginning in 2005, the Institute of Medicine recommended posting calorie content on menus and menu boards in restaurants (hereafter “menu calorie labeling”) as a strategy to address the US obesity epidemic. 6,7 Menu labeling proposals have been supported by the argument that consumers have a right to calorie information to allow them to make healthier choices in the context of the ongoing obesity epidemic. 8 Without labeling, consumers regularly underestimate the caloric content of restaurant meals. 8 Parallel evidence from nutrition labeling on packaged foods suggests that at least some consumers make healthier food choices when nutrition information is available at the point of purchase. 9 By 2009, 4 states and a number of counties and cities around the country, including New York City, had passed menu calorie labeling legislation. 9 Concerned with the difficulty of compliance with a range of local regulations, the National Restaurant Association supported a national menu calorie labeling law that would preempt local regulations. In 2010, the Patient Protection and Affordable Care Act of 2010 required menu calorie labeling by chain restaurants. To implement the menu calorie labeling law, in December 2014, the US Food and Drug Administration released final regulations requiring calorie labels and a suggested daily total calorie intake (hereafter “daily anchor statement”) on all menus and menu boards for restaurants and similar establishments with 20 or more locations. 10 The impact of menu labeling on food choices in cafeterias and restaurants was evaluated in 3 previous systematic reviews. 11–13 The previous narrative reviews did not provide a quantitative estimate of the potential population-level impact that this relatively low-cost and broad-reaching policy intervention may have. Pooling data across studies with small sample sizes would increase the statistical power to detect a small, but meaningful, association between menu labeling and population-level purchasing behaviors. Sinclair et al. recently reported the results of a systematic review and meta-analysis of calorie and other types of restaurant menu labeling, but included a broader definition of menu labeling not relevant to current regulations in the United States and did not quantitatively summarize the impact of menu calorie labeling in restaurant settings, which is the primary focus of the current review. 14 We conducted the current systematic review and meta-analysis as part of the Childhood Obesity Intervention Cost Effectiveness Study project, which is evaluating a range of policy and programmatic interventions to reduce obesity in the United States. The objective of this review is to provide the evidence needed to quantitatively evaluate the potential impact of the national menu calorie labeling regulations proposed in the Affordable Care Act. The regulations promulgated by the Food and Drug Administration will require menu calorie labeling and a suggested daily anchor statement for restaurants with 20 or more locations. In this review, we evaluated the impact of menu calorie labeling with or without a daily anchor statement compared with menus without calorie labeling on calories ordered, purchased, or consumed during the meal as well as impact on total daily energy intake or weight or body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) or BMI z score among adults and children of any age from experimental and quasi-experimental studies.
