Association of Food and Nonalcoholic Beverage Marketing With Children and Adolescents’ Eating Behaviors and Health

Importance

There is widespread interest in the effect of food marketing on children; however, the comprehensive global evidence reviews are now dated.

Objective

To quantify the association of food and nonalcoholic beverage marketing with behavioral and health outcomes in children and adolescents to inform updated World Health Organization guidelines.

Data Sources

Twenty-two databases were searched (including MEDLINE, CINAHL, Web of Science, Embase, and The Cochrane Library) with a publication date limit from January 2009 through March 2020.

Study Selection

Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Inclusion criteria were primary studies assessing the association of food marketing with specified outcomes in children and adolescents (aged 0-19 years). Exclusion criteria were qualitative studies or those on advertising of infant formula. Of 31 063 articles identified, 96 articles were eligible for inclusion in the systematic review, and 80 articles in the meta-analysis (19 372 participants).

Data Extraction and Synthesis

Two reviewers independently extracted data. Random-effects models were used for meta-analyses; meta-regressions, sensitivity analyses, andPcurve analyses were also performed. Where appropriate, pooling was conducted using combiningPvalues and vote counting by direction of effect. Grading of Recommendations Assessment, Development, and Evaluation was used to judge certainty of evidence.

Main Outcomes and Measures

Critical outcomes were intake, choice, preference, and purchasing. Important outcomes were purchase requests, dental caries, body weight, and diet-related noncommunicable diseases.

Results

Participants totaled 19 372 from 80 included articles. Food marketing was associated with significant increases in intake (standardized mean difference [SMD], 0.25; 95% CI, 0.15-0.35;P < .001), choice (odds ratio, 1.77; 95% CI, 1.26-2.50;P < .001), and preference (SMD, 0.30; 95% CI, 0.12-0.49;P = .001). Substantial heterogeneity (all >76%) was unexplained by sensitivity or moderator analyses. The combination ofPvalues for purchase requests was significant but no clear evidence was found for an association of marketing with purchasing. Data on dental health and body weight outcomes were scarce. The certainty of evidence was graded as very low to moderate for intake and choice, and very low for preference and purchasing.

Conclusions and Relevance

In this systematic review and meta-analysis, food marketing was associated with increased intake, choice, preference, and purchase requests in children and adolescents. Implementation of policies to restrict children’s exposure is expected to benefit child health.