Reducing harmful consumption of food (including non-alcoholic drinks) and alcoholic drinks would prevent much disease. Evidence from tobacco control shows that placing health warning labels (HWLs) on these products reduces their selection and consumption. A systematic review with meta-analysis was conducted using Cochrane methods to assess the impact on selection (including hypothetical selection) or consumption of food or alcoholic drinks with image-and-text (sometimes termed ‘pictorial’) and text-only HWLs placed on these products. Studies were required to be randomised or quasi-randomised controlled trials. Fourteen studies were included, three on alcohol, eleven on food. For our primary outcomes, eleven studies measured selection and one measured consumption (two measured only other secondary outcomes). Meta-analysis of twelve comparisons from nine studies (n=12,635) found HWLs reduced selection of the targeted product compared to a control group with no HWL (RR=0.74 (95% CI 0.68 to 0.80)), with participants 26% less likely to choose a product displaying a HWL. A planned subgroup analysis suggested a larger effect on selection of image-and-text HWLs (RR=0.65 (95% CI 0.54 to 0.80)) than text-only HWLs (RR=0.79 (95% CI 0.74 to 0.85)), but this difference was not statistically significant. These findings suggest significant potential for HWLs to reduce selection of food and alcohol, but all experimental studies to date were conducted in laboratory or online settings with outcomes assessed immediately after a single exposure. Studies in field and more naturalistic laboratory settings are urgently needed to estimate the potential effects of HWLs on food and alcohol.

Study registration : PROSPERO 2018 (registration number: CRD42018106522).

减少有害食物（包括非酒精饮料）和酒精饮料的消费可以预防许多疾病。烟草控制的证据表明，在这些产品上贴上健康警示标签 (HWL) 会减少它们的选择和消费。使用 Cochrane 方法进行了系统综述和荟萃分析，以评估对食物或酒精饮料的选择（包括假设选择）或消费的影响，其中包含图像和文本（有时称为“图画”）和纯文本 HWL。这些产品。研究必须是随机或半随机对照试验。纳入了十四项研究，其中三项关于酒精，十一项关于食物。对于我们的主要结果，十一项研究测量了选择，一项研究测量了消费（两项仅测量了其他次要结果）。对 9 项研究 (n=12,635) 的 12 项比较进行荟萃分析发现，与没有 HWL 的对照组相比，HWL 减少了目标产品的选择 (RR=0.74 (95% CI 0.68 至 0.80))，参与者的可能性降低了 26%选择显示 HWL 的产品。计划的亚组分析表明，图像和文本 HWL（RR=0.65（95% CI 0.54 至 0.80））的选择对纯文本 HWL（RR=0.79（95% CI 0.74 至 0.85））的影响更大，但是这种差异没有统计学意义。这些发现表明 HWL 具有减少食物和酒精选择的巨大潜力，但迄今为止所有实验研究都是在实验室或在线环境中进行的，在单次接触后立即评估结果。迫切需要在现场和更自然的实验室环境中进行研究，以估计 HWL 对食品和酒精的潜在影响。

研究注册： PROSPERO 2018（注册号：CRD42018106522）。