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, and P curve analyses were also performed. Where appropriate, pooling was conducted using combining P values 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 of P values 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.

中文翻译：

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食品和非酒精饮料营销与儿童和青少年饮食行为与健康的关联：系统评价和荟萃分析。

重要性 人们普遍关注食品营销对儿童的影响；然而，全面的全球证据审查现在已经过时了。目的 量化食品和非酒精饮料营销与儿童和青少年行为和健康结果的关联，为更新的世界卫生组织指南提供信息。数据源 检索了 22 个数据库（包括 MEDLINE、CINAHL、Web of Science、Embase 和 Cochrane 图书馆），出版日期限制为 2009 年 1 月至 2020 年 3 月。系统评价和元分析报告的研究选择首选报告项目遵循了指导方针。纳入标准是评估食品营销与儿童和青少年（0-19 岁）特定结果之间关系的主要研究。排除标准是定性研究或婴儿配方奶粉广告。在确定的 31 063 篇文章中，96 篇文章符合纳入系统评价的条件，80 篇文章符合荟萃分析（19 372 名参与者）。数据提取与综合 两名评审员独立提取数据。随机效应模型用于荟萃分析；还进行了元回归、敏感性分析和 P 曲线分析。在适当的情况下，使用结合 P 值和按效果方向计票进行合并。推荐评估、开发和评估的分级用于判断证据的确定性。主要结果和措施 关键结果是摄入、选择、偏好和购买。重要结果是购买请求、龋齿、体重、和饮食相关的非传染性疾病。结果 纳入的 80 篇文章共有 19 372 名参与者。食品营销与摄入量显着增加相关（标准化平均差 [S​​MD]，0.25；95% CI，0.15-0.35；P < .001），选择（优势比，1.77；95% CI，1.26-2.50；P < .001）和偏好（SMD，0.30；95% CI，0.12-0.49；P = .001）。敏感性或调节性分析无法解释大量异质性（均>76%）。购买请求的 P 值的组合是显着的，但没有发现明确的证据表明营销与购买之间存在关联。关于牙齿健康和体重结果的数据很少。证据的确定性在摄入和选择方面被评为非常低到中等，在偏好和购买方面非常低。结论和相关性 在这项系统评价和荟萃分析中，食品营销与儿童和青少年的摄入量、选择、偏好和购买请求增加有关。实施限制儿童接触的政策有望有益于儿童健康。