Front-of-Package Nutrition Labeling for Foods and Beverages Marketed to Children: Behavioral, Nutritional, and Cognitive-Affective Outcomes and Methodological Quality-A Systematic Review.

Front-of-package labeling (FOPL) is increasingly used to support healthier food choices, but its role in early childhood, where decisions are largely caregiver-mediated, remains uncertain. This systematic review assessed the methodological quality and certainty of evidence on FOPL for foods and beverages marketed to children and synthesized behavioral, nutritional, and cognitive-affective outcomes among children and caregivers. Following PRISMA 2020, five bibliographic databases and BASE were searched through July 2025. Risk of bias was assessed using JBI tools, and certainty was evaluated using GRADE and GRADE-CERQual. Thirty-nine studies were included: 18 RCTs, five quasi-experimental studies, six cross-sectional studies, and 10 qualitative studies. Evidence most consistently supported effects on perceived healthfulness, purchase intention, and, in some comparisons, product selection and purchase. Warning labels showed the clearest directional pattern, particularly for discouraging selection or intended purchase of less healthy products, but evidence varied by outcome and comparator. Nutritional outcomes were more heterogeneous and generally of low or very low certainty. Educational components tended to favor FOPL conditions in direction-of-effect summaries, but the evidence was of very low certainty and insufficient to establish a reliable incremental benefit. Qualitative findings indicated that FOPL can function as a simple heuristic for caregivers, although use is shaped by comprehension, trust, context, and everyday constraints. Overall, FOPL may support early stages of caregiver-mediated decision-making, but sustained nutritional impact remains uncertain. The absence of a universally superior format argues against one-size-fits-all labeling; policies should prioritize interpretive clarity and contextual fit and support longitudinal, real-world evaluations.