International Journal of Community Medicine and Public Health

Anitha MC et al. Int J Community Med Public Health. 2017 Sep;4(9):3461-3467

http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20173862
Original Research Article

An outlook on nutrition and food labelling among selected school

children aged 10-12 years in Coimbatore city
Anitha M. C.*, Anusuya Devi K.

Department of Nutrition and Dietetics, P.S.G College of Arts and Science, Coimbatore, Tamil Nadu, India

Received: 25 July 2017

Revised: 09 August 2017
Accepted: 10 August 2017

*Correspondence:
Anitha M. C.,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Use of nutritional labels in choosing food is associated with healthier eating habits including lower fat
intake. Current public health efforts have focused on the revamping of nutritional labels to make them easier to read
and use for the consumer. The objective of this study is to assess the frequency of use of nutritional labels and find
out the awareness of nutrition labels.
Methods: The study was designed to find the awareness among 1409 school children constituting both boys and girls
from various boards like Government, Government aided, Matriculation and CBSE schools aged 10-12 years in
Sundrapuram, Coimbatore city. The structured and validated questionnaire on basic information like Personal
Information, socio-economic information, anthropometry and frequency and awareness nutrition labelling was made
by asking dichotomous questions.
Results: Many children who belong to low-income do not regularly use the nutrition facts panel information.
Conclusions: The study took initiative in creating knowledge through demonstration on facts about Nutrition
Labeling.

Keywords: Nutrition labels, Healthier eating habits, Awareness, Nutrition facts

INTRODUCTION as candy and bakery goods), and packaged foods

(convenience or shelf stable foods, which are ready to eat
India has the largest adolescent population in the world or need minimal processing, and which come in packaged
and is home to over 20% of the world's adolescents. form) has been increasing in India at a rapid pace, and
These 10- to 19-year-olds constitute 243 million of more so among adolescents and children in urban areas.6,7
India's 1.2 billion population.1 About 10% to 15% of According to Food Safety and Standards Authority of
adolescents in urban areas in India are overweight or India (FSSAI), 2011, nutrition information on NFP shall
obese.2-4 The reported rates of overweight and obesity be given as “per 100 gm” or “100 ml” or “per serving” of
among affluent school-going adolescents were 17.6% and the product on the label. On the other hand US Food and
5%, respectively.5 Although there are many reasons for Drugs Administration (USFDA) mandates that NFP
an increase in the prevalence of obesity, frequent should report nutrients in "amount per serving" and "%
consumption of unhealthy processed foods is an Daily Value", with footnote and caloric conversion
important risk factor. Consumption of nontraditional fast information.8 The purpose of this research was to assess
foods (such as pizza and burgers), processed foods (such the frequency of nutrition label usage among school

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 Anitha MC et al. Int J Community Med Public Health. 2017 Sep;4(9):3461-3467

children and determine if label users differed from non- B. Anthropometry

users in terms of their knowledge of nutrition labels and
basic nutrition information, attitudes toward nutrition i) Height
labels, and beliefs about diet-disease relationships.
A stadiometer was used to measure the height of the
METHODS children. The children were made to stand erect without
shoes on a flat floor by the scale with heels together and
Selection of population toes apart. The head was comfortably held erect and the
arms were relaxed and held in a natural manner. The head
The author contacted 11 Government schools piece of the stadiometer was lowered slowly and was
(Government and Government aided) and 8 non- placed in the sagital plane over the head of the child
government schools (Matriculation and CBSE). applying a slight pressure to reduce the thickness of hair
Government schools are run by government where the fee and make contact with the top of the head. Using this
ranged from Rs.1000-2000/year, whereas the selected technique, the height of the children was measured to the
non-government school collected a fee of Rs. 30,000- nearest 0.1 cm accuracy.10
50,000/year. Permission was granted and data collection
was done among 6 government and 5 non-government ii) Weight
schools respectively. Consenting male and female
students of class 5- 7 were included in the study. Body weight is the most widely used and the simplest
reproducible anthropometric measurement for the
Selection of sample evaluation of nutritional status of young children. Body
weight of all the children was measured using a digital
Our sample size was 1409 school children. Gender weighing balance. The balance was validated using
differences were not considered in our calculation. known weight for every 5 readings. The children were
made to stand erect with minimum clothing and barefoot.
However, we collected data from all consenting students
The weight was noted to the nearest 0.1 kg.10
from within the selected grades and schools. Duration of
Study was about 3 months starting from July –September
iii) Body mass index (BMI)
2016.
BMI is a simple index and is defined as weight in
Data collection
kilograms divided by height in meters squared.11
Using validated questionnaire, data like Age and Gender,
Socio-Economic Background, anthropometry, frequency BMI =
and awareness about nutrition labels were collected. Data
collection was carried out using interview schedule After calculating the BMI for the children, BMI
method as it allows the researcher to build a rapport with percentiles and Z score were calculated using the online
the child and gives validation to the data. calculator.

A. Socio-economic status C. Frequency and awareness of viewing nutrition

labeling
India, a country with vast differences among people
based on their economy so this is assessed using Revised A pre and post questionnaire to check the awareness on
Kuppuswamy Scale 20129as tabulated below nutrition labeling (Dichotomous questions) was collected
from the respondents (School children). These
Socio-economic category* Monthly income (Rs.) dichotomous type questions were framed since the school
Upper ≥32,050 children may find easier to mark a yes or no.
Upper middle 12020-32,049
Middle/lower middle D. Education on nutrition labeling
12,019-8,010
income
Lower/upper lower 8,009-4,810 Education on nutritional labels emphasizing on certain
Lower 4,809-1,600/ and less facts were demonstrated with a help of nutrition label as
* Revised Kuppuswamy scale 2012. found in the image.

Because of the convenience, we have merged upper Ethical statement

middle and Middle/lower Middle income to a category of
middle SES, in the same way lower SES comprises of The study was granted approval by the Ethics Review
lower/upper lower and lower income. Committee of the PSG Institute of Medical Research,
Coimbatore. Consent forms, in both English and Tamil,
for all students of grades 5 to 7th were signed by either of

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 Anitha MC et al. Int J Community Med Public Health. 2017 Sep;4(9):3461-3467

the parents of the children, and data were collected only from them.

Figure 1: Children`s hospital of the King`s daughter, way to grow, reviewed on 04/2008.12

RESULTS 12,020-Rs. 32,049/ month) and 73% of non-government

school students belong to the family earning Rs.
Number of children by age group ≥32,050/month (high income category). Overall we could
note that 49% of the selected school children belong to
The results depicts that government school students high SES followed by 40% (Middle SES) and 11% in low
comprise 58% of the study population whereas 40% were SES category (Rs. <12,000/month)
from non-government schools. More than 50% of the
children belong to 11 years age in both the schools (Table BMI categories against socioeconomic status for
1). selected school children.

Distribution of different school children according to From the Table 3 and Figure 3 we could understand the
socio-economic status BMI categories against socio-economic status for
selected school children
Distribution of different school children according to
socio-economic status is clearly mentioned in the Table 2 We could note that 17% of government school children
given below. were categorized as underweight and obese, as usual
results support that underweight was prevalent among
Table 2 and Figure 1 shows that 50% of government low SES.
school students belong to middle Income category (Rs.

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 Anitha MC et al. Int J Community Med Public Health. 2017 Sep;4(9):3461-3467

Table 1: Number of children by age group (n=1409).

Age group (in years)

S. Total Percentage
Schools 10 11 12
No number (%)
No % No % No %
1 Government 264 32 443 54 111 13.5 818 58
2 Non-government 116 20 386 65 89 15 591 42

Table 2: Distribution of different school children according to socio-economic status (n=1409).

Government school Non-government

S. Socio-economic Total Percentage
children school children
No Class number (%)
No % No %
1 Low SES 154 19 2 0.33 156 11
2 Middle SES 406 49.6 160 27 566 40
2 High SES 257 31.4 430 73 687 49

Table 3: BMI categories against socioeconomic status for selected school children (n=1409).

Under
Obese (n=407) Overweight(n=284) Normal (n=526)
Weight (n=192)
Socio
Non- Non- Non-
economic Govt. Non-govt.* Govt. Govt. Govt
govt.* govt* govt*
Status School School School School School
School School School
children children children children children
children children children
Low No % No % No % No % No % No % No % No %
1 SES 2 1 -- -- 34 22 -- -- 63 41 1 50 55 36 1 50
Middle
2 95 23 102 64 62 15 33 21 202 50 12 8 47 12 13 8
SES
High
3 40 16 168 39 39 15 116 27 141 55 107 25 37 14 39 2
SES
Total 137 17 270 46 135 17 149 25 406 50 120 20 139 17 53 9
*Non-govt= non-government.

taught and the randomly selected children were made to

Government Non-government explain the concepts of food and Nutrition labeling after
73
the education to assure the child whether it is learned. A
post test was conducted and the responses were recorded
49.6 to find out the effectiveness of the education.

31.4
27 Low SES Middle SES High SES
19 64
70
60 55
0.33 50 50 50
50 39 41
36
40 32
Low SES Middle SES High SES 27 25
30 23 21
16 1515
20 1214
8 8
Figure 2: Distribution of different school children 10 1 0 0 2
0
according to socio-economic status.
Government

Government

Government

Government
Non-govt

Non-govt

Non-govt

Non-govt

Intervention study

An intervention study was carried out for a period of 5

continuous days with an education given to the selected Obese Overweight Normal Underweight
school children for the duration of 30 minutes. A pre-test
questionnaire was formulated and the responses for the
questions were recorded in the beginning of the study. A Figure 3: BMI categories against socio-economic
demonstration with the help of a food product cover was status for selected school children.

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 Anitha MC et al. Int J Community Med Public Health. 2017 Sep;4(9):3461-3467

Pre-test awareness on food and nutrition labeling percentage showed higher in the children who had an
before education unknown answer for the questions about food labels and
food product certifications in government school
From the Table 4 we could see the pre-test awareness on children. This shows that the government school children
Food and Nutrition labeling before education. From the require a good education on nutrition and food labels
above Table 4 shows the pre-test awareness on nutrition along with a knowledge given on food safety and product
labeling before education showed majority response certifications.

Table 4: Pre-test awareness on food and nutrition labeling before education (N=1409).

Nutrition labeling assessment

S.
Questions Government (n=818) Non-government (n=591)
No
Yes % No % Yes % No %
1 Do you know about food labels? 355 43 463 57 366 52 225 48
Do you consider examining food labels while
2 318 39 500 61 392 66 199 34
food product purchase?
Do you read nutrition labels before snack
3 262 32 556 68 466 79 125 21
purchase?
Do you choose food products according to
4 305 37 513 63 362 61 229 39
nutritional information?
Where do you acquire information about a food
5 product other than food labels (media/health 362 44 456 56 446 75 145 25
professionals/retailers)?
Do you think food label to be standardized and
6 446 54.5 372 45.5 432 73 159 27
applied to all food products?
Do you think food labels are mandatory for all
7 317 39 501 61 346 58.5 245 41.5
food products?
Do you think all the food product
8 manufacturers/entrepreneurs must include food 142 17 676 83 218 37 373 63
labels for their upcoming innovations?
If a food product new to market, low in MRP,
9 providing free gifts/offers but without nutritional 201 24.5 617 75.5 316 53 275 47
information, will you prefer it?
If your favourite celebrity is introducing a food
product through advertisements but the product is
10 322 39 496 61 443 75 148 25
without food product certification, will you prefer
it?
Are you aware about the food product
11 301 37 517 63 321 54 270 46
certifications and seal in food products?
Are you aware in choosing healthier food choices
12 306 37 512 63 396 67 195 33
by comparing food and nutrition labels?
Are you aware about manufacturing/expiry date
13 541 66 277 34 252 43 339 57
in food labels?
Do you consider brand name of a product for
14 320 39 498 61 317 54 274 46
choosing a food product?
Do you think imported foods are healthy and
15 456 56 362 44 328 55 263 45
prefer it?
Do you think traditional snack/product made with
16 commonly cultivated crop in the zone is healthy 246 30 572 70 266 45 325 55
comparing to imported foods?
Do you think artificial food preservatives/colours
17 added to food product is healthy and can be 346 42 472 58 104 17.5 487 82.5
considered for purchase?

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 Anitha MC et al. Int J Community Med Public Health. 2017 Sep;4(9):3461-3467

Post-test awareness on nutrition labeling after improvement in the responses given by selected children
education after education. From this we could understand that
nutrition labeling education should be given periodically
Table 5 shows the post-test awareness on nutrition and to government school children with more attention given
food labeling after education. Table 5 showed posttest on food product certifications and choosing healthy snack
awareness on Nutrition labeling after education. This by viewing nutrition and food labeling.
result clearly depicts that there was an excellent

Table 5: Post-test awareness on nutrition labeling after education (N=1409).

Nutrition labeling assessment

S.
Questions Government (n=818) Non-government (n=591)
No
Yes % No % Yes % No %
1 Do you know about food labels? 627 44 191 56 496 84 95 16
Do you consider examining food labels while
2 592 72 226 28 432 73 159 27
food product purchase?
Do you read nutrition labels before snack
3 636 78 182 22 514 87 77 13
purchase?
Do you choose food products according to
4 721 88 97 12 536 91 55 9
nutritional information?
Where do you acquire information about a
5 food product other than food labels 568 69 40 31 431 73 160 27
(media/health professionals/retailers)?
Do you think food label to be standardized
6 621 76 197 24 449 76 142 24
and applied to all food products?
Do you think food labels are mandatory for all
7 726 89 92 11 476 80.5 115 19.5
food products?
Do you think all the food product
8 manufacturers/entrepreneurs must include 749 91.5 69 8.5 493 83 98 17
food labels for their upcoming innovations?
If a food product new to market, low in MRP,
9 providing free gifts/offers but without 718 88 100 12 432 73 159 27
nutritional information, Will you prefer it?
If your favourite celebrity is introducing a
food product through advertisements but the
10 663 81 155 19 441 75 150 25
product is without food product certification,
will you prefer it?
Are you aware about the food product
11 638 78 180 22 509 86 82 14
certifications and seal in food products?
Are you aware in choosing Healthier food
12 choices by comparing food and Nutrition 697 85 121 15 516 87 75 13
Labels?
Are you aware about Manufacturing/Expiry
13 796 97 22 3 492 83 99 17
date in food labels?
Do you consider brand name of a product for
14 749 91.5 69 8.5 446 75 145 25
choosing a food product?
Do you think imported foods are healthy and
15 242 29.5 576 70.5 133 22.5 458 77.5
prefer it?
Do you think traditional snack/product made
16 with commonly cultivated crop in the zone is 341 42 477 58 433 73 406 27
healthy comparing to imported foods
Do you think artificial food
17 preservatives/colours added to food product is 633 77 185 23 466 79 494 21
healthy and can be considered for purchase?

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 Anitha MC et al. Int J Community Med Public Health. 2017 Sep;4(9):3461-3467

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We would like to thank all the students, teachers and the Grow, Reviewed on 2008.
principals of the schools for their co-operation and 13. Wojcicki JM, Heyman MB. Adolescent nutritional
valuable support during the study period. awareness and use of food labels: Results from the
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outlook on nutrition and food labelling among
selected school children aged 10-12 years in
Coimbatore city. Int J Community Med Public Health
2017;4:3461-7.

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