https://revistas.utm.edu.ec/index.php/QhaliKay | revista.qhalikay@utm.edu.ec
Original Research Mayo-Agosto 2022;6(2):64-72
https://doi.org/10.33936/qkrcs.v6i2.4540
Facultad de Ciencias de la Salud. Universidad Técnica de Manabí. Portoviejo, Ecuador 64
An evaluation of food labeling attitude, preferences, and knowledge for nutrition consultancy
Una evaluación de la actitud, las preferencias y el conocimiento sobre el etiquetado de alimentos para la
consultoría nutricional
A.Ebru Uyan Kulcu
1
Muhammet Ali Cebirbay
2
*
Abstract
The aim of the study was to determine the knowledge, attitudes, and preferences of individuals towards food
labels according to their nutrition consultancy. The study was performed as a survey model, and a total of 580
participants were sampled in two groups according to their nutrition counseling on adults, private nutrition
and diet counseling centers in Konya, Turkey. The data were collected by obtaining a face-to-face interview
method, consisting of five parts. Food label reading according to the duration of counseling differed (p<0.05).
According to nutrition counseling, due to the food label reading levels of participant’s difference was
determined in dairy products, canned foods and tomato paste, meat products (p<0.05). The expiration date,
food label reading, and amount of fat and sugar were found to be high in the nutrition counseling group. The
nutrition knowledge scores (x
̄
±SE) were determined as 75.1±0.7 and a difference was obtained in gender,
BMI, education level, nutrition counseling, and food label reading (p<0.05). Significant results were revealed
between food label reading and nutrition counseling, and it is predicted that increasing awareness of nutrition
consultancy centers related to reading food labels.
Keywords: food label; nutrition consultancy; food preferences.
Resumen
El objetivo del estudio fue determinar los conocimientos, actitudes y preferencias de los individuos hacia las
etiquetas de los alimentos según su consulta de nutrición. El estudio se realizó como un modelo de encuesta,
y se muestreó un total de 580 participantes en dos grupos según su asesoramiento nutricional en adultos,
centros privados de asesoramiento nutricional y dietético en Konya, Turquía. Los datos fueron recolectados
mediante la obtención de un método de entrevista cara a cara, que consta de cinco partes. La lectura de las
etiquetas de los alimentos según la duración de la consejería difirió (p<0,05). De acuerdo con el
asesoramiento nutricional, debido a los niveles de lectura de las etiquetas de los alimentos de los
participantes, se determinó diferencia en productos lácteos, alimentos enlatados y pasta de tomate, productos
cárnicos (p<0,05). Se encontró que la fecha de caducidad, la lectura de la etiqueta de los alimentos y la
cantidad de grasa y azúcar eran altas en el grupo de asesoramiento nutricional. Los puntajes de conocimiento
de nutrición (x
̄
±DE) se determinaron como 75,1±0,7 y se obtuvo una diferencia en género, IMC, nivel
educativo, asesoramiento nutricional y lectura de etiquetas de alimentos (p<0,05). Se han revelado resultados
significativos entre la lectura de las etiquetas de los alimentos y el asesoramiento nutricional, y se prevé que
aumente la concienciación de los centros de asesoramiento nutricional relacionados con la lectura de las
etiquetas de los alimentos.
Palabras clave: etiqueta de los alimentos; consultoría de nutrición; preferencias de alimentos.
*Dirección para correspondencia: cebirbay@gmail.com
Artículo recibido el 27-03-2022 Artículo aceptado el 12-05-2022 Artículo publicado el 28-06-2022
Fundada 2016 Facultad de Ciencias de la Salud de la Universidad Técnica de Manabí, Ecuador.
1
MSc. Dietician, Ayse Ebru Uyan Nutrition Counseling Center, Sefikcan Street, No. 45/B 42250, Selcuklu, Konya, Turkey. https://orcid.org/0000-0002-5973-7440
2
Assist. Prof. Dr., Selcuk University, Faculty of Health Sciences, Nutrition and Dietetics Department, Alaaddin Keykubad Campus, 42250, Selcuklu, Konya, Turkey.
https://orcid.org/0000-0003-3484-7173
QhaliKay. Revista de Ciencias de la Salud. Publicación arbitrada cuatrimestral. ISSN 2588-0608 / Mayo-Agosto 2022;6(2):64-72
Facultad de Ciencias de la Salud. Universidad Técnica de Manabí. Portoviejo, Ecuador 65
Introduction
It is well known that a balanced and healthy diet can significantly contribute to the prevention of
some chronic diseases associated with obesity
1
. Today, the benefits of food labels are accepted as an
important component among the factors used in the fight against nutrition-related diseases that can
be seen in the society. Food labels are a very important resource for consumers to obtain nutritional
and health-related information about food products
2
. Food labels provide the consumer with
information about the product, making it easier to identify and choose healthy foods that are rich in
nutrients and low in energy, and affect their food purchasing behavior and decisions
3-6
. A correct food
labeling scheme should meet all the goals and objectives of the society's health problems, nutrients,
adequate and balanced nutrition
7,8
. To achieve these goals and objectives, food labels must be easily
understood, updated in visual and written form, and reflect the developments in nutrition and
health
9,10
.
Today, due to the increasing variety and marketing of packaged and ready-to-eat foods, the role of
the dietitian in assisting the public in making healthy food choices has become increasingly
important
11,12
. Nutrition education and behavior change are widely used for the individuals to choose
the right and healthy food. Individuals who receive counseling by dietitians are more interested in
diet, food selection and nutrition
13
. It will also be possible to prevent wrong and unhealthy food
selection by developing label reading behavior with counseling service. Revealing the effects of
nutritional counseling on the status and preferences of individuals regarding food labels will have
beneficial effects on individuals' label reading and healthy eating
14
. Health professionals play a vital
role in ensuing nutrition information and knowledge on food labels to understand the consumers. The
dieticians’ knowledge not only has focused on purchasing foods, healthy food choices or diet, and
disease but also food labeling. In this study, determination of the food labeling knowledge, attitudes,
and preferences of adults in Konya, according to nutritional consultancy was aimed.
Methodology
The research was designed as a relational survey model, and the data were made through face-to-
face interviews by using a questionnaire. The population consists of 18-65 aged adults living in
Konya. In calculating the sample size, the parameters for the G*Power 3.1.9.2 program were
determined as 0.30 for the effect size, 0.05 for the margin of error (α), and 0.95 for the power (1-β)
15
.
According to the simple random sampling method was planned as two groups as those who
received nutrition counseling and those who did not, and the sample size was calculated as 580, with
290 participants in each group. The data of the participants who received nutrition counseling were
obtained from private nutrition counseling centers located in Konya on a voluntary and consent basis.
Voluntary institutions in the selection of nutrition counseling centers from the central districts were
included in the study and the consent of the institution officials was obtained. The research was found
ethically appropriate with the decision numbered 2019/74 by the Non-Interventional Clinical
Research Ethics Committee of the Faculty of Health Sciences of Selcuk University.
The data were obtained in the form of a face-to-face interview with a questionnaire. The
questionnaire was prepared independently of the authors by 3 experts with academic positions in
Nutrition and Dietetics, and it was applied to a group of 20 people before the study, and it was applied
in the sample by making the necessary corrections and trying to establish the content validity. The
questionnaire consists of five parts. In the first part socio-demographic information and
anthropometric measurements (e.g., height, body weight) taken by the dietitian. Body Mass Index
(BMI) (kg/m
2
) values were obtained by using body weight (kg) and height (m). The BMI values of
the participants were used in the classification prescribed by the World Health Organization
(WHO)
16
. The duration of consultancy and the status and preferences of the service was in the second
part. In the third section, there are situations such as the frequency of reading the food label, accessing
the information with the food label, and the factors that are affected when purchasing foods. The furth
An evaluation of food labeling attitude, preferences, and knowledge for nutrition consultancy
Uyan Kulc, Cebirbay
66 Facultad de Ciencias de la Salud. Universidad Técnica de Manabí. Portoviejo, Ecuador
chapter, consists of the purpose of use of food labels reflecting consumer attitudes in reading food
labels, the situation and preferences for food labels, the food label order in our country, etc. with 40
attitude statements. Participants were answered to make a 5-point Likert-type scale (1. Strongly
disagree, 2. Disagree, 3. Undecided, 4. Agree, 5. Strongly agree) to determine the levels for each
attitude statement. In the fifth part of the questionnaire, a closed-ended knowledge test with 40
questions prepared to measure the nutritional knowledge level of the participants. Knowledge test
questions are healthy eating behaviors, food purchasing behaviors, and nutrients related to food
labeling. Turkey Dietary Guide (TDG)
17
was used to form the knowledge test. The scores in the
knowledge test range from 0 to 100. Cronbach α calculated was 0.71.
Data was analyzed by using the SPSS 22.0 package program. Statistical analyses included
descriptive analyzses as number (n), percent (%), arithmetic mean (x
̄
), standard error (SE). Parametric
(e.g., One way ANOVA) and non-parametric (e.g., Chi-square) tests were used to predict the
differences between the variables according to the distribution of the findings. The significance level
was accepted as p<0.05 in all statistical analyses.
Results and discussion
According to the results, 56.4% of the participants were female, 43.6% were male, and 18-25, 26-
35, 36-45, 56-65-year-old age groups were found 15.5, 36.6, 29.7, and 18.3%, respectively. A study
18
found that 72.5% of male and 80.6% of females were food label readers. Population consists of 2.1%
underweight, 35.7% normal, 43.6% pre-obese, 16.2% obese class I, 2.4% were obese class II
according to BMI. Pre-obese were higher in BMI groups than others. When the job groups of the
participants were examined, 9.3% workers, 27.4% self-employed, 34% civil servants, and 29.3%
were housewives. Nutritional counseling time of second group (n=290) 1, 2, 3, and 4 month or more
was found 17.1%, 34.1%, 15.6%, 33.2% respectively. When the distribution of counseling (n=290)
by gender was examined; it was determined that 57.0% of the women received counseling and 41.8%
of the men received counseling.
It was determined that 92.3% of the participants who received nutritional counseling reached the
label information through a dietitian. The other group the most preferred among the media tools are
radio (92.3%) and newspaper (93.8%). In the study of Ozgul and Aksulu
19
, 87% of consumers have
shown interest in food label reading in 1995, in 2005 this data increased to 96% and consumers giving
importance to food labeling increased from 6.6% to 18.0%. Trandafilović et al.
20
stated that they have
a similar relationship with the frequency of food reading and that the level of education affects the
frequency of reading. Table 1 shows the food label reading status for purchasing foods due to
demographic characteristics and BMI of participants.
According to Table 1, food label reading did not differ for gender (p<0.05). But significant
differences were obtained in terms of age groups, BMI, education level, profession, and income
groups (p<0.05). The highest level (48.2%) among participants who always read food label when
purchasing foods is in ages 26-35. A similar situation was also found in the pre-obese and normal
groups according to BMI. Bachelor education level (67.3%) was found to be the group that always
read food label. Housewives (32.2%) constitute the participants who always read food labels among
the job groups. In TURKSTAT 2019
21
data of Turkey, it has been determined that individuals with
income levels above the poverty line (47.9%) have the highest food label reading.
Demir and Pala
22
stated that 91.7% of the participants read the food labels at the time of purchase.
In their study, Budak et al.
23
, the food label reading status of the participants was examined according
to their educational level, and the label reading rate of the individuals who graduated from college
was found to be 89.3%. Akar Sahingoz
24
reported that 58.7% of women and 4.3% of men have a habit
of food label reading. In the same study, the rate of food label reading in the 35-44 age group was
high, and when the individuals who read labels were examined, it was found that 63.2% had
undergraduate education, 83.2% were officers, and 56.5% had income levels between 2501-4000 TL.
QhaliKay. Revista de Ciencias de la Salud. Publicación arbitrada cuatrimestral. ISSN 2588-0608 / Mayo-Agosto 2022;6(2):64-72
Facultad de Ciencias de la Salud. Universidad Técnica de Manabí. Portoviejo, Ecuador 67
In another study
25
, food label reading rate of individuals aged 19-34 was 62.7%, income level of 2001
TL and above, individuals with sufficient health literacy and undergraduate and graduate education
determined as 64.6%, 64.9%, 65%, respectively.
Table 1. Food label reading according to the purchasing foods for demographic characteristics and
BMI
Indicator
Always
Sometimes
Never
p
**
n
%
n
%
n
%
Women
141
57.6
166
56.5
20
48.8
0.577
Men
104
42.4
128
43.5
21
51.2
Total
245
100.0
294
100.0
41
100.0
18-25
28
11.4
58
19.7
4
9.8
0.000
26-35
118
48.2
81
27.6
13
31.7
36-45
69
28.2
92
31.3
11
26.8
56-65
30
12.2
63
21.4
41
31.7
Total
245
100.0
294
100.0
41
100.0
Underweight
3
1.2
8
2.7
1
2.4
0.000
Normal
104
42.4
87
29.6
16
39.1
Pre-obese
109
44.5
137
46.6
7
17.1
Obese Class I
27
11.1
53
18.0
14
34.1
Obese Class II
2
0.8
9
3.1
3
7.3
Total
245
100.0
294
100.0
41
100.0
Primary and
Secondary School
27
11.0
41
14.0
15
36.6
0.000
High School
53
21.6
91
31
10
24.4
Bachelor
165
67.3
162
55.1
16
39
Total
245
100.0
294
100.0
41
100.0
Starvation wage
20
31.3
33
51.6
11
17.2
0.018
Below the poverty
42
34.7
70
57.9
9
7.4
Above the poverty
91
47.9
89
46.8
10
5.3
Total
42
42.9
50
51
6
6.1
*Starvation and Poverty Line evaluated according to TURKSTAT January 2019 national data.
** Chi-Square test.
A statistical difference was observed between the receiving nutritional consultancy and the food
label reading (p<0.05). The food label reading status of the participants was examined according to
the duration of their nutritional counseling. The food label reading levels of the participants who
received counseling for 1 month, 2 months, 3 months, and 4 months or more were found different
(p<0.05). When purchasing food, women were most influenced by experiences (38.8%) and the least
by advertisements (0.9%). Men, on the other hand, were most affected by experiences (41.9%) and
the least by the environment (2.3%).
Coşkun and Kayışoğlu
26
found that the sources of obtaining food label information in women and
men are TV (25.4%, 28.7%), newspapers and magazines (19.0, 21.3%), doctors and dieticians
(12.9%, 7.5%) and internet (0.9%, 1.7%). Among the reasons for food label reading in the nutrition
counseling group, it was seen that the most chosen reason was for a healthy and balanced diet (92.8%),
while the least preferred reason was to guide the consumer in fortified food (14.9%). In the other
group, the reason for food label reading was found as the healthiest and balanced diet (98.3%) and
choosing according to the least is calories (30.0%). From the data obtained, it is understood that most
of the participants read food labels for a healthy and balanced diet. It was determined that the
percentage of label reading for calorie (66.9%) of individuals who received nutritional counseling
was higher than those who did not (30.0%). Another study
23
found that nutrition education and
continued diet had a higher frequency of food label reading.
An evaluation of food labeling attitude, preferences, and knowledge for nutrition consultancy
Uyan Kulc, Cebirbay
68 Facultad de Ciencias de la Salud. Universidad Técnica de Manabí. Portoviejo, Ecuador
Table 2. Frequency of food label reading and duration of receive nutrition consultancy
Indicator
Always
Sometimes
Never
Total
p
*
n
%
n
%
n
%
n
%
Nutrition
consultancy
Yes
174
71.0
113
38.4
3
7.3
290
50.0
0.000
No
71
29.0
181
61.6
38
92.7
290
50.0
Total
245
100.0
294
100.0
41
100.0
580
100.0
Consultancy
period
(month)
1
12
6.9
37
32.7
1
33.3
50
17.2
0.000
2
49
28.1
50
44.2
-
-
99
34.1
3
33
19.0
12
10.6
-
-
45
15.5
4 and more
80
46.0
14
12.4
2
66.7
96
33.1
Total
174
100.0
113
100.0
3
100.0
290
100.0
** Chi-Square test.
In a cross-sectional study conducted in Turkey
27
, the level of reading food label information and
nutrition knowledge on the food label was found to be 76.5% and 72.4%, respectively. Another aspect
of the study is to reveal the attitudes of the participants towards food labels. According to the attitudes
and behavior statements of individuals in counseling group, the expressions with the highest and
lowest levels of "strongly agree" were determined as “purchasing a product by looking at the
expiration date” (86.2%) and “I prefer a more known brand of the same product” (24.8%). In the
other group, the highest and lowest levels of "strongly agree" were found to be intelligible (5.2%) in
terms of “purchasing products by looking at the expiration date” (69.0%) and “labeling systems made
in our country”.
In Table 3, the data represent that a significant difference was found according to the nutrition
counseling of participants in dairy products, canned and tomato paste, and meat products (p<0.05).
other foods were not differed by counseling (p>0.05).
Table 3. Food label reading of foods according to nutritional counseling
Foods
Nutrition
Consultancy
Food Label Reading
Always
Sometimes
Never
Total
p
*
N
%
n
%
n
%
n
%
Bakery
Yes
74
25.5
52
17.9
164
56.6
290
100.0
0.187
No
79
27.2
115
39.7
96
33.1
290
100.0
Drinks
Yes
206
71.0
53
18.3
31
10.7
290
100.0
0.366
No
127
43.8
117
40.3
46
15.9
290
100.0
Dairy Products
Yes
251
86.6
29
10.0
10
3.4
290
100.0
0.003
No
105
70.7
56
19.3
29
10.0
290
100.0
Canned Food and
Tomato Paste
Yes
215
74.1
40
13.8
35
12.1
290
100.0
0.000
No
143
49.3
87
30.0
60
20.7
290
100.0
Meat and
Products
Yes
181
62.4
54
18.6
55
19.0
290
100.0
0.008
No
183
63.1
46
15.9
61
21.0
290
100.0
Oils
Yes
168
57.9
61
21.0
61
21.1
290
100.0
0.061
No
127
43.8
89
30.7
74
25.5
290
100.0
Frozen Processed
Foods
Yes
217
74.8
40
13.8
33
11.4
290
100.0
0.218
No
164
56.6
62
21.4
64
22.1
290
100.0
Snacks
Yes
173
59.7
54
18.6
63
21.7
290
100.0
0.264
No
126
43.4
82
28.3
82
28.3
290
100.0
Honey-Jam-
Marmalade
Yes
86
29.7
71
24.5
133
45.9
290
100.0
0.540
No
98
33.8
104
35.9
88
30.3
290
100.0
Chopera et al.
18
, when looking at the nutritional components that attract the attention of food label
readers; 16% contains preservatives, 14% fat, 11.7% vitamin, 11.8% calories, 10.1% carbohydrate
QhaliKay. Revista de Ciencias de la Salud. Publicación arbitrada cuatrimestral. ISSN 2588-0608 / Mayo-Agosto 2022;6(2):64-72
Facultad de Ciencias de la Salud. Universidad Técnica de Manabí. Portoviejo, Ecuador 69
content. In addition, 10.9% of them read sugars, 9.5% protein and 6.7% sodium content of foods.
Gezmen-Karadag and Turkozu
28
, stated that women and men read the food label while purchasing
dairy products 23.9% and 21.8%; in addition, meat products 18.8% and 17.6% respectively. However,
saturated fat content food label reading was found 19.9% in women and 17.4% in men, and chocolate
and biscuits 21.9% and 18.1%, respectively.
According to the statements of attitude towards food labels, 86.2% of the participants in nutrition
counseling groups expressed "I pay attention to the expiration date when purchasing foods", 82.1%
"I think that the food labels should be read", 81.4% "The amount of fat should be included in the food
label" and 81.7% of strongly agreed with the statements “The amount of sugar should be included in
the food label”. On the other hand, it is seen as an important finding that the level of participants who
strongly agree with the statements "I do not think that reading labels will contribute to me" and
"Reading food labels is a waste of time" was 83.8% and 84.5%, respectively. In addition, the level of
agreement with the statement "Labeling systems in our country is insufficient compared to other
countries" was determined as 63.1%. In another study
19
, it was emphasized that participants were
able to understand the health content of products through food labels.
When the nutrition knowledge scores of all participants on the food labels were examined, the
mean score (x
̄
±SE) was determined as 75.1±0.755. A difference was found between the scores of the
participants in the nutrition knowledge test for food labels in terms of gender, BMI, education level,
nutrition consultancy and food label reading (p<0.05) which was represented in Table 4. In nutrition
knowledge score results showed us in women, normal and pre-obese, bachelor and high school,
consultation and always food label reading obtained high scores among their own groups. In
Soydemir
29
indicated that women (65.3±16.02) were higher than men, individuals between the ages
of 40-49 had the highest knowledge scores, and undergraduates (67.1±16.62) were higher than the
others.
Table 4. Nutrition knowledge test scores due to variables
Indicator
x
̄
±SE
p
*
Gender
Women
77.6±0.881
0.000
Men
72.0±1.280
BMI
Underweight
70.2±6.249
0.000
Normal
76.4±1.321
Pre-obese
76.2±1.040
Obese Class I
70.3±2.024
Obese Class II
71.0±4.574
Education
level
Literate
62.7±8.563
0.000
Primary and
Secondary School
68.0±2.545
High School
75.1±1.434
Bachelor
77.0±0.907
Nutrition
consultancy
Yes
83.2±0.700
0.000
No
67.1±1.160
Food label
reading
Always
81.4±0.954
0.000
Sometimes
72.3±1.007
Never
58.1±3.962
*One way ANOVA (Duncan Test) and Independent T test.
Grunert et al.
30
stated that an average of 16.8% of consumers pay attention to nutritional
information on the label and the interest in the label increased with age, but the level of nutritional
knowledge decreased. Krešić et al.
31
, focus on the nutritional knowledge scores by age groups, it was
implied that consumers between the ages of 30-44 had the highest score, and with the increase in
education level, the average scores of general nutrition knowledge increased and food label reading
An evaluation of food labeling attitude, preferences, and knowledge for nutrition consultancy
Uyan Kulc, Cebirbay
70 Facultad de Ciencias de la Salud. Universidad Técnica de Manabí. Portoviejo, Ecuador
rate of individuals with a significantly higher nutrition knowledge was 46%, but low nutrition
knowledge was 25%. Hawley et al.
32
, there was no significant difference in the education levels of
individuals with low nutritional knowledge. However, it was represented that individuals with low
nutrition knowledge (33%) had difficulties in understanding label information. Wiles et al.
33
found
that nutrition knowledge was higher for those who received higher education and related to their
attitudes.
Conclusions
The study results indicate that, women have a higher rate of reading labels than men for food labels,
which play an important role in providing the necessary information for consumers to make healthy
choices and reach safe and healthy food. However, food label reading of receiving nutrition
consultancy has an important place in healthy eating and choosing healthy foods. In addition, it was
determined that the nutrition consultancy showed higher participation in the attitude statements
prepared for the food labels. Another striking result, participants had a great dilemma in attitudes for
food labeling for wasting time and contribution. The fact remains that the knowledge on food labels
differs according to nutrition counseling, and participants gain knowledge about food labels in the
nutrition consultancy service provided. Considering the whole of the research, it would be beneficial
to organize trainings on nutrition labels or to provide nutrition counseling services to all individuals,
especially those in the risk group in terms of health, to gain the habit of reading food labels to make
healthy food choices and to raise awareness about the positive effect of reading food labels on health.
Acknowledgement
We would like to thank the participants, together with the nutrition counseling centers that were
partners in the study in Konya.
Conflict of Interest
All authors declared no conflicts of the study. This manuscript summarized first authors’ MSc
thesis finished at Selcuk University, Institute of Social Sciences and second author as supervisor.
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