Nutrition 32 (2016) 56–60

Contents lists available at ScienceDirect

Nutrition

journal homepage: www.nutritionjrnl.com

Applied nutritional investigation

Can nutrition label recognition or usage affect nutrition

intake according to age?
Hak-Seon Kim Ph.D. a, Chorong Oh M.S. b, Jae-Kyung No Ph.D. c, *
a
Department of Foodservice Management, Kyungsung University, Busan, South Korea
b
Department of Hospitality & Tourism Management, Kyungsung University, Busan, South Korea
c
Department of Nutrition and Health Care, Kyungsung University, Busan, South Korea

articleinfo abstract

Article history: Objectives: The aim of this study was to investigate the effect of the use of nutrition labeling on
Received 2 April 2015 nutritional intake according to age groups, focusing on Korean elderly.
Accepted 11 July 2015
Methods: Study participants (N ¼ 5223) were adults at least 20 y of age and had participated in the
Korean National Health Examination and Nutrition Survey in 2012. Data for recognition/use of
Keywords: nutrition labels were obtained by self-report. Nutrition intake also was estimated by 24-h dietary
Elderly
recall. Participants were categorized into three age groups: 20 to 39 y, 40 to 59 y, and !60 y.
Nutrient intake
Generalized linear model was conducted to test mean differences between nutrition label recog -
Nutrition label recognition
Nutrition label use
nition (NLR) and nutrition label use (NLU) groups for nutrient intake, according to the age groups.
Korean National Health and Nutrition Results: Results from this study indicated that younger individuals (age groups of 20–39 and 40–
Examination Survey (KNHANES) 59 y) in the NLU group showed a significant association with nutrient intake compared to those in
the NLR group. Additionally, nutrition intake status in the NLU group improved positively. Whereas
older participants (!60 y) in the NLR group showed a significant association with most nutrient
intake compared with the NLU group. The study also found that protein intake was reduced in the
NLU group compared with the non-NLU group across the age groups, except for older participants
(age group 20–39 y: 79.16 versus 86.30 g, P ¼ 0.050; age group 40–59 y: 69.97 versus 75.58 g,
P ¼ 0.040; age group of !60 y: 64.72 versus 64.89 g, P ¼ 0.967).
Conclusions: The present study revealed that nutrition labeling cannot be effective for the elderly,
and there were several areas of misunderstanding. Therefore, more systematic education on the
topic of nutrition labeling is required to help the elderly make healthier food decisions.
Ó 2016 Elsevier Inc. All rights reserved.

Introduction significantly associated with nutrients and thus as the frequency

Over the past 2 decades, eating habits have shown an increase
in consumption of prepared foods and take-out meals. This
phenomenon has resulted in diet-related chronic diseases
including obesity, diabetes, and cardiovascular diseases (CVDs)
[1]. One study demonstrated that the frequency of dining out is
Hak-Seon Kim and Chorong Oh contributed equally to this study and should be
considered co-first authors.
CRO, JKN, and HSK designed the study. CRO carried out the data analysis and
wrote the manuscript. JKN and HSK advised on the data analysis. All authors
contributed to the revising of the paper. All authors had full access to all of the
study data and took responsibility for the integrity of the data and the accuracy
of the data analysis. The authors have no conflicts of interest to declare.
* Corresponding author. Tel.: þ82 51 663 4651; fax: þ82 51 627 6830.
E-mail address: jkno3@ks.ac.kr (J.-K. No).
of dining out increased, so did energy intake in Korea [2].
Recognition of these problems motivates people to select healthy
foods. Nutrition labeling is an important educational and prac-
tical tool for promoting healthier food choice and laws on
nutrition labeling for all prepackaged foods as well as for
restaurant menus have been enforced in many countries. Since
the enforcement of nutrition labeling laws in the 1990s, risks for
CVD and cancer have decreased, and the average life span has
been extended [3,4]. Since the Nutrition Labeling and Education
Act (NLEA) of 1990 was promulgated to change nutrition labeling
regulations and also to strengthen the education, making addi-
tional nutrition information available for consumers, which al-
lows them to choose healthier and more nutritious foods [5].
Therefore, consumers have a right to know existing nutrition
labeling formats and the nutrient contents defined for any age
group by education.

http://dx.doi.org/10.1016/j.nut.2015.07.004
0899-9007/Ó 2016 Elsevier Inc. All rights reserved.
 H.-S. Kim et al. / Nutrition 32 (2016) 56–60 57

The regulation of nutrition labeling has changed since it was assist in estimating portion sizes. A self-reported survey was adopted for
measuring the recognition and usage levels of nutrition labels Binominal ques-
introduced in South Korea in 1995. Nutrition labels were dis-
tions were used to ask about NLR and NLU. Respondents were required to answer
played on 18.7% of all food products in 2001. That percentage
either “yes” or “no.” There were two questions on nutrition label recognition and
increased in 2005 by 24.1% and in 2007 by 79% [6]. But how many use to screen the participants: 1) Do you know the nutrition label? 2) Do you use
consumers actually read the labels displayed on the package nutrition labels when you purchase food products? Only respondents who
when purchasing foods? As consumer interest in health rises, answered “yes” on the NLR question could answer the NLU question.
their attention to nutrition labeling also increases. However,
Statistical analysis
there are still differences between nutrition label recognition
(NLR) and actual nutritional label use (NLU). It has been reported All statistical analyses were conducted using SPSS 20.0 for Windows (SPSS
that consumers showed higher NLR than the actual usage level Inc., Chicago, IL, USA). All data were weighted based on a stratified, multistage,
and that they were mainly aware of calories [7]. According to the and probability sampling design. Relationships between general characteristics
of respondents and NLR/NLU were assessed using c2 tests. The generalized linear
Korean Food and Drug Administration (KFDA), 85% of re-
model was used to test mean differences between NLR and NLU groups for
spondents said they recognized nutrition labels; however, only nutrient intake according to the three age groups. Level of significance was set at
50% actually used them [6]. Other studies [8–10] reported that P < 0.05.
the NLU depends on the individual’s various characteristics and
is expected to improve meal quality by increasing recommended Results
nutrient intake, and reducing excessive fat and cholesterol
intake. NLU levels were influenced by demographic, social, and The general characteristics of the respondents according to
psychological factors [11]. Different age groups might show dif- NLR and NLU status are shown in Table 1. There were 3280
ferences between awareness and usage. Differences will vary (62.8%) respondents in the NLR group and 1943 (37.2%) in the
depending on how individuals were educated. The younger non-NLR. All variables except sex were significantly different
generation, part of an aggressive food marketing age, has much according to NLR status; 37.38% of the respondents were men,
opportunity to receive education on nutrition labeling. However, and 62.62% were women. Participants were categorized into
only limited data exist on nutrition labeling for the elderly in three age groups: 20 to 39 y, 40 to 59 y, and !60 (38.23%, 42.23%,
Korea. Today, as consumer interest in obesity and calorie re- and 19.54%, respectively). The recognition level in the 40 to 59 y
striction is increasing, nutrition labeling could be an important group was higher than other age groups, followed by 20 to 39 y
factor that can be implemented effectively [12]. In this regard, we group. In terms of the education level, respondents with a higher
could conjecture that NLU after proper education is more education level tended to have the higher NLR. The results also
important than NLR for all age groups. indicated that unemployed participants showed the highest
To properly manage and settle on a food nutrition labeling recognition level (39.62%). The agriculture and fishing industry
system and the accurate assessment of needs, a feasibility study
on food NLU must be studied. To our knowledge, few studies
Table 1
have assessed the difference between NLR or NLU and nutrition
Associations of demographic characteristics according to nutrition label recog-
intake among different age groups, but especially for the elderly. nition and nutrition label use
The present study was conducted with Korean adults ages !20 y Variable NLR group P-value* NLU group P-value*
who participated in the 2012 Korean National Health Examina-
n ¼ 3280 n ¼ 1141
tion and Nutrition Survey (KNHANES). The present study can (62.8%) (34.78%)
enhance the nutrition labeling system, and the results can help Sex
individuals to be healthier as well as can provide guidelines for Male 1226 (37.38) 0.415 268 (23.50) 0.000
health care providers. Female 2054 (62.62) 872 (76.49)
Age (y)
20–39 1254 (38.23) 0.000 545 (47.80) 0.000
Participants and methods
40–59 1385 (42.23) 479 (42.01)
Study population !60 641 (19.54) 116 (10.17)
Education level
Up to elementary school 326 (10.37) 0.000 45 (4.07) 0.000
This study used the 2012 KNHANES of noninstitutionalized Korean civilians.
Middle school 282 (8.97) 72 (6.52)
All analyses were based on the KNHANES conducted in 2012 in South Korean. The
High school 1265 (40.24) 455 (41.25)
study protocol was approved by the Institutional Review Board at the Korea
College or higher 1271 (40.43) 531 (48.14)
Centers for Disease Control and Prevention (IRB No: 2012-02 CON-06-C). The
Occupation
KNHANES consisted of health records based on a health interview, a health ex-
Manager & expert 534 (17.00) 0.000 216 (10.01) 0.000
amination, and a nutrition survey. Each participant was interviewed and asked to
Clerk 332 (10.57) 120 (5.56)
complete a questionnaire regarding his or her alcohol consumption, smoking
Service industry & seller 400 (12.73) 139 (6.44)
status, presence of diabetes mellitus or hypertension, and physical activity level.
Agriculture & fishing 128 (4.07) 28 (1.29)
The physical activity level was calculated using the metabolic equivalent of task
values based on self-reported frequency and duration of activities during the industry
Mechanic 265 (8.43) 67 (3.10)
week. In all, 34 145 individuals from a stratified, multistage probability sampling
Laborer 238 (7.57) 483 (22.39)
design were selected for the Health Interview study. Of the individuals included
Unemployedy 1245 (39.62) 1104 (51.18)
in the study, 5223 satisfied the age category (i.e., !20 y) and participated in the
Income (Korean 10,000 Won) z
KNHANES [13]. Participants were categorized into three age groups: 20 to 39 y, 40
199 714 (22.08) 0.000 183 (16.28) 0.017
to 59 y, and !60 y.
200–299 590 (18.24) 192 (17.08)
300–399 529 (16.36) 184 (16.37)
Data collection
400–499 444 (13.73) 166 (14.76)
!500 957 (29.59) 399 (35.49)
A general questionnaire was administered to obtain basic demographic in-
formation such as age, sex, education, income, occupation, weight control, and NLR, nutrition label recognition; NLU, nutrition label use
body image. These data were gathered by self-report. Dietary intake was Level of significance was set at P < 0.05
measured by the single 24-h dietary recall method. Trained staff instructed re- 2
*
y
P from c test.
spondents to recall and describe all foods and beverages they consumed the Unemployed included housewife and student.
previous day. Food models and measuring bowls, cups, and spoons were used to z
Income is monthly household income: 1 USD ¼ 1000 Korean Won.
58 H.-S. Kim et al. / Nutrition 32 (2016) 56–60

group had the lowest recognition level (4.07%). Of the group who Table 3
had experience with weight control, 73% recognized nutrition Effect of nutrition label use on nutrition intake according to age

labels, whereas 77.2% of the group who considered themselves Nutrition intake NLU group Non-NLU group P-value*
overweight recognized nutrition labels. Table 1 also shows the n ¼ 1141 n ¼ 2139
association of demographic characteristics between NLR and Energy (kcal)
NLU respondents. In terms of use of nutrition labeling, the NLU 20–39 y 2053.62 Æ 60.89 y 2280.32 Æ 59.27 0.008
40–59 y 1895.30 Æ 47.76 2084.43 Æ 37.44 0.002
group was 34.78%, and non-NLU group was 65.22%. This finding
!60 y 1814.45 Æ 62.44 1806.88 Æ 39.24 0.925
indicated that most individuals do not actually use nutrition la- Carbohydrate
bels, despite recognizing them. The NLU was significantly asso- 20–39 y 300.10 Æ 7.79 323.62 Æ 6.60 0.019
ciated with respondents’ sex, age, education level, and 40–59 y 304.24 Æ 7.53 331.41 Æ 6.02 0.007
!60 y 315.29 Æ 10.47 310.33 Æ 6.46 0.694
occupation, but not with their weight control and body image.
Protein (g)
Women (76.49%) had higher NLU levels than men (23.50%). In 79.16 Æ 2.92 86.30 Æ 2.46
20–39 y 0.050
terms of age, individuals !60 had lower NLU (10.17%). Students 40–59 y 69.97 Æ 2.08 75.58 Æ 1.55 0.040
and housewives demonstrated higher NLU levels, and re- !60 y 64.72 Æ 3.09 64.89 Æ 1.96 0.967
spondents with higher education levels showed higher NLU in Fat (g)
20–39 y 55.85 Æ 2.51 60.41 Æ 2.16 0.171
accordance with the results of NLR.
40–59 y 39.61 Æ 1.54 42.21 Æ 1.17 0.185
Tables 2 and 3 presented the effects of NLR and NLU on 0.728
!60 y 32.35 Æ 1.76 31.53 Æ 1.28
nutrition intake according to age of the respondents. The older Sodium (mg)
NLR group (!60) showed a significant difference in all nutrients, 20–39 y 4717.96 Æ 180.11 5314.96 Æ 189.61 0.022
such as energy, carbohydrate, protein, fat, and sodium, but no 40–59 y 4743.13 Æ 178.06 5216.91 Æ 153.84 0.054
!60 y 4270.70 Æ 259.31 4261.31 Æ 156.06 0.976
significant difference was found in the NLU group. On the other
NLU, Nutrition label use
hand, the two younger groups showed significant differences in
Level of significance was set at P < 0.05
intake of all nutrients in NLU group, but not in the NLR group. The
* Differences were tested using generalized linear model.
NLU group had significantly lower energy intake levels; however, y
Numerical variables are given as means Æ SE. All models were adjusted for
the opposite result was found for older respondents. The pro- age.
portion of NLU and NLR in the older group was lower due to a lack
of understanding of the system. For older individuals in whom
one could easily recognize malnutrition, the dietary intake was in including total energy, carbohydrate, protein, fat, and sodium.
the recommended level, but sodium intake remained uncon- However, protein intake was considered an important factor,
trolled. The lack of research in this field indicates that this are especially for those with sedentary jobs, resulting in poor body
should be further investigated as the number of elderly in society composition and poor maintenance of proper protein intake.
and as consumers is increasing. Therefore, policymakers should Therefore, proper education in this area is needed. Moreover,
be aware of the needs of nutrition labels to assist individuals in the protein intake was reduced in the NLU group, with the exception
older population to increase their usage level of nutrition labels. of those !60 y. This indicates that understanding the importance
Most respondents in the NLR group showed unbalanced of protein intake is crucial for consumers to properly maintain a
nutritional condition, whereas the NLU group respondents healthy body composition, which is directly related to chronic
showed that nutrient intakes in the moderate levels. Re- disease. The present study found that older respondents showed
spondents in the NLU group reduced intake of all nutrients significant differences in NLR, but not in NLU. On the other hand,
younger individuals showed significant differences in NLU, but
not in NLR. The present study also demonstrated that nutrition
Table 2 status in the NLU group was much better than in the NLR group.
Effect of nutrition label recognition on nutrition intake according to age
The 40 to 59 y age group showed the highest NLR and NLU
Nutrition intake NLR group Non-NLR group P-value* levels among the three age groups. This group showed the
n ¼ 3280 n ¼ 1943 biggest improvement in nutritional status as well. Total energy,
Energy (kcal) carbohydrate, fat, and sodium intakes related with chronic dis-
20–39 y 2188.97 Æ 43.671y 2097.35 Æ 116.47 0.471
ease were reduced significantly in the NLU group compared with
40–59 y 2025.50 Æ 28.95 2125.05 Æ 60.14 0.103
the NLR group. This result indicated that Korean adults still
!60 y 1808.17 Æ 32.34 1667.91 Æ 30.32 0.001
Carbohydrate consumed higher levels of sodium (w4000–5000 mg) compared
20–39 y 313.97 Æ 5.18 307.91 Æ 14.06 0.699 with the Korean reference intake (2000 mg) [14] and the World
40–59 y 323.16 Æ 4.67 336.00 Æ 7.51 0.091 Health Organization reference intake (2000 mg). Protein intake
!60 y 311.18 Æ 5.58 306.06 Æ 5.37 0.443
in the older group was increased significantly in the NLR group,
Protein (g)
84.46 Æ 1.99 75.38 Æ 4.55 but not in the NLU group. On the other hand, protein intake in
20–39 y 0.100
40–59 y 73.87 Æ 1.20 75.26 Æ 2.61 0.613 younger groups was significantly reduced in the NLU group.
!60 y 64.86 Æ 1.59 53.27 Æ 1.19 0.000
Fat (g)
58.65 Æ 1.64 54.47 Æ 4.46 0.385
Discussion
20–39 y
40–59 y 41.42 Æ 0.93 40.04 Æ 2.38 0.591
!60 y 31.67 Æ 1.06 22.75 Æ 0.75 0.000 The present study demonstrated that demographic factors and
Sodium (mg) nutrition intake were correlated with NLR and NLU. The study
20–39 y 5075.35 Æ 135.99 4684.73 Æ 289.74 0.226 examined the relationship between NLU and change in nutrition
40–59 y 5072.92 Æ 115.59 5362.15 Æ 211.47 0.235
intake in Korean adults across the two younger age groups.
!60 y 4262.91 Æ 135.70 3885.88 Æ 105.76 0.022
Furthermore, this study described how well the participants
NLR, nutrition label recognition
recognized or used nutrition labels and provided a basic foun-
All models were adjusted for age. Level of significance was set at P < 0.05
* Differences were tested using generalized linear model.
dation for promoting and setting nutrition labeling laws. Policy-
y
Numerical variables are given as means Æ SE. makers and health professionals should be aware that providing
 H.-S. Kim et al. / Nutrition 32 (2016) 56–60
nutrition information through the use and recognition of nutri-
tion labels could be an important educational tool in promoting
healthy eating behavior for all age groups. In this study, the per-
centage of NLR (62.8%) was higher than NLU (34.78%) in all in-
dividuals. The study findings indicated that Korean adults have
higher interest in nutrition labels on food, but did not actually
practice this while purchasing food. Despite data from the 2005–
2006 NHANES report that 61.6% of a general sample of consumers
used nutrition labels [15], the present study revealed that only
34.8% of respondents did so. This may be due to overestimated
self-reports or rapidly changing behavior of the general popula-
tion. However, although data were obtained using self-reports,
previous research studies reported that self-reported data on
food label usage corresponded well to actual label usage [16,17].
For the !60 y group, the amount of NLR was too low. The present
study showed that the nutritional intake of the elderly in the NLU
group was not significantly different and also not sufficient from
elderly in the NLR group. This finding indicates that an education
strategy on nutrition labeling for the elderly is necessary in a
Korean society that is aging rapidly. Elderly individuals make up a
vulnerable group that struggles to manage food safety and bal-
ance their nutritional needs [17,18]. The US FDA has proposed
guidelines for the elderly on nutrition labeling and what nutri-
tional information must be included [19]. Although there are
nutrition education programs for the elderly in hospitals or public
health centers in Korea, there are not enough. In this regard, the
Nutrition Education Program for the elderly contributes to suc-
cessful aging, and will contribute to reducing the cost of health
care in Korea. At this point, it is important to understand why
inconsistency existed between the recognition and usage levels.
According to the KFDA, the reasons were as follows: lack of in-
terest (53.9%), do not know how to take advantage of it (18.8%),
and lack of understanding of the content itself (16.2%) [6,11].
According to one study, 31.6% of Korean adult women use nutri-
tion labels [11]. The present study found that women tended to
use nutrition labels more than men, as was also found in two other
studies [20,21]. The reason for this may be because women are
more interested than men in body image, shape, and family
member’s health [22]. Additionally, people who are younger age,
are more educated, and have higher income levels showed more
NLU [23–25]. However, it has been argued [26] that providing
health-related food information did not always lead consumers to
switch their purchasing behavior from unhealthy to healthy [27].
This finding indicates that consumers need to be educated about
the beneficial effects of NLU for the healthy food decision making,
as shown in a previous study [28]. Most research studies, how-
ever, supported the provision and usage of nutritional informa-
tion to significantly change dietary patterns [29]. General
nutrition knowledge reduces the intake of total fat, saturated fat,
and cholesterol; however, the results need to be more specific n
terms of he use of nutritional information. In this study, partici-
pants with a high school education or higher were more likely to
recognize or use food labels. In terms of occupation, recognition
level was higher in students and housewives, as >50% reported
using nutrition labels when making food choices. This finding is
aligned with previous results that indicated that respondents
with more education tend to recognize and use nutrition labels
[30]. According to another study, there was a strong correlation
between parents and their children regarding NLU; therefore,
proper education is necessary for children as well as for their
parents [31].
Another finding of this study was that younger respondents
were more likely to use nutrition labeling than participants age
!60 probably because younger participants were able to more
59
easily obtain information through more resources. One study has
demonstrated that younger individuals and those with a higher
level of education obtained information regarding nutrition and
food from the Internet [32]. For those in the younger group, there
was a tendency to acquire comprehensive and immediate in-
formation via the Internet and they had more familiarity with
the use of computers than did the !60 group. Compared to
young respondent, lack of understanding nutrition labels in the
elderly group may lead to less use nutrition labels. This result is
consistent with other studies [33,34]. Furthermore, older par-
ticipants (!60) showed a significant association between nutri-
tional intake and NLR but not NLU. This group seems to lack
understanding of nutrition labeling. The present study also
indicated that energy, carbohydrate, protein, and sodium intake
were significantly reduced in the younger NLU group. Many re-
searchers have demonstrated that when individuals use nutri-
tion labels properly, there is a reduction in obesity and health
problems owing to reduced intake of total energy, carbohydrate,
sodium, and so on. According to two studies [35,36], individuals
with high blood pressure or high cholesterol showed more
knowledge regarding fat intake and better use of nutrition labels.
Other previous studies reported that people with obesity used
nutrition labels more than twice as often as their nonobese
counterparts [23]. Another interesting finding from the present
study was that the level of protein intake declined in the NLU
group compared with the non-NLU group, except for individuals
age !60. This might indicate that individuals in this age group do
not understand diet patterns regarding protein or fat from food.
Although individuals try to lose fat, they often lose protein as
well. This is especially true in older individuals, in whom protein
intake is very important for maintaining muscle [37]. Education
on the proper use of nutrition labeling would enable this group
to better understand how much protein they are getting from
their food. One study indicated that consumers showed a higher
awareness of the information on nutrition labels than usage, as
was aligned with the present study findings [7]. They were most
aware of calories (89%), followed by total fat (81%), sodium (75%),
sugars (73%), carbohydrates (72%), saturated fat (71%), and
cholesterol (66%) [7,9]. Generally, the effect of NLU on the change
of healthier dietary patterns and food choice motivation was well
known [38,39]. One study [40] found that nutrition label users
had a lower percentage of calorie intake from fat and saturated
fat, lower cholesterol and sodium intake, and higher fiber intake
[41]. Another study found that the nutrition usage level was
associated with diets high in vitamin C and low in cholesterol in
the NLU but not in the non-NLU group. According to the 2004
Food Marketing Institute’s Shopping for Health survey [7], 48% of
consumers checked nutrition labels to ensure that they were
purchasing healthy foods for their family, and 23% did so to lose
weight. Given the fact that foods away from home are less
healthy, individuals should pay more attention to nutrition labels
as a way of promoting healthy eating behavior, and policymakers
and health professionals should regulate food manufacturers and
restaurants in an effort to produce healthier food options. For
example, restaurants can serve healthier foods and smaller
portion sizes. To leave it only to consumers to make better
choices and reduce portions sizes is not sufficient. Consumers
often cannot judge whether portion size is correct or the food is
healthy because they do not know the ingredients and they do
not have measuring tools.
The present study had several strengths. To our knowledge,
this was the first study to determine the effect of NLU on nutrition
intake according to the different age groups in the Korean popu-
lation. More studies are needed on this subject. Despite the
60 H.-S. Kim et al. / Nutrition 32 (2016) 56–60
strengths just addressed, some limitations still existed. Because
the present study used data from a KNHANES questionnaire on
nutrition labeling, some prominent informationdexpiration
date, quantity, ingredients, place of origin, food additives,
etc.dcould not be included in the analysis. This might limit
interpretation of the results about the complete understanding of
Korean adults’ NLU patterns. Another limitation was that the
present study used data from a single 24-h recall, which might not
exactly represent usual intake. However, 24-h recalls could be
used as a surrogate measure of usual intake at the population
level. Additionally, dichotomized variables for body image and
weight control were used in this study, limiting the nature of their
own variables. Finally, the study’s cross-sectional design limited
causal inference between NLU levels and the respondents’
improved eating behavior across all age groups. Thus, these re-
sults should be confirmed with additional longitudinal data.
Conclusion
The study findings suggested that NLU can work as a simple
way to help individuals <60 y make healthier food choices. There
was, however, misunderstanding between NLU and actual intake
of protein. Additionally, nutrition labeling did not affect the
nutritional intake of older participants. This might indicate that
there is misunderstanding regarding diets including protein or
fat in all age groups. Frequently, when individuals attempt to lose
weight by reducing their fat intake, they reduce the amount of
protein consumption also. As the elderly are becoming a major
target market in the food industry, more studies should be
conducted with this age group. Therefore, more systematic ed-
ucation on the topic of nutrition labels is required so that con-
sumers, especially those !60, can make informed and healthier
food choices.
References
[1] Oh K, Hu FB, Manson JE, Stampfer MJ, Willett WC. Dietary fat intake and
risk of coronary heart disease in women: 20 years of follow-up of the
Nurses’ Health Study. Am J Epidemiol 2005;161:672–9.
[2] Oh CR, Kim HS, No JK. Impact of dining out on nutritional intake and
metabolic syndrome risk factors: data from the 2011 Korea National Health
and Nutrition Survey. Br J Nutr 2015;113:473–8.
[3] Zarkin GA, Dean N, Mauskopf JA, Williams R. Potential health benefits of
nutrition label changes. Am J Public Health 1993;83:717–24.
[4] Variyam JN, Cawley J. Nutriton labels and obesity. Cambridge, MA: National
Bureau of Economic Research; 2006.
[5] Nutrition Labeling and Education Act. Public law 1990;21.
[6] Kwon KI, Park SH, Lee JH, Kim JY, Yoo KS, Lee JS, et al. Prevalence of
nutrition labeling and claims on processed, and packaged foods. Korean J
Community Nutr 2007;12:206–13.
[7] Borra S. Consumer perspectives on food labels. Am J Clin Nutr 2006;83:12–35.
[8] Petrovici DA, Ritson C. Factors influencing consumer dietary health pre-
ventative behaviours. BMC Public Health 2006;6:222.
[9] Neuhouser ML, Kristal AR, Patterson RE. Use of food nutrition labels is
associated with lower fat intake. J Am Diet Assoc 1999;99:45–53.
[10] Roberto CA, Larsen PD, Agnew H, Baik J, Brownell KD. Evaluating the impact
of menu labeling on food choices and intake. Am J Public Health
2010;100:312–8.
[11] Lee I, Choi B, You D, Park Y. College students characteristics and utilization of
the nutrition labels on food package. Korean J Diet Cult 2002;17:299–308.
[12] Arsenault JE. Can nutrition labeling affect obesity? Choices Magazine; 2010.
Available at: http://www.choicesmagazine.org/magazine/article.php?
article¼140. Accessed August 6, 2015.
[13] Moon SS. Low skeletal muscle mass is associated with insulin resistance,
diabetes, and metabolic syndrome in the Korean population: the Korea
National Health and Nutrition Examination Survey (KNHANES) 2009–2010.
Endocr J 2014;61:61–70.
[14] Department of Health and Human Services. Korean nutrition standards
guidebook. Seoul, South Korea: Department of Health and Human Services;
2013.
[15] Ollberding NJ, Wolf RL, Contento I. Food label use and its relation to dietary
intake among US adults. J Am Diet Assoc 2010;110:1233–7.
[16] Vandenberg RJ. Food label information: what consumers say they use and
what they actually use. Adv Consum Res 1981;8:484–7.
[17] Marquis M, Dubeau C, Thibault I. Canadians’ level of confidence in
their sources of nutrition information. Can J Diet Pract Res 2005;66:
170–5.
[18] Buzby JC. Older adults at risk of complications from microbial foodborne
illness. Food Rev 2002;25:30–5.
[19] U.S. Food and Drug Administration (2011). Using the nutrition facts label: A
how-to guide for older adults. Available at: http://www.fda.gov/Food/
ResourcesForYou/Consumers/ucm267499.htm. Accessed August 6, 2015.
[20] Marietta AB, Welshimer KJ, Long A. Knowledge, attitudes, and behaviors of
college students regarding the 1990 Nutrition Labeling Education Act food
labels. J Am Diet Assoc 1999;99:445–9.
[21] Bowman SA. A comparison of the socioeconomic characteristics, dietary
practices, and health status of women food shoppers with different food
price attitudes. Nutr Res 2006;26:318–24.
[22] Kim HS. Assessing college students’ nutrition knowledge, belief, and
health behaviors: Applying the belief model to a university foodservice
setting. Unpublished doctoral dissertation. Texas Tech University,
Lubbock, TX.
[23] Satia JA, Galanko JA, Neuhouser ML. Food nutrition label use is associated
with demographic, behavioral, and psychosocial factors and dietary intake
among African Americans in North Carolina. J Am Diet Assoc
2005;105:392–402.
[24] Ollberding NJ, Wolf RL, Contento I. Food label use and its relation to dietary
intake among US adults. J Am Diet Assoc 2011;111:S47–51.
[25] Stran KA, Knol LL. Determinants of food label use differ by sex. J Acad Nutr
Diet 2013;113:673–9.
[26] Teisl MF, Bockstael NE, Levy A. Measuring the welfare effects of nutrition
information. Am J Agric Econ 2001;83:133–49.
[27] Gorton D. Clinical Trials Research Unit. Nutrition labels: a quantitative
survey of understanding and use by ethnicity and income in New Zealand.
Auckland: University of Auckland; 2007.
[28] Golodner LF. Healthy confusion for consumers. JPP&M 1993;12:130–2.
[29] Drichoutis A, Lazaridis P, Nayga RM Jr. Consumers’ use of nutritional
labels: a review of research studies and issues. Acad Mar Sci Rev
2006;10:1–22.
[30] Kim N, Lee J. A Study on perception and utilization of food-nutrition
labeling by age in Busan residents. J Korean Soc Food Sci Nutr
2009;38.
[31] Kim DS, Lee JW. Use and recognition about nutrition labeling of processed
foods among middle school students and their parents. J Korean Diet Assoc
2002;8:301–10.
[32] Kwak JE, Lee SY, Lee SH, Ko KS. A survey for needs and preference of food
and nutrition information on mass media for Korean female adults. Korean
J Community Nutr 2014;19:550–7.
[33] Balasubramanian SK, Cole C. Consumers’ search and use of nutrition in-
formation: the challenge and promise of the nutrition labeling and edu-
cation act. J Mark 2002;66:112–7.
[34] Macon JF, Oakland MJ, Jensen HH, Kissack PA. Food label use by older
Americans: data from the continuing survey of food intakes by individuals
and the diet and health knowledge survey 1994–96. J Nutr Elder
2004;24:35–52.
[35] Kreuter MW, Brennan LK, Scharff DP, Lukwago SN. Do nutrition label
readers eat healthier diets? Behavioral correlates of adults’ use of food
labels. Am J Prev Med 1996;13:277–83.
[36] Post RE, Mainous AG, Diaz VA, Matheson EM, Everett CJ. Use of the
nutrition facts label in chronic disease management: results from the na-
tional health and nutrition examination survey. J Am Diet Assoc
2010;110:628–32.
[37] Cho JK, Kang HS, Yoon JH. Increased dietary intake of proteins for the
prevention and treatment of sarcopenic obesity in the elderly. Korean J
Obes 2013;22:77–82.
[38] Coulson NS. An application of the stages of change model to consumer use
of food labels. Br Food J 2000;102:661–8.
[39] Miller LM, Cassady DL, Applegate EA, Beckett LA, Wilson MD, Gibson TN,
et al. Relationships among food label use, motivation, and dietary quality.
Nutrients 2015;7:1068–80.
[40] Kim SY, Nayga RM Jr, Capps O Jr. The effect of food label use on nutrient
intakes: an endogenous switching regression analysis. J Agr Resource Econ
2000;25:215–31.
[41] Lin CT, Lee JY, Yen ST. Do dietary intakes affect search for nutrient infor-
mation on food labels? Soc Sci Med 2004;59:1955–67.
Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.