DOES THE LANGUAGE USED IN LABELLING OF FOOD MATTER? Yashasvi Sanja Perera ASCEND Research Network Trainee cohort 2 SRI LANKA Sri Lanka An Island in the Indian Ocean, off the south-eastern coast of India. It (65,610 km2) is about 0.93 times as big as Ireland (70,273km2). Population is about 20 million. The Sinhalese, make up 74.9% of the population . Tamils are 15.4% Official Languages: Sinhala and Tamil. INTRODUCTION The Asia-Pacific region is facing an epidemic of NonCommunicable Diseases (NCDs) partly as result of

changing food habits and sedentary life styles. Estimates suggest 2% reduction of annual deaths would save lives of 8 million people over 10 years simply through simple life style modifications. NCDs and health related information Availability of health related information is a critical step to gain knowledge and subsequently to have positive health related behaviour. In this regards, proper labelling of food could be considered a prerequisite to provide information that is necessary for consumers to make an informed choice as regards to their consumption patterns Labelling Defined in the Federal Food, Drug and Cosmetic Act (FFDCA) in the United States of America (USA) as a written, printed, or graphic matter

(i) upon any article or any of its containers or wrappers or (ii) accompanying such article. Labelling is a subset of packaging. Sellers need to label their products. The label may be a simple tag attached to the product or an elaborately designed graphic that is a part of the package FOOD ACT Food (Labelling & Advertising) Regulations 2005 1. Package or container is labeled in accordance with the regulations 2. Label with two languages (with certain exceptions) 3. Label indelibly printed or painted or affixed on the main panel (Supplementary label may be affixed for imported foods) 4. (i) Main panel: a) Common Name

- two languages b) Brand/Trade Name - one or more languages (Shall not mislead the public) c) Net contents in international symbols eg: g or kg, ml or l Contd. (ii) Main or any other panel anyone or more of the three languages a) Food Additives by name or INS number b) Instructions for storage/use, if any

c) Name & address of manufacturer, packer or distributor in Sri Lanka d) Batch No. or Code No. or decipherable code marking e) The date of expiry exp date f) The date of manufacture g)

Bulk imports & repacking date of manufacture, date of repacking h) List of ingredients in descending order i. ii. Country of origin for imported foods Any other declarations required by regulations Letter Size a) Common name minimum height 3 mm and shall be not less than 1/3 of brand name

b) When common name consisted of more than one word, the words shall be in identical type and size and similarly displayed c) 25 g or 30 ml or less size packs letter size shall not be less than 1.5 mm (exceptions may be allowed by Chief Food Authority for packages not exceeding 25 d) Net content & Date of Expiry letter size Minimum Height Area 1 mm Bottles closures containing aerated

waters and liquid with not exceeding 1.5 mm 120 cm2 3 mm 120 240 cm2 6 mm 240 600 cm2 e) Date of Expiry : Exp/Expiry/Best Before/Use Before f) Oil Source has to be declared g)

Blended X Vegetable Oil X more than 75% of single constituent When none of the oil exceeds 75% Blended Vegetable Oil - Constituents shall be declared on the label h) Use the word butter Sugar/Chocolate confectionery at least 4% Butter fat of total fat Flour confectionery entirely of butter fat i) Artificial Products Eg: Artificial Vinegar Similar words in Artificial Cordial close proximity No pictorial representations

j) Irradiated foods should have the international logo for irradiation Existing gap Availability of appropriate health related information in food labels is essential for consumers to make an informed choice as regards to their consumption patterns. Studies have shown that Sri Lankan consumers are receptive to labelling and are willing to pay for these items. However, there is a wide variation in the labelling of foods. OBJECTIVES To describe the contents and language used in the labelling of foods in Sri Lanka.

To investigate the ability of a group of potential consumers to read the contents of these labels. METHODOLOGY Phase 1 Food labels in 10 categories of pre-packaged foods (158 items) in main supermarket chains in the commercial capital of Sri Lanka (Colombo) and its suburbs were audited. A questionnaire was used to gather data from food labels of shelf items The items were categorized to cover the common food items available such as biscuits, cookies, chocolates, sweets, aerated drinks, fruit juices, ice cream, cereals, butter, margarine and milk-powder. The languages used in labelling name, ingredients and nutrition information were documented, entered into a database and analysed.

At least 10 brands for each food item were collected. METHODOLOGY Phase 2 A list of 10 common words used in the sections on ingredients and nutrition information were compiled. This was given to randomly selected 50 male and 50 female patients in the age group of 40-60y admitted to National Hospital of Sri Lanka with diabetes and / or ischaemic heart disease / NCDs. RESULTS Phase 1 COUNTRY OF ORIGIN Sri Lanka 57.6 % Country of origin not mentioned in 3.2% COUNTRY OF PACKING Sri Lanka 69 % (109)

Information on food item The name of the food item was present in all labels while 47 (29.7%) had it only in English and 64 (40.5%) in English and the two native Languages (i.e. Sinhala and Tamil). In 6.5% of labels contained English languages apart from native languages and other Information on ingredients In 93.5% of products the ingredients were mentioned. The language used was only English (56.2%) and Sinhala (29.9%) in majority. Information on nutritional

compositions Nutrition information and calorie compositions were provided mainly in English, and Sinhala or Tamil was used in less than 10% of labels. Information on labels Information label Number of labels in with the relevant informati on 1. Ingredients 153

(96.8%) 1. Nutrients 118 (74.4%) 1. Total calorie 103 65.2%) 1. Calorie 76 Language used in label (% from number of labels that give the information) English English, Sinhala or without Sinhala and Tamil with Sinhala and Tamil or without

Tamil English 100 (65%) 27 (17.5%) 26 (17.5%) 85 (72.6%) 2 (1.8%) 9 (7.7%) 77 (74.8%) 1 (0.9%) 8 (7.5%)

53 (69.7%) 1 (1.3%) 6 (7.9%) Packages from Sri Lanka had a significantly higher chance of containing information in Sinhala or Tamil. Information label Proportion with information in one or in more native languages (Sinhala or

Tamil) with or without English Packaged in Packaged Sri Lanka abroad ( n=109) (n=44) 1. Labels 89 1. Ingredients 51 1. Nutrients Labelling with one or 9 more native 8 2

2 languages Odds Ratio (95% CI) of labels containing Native Language when packaged in Sri Lanka, compared to abroad 20.03 (8.1- 49.6)

18.5 (4.3 - 80.1) 1.9 (0.4 - 9.1) English RESULTS Phase 2 Mean age- 51.4y, male:female- 1:1 , 36% on special diets. Almost a third of adults were not able to read a single word of English commonly used in packages. Results phase 2 The nutritional information on food items in native language was vital for their purchasing decisions in 76%. Seventy two per cent of them were willing to pay for

nutritional labelling in their native languages. Habit of reading the labels prior to purchase 8 30 62 always sometimes never DISCUSSION Food labels in Sri Lanka provide scant information in native languages of Sinhala and Tamil.

A majority of patients accessing a premier hospital in the capital were unable to read the common contents given in label. Conclusions Language compatibility of food labels to consumer needs in Sri Lanka is poor. It is mandatory to have information in Sinhala and Tamil and reverse the discrimination of persons who are unable to read English These areas need urgent attention in national legislative instruments and in international food policy agreements because of the rapid increase in cross border trade of food items. Acknowledgements Supported by the

ASCEND Program ( funded by the Fogarty International Centre, National Institutes of Health, under Award Number: D43TW008332. The contents of this [poster/booklet/publication/presentation] is solely the responsibility of the author(s) and does not necessarily represent the official views of the National Institutes of Health or the ASCEND Program. Reference Dans A, Ng N, Varghese C, Tai ES, Firestone R, Bonita R. The rise of chronic non-communicable diseases in southeast Asia: time for action The Lancet 2011;377:680-689.

Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): casecontrol study. Lancet 2004;364:937952. Cecchini M, Sassi F, Lauer JA, Lee YY, Guajardo-Barron V, Chisholm D. effectiveness. The Lancet, 2010; 376: 1755-1784. Prathiraja PHK, Ariyawardana A. Impact of Nutritional Labeling on Consumer Buying Behavior. Sri Lankan Journal of Agricultural Economics 2003;5:36-45. Mendis S, Jayasinghe S. Labels, packages and leaflets in drugs and devices: the language matters a lot Ceylon Medical Journal 2002;47:100. Bonsmann, SS , Celemn, LF, Larranaga,A, Egger, S, Wills JM, Hodgkins C and Raats MM on behalf of the FLABEL consortium. Penetration of nutrition information on

food labels across the EU-27 plus Turkey. European Journal of Clinical Nutrition. 2010;64:13791385. Wills JM, Schmidt DB, Pillo-Blocka F, Cairns G. Exploring global consumer attitudes toward nutrition information on food labels. Nutr Rev. 2009;67 Suppl 1:S102-6. Food Act in Sri Lanka. Available from''a&path=2(Official website of the Ministry of Justice, Government of Sri Lanka) Codex Alimentarius Commission. Available from: The Codex Alimentarius Commission. Food Labelling. Fifth edition. World Health Organization, Food and Agriculture Organization of the United Nations. Rome, 2007

Kasapila W, Shaarani SM. Harmonisation of food labelling regulations in Southeast Asia: benefits, challenges and implications. Asia Pac J Clin Nutr. 2011;20:1-8. ASEAN common principles and requirements for the labelling of pre-packaged foodstuffs. 2005; Available from: . Health and Consumer Protection Directorate-General of European Commission. Summary of results for the consultation document on: Labelling: competitiveness, consumer information and better regulation for the

EU. Available from: The European Commission and the Health and Consumer Directorate General Labelling: competitiveness, consumer information and better regulation for the EU 2006. European Union. National Institute for Clinical Excellence (NICE) PH 35: Preventing type 2 diabetes: population and community-level interventions in high-risk groups and the general population. Available from: Kelly B, Hughes C, Chapman K, Louie J, Dixon H, King L, on behalf of a collaboration of public health and consumer research groups: Front-of-Pack Food Labelling: Traffic Light Labelling Gets the Green Light. Sydney: Cancer Council, 2008, Available from: Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-


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