Assessment of Food Additives

Consumption, Knowledge and

Attitude among University
Students of Medical Faculties
Thesis Submitted for fulfillment of Professional diploma in Clinical
Nutrition

Ann Ahmed
Heba fahmy
Amal Sabry Eldidamony
Naglaa Fathy Labib
Dalia Mohamed BahaaEldin
Nameer Mohamed Abd-Elfatah
Heba Mostafa Elwi
Rasha Hashem Sayed
Malik Mohamed Moustafa
Soha Saeed Atteya
 Supervised by
Prof. Dr. Wafaa Fahmi
Professor of public health & nutrition
Growth department-National Nutrition Institute

National Nutrition Institute

2020
Introduction
Introduction

• Food additives are present in almost every product in the markets.

• University students commenly consume many manufactured products every day

which may have great effect on their health and growth.
Aim of the work
Aim of the work

The aim of this study is to explore the consumption of food additives

among university students and to assess their knowledge and attitude
about it.
Review of literature
Review
• Food additives are defined as any substance not normally consumed as a food in itself and
not normally used as a characteristic ingredient of food whether or not it has nutritive
value.

• Food additives are divided into categories or functional classes according to their
technological function, for example preservatives, anti-oxidants, sweeteners, color
additives, flavours and spices, etc.

• E numbers are codes for food additives that have been assessed for use within the
European Union.
Review
Advantages of food additives:
1.To provide leavening or control acidity/alkalinity.

2. To enhance flavor or impact desired color.

3. To maintain product consistency and quality.

4. To maintain product consistency.

5. To improve or maintain nutritional value.

6. To maintain palatability and wholesomeness.

 Review
• Each country of the world has designed several agencies to control the type and
the amount of the substance added to food.

• In USA the Food and drug administration (FDA) should approve any substance
before being added to food as safe.
Review
Methodology:
• Type of study: Cross-sectional study.

• Population: Medical students from Cairo, Ain Shams and Mansoura

universities.

• Duration of study: From January 2020 till end of June 2020

Data were collected through semi structured questionnaire in which questions
were divided into 3 main groups:

•Group (1): A Socio-demographic structured self-administered questionnaire

concerned with elicitation information about demographic data of the students.

•Group (2): A Types of foods and drinks knowledge and attitude structured self-
admitted questionnaire was used to explore students’ knowledge and attitude
towards the food consumption during the participants stay at the faculty.

•Group (3): A Food frequency questionnaire. This helps assess the consumption of
different forms and types of food/drinks, during the participants stay at the faculty.
Results
Level of knowledge about food additives among
university students:
Level of knowledge about food additives among university students

Poor
13%

Excellent
28%

Fair
24%

Good
36%
The number and percentage of participants taking home-made food during university time:

Do you take home-made food? No %

Always
Sometimes 15 9.4
None 57 35.6
88 55.0
Cause of not taking home-made
No %
food?
Awkwardness
15 17.1
Availability of an alternative
73 82.9
The number and percentage of different types of home-
made food taken by participants to their faculties:
Vegetables and fruits No %
Yes
21 13.1
No
139 86.9
Sandwiches No %
Yes
51 31.9
No
109 68.1
Dairy products No %
Yes
10 6.3
No
150 93.7
Home juice No %
Yes
6 3.8
No
154 96.2
Available at home No %
Yes
24 15.0
No
136 85.0
The Distribution of Meals consumed by participants outside their
homes:
Food from the booth No %
Yes 48 30.0
No 112 70.0
Pizza No %
Yes 90 56.2
No 70 43.8
Liver No %
Yes 50 31.3
No 110 68.7
Indomi No %
Yes 25 15.6
No 135 84.4
Traditional meals No %
Yes 52 32.5
No 108 67.5
 The distribution of food habits among participants:
Enjoying with friends is associated with eating out No % Do you read nutritional ingredients and facts? No %
Yes Always
No Sometimes
116 72.5 None 16 10.0
44 27.5 105 65.6
Do you keep healthy choices in ready foods 39 24.4
No % Do you trust the information written on the covers
Always No %
Sometimes Yes
None No 62 38.8
20 12.5
104 65.0 98 61.2
36 22.5 Do you eat preserved foods? No %
Do you prefer eating candied meals? No % Always
Sometimes
Yes None 28 17.5
No 128 80.0
88 55.0 4 2.5
72 45.0 Do you eat foods with added flavors and color
Do you prefer eating salted meals? No %
No %
Always
Yes Sometimes
No None 19 11.9
122 76.2 127 79.3
38 23.8 14 8.8
The distribution of knowledge of participants about some
food additives:
Aspartame
No %
Yes 87 54.4
No 73 45.6
MSG
Yes
No 85 53.1
75 46.9
Vitamin E
Yes
No 143 89.4
17 10.6
Ascorbic acid
Yes
No 131 81.9
29 18.1
Sodium benzoate
Yes
No 114 71.2
46 28.8
Citric acid
Yes
No 144 90.0
16 10.0
Sodium nitrate
Yes
No 125 78.1
35 21.9
Fructose syrup
Yes
No 143 89.4
17 10.6
The distribution of the participant’s knowledge of Preservatives regulations:
Did you know that there are regulations
to add preservatives? No %
Yes 93 58.1
No 47 41.9
Did you know that there is a list of
preservatives authorized to be added to
food?
Yes 110 68.7
No 50 31.3
Did you know that all packaged foods
are added preservatives?
Yes 125 78.1
No 35 21.9
Are E-preservatives harmful to health?
Yes 10 6.3
No 15 93.7
Did you know that vitamins can be used
as preservatives?
Yes 32 20.0
No 128 80.0
The distribution of the participants’ knowledge of the side effects of
added flavors and color, and their relation to some diseases:
Obesity No %
Yes
140 87.5
No
20 12.5
Alzheimer's
Yes
No 73 45.6
87 54.4
Diabetes
Yes
No 125 78.1
35 21.9
Hypertension
Yes
No 146 91.2
14 8.8
Heart and arterial diseases
Yes
No 137 85.6
23 14.4
Body allergy
Yes
No 100 62.5
60 37.5
The distribution of the source of the participants’ knowledge
about preservatives:
Radio and T.V No %
Yes 37 23.1
No 123 76.9
Advertising
Yes 50 31.3
No 110 68.7
Internet
Yes 116 72.5
No 44 27.5
Publications from official bodies
Yes 42 26.3
No 118 73.7
Family and fiends
Yes 74 46.3
No 86 53.7
Food awareness campaigns
Yes 46 28.8
No 114 71.2
The relation between the socioeconomic classes to the participants’ knowledge of food
additives according to sex:

  Male Female Total

p
No % No % No %
Socioeconomic:          
Medium 19 28.4 39 24.4 0.209
High 20 21.5 48 71.6 121 75.6
73 78.5
Knowledge:          
Poor 3 4.5 20 12.5  
Fair     15 22.4 38 23.8 0.050
Good 17 18.3 27 40.3 57 35.6
Excellent 23 24.7 22 32.8 45 28.1
30 32.3
23 24.7
The relation between the socioeconomic classes and the
participants’ knowledge of food additive

  Medium High Total

p
No % No % No %
Knowledge:          
Poor 7 17.9 13 10.7 20 12.5  
Fair 9 23.1 29 24.0 38 23.8 0.636
Good 14 35.9 43 35.5 57 35.6
Excellent 9 23.1 36 29.8 45 28.1
The distribution of crisps group according to their consumption by
participants and their degree of knowledge about food additives:
  Poor Fair Good Excellent
P
No % No % No % No %
Chips                
Low 11 55.0 15 39.4 20 35 15 3.3
Medium 4 20.0 8 21.1 11 19.3 8 17.8 0.261
High 4 20.0 9 23.7 16 28.1 20 44.4
Very high 1 5.0 6 15.8 10 17.5 2 4.5
Corn crisps
Low 14 70.0 16 42.1 29 50.9 23 51.1
Medium 0 0.0 7 18.4 7 12.3 5 11.1 0.542
High 6 30.0 11 28.9 17 29.8 14 31.1
Very high 0 0.0 4 10.6 4 7.0 3 6.7
Wheat crisps
Low 17 85.0 18 47.4 30 52.6 26 57.8
Medium 1 5.0 7 18.5 8 14.0 3 6.7 0.224
High 1 5.0 10 26.3 14 24.6 14 31.1
Very high 1 5.0 3 7.9 5 8.8 2 4.4
 Distribution of sweets group according to their consumption by
university students and their degree of knowledge about food
additives:
  Poor Fair Good Excellent   Poor Fair Good Excellent P
P
No % No % No % No % Eastern
Chocolate sweets Low
Low Medium 17 85.0 24 63.1 49 86.0 39 86.7
Medium High 0 0.0 8 21.1 3 5.2 4 8.9 0.041
High 14 70.0 14 36.8 20 35.0 26 57.8 0.079 1 5.0 5 13.2 4 7.0 1 2.2
2 10.0 8 21.1 12 211 6 13.3
Very high
Very high 2 10.0 1 2.6 1 1.8 1 2.2
4 20.0 10 26.3 18 31.6 12 26.7
0 0.0 6 15.8 7 12.3 1 2.2
Western
Gum sweets
Low Low 16 80.0 23 60.5 47 82.4 42 93.4
0.061
Medium Medium 1 5.0 6 15.8 3 5.3 1 2.2
High 13 65.0 18 47.3 27 47.5 22 48.9 0.230 High 3 15.0 8 21.1 6 10.5 1 2.2
Very high 2 10.0 5 13.2 10 17.5 4 8.9
Very high 0 0.0 1 2.6 1 1.8 1 2.2
3 15.0 9 23.7 10 17.5 17 37.8
2 10.0 6 15.8 10 17.5 2 4.4 Canned juices
Biscuits Low
Low Medium 12 60.0 16 42.1 22 38.6 18 40.0
Medium High 4 20.0 7 18.4 11 19.3 7 15.6 0.833
High 10 50.0 11 28.9 22 38.6 17 37.8 0.679 Very high 4 20.0 11 28.9 18 31.6 15 33.3
Very high 5 25.0 6 15.8 13 22.8 9 20.0 0 0.0 4 10.5 6 10.5 5 11.1
5 25.0 16 42.1 18 31.6 15 33.3
0 0.0 5 13.2 4 7.0 4 8.9
Distribution of soft drinks group according to their consumption by
university students and their degree of knowledge about food
additives:
  Poor Fair Good Excellent
P
No % No % No % No %
Soft drinks

Low
Medium 11 55.0 18 47.4 27 47.4 17 37.8 0.437
High 4 20.0 10 26.3 6 10.5 7 15.5
Very high 3 15.0 7 18.4 18 31.6 17 37.8
2 10.0 3 7.9 6 10.5 4 8.9
Diet soft drinks

Low 0.530
Medium 18 90.0 27 71.0 50 87.7 35 77.8
High 0 0.0 5 13.2 3 5.3 4 8.9
Very high 1 5.0 5 13.2 2 35 4 8.9
1 5.0 1 2.6 2 3.5 2 4.4
Distribution of indomi group according to their consumption by university students and their degree of knowledge about food additives

  Fair Good Excellent

Poor
P
No % No % No % No %
Indomi

Low
Medium
High 13 65.0 21 55.2 37 64.9 30 66.7
Very high 0.751
0 0.0 5 13.2 7 12.3 4 8.9
5 25.0 10 26.3 11 19.3 10 22.2
2 10.0 2 5.3 2 3.5 1 2.2
Distribution of sweets group according to their consumption by university
students and their degree of knowledge about food additives:
  Poor Fair Good Excellent   Poor Fair Good Excellent
P
No % No % No % No % P
Shawarma No % No % No % No %
Coated bakery
Low 16 80.0 24 63.2 42 73.7 35 77.8
Medium 3 15.0 12 31.6 8 14.0 6 13.3 0.38
High 1 5.0 1 2.6 5 8.8 4 8.9 5
Low
Very high 0 0.0 1 2.6 2 3.5 0 0.0
Medium 12 60.0 18 47.4 22 38.6 20 44.4 0.94
Pizza
High 4 20.0 7 18.4 13 22.8 9 20.0
Very high 3
3 15.0 11 289 18 31.6 13 28.9
0.34 1 5.0 2 5.3 4 7.0 3 6.7
Low 16 80.0 28 73.7 43 75.4 39 86.7
8 Take Away
Medium 1 5.0 3 7.9 10 17.5 4 8.9
High 2 10.0 6 15.8 3 5.3 2 4.4 meals
Very high 1 5.0 1 2.6 1 1.8 0 0.0
Pies

Low
0.60 Medium
7 High
Low 16 80.0 25 65.8 40 70.1 30 66.6 13 65.0 20 52.6 32 56.1 28 62.2 0.77
Medium 1 5.0 6 15.8 12 21.1 8 17.8 Very high 2 10.0 7 18.4 9 15.8 7 15.6 5
High 3 15.0 7 18.4 5 8.8 7 15.6 3 15.0 7 18.4 14 24.6 9 20.0
2 10.0 4 10.5 2 3.5 1 2.2
Distribution of quick beverages according to their consumption by
university students and their degree of knowledge about food
additives:

  Poor Fair Good Excellent

P
No % No % No % No %
Nescafe
Low 11 55.0 15 39.5 15 26.3 14 31.1
0.18
Medium 2 10.0 7 18.4 5 8.8 8 17.8
2
High 6 30.0 11 28.9 21 36.8 16 35.5
Very high 1 5.0 5 13.2 16 28.1 7 15.6
Creamer
Low 15 75.0 27 71.0 43 75.4 37 82.2
0.18
Medium 2 10.0 3 7.9 2 3.6 3 6.7
7
High 3 15.0 8 21.1 6 10.5 2 4.4
Very high 0 0.0 0 0.0 6 10.5 3 6.7
Distribution of quick beverages according to their consumption by
university students and their degree of knowledge about food
additives

  Poor Fair Good Excellent

P
No % No % No % No %
Fruits milk
Low 14 70.0 19 50.0 30 52.6 23 51.1
Medium 1 5.0 6 15.8 12 21.1 6 13.3 0.380
High 5 25.0 9 23.7 9 15.8 14 31.1
Very high 0 0.0 4 10.5 6 10.5 2 4.5
White cheese
Low 6 30.0 14 36.8 17 29.8 16 35.6
Medium 4 20.0 5 13.2 5 8.8 2 4.4 0.434
High 9 45.0 13 34.2 20 35.1 19 42.2
Very high 1 5.0 6 15.8 15 26.3 8 17.8
Distribution of processed meat and cheese according to their
consumption by university students and their degree of knowledge
about food additives:
  Poor Fair Good Excellent
P
No % No % No % No %
Processed meat
Low 13 65.0 27 71.0 42 37.7 31 68.9
0.76
Medium 5 25.0 5 13.2 11 19.3 8 17.8
7
High 2 10.0 5 13.2 4 7.0 6 13.3
Very high 0 0.0 1 2.6 0 0.0 0 0.0
Romy cheese
Low 12 60.0 15 39.4 26 45.6 16 35.6
0.56
Medium 3 15.0 12 31.6 9 15.8 10 22.2
8
High 3 15.0 9 23.7 16 28.1 14 31.1
Very high 2 10.0 2 5.3 6 10.5 5 11.1
Spread cheese
Low 16 80.0 23 60.5 38 66.7 26 57.7
0.81
Medium 1 5.0 5 13.2 6 10.5 4 8.9
7
High 3 15.0 7 18.4 10 17.5 12 26.7
Very high 0 0.0 3 7.9 3 5.3 3 6.7
Distribution of appetizer and canned according to their consumption by
university students and their degree of knowledge about food additives:
  Poor Fair Good Excellent
P
No % No % No % No %
Ketchup
Low 12 60.0 14 36.8 26 45.6 14 31.1
Medium 1 5.0 7 18.4 8 14.0 10 22.2 0.189
High 6 30.0 16 42.1 15 26.4 14 31.1
Very high 1 5.0 1 2.7 8 14.0 7 15.6
Canned beans
Low 18 90.0 29 76.3 43 75.4 33 73.3
Medium 0 0.0 1 2.6 6 10.5 4 8.9 0.694
High 2 10.0 6 15.8 6 10.5 7 15.6
Very high 0 0.0 2 5.3 2 3.6 1 2.2
Preserved vegetables
Low 19 95.0 30 78.9 42 73.7 32 71.1
Medium 0 0.0 2 5.3 6 10.5 4 8.9 0.241
High 1 5.0 2 5.3 6 10.5 8 17.8
Very high 0 0.0 4 10.5 3 5.3 1 2.2
Pickled
Low 12 60.0 18 47.4 28 491 19 42.2
Medium 2 10.0 6 15.8 5 8.8 6 13.3 0.859
High 3 15.0 10 26.3 17 29.8 16 35.6
Very high 3 15.0 4 10.5 7 12.3 4 8.9
Distribution of cooked supplies according to their consumption by
university students and their degree of knowledge about food additives:

  Poor Fair Good Excellent

P
No % No % No % No %
Mage cubes
Low 18 90.0 24 63.1 43 75.4 30 66.7
Medium 1 5.0 5 13.2 5 8.8 4 8.9 0.432
High 1 5.0 8 21.1 9 15.8 11 24.4
Very high 0 0.0 1 2.6 0 0.0 0 0.0
Vegetable ghee
Low 17 85.0 24 63.1 44 77.1 33 73.3
Medium 2 10.0 5 13.2 3 5.3 2 4.4 0.278
High 1 5.0 8 21.1 5 8.8 8 17.9
Very high 0 0.0 1 2.6 5 8.8 2 4.4
Conclusion
Conclusion:
•This study was aimed at survey of undergraduate university student’s knowledge
about food additives and impact on food preference.

•Our findings show that 35.6% of the respondents had good knowledge and 28.1%
had excellent knowledge about food additives.

•In spite of the high percent of good and excellent knowledge about food additives
among the students , there was high consumption of food containing food
additives especially soft drinks , ketchup , Nescafe , pickles and chips

•Large percent of the participants preferred ready made meals because of its
availability and because of enjoying the company of their friends
Recommendations
Recommendations:
1- All non-essential food additives should be banned, particularly all cosmetic
agents such as food colorants.

2- The various regulating agencies should ensure that it is only those food
additives which are generally recognized as safe (GRAS) that is added to
foods.

3- All foods which include additives with carcinogenic, mutagenic and

teratogenic properties should be clearly labeled with the appropriate warning.

4- All food additives that are not generally recognized as safe (Non GRAS)
must not exceed the acceptable Daily Intakes (ADIs)
5- The amount of TV advertising which encourages children to buy
and eat unhealthy junk food should be vigorously cut down by various
regulating agencies.

6- Health education programs for university students regarding harms of

food additives.

7- Providing healthy eating options in universities such as fruits and

vegetables.