Introduction

Adolescence is the transitional phase between childhood and adulthood and encompasses significant cognitive, psychological, and physical changes [1]. This pivotal period encourages adolescents to cultivate resilience, assertiveness, and social interaction skills, which are essential for navigating the complexities of the world around them [1]. Central to their development is the critical need for nutritious food to ensure healthy growth and well-being [2]. However, in today’s digital era, social media trends exert substantial influence over dietary choices [3], often overshadowing nutritional considerations [4].

The proliferation of viral content and trending topics on social media platforms has reshaped societal norms, including food preferences and consumption habits [5]. Viral videos, such as product introductions for new food items, captivate audiences and can influence widespread dietary behaviours [6]. This remains relevant, as a recent study states that food and beverage marketing significantly influence the development of a preference for and desire to consume energy-dense, low-nutrient foods [7]. Recent Malaysian studies highlight social media’s impact on food choices among youth. Kei (2024) [8] found that Instagram influencers play a key role in promoting healthier eating. Additionally, Salleh et al. (2021) [9] explored how social media impacts food popularity among Malaysian students, finding that YouTube had the greatest influence due to its visual appeal, which significantly shaped students’ food preferences. These studies underscore social media’s growing influence on Malaysian adolescents’ food choices. Consequently, the focus on nutritional content in food selection has diminished despite the presence of food labels intended to guide informed choices [10].

Food label literacy refers to an individual’s capacity to obtain, comprehend, and utilise information found on nutrition labels [11]. It emerges as a critical skill in the midst of evolving dietary landscapes [12]. Asakura et al. (2017) [13] emphasised that high nutritional knowledge, a foundation of food label literacy, is linked to healthier eating patterns among children. However, the increasing prevalence of obesity and related non-communicable diseases among them highlights the urgency of promoting health literacy, particularly concerning dietary practices [14]. Those who interpret food labels accurately can incorporate healthy eating habits into their daily lives [15].

In Malaysia, 84% of adolescents engage with product labels, yet only 33% routinely reading labels, focusing primarily focusing on the expiration dates [16]. As agents of change, adolescents play a pivotal role in shaping the future of society and the nation [17]. This phase of life is not only a period of personal growth but also a crucial time for societal development [17], making it essential to equip them with strong health literacy skills. according to the WHO’s holistic definition of health which encompasses physical, mental, and social well-being, health literacy is a fundamental component of overall well-being [14]. This aligns with the growing body of literature on nutrition and food literacy, which underscores the importance of developing health literacy skills in relation to food [18]. As outlined by Miller (2016) [19], food label literacy is an integral part of health literacy.

In light of this, one proactive step towards making informed food choices and maintaining proper nutrition is to read the nutritional labels on the food products one intends to purchase. By fostering comprehension, skills, and attitudes toward food labels, a crucial gap in health education can be addressed, facilitating informed dietary practices among adolescents, as stated by Janeta and Santoso (2018) [20], i.e., the quality of life can be determined by an individual’s food choices.

Given the significance of this issue, the present study aims to assess food label reading and literacy among adolescents aged 13–16 years in Malaysia. Furthermore, this study seeks to identify the influence of sociodemographic factors on food label literacy, building upon more information to highlight the significant associations. Nowadays, understanding and promoting food label literacy are proactive steps to empower adolescents to make informed and healthier food choices, thereby contributing to their overall well-being and societal advancement.

Methods

Results

Table 1 illustrates the sociodemographic characteristics of the study participants. A total of 1,983 subjects were included, comprising four age groups: 13 years old (406 subjects), 14 years old (452 subjects), 15 years old (542 subjects), and the majority at 16 years old (583 subjects). On average, the subjects are 14.7 ± 1.1 years old. The sample included 662 males and 1321 females. The study participants were drawn from five primary regions across Malaysia: Central, Southern, Northern, and East Coast of Peninsular Malaysia, and East Malaysia (Sabah and Sarawak), with participation percentages of 28.1%, 22.2%, 15.6%, 15.7%, and 18.4%, respectively. Approximately 77.9% of the participants resided in urban areas, while 22.1% were from rural areas. The ethnicity of the subjects is categorised into five groups: Malay, Chinese, Indian, Sabah Bumiputera, and Sarawak Bumiputera. The largest ethnic group among the subjects is Malay (59.3%), followed by Chinese (16.8%), natives of Sabah (12.1%), natives of Sarawak (6.4%), and Indian (5.3%). This is attributed to the fact that although the Malaysian population comprises three major ethnic groups‒the Bumiputera (i.e., the Malays and indigenous people), Chinese, and Indian, the Malay ethnic group is among the majority at 69.4%, followed by the Chinese at 23.2%, and the Indian at 6.7% [27].

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Table 1. Subject’s sociodemographic characteristics.

https://doi.org/10.1371/journal.pone.0324142.t001

In terms of socioeconomic status, over 73.4% of all subjects are categorised under the B40 group. The B40 cluster represents the bottom 40% of income earners, comprising individuals with household incomes below RM5,250 per month. Subsequently, 20.1% of the subjects belong to the M40 group, i.e., the middle 40%, which includes household incomes ranging from RM5,250 to RM11,819. Meanwhile, only 6.5% fall into the T20 group, i.e., the top 20%, comprising individuals with household incomes exceeding RM11,820 per month. According to the Household Income Survey 2022 [27], the T20 group constitutes the majority of household income categories in Malaysia, at 46.3%. In this study, the mean for household income is 4531.0 ± 8292.3. Most of the participants’ parents’ marital status is predominantly married, with 1,728 individuals, while 255 individuals are either divorced or widowed. Regarding the educational attainment of fathers, 67.6% have completed primary or secondary education, 30.1% have completed higher education, and only 2.4% have no educational background. Similarly, for mothers, 63.9% have completed primary or secondary education, 33.7% have completed higher education, and 2.4% have no education educational background.

Table 2 illustrates the BAZ distribution of the subjects. The majority of the subjects are in the normal BAZ category (65.9%), followed by those categorised as overweight (17.2%), obese (9.7%), and thin (5.3%). The smallest proportion of subjects fell into the severe thinness category, comprising only 2.0%. On average, the subjects’ BAZ is 21.0 ± 4.82 kg/m².

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Table 2. Subject’s body-mass-index-for-age z-score categories.

https://doi.org/10.1371/journal.pone.0324142.t002

The findings in Table 3 reveal that 89.7% of Malaysian adolescents read food labels, while 10.3% reported never reading them. Additionally, the data indicate that a slightly higher percentage of girls (90.3%) read food labels compared to boys (88.4%). Conversely, 9.7% of girl subjects and 11.6% of boy subjects reported never reading food labels.

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Table 3. Food label reading habits of Malaysian adolescents.

https://doi.org/10.1371/journal.pone.0324142.t003

Table 4 illustrates the food label literacy level among Malaysian school adolescents, evaluated based on food label literacy domains. The primary outcome indicates that, overall, Malaysian adolescents demonstrate a moderate level of proficiency across all assessed domains: understanding and interpreting food labels, skills using food labels, and attitude toward food labels, with the means for each domain of 4.66 ± 1.24, 65.8 ± 21.3, and 4.97 ± 1.23, respectively. However, upon comparison among the five regions, while the results are consistently moderate, the central region exhibits the lowest means across all domains: understanding and interpreting food labels (4.35 ± 1.43), utilising food labels (59.7 ± 20.1), and attitude toward food labels (4.63 ± 1.18) compared to other regions. Additionally, the East Coast region is noted with the highest mean in understanding and interpreting food labels, whereas the Northern region demonstrates the highest mean in skills in using food labels as well as an attitude toward food labels, with means of 69.3 ± 19.9 and 5.26 ± 1.25. Other than that, the results indicate significant differences in all domains: Domain A – F(4,1978) = 25.8, p < 0.0001, Domain B – F(4,1978) =17.43, p < 0.001, and Domain C – F(4,1978) = 25.20, p < 0.001.

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Table 4. Food label literacy level of Malaysian adolescents by region.

https://doi.org/10.1371/journal.pone.0324142.t004

Table 5 depicts the comparison between all three domains: understanding and interpretation of nutrition labels, skills in using nutrition labels, and attitudes toward food labels among various sociodemographic factors, including age, gender, parental marital status, parental education, family economic status, and BAZ. Upon analysis of the p-value results for domains A and B (understanding and interpreting food labels and skills using food labels), all sociodemographic factors exhibit non-significant values (p > 0.05), except for age and BAZ. For age, the results show a p-value of p < 0.001 for both understanding and interpretation of nutrition labels, as well as skills in using nutrition labels. Consequently, age emerges as the sole significant factor influencing both the understanding and interpretation, as well as skills in using nutrition labels among the specified sociodemographic factors. In the comparison of attitudes toward food labels with various sociodemographic factors, a notable p-value (p < 0.05) is noted only in the comparison based on the father’s education level. This suggests that a father’s education level may play a significant role in shaping adolescents’ attitudes toward food labels, highlighting the potential influence of the father’s educational background on nutritional literacy and decision-making behaviours among adolescents. When comparing food label literacy across socioeconomic groups, a significant difference was found in the understanding and interpretation of food labels across socioeconomic groups (p < 0.05), with adolescents from higher-income households demonstrating better comprehension. However, there were no significant differences in skills using food labels or attitudes toward them (p > 0.05

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Table 5. Comparison between food label literacy domains with sociodemographic factors.

https://doi.org/10.1371/journal.pone.0324142.t005

Table 6 presents the results of the Games-Howell post hoc test, which was conducted to identify pairwise differences in Comprehension & Interpreting Food Labels, Skills Using Food Labels, and Attitudes Toward Food Labels across different regions. Only significant comparisons (p < 0.05) are reported. For Comprehension & Interpreting Food Labels, significant regional differences were observed. Central scored significantly lower than Southern (M = -0.4391, p = 0.000), Northern (M = -0.5194, p = 0.000), and East (M = -0.7580, p = 0.000). Additionally, Southern had significantly lower scores than East (M = -0.3188, p = 0.003) and East Malaysia (M = -0.3159, p = 0.004). Lastly, East scored significantly lower than Northern (M = 0.2385, p = 0.014). For Skills Using Food Labels, Central demonstrated significantly lower scores compared to Southern (M = -5.4671, p = 0.008), East (M = -9.5822, p = 0.000), and East Malaysia (M = -7.1376, p = 0.000). Similarly, Northern outperformed Central (M = -9.5441, p = 0.000), while East (M = 9.5822, p = 0.000) and East Malaysia (M = 7.1376, p = 0.000) also demonstrated significantly higher scores. For Attitudes Toward Food Labels, Central had significantly lower scores than Northern (M = -9.5441, p = 0.000), East (M = -0.6437, p = 0.000), and East Malaysia (M = -0.4942, p = 0.000). Similarly, Southern scored significantly lower than Northern (M = -0.5949, p = 0.000) and East (M = -0.5086, p = 0.000). Additionally, East Malaysia exhibited significantly lower scores compared to Central (M = -0.3591, p = 0.003).

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Table 6. Post-hoc comparison of food label literacy domains across zones.

https://doi.org/10.1371/journal.pone.0324142.t006

Discussion

The percentage of adolescents reading nutrition labels in this study is slightly higher at 89.7% compared to 84% reported in NHMS 2017 [16]. This may be due to effective educational programs, changes in dietary trends, or increased access and awareness of nutrition labels [27–29]. However, when comparing the actual number of adolescents who always read food labels, this study showed a slightly lower percentage of 23.5% compared to 33% in NHMS 2017. Additionally, 66.2% reported sometimes reading food labels in this study, whereas only 51% reported sometimes reading food labels in NHMS 2017.

In relation to the decreasing percentage of subjects who always read food labels, Jefrydin et al. (2019) [21] identified several barriers that hinder adolescents from doing so. Among them is the lack of interest in reading food labels, considering food labels unimportant, especially for familiar foods, and cravings for certain foods, which led them to ignore labels in favour of immediate satisfaction. Other than that, many adolescents find food labels complex and difficult to understand, which discourages their regular use [30]. Moreover, time constraints further deter adolescents from reading food labels thoroughly, and they tend to prioritise food based on packaging rather than nutritional value [31]. These factors were also discussed in NHMS 2017 and may be the primary reasons for the decrease in the number of adolescents who always read food labels.

A one-way ANOVA test reveals that the mean scores across all three domains for all five regions in Malaysia, Central, Southern, Northern, East Coast, and East Malaysia, are at a moderate level. This finding contradicts the study by Jefrydin et al. (2019) [21], who reported that food label utilisation was low. The East zone has the highest mean score for domain A, i.e., understanding and interpretation of food labels (5.10 ± 1.13), indicating that adolescents in this zone have a better understanding and interpretation of food labels than other zones. However, the Northern zone scored the highest in domain B, i.e., skills in using food labels (18.9 ± 3.7) and domain C, i.e., attitudes towards food labels (5.26 ± 1.25). The results signify that adolescents in these zones are more proficient in using nutrition labels and can utilise the information on nutrition labels to make informed food choices.

While Malaysian adolescents demonstrate a moderate level of food label literacy, comparisons with other populations reveal varying levels of nutrition literacy among adolescents globally. For instance, a large-scale study across ten Arab nations found that 28% of adolescents had poor nutrition literacy, with the highest prevalence observed in Qatar (44%), Lebanon (37.4%), and Saudi Arabia (34.9%) [32]. Similarly, research in Kuwait reported that while 72.5% of adolescents had median overall nutrition literacy, 73.3% exhibited inadequate understanding of food labels [33]. In Turkey, moderate nutrition literacy levels were observed, with dietary habits and food label use playing a significant role in influencing literacy [34]. In Korea, food literacy was explored in relation to adolescent food-related lifestyles, media use, and eating behaviors, further emphasizing the role of nutrition education in dietary habits and the finding reveals that the average food literacy score was 55.57 points which is moderate [35]. These comparisons highlight the need for targeted interventions to enhance food label literacy among adolescents globally, considering cultural and regional dietary influences. Studies in other Asian countries, such as Thailand and Indonesia, have shown the positive impact of nutrition education on adolescents’ food label literacy. In Thailand, Singtong et al. (2021) [36] found that targeted programs improved secondary school students’ understanding of food labels, contributing to healthier eating behaviors. Similarly, in Indonesia, food literacy initiatives enhanced food label comprehension and promoted healthier dietary choices among high school students (Dwijayanti et al., 2021; Safitri & Rahayu, 2018) [37,38]. However, these studies did not specifically categorize literacy levels into low, moderate, or high. Despite this, their findings suggest that food label literacy interventions can effectively promote healthier food choices. These insights highlight the potential for similar initiatives in Malaysia to improve adolescents’ food label literacy and dietary behaviors.

The Games-Howell post hoc test revealed significant regional differences in Comprehension & Interpreting Food Labels, Skills Using Food Labels, and Attitudes Toward Food Labels, indicating disparities in food label literacy across regions. For comprehension and interpreting food labels, participants in Central had significantly lower scores than those in Southern, Northern, and East, suggesting possible differences in education, awareness, or consumer behavior. Additionally, Southern scored lower than East and East Malaysia, highlighting potential gaps in food label comprehension across regions. For skills using food labels, Central performed worse than Southern, East, and East Malaysia, while Northern and East outperformed Central. Although consumers may be aware of the benefits of nutrition labels, they often do not refer to them when purchasing food products. This behavior contributes to unhealthy food choices and an increased risk of health problems [11]. This could explain why participants from Central performed worse in skills using food labels compared to other regions, as they may lack the habit of actively using nutrition labels when making food choices. This may explain why Central performed worse, as they may not habitually use nutrition labels when choosing food. Also, a review found that consumers with prior nutrition knowledge use food labels more effectively [39], suggesting that better-performing regions like Northern and East may have a population with higher nutrition knowledge, allowing them to interpret and utilize food labels more effectively in their decision-making process. As for attitudes toward food labels, Central had significantly lower scores than Northern, East, and East Malaysia, while Southern scored lower than Northern and East. This suggests that attitudes toward food labels vary by region, potentially influenced by media exposure, public health policies, or consumer awareness. Overall, this indicates a need for targeted interventions in lower-performing regions, particularly Central and Southern, to enhance food label literacy and encourage informed dietary choices.

Apart from that, the findings of this study reveal that the mean scores for all three domains tend to increase with age. The lower scores suggest a lesser understanding of food labels, which is potentially influenced by the fact that most food purchases are made by their parents. These results align with the research by Zhang et al. (2017) [40] and Mengi et al. (2023) [41], who showed age-related variations in literacy levels. This trend may be attributed to a growing interest in nutrition and health, coupled with extensive exposure [42]. Additionally, a study suggests that nutrition literacy tends to improve with age [34]. As anticipated, age emerged as a significant factor in food label literacy, with older adolescents demonstrating higher literacy levels. While the expected increase in food label literacy with age was observed, it was unexpected that socioeconomic status was significantly associated with understanding, but not with skills or attitudes. This finding suggests that factors beyond household income such as school-based education or media exposure may play a more influential role in shaping label-related behaviors, as recent studies have shown that such interventions can significantly improve adolescents’ food label literacy, often independently of socioeconomic status [43,44]. Additionally, the lack of significant sex differences in skills and attitudes was surprising, especially given that previous studies often report greater engagement among females. Supporting this, Rafiya et al. (2024) [45] found that although adolescent girls had varying levels of knowledge about food labels, this did not significantly influence their attitudes or practices. These findings suggest that increasing knowledge alone may not be sufficient to change behavior, highlighting the need for targeted intervention programs to improve label literacy. No significant difference was observed in BAZ concerning the level of nutrition label literacy. This finding is aligned with a study reporting that reading food labels is inversely associated with BMI [46]. In addition, another study reported that food label reading was not significantly influenced by BMI [31]. The mean score readings for the obese category in the attitude towards food labels domain are high, possibly because they want to avoid foods or nutrients that may pose health risks, as informed by [21].

Conclusion

In conclusion, although the prevalence of food label reading among adolescents in Malaysia is high at 89.7%, the level of food label literacy among adolescents aged 13–16 in schools in Malaysia is at a moderate level. When comparing the level of food label literacy among adolescents across five zones in Malaysia with sociodemographic factors, a significant relationship (p < 0.05) was found between age and the level of food label literacy, indicating higher literacy values in older adolescents. Likewise, skills in using food labels showed a significant difference based on the father’s educational level. In an “obesogenic” environment that disrupts the balance between calorie intake and energy expenditure [47], many Malaysian children from various sociodemographic backgrounds do not meet dietary recommendations [48]. While our study emphasizes the role of food label literacy in fostering healthier food choices, it does not establish a direct causal link between literacy and obesity risk. However, considering that obesogenic environments contribute to poor eating habits, enhancing food label literacy could be an important strategy to mitigate obesity risk.

Thus, an intervention study to educate adolescents on nutrition labels is crucial to promote healthier food choices and address these dietary deficiencies. A crucial gap in health education can be addressed by fostering proper comprehension, skills, and attitudes toward food labels. This can be achieved through initiatives, such as school-based educational campaigns or social media campaigns that actively engage adolescents, helping them understand the importance of reading food labels and interpreting them to facilitate informed dietary practices. School-based campaigns should integrate food label education into the curriculum through interactive hands-on activities like supermarket tours, and peer-led initiatives. Parental and teacher involvement, along with digital tools such as apps and social media challenges, can further enhance engagement, fostering a sustainable approach to improving food label literacy among adolescents. Future research should further explore this potential relationship.

Acknowledgments

The authors would like to acknowledge the districts, schools and students who participated in the study. Additionally, we extend our gratitude to the undergraduate students, Faten Zulaikah Abdul Razak, Nurul Amnani Hassan, and Vaishnaveey A/P Gurumoorthy, for their involvement in data collection.