Nutrition Literacy Research Articles

Knowledge, Attitudes, and Practices of Vulnerable Populations for Achieving Sustainable Dietary Practices in India

Knowledge, Attitudes, and Practices (KAP) studies offer valuable insights into the socio-cultural, psychological, and behavioral determinants of nutrition. This study aims to assess nutrition KAP during pregnancy and lactation in selected areas of Adilabad and Kumaram Bheem Asifabad districts, Telangana, India. A cross-sectional KAP survey was conducted on 536 individuals from February to March 2020, employing tablet-based data collection for pregnant women, lactating mothers, young mothers, and frontline staff. Departing from the standard equal-weight approach, we assigned different weights to responses based on existing literature and stakeholder consultation, acknowledging the varying significance of each response. This novel approach aims to mitigate the risk of overestimating or underestimating factors, thereby designing more effective policy interventions tailored to societal complexities. The results reveal that regarding the three micronutrients (Iron, vitamin A, and Iodine), the knowledge levels of pregnant women, lactating mothers, and young mothers were low, that is, less than 50% when compared with the functionaries/frontline staff. Pregnant women scored low on attitudes regarding micronutrients compared to lactating mothers, young mothers, and functionaries/frontline staff. Attitudes translate into practices; however, the data revealed that pregnant women, lactating mothers, and young mothers were not adopting appropriate dietary and nutrition practices except for the micronutrient iodine. The inadequate knowledge of all categories of respondents indicates a gap in nutrition literacy and education. The results point to the urgent need for policy action for nutrition education interventions among the vulnerable population.

Nutrition Literacy, Mediterranean Diet adherence and lifestyle of Adolescents, Giza, Egypt.

Nutrition Literacy, Mediterranean Diet adherence and lifestyle of Adolescents, Giza, Egypt.

Protocol to Develop and Validate of an Online Digital Food and Nutrition Literacy Survey for Tailoring Interventions to Improve Diet Quality in Low-Income Adults

Protocol to Develop and Validate of an Online Digital Food and Nutrition Literacy Survey for Tailoring Interventions to Improve Diet Quality in Low-Income Adults

Factors associated with adherence to a public mobile nutritional health intervention: Retrospective cohort study

BackgroundObesity is a global health issue affecting over 2 billion people. Mobile health apps, specifically nutrition apps, have been identified as promising solutions to combat obesity. However, research on adherence to nutrition apps is scarce, especially for publicly available apps without monetary incentives and personal onboarding. Understanding factors associated with adherence is essential to improve the efficacy of these apps. This study aims to identify such factors by analyzing a large dataset of a free and publicly available app (“MySwissFoodPyramid”) that promotes healthy eating through dietary self-monitoring and nutrition literacy delivered via a conversational agent. MethodsA retrospective analysis was conducted on 19,805 users who used the app for at least two days between November 2018 and May 2022. Adherence was defined as completing a food diary by tracking dietary intake over a suggested period of three days. Users who finished multiple diaries were considered long-term adherent. The associations between the day and time of installation, tutorial use, reminder use, and conversational agent choice were examined regarding adherence, long-term adherence, and the number of completed diaries. ResultsOverall, 66.8% of included users were adherent, and 8.5% were long-term adherent. Users who started the intervention during the day (5 a.m.–7 p.m.) were more likely to be adherent and completed more diaries. Starting to use the intervention between Sunday and Wednesday was associated with better adherence and a higher number of completed diaries. Users who chose the female conversational agent were more likely to be adherent, long-term adherent, and completed more diaries. Users who skipped the tutorial were less adherent and completed fewer diaries. Users who set a follow-up reminder were more likely to be long-term adherent and completed more diaries. ConclusionsThis study demonstrates the potential of digital health interventions to achieve comparably high adherence rates, even without monetary incentives or human-delivered support. It also reveals factors associated with adherence highlighting the importance of app tutorials, customizable reminders, tailored content, and the date and time of user onboarding for improving adherence to mHealth apps. Ultimately, these findings may help improve the effectiveness of digital health interventions in promoting healthy behaviors.

Nutrition literacy and decision confidence among nutrition gatekeepers of restaurants

Nutritional decisions regarding commercial foods by handlers play a crucial role in diners' health, either for good or bad. This emphasizes the importance of understanding the connection between nutrition literacy and the confidence of gatekeepers in taking nutrition decisions and inherent hurdles. The limited research on this subject within the restaurant sector, combined with increasing eating out and the relatively weak governance of food and nutrition safety in developing economies, motivated this study. A survey involving 497 cooks and chefs in restaurants in Ghana, drawing on the nutrition literacy theory, revealed that overall nutrition literacy significantly influences confidence in nutrition decision-making of chefs and cooks. However, higher probabilities of this influence were observed among chefs compared to cooks, and there were additional variations in the impact of specific dimensions of nutrition literacy on confidence across independent and hotel-based restaurants. Opportunities, therefore, exist for improving the nutritional quality of foods prepared in restaurants through ongoing targeted interventions to enhance nutrition literacy among these professionals and undo barriers.

Assessment of nutrition knowledge and associated factors among secondary school students in Haramaya district, Oromia region, eastern Ethiopia: implications for health education.

Nutrition knowledge stands as a cornerstone in facilitating informed dietary choices, thereby profoundly impacting overall health and lifestyle outcomes. Malnutrition often correlates with deficient nutritional knowledge, highlighting the critical need for comprehensive understanding in this domain. While Ethiopia has seen considerable research on nutritional status and associated factors, there remains a paucity of studies specifically addressing nutrition knowledge among secondary school students, particularly within the Haramaya District. Therefore, this study aimed to meticulously assess nutrition knowledge and its determinants among secondary school students in Eastern Ethiopia. Employing an institutional-based cross-sectional design, we carefully selected 417 students from secondary schools in Haramaya District, Eastern Ethiopia, through simple random sampling. Data Research Topic entailed structured interviews, with subsequent entry into Epi Data version 3.1 for meticulous analysis utilizing SPSS version 21 software. Descriptive statistics summarized participant characteristics, while both bivariable and multivariable logistic regression analyses were conducted to elucidate factors associated with nutritional knowledge, setting statistical significance at p-value <0.05. All 417 selected students participated in the study, yielding a commendable response rate of 100%. The median nutritional knowledge score among students stood at 58, with an interquartile range spanning from 44 to 66. Approximately 46.76% (95% CI: 42-51.59) of students exhibited good nutritional knowledge. Significant determinants of nutrition knowledge included sex [adjusted odds ratio (AOR) = 1.77, 95% CI: 1.03-3.04], being senior secondary students (AOR = 3.3, 95% CI: 1.95-5.73), and access to nutrition information (AOR = 3.3, 95% CI: 1.60-6.87). Our findings illuminate a notable level of nutritional knowledge among secondary school students in Haramaya District. However, discernible disparities in nutrition knowledge emerged based on gender, educational level, and access to nutrition information. These insights underscore the exigency of targeted interventions aimed at enhancing nutrition literacy among students, thereby fostering holistic health promotion endeavors.

A Group-Based, Six-Lesson Healthy Eating Curriculum for Individuals With Serious Mental Illnesses: Development and Implementation.

As part of an intervention tailored to individuals with serious mental illnesses in residential settings that aimed to increase dietary intake of fresh vegetables and fruits, we developed and implemented a nutrition and cooking curriculum. To develop the curriculum, we assembled a Workgroup that consisted of professionals from multiple fields. The Workgroup held weekly discussions before drafting what would become the Workbook. Residential staff at partnering housing agencies taught the curriculum to residents. The curriculum Workbook contains six lessons, which are organized around two field trips to a mobile farmers market and a grocery store, and four cooking methods. The Workbook also includes instructions on using FreshConnect Checks at mobile farmers markets. The new curriculum distinguishes itself from other nutrition and culinary literacy curricula in that it delivers knowledge about fresh produce and skills in preparing fruits and vegetables in a way that is tailored to individuals with serious mental illnesses.

Perception of the City Outskirts Women on the Barriers to Healthy Eating: A Qualitative Study

Background: A crucial prerequisite for managing non-communicable diseases (NCDs) and their risk factors is community experiences and perceptions about the challenges of unhealthy eating. On the other hand, there is no literature on nutritional literacy in the city›s outskirts, which are the vulnerable parts of society. Thus, this study aimed to examine the barriers to healthy nutrition for resident women in low-income areas of Mashhad. Methods: This qualitative study used 28 women as a representative sample of the residents of marginalized areas of Mashhad in Iran. Data collection was conducted using interviews between 2021 and 2022. Data analysis was done using a content analysis approach (open and selective coding). Results: The most critical obstacles related to healthy eating were listed as follows: (a) low income, high expenses or expensive, (b) incorrect habits or lack of awareness, (c) food preferences, (d) lack of feeling of necessity and insufficient motivation, (e) lack of convenient access in the area, and (f) illness or physical condition. However, participants stated economic, social, and cultural issues as the main barriers to choosing healthy food among residents of low-income areas. Conclusion: This study identified the main barriers to a healthy diet in marginal areas. Overcoming these obstacles can be a strategy for local and national planning to deal with NCDs.

An Evidence-based Systematic Review on the Influence of Food and Nutrition Literacy Interventions on the Dietary Choices of Children and Adolescents in the Middle East and North Africa Region

An Evidence-based Systematic Review on the Influence of Food and Nutrition Literacy Interventions on the Dietary Choices of Children and Adolescents in the Middle East and North Africa Region

Adaptation and Validation of the S-NutLit Scale to Assess Nutritional Literacy in the Peruvian Population.

Maintaining good dietary practices is a factor that allows a better quality of life; therefore, it is necessary to promote health via the fundamental tool of nutritional literacy. In this context, this study aims to evaluate nutritional literacy in Peru through the S-NutLit tool, which is composed of two dimensions. The scale, composed of 11 items, was applied to 396 Peruvian adults. According to the evaluation of the indicators, an acceptable reliability was found, as was a model fit with excellent estimation according to its indicators (CMIN/DIF 2.559; IFC 0.965; SRMR 0.043; RMSEA 0.063; and PClose 0.070). In this way, we seek to reinforce health promotion activities through a nutritional literacy diagnosis, which, due to its characteristics, can be self-administered and used by health entities and other entities in general that are interested in knowing the eating practices of an individual, which undoubtedly leads to good health.

Research trends and gaps concerning food insecurity in college students in the United States: a scoping review

Objective This scoping review explores the broad body of peer-reviewed research measuring food insecurity in post-secondary students in the U.S. to identify trends and gaps to inform future research. Methods Three search engines (PubMed, Web of Science, and CINHAL Full Text) were systematically searched for articles reporting on food security status in U.S. college students. Results One-hundred and sixty studies met inclusion criteria. Emerging high-risk student characteristics include gender non-conforming (GNC) and non-binary, financial independence in college, and pregnant and parenting students. Emerging correlates include lack of transportation, anxiety, and eating disorders. Conclusions Prevalence data can be used by colleges to advocate for services and programs. Additional multi-institutional cohort, longitudinal and qualitative studies are needed to identify timely interventions and effective solutions. A new “rights-based” approach to food security solutions that includes nutrition and food literacy for all students is needed.

Exploring the factors influencing nutritional literacy based on the socioecological model among patients with age-related macular degeneration: a qualitative study from China

ObjectivesAlthough nutritional support is beneficial to the visual rehabilitation of patients with age-related macular degeneration (AMD), a large gap continues to exist between the relevant guidelines and the actual practices...

Fish markets facilitate nutrition security in coastal Kenya: Empirical evidence for policy leveraging

Fish markets are key to supporting the availability and accessibility of nutritious food but are often overlooked in food and nutrition research and policy. This study investigated fish markets in coastal Kenya, using data from 223 semi-structured interviews collected through market surveys, and analyzed their potential to meet recommendations for consumption and alleviate malnutrition in a vulnerable coastal population (children under five years). Findings reveal that women small-scale traders dealt in lower quantities of fish per trader than the other traders, yet sold more nutritious fish. Fish shop traders sold enough fish to meet 129% of the recommended intake of fish (10.4 kg cap−1 yr−1) for all people within the assessed towns, whereas women small-scale traders sold enough to meet 84% of the intake. All market traders were key to making nutrient-dense fish available, with a 100 g portion of fish providing at least 25% of required intakes, across five nutrients, and women small-scale traders providing over 25% of required intakes across six nutrients for a child under five years. The average cost of a nutritious portion of fish was KES 31 (USD 0.22), ranging from KES 12 (USD 0.08) to 49 (USD (0.34), which provide 33.3% of the required nutrients (averaged across six nutrients), with nutrient-dense fish being notably cheaper. This study contributes empirical evidence on how territorial fish markets support nutrition, which is important for food policy interventions that promote nutritional literacy, address nutrient gaps, and improve postharvest practices and infrastructure for fish quality and safety in Kenya.

Assessing nutrition literacy and nutrition counseling proficiency following an interdisciplinary culinary medicine elective.

Culinary medicine (CM) is a growing field of education that aims to bridge the gap between the clinical need for nutritional counseling and the lack of education on the topic. Healthcare professionals can aid in nutrition-related noncommunicable disease (NCD) prevention by improving a patient's dietary behavior. However, the presence of nutrition education in healthcare curricula is lacking. Early evidence indicates that CM could address this gap. The objectives of this study are to determine ifthe provision of an interdisciplinary CM elective will improve student knowledge and confidence with counseling on nutrition and culinary principles, and to improve personal dietary habits of students. This was a one-group pretest-posttest quasi-experimental design. First- and second-year osteopathic medical students (OMS) and nurse practitioner students were recruited to participate in a CM elective via email. Participants were excluded if they were not in good academic standing at their respective institutions. Twelve individuals (n=8 medical; n=4 nursing) were enrolled in the course. Participants completed pre- and postcourse surveys to determine changes in nutrition literacy (Nutrition Literacy Assessment Instrument [NLit42]), nutrition counseling proficiency (Nutrition Survey for Family Practitioners), and dietary quality (Automated Self-Administered 24-h dietary assessment tool; ASA24®). A two-sided, paired t test was conducted to determine changes in outcome variables. All 12 participants completed the precourse assessments, and 8 participants completed the postcourse assessments. Culinary activity attendance was 94.5 %. Participants exhibited a statistically significant increase in their overall nutrition literacy scores after completing the CM elective (p=0.006). Literacy subcategories indicated that the improvement came from the participant's ability to understand household measurements (p=0.005) better. Increases in self-reported proficiency were observed for participants' confidence to counsel on nutrition and prevention/wellness (p=0.02) and macronutrients in health and food safety (p=0.01). No statistically significant changes in the personal dietary pattern or quality were observed. The interdisciplinary CM elective improved nutrition literacy and some aspects of counseling proficiency. Although small shifts in dietary variables were observed, the elective did not statistically improve participants' dietary pattern. However, some changes that were observed may lead to clinically relevant outcomes if maintained long-term. These findings are encouraging. Implementing CM as an educational tool could improve healthcare practitioners' ability to understand and counsel patients on nutrition to prevent the nutrition-related NCDs.

Development and validation of a photograph-based instrument to assess nutrition literacy: The NUTLY project

Most instruments measuring nutrition literacy evaluate theoretical knowledge, not necessarily reflecting skills relevant to food choices. We aimed to develop and validate a photograph-based instrument to assess nutrition literacy (NUTLY) among adults in Portugal. NUTLY assesses the ability to distinguish foods with different nutritional profiles; from each of several combinations of three photographs (two foods with similar contents and one with higher content) participants are asked to identify the food with the highest energy/sodium content. The NUTLY version with 79 combinations, obtained after experts/lay people evaluations, was applied to a sample representing different age, gender and education groups (n = 329). Dimensionality was evaluated through latent trait models. Combinations with negative or with positive small factor loadings were excluded after critical assessment. Internal consistency was measured using Cronbach's alpha and construct validity by comparing NUTLY scores with those obtained in the Medical Term Recognition Test and the Newest Vital Sign (NVS), and across education and training in nutrition/health groups. The cut-off to distinguish adequate/inadequate nutrition literacy was defined through ROC analysis using the Youden index criterion, after performing a Latent class analysis which identified a two-class model to have the best goodness of fit. Test-retest reliability was assessed after one month (n = 158). The final NUTLY scale was unidimensional and included 48 combinations (energy: 33; sodium: 15; α = 0.74). Mean scores (±standard deviation) were highest among nutritionists (39.9 ± 4.4), followed by health professionals (38.5 ± 4.1) and declined with decreasing education (p < 0.001). Those with adequate nutrition literacy according to NVS showed higher NUTLY scores (37.9 ± 4.3 vs. 33.9 ± 6.9, p < 0.001). Adequate nutrition literacy was defined as a NUTLY score≥35 (sensitivity: 89.3%; specificity: 93.7%). Test-retest reliability was high (ICC = 0.77). NUTLY is a valid and reliable nutrition literacy measurement tool.

Relationships among Sleep Time, Physical Activity Time, Screen Time, and Nutrition Literacy of Adolescents: A Cross-Sectional Study in Chongqing, China.

Background: Unhealthy lifestyles among adolescents are reaching alarming levels and have become a major public health problem. This study aimed to assess the relationship between sleep time, physical activity (PA) time, screen time (ST), and nutritional literacy (NL). Methods: This cross-sectional online study involving adolescents aged 10-18 years was conducted in September 2020 in 239 schools in Chongqing, China. NL was measured using the "Nutrition Literacy Scale for middle school students in Chongqing (CM-NLS)". According to the recommended by the Chinese dietary guidelines (2022), we divided the sleep time of junior high school students into <9 h and ≥9 h, high school students into <8 h and ≥8 h, divided the workdays into weekend PA time < 1 h and ≥1 h, and divided the workdays into weekend ST < 2 h and ≥2 h. The multinomial logistic regression model was used to examine the association. Results: A total of 18,660 adolescents (50.2% males) were included. The proportion of participants that were junior high school students and attended boarding schools was 57.2% and 65.3%, respectively. Compared with senior high school students, junior high school students had a higher level of NL. Whether on workdays or weekends, participants with sleep time ≥ 8/9 h, PA time ≥ 1 h, and ST < 2 h per day had higher levels of NL. On weekdays, participants who met the sleep time ≥ 8 h/9 h (OR = 1.48, 95% CI: 1.36, 1.62) and PA time ≥ 1 h (OR = 1.69, 95% CI: 1.59, 1.81) had higher reporting of NL levels. Conclusions: Sleep time, PA time, and ST were positively correlated with NL among adolescents, especially junior high school students.

Individual and family factors correlated with children's fruit consumption.

Fruits are essential for health, yet their consumption in children is inadequate, with unclear influencing factors. A cross-sectional study was conducted among students in grades 3-12 in Beijing, China, from September 2020 to June 2021. Fruit consumption in children was surveyed using a self-administered food frequency questionnaire. Additionally, children's food and nutrition literacy and family food environments were assessed using the "Food and Nutrition Literacy Questionnaire for Chinese School-age Children" and the "Family Food Environment Questionnaire for Chinese School-age Children," respectively. Out of 10,000 participating children, 62.5% consumed fruit daily, with a lower frequency among boys (59.3%) compared to girls (65.8%), and among senior students (48.6%) compared to junior (63.6%) and primary students (71.2%). Fruit consumption was positively associated with other healthy foods (vegetables, whole grains, etc.) and negatively with unhealthy foods (sugared soft drinks). Children with higher food and nutrition literacy consumed fruits daily more frequently (82.4% vs. 59.9%, ORs = 2.438, 95%CI: 2.072-2.868). A significant positive correlation was found between children's fruit consumption and a healthy family food environment (66.4% vs. 50.2%, OR = 1.507, 95%CI: 1.363-1.667). The results indicate that individual food and nutrition literacy and family food environment are key positive predictors of children's fruit consumption. Future interventions should focus on educating children and encouraging parents to foster supportive family environments.

Mapping the Evolution of Nutrition Education: A Scientometric Review from 1970 to 2023, Unveiling Insights Over Half a Century

This scientometric review aims to systematically analyse and document the development and transformation of nutrition education research over more than fifty years. The study seeks to identify key themes, trends, and shifts in the field, offering a comprehensive overview of its historical trajectory and current state. A thorough visual analysis of the Web of Science Core Collection literature, including publication, institution, country/region, author, journal, keywords, and reference in nutrition education from 1970 to 2023, was carried out using Citespace 5.8.R1 (64-bit). The study employs advanced data mining techniques and network analysis to identify citation bursts, major research themes, and influential works in the field. The analysis reveals several significant trends and shifts in nutrition education research. Key themes such as obesity, nutrition literacy, evidence-based strategies, and localised interventions emerged as focal points of academic discourse. The study noted increasing citation bursts related to these themes, indicating a field responsive to emerging health challenges and societal needs. The research landscape evolved from foundational principles in the early years to an era of interdisciplinary approaches and the integration of advanced technologies. The review concludes that nutrition education research has undergone substantial growth and transformation over the past fifty years. It has evolved to address complex nutritional challenges through informed, evidence-based strategies, reflecting its adaptability and responsiveness to changing public health concerns and scientific evidence. This scientometric review maps the field's historical development. It serves as a guidepost for future research directions, underscoring the ongoing importance of nutrition education in enhancing global health and well-being.

Evaluation of nutritional literacy among undergraduate nursing students

Background/Objective: It is difficult to describe or quantify the extensiveness and importance of the nurses’ role in direct patient care. Although Registered Dietitian Nutritionists (RDN) are available, it is often the nurse who is tasked with monitoring a patient’s nutritional status and carrying out nutrition interventions to optimize oral intake such as providing meals and oral supplements, as well as administering enteral and parenteral nutrition. Therefore, it is critical that nurses have an understanding of nutrition to promote good health. Although fundamental nursing courses stress the nurse’s role in promoting healthy nutrition as a means to prevent disease and assist patients in sustaining wellness, there is no standardized nursing curriculum enforcing an independent nutrition course within nursing programs.Methods: A quantitative methodology was used to explore the level of nutritional awareness as measured by the Nutritional Literacy Assessment Instrument (NLit) among BSN nursing students in a public, 4-year institution in the Mid-West of the United States. Nutritional literacy, as defined by Gibbs et al., students’ knowledge of food and associated impact on nutrition was evaluated. Results: The data indicated that 70% of participants had completed an undergraduate nutrition course, with the highest performance on the Nutritional Literacy Survey within the understanding of food groups. Over 80% of respondents were found to have a likelihood of good nutrition literacy. Although no statistical significance was found between a pre-requisite Nutrition course and/or an integrated Nursing Nutrition course and Nutritional Literacy, statistical significance was found when examining student classification (sophomores versus seniors) impact on Nutritional Literacy scores.Conclusions: Promoting the integration of nutrition concepts across a variety of courses within the nursing curriculum will assist the student to utilize clinical judgment in the application and synthesis of nutritional concepts in relation to patient health and wellness.

Nutritional knowledge and related factors among patients with diabetes: A systematic review

This systematic review endeavors to investigate the extent of nutritional knowledge and related factors among individuals diagnosed with diabetes. A meticulous and methodical inquiry was conducted across various international electronic databases, including Scopus, PubMed, and Web of Science, alongside Persian electronic databases such as Iranmedex and the Scientific Information Database. Employing keywords derived from Medical Subject Headings such as "knowledge", "diabetes", and "nutrition", the search encompassed literature up to February 1, 2024. The quality assessment of the studies incorporated in this systematic review was conducted utilizing the Appraisal Tool for Cross-Sectional Studies (AXIS tool). A total of 8,779 diabetic patients across fourteen cross-sectional studies were included in the analysis. The evaluation of nutritional knowledge among diabetic patients yielded a mean score of 53.90 out of 100. Numerous factors, including age, level of education, occupation, attitude, and family history of diabetes, demonstrated significant correlations with the nutritional knowledge of diabetic patients. Thus, policymakers and health administrators must prioritize interventions targeting these factors to enhance nutritional literacy among diabetic populations. Collaboration and support from healthcare professionals, particularly nurses, are instrumental in achieving this objective.