Nutrition literacy predicts adherence to healthy/unhealthy diet patterns in adults with a nutrition-related chronic condition

Attitudinal factors associated with protein sufficiency in Chilean vegan university students - A pilot study

Introduction

Introduction: vegan diets are currently an essential topic of discussion because they are recognized as a prototype of a healthy diet but are also associated with deficits in the intake of critical nutrients such as protein. Evaluating the factors that influence the deficit in their intake in vulnerable populations such as university students represents an important topic of interest, considering that this is one of the groups where veganism is most popular. Given this, the present study aimed to determine the degree of protein sufficiency and its associated factors in a sample of Chilean vegan university students. Materials and methods: an exploratory cross-sectional study was conducted on 114 vegan university students who responded to an online survey on academic, attitudinal, clinical, dietary, and sociodemographic variables. Protein intake was calculated, and based on self-reported weight, daily protein adequacy was calculated according to the recommendation of 0.9 g/kg/day. Finally, the association between protein adequacy and previously consulted variables was calculated by determining the odds ratios. Results: only 53.5 % had adequate daily protein intake, which was associated with the length of time respondents had been vegan (OR, 2.86; 95 % CI, 1.07 to 7.34; p < 0.05), use of supplements (OR, 5.24; 95 % CI, 1.17 to 25.2; p < 0.05), and the frequency with which they ate lunch at home (OR, 87.7; 95 % CI, 24.1 to 304; p = 0.000). Conclusion: there needs to be more protein adequacy in the assessed sample. Protein adequacy is associated with the length of time on the vegan diet, frequency of eating lunch away from home, and use of supplements regularly.

Combined effects of a Mediterranean diet and respiratory muscle training on higher education woodwind musicians: A randomized controlled trial

A two-factor within subjects and randomized controlled was conducted with three groups (two experimental and one control) to explore the effects of the Mediterranean diet and respiratory muscle training on ventilatory fatigue, stress, and emotional performance of woodwind musicians. 70 students from the Valencia Conservatory of Music were recruited and randomized into three groups: respiratory training group + nutrition program (RTG; n = 17), control group (CG; n = 35) and nutrition program group (NPG; n = 18). The nutritional program was based on Mediterranean a diet. Body composition, emotional intelligence, physiological stress and ventilatory response were assessed for all groups before and after intervention. Mixed ANOVA showed main effects of diet and training interventions on emotional attention (F = 8.042; p = 0.006), clarity (F = 9.306; p = 0.003), repair (F = 5.527; p = 0.022), Forced-Expiratory-Volume (F = 30.196; p < 0.000) and Forced-Vital-Capacity (F = 21.052; p < 0.000), with both interventions improving emotional intelligence and ventilatory variables. Bonferroni post-hoc analysis revealed significant differences of RTG and CG for emotional attention (MD = 4.60; p = 0.023), comprehension (MD = 5.734; p = 0.005), repair (MD = 8.576; p < 0.000), FEV1 (MD = 0.862; p = 0.005), and FCV (MD = 1.608; p < 0.001); with similar results when comparing NTG and CG: emotional attention (MD = 4.156; p = 0.041), comprehension (MD = 4.473; p = 0.033), repair (MD = 6.511; p = 0.001), Forced-Expiratory-Volume (MD = 1.608; p < 0.001), and Forced-Vital-Capacity (MD = 1.183; p < 0.001). No significant effects of experimental groups were observed for physiological stress variables (p > 0.05). This results suggests that respiratory training enhances emotional intelligence and lessens respiratory fatigue in musicians, and a combination of a Mediterranean diet and respiratory muscle training further boosts emotional intelligence, albeit with limited impact on physiological stress. This study represents a novel investigation into the approach by dietary interventions and respiratory muscle training in wind musicians since there are no studies that analyze it.

Nutrition literacy level of medical personnel in tertiary hospitals: evidence from a cross-sectional study

BACKGROUND

Nutrition literacy (NL), stemming from health literacy, profoundly influences dietary habits and chronic diseases. Despite their pivotal societal role, scant research exists on NL levels among medical personnel. This study examined NL levels among tertiary hospital medical staff in Bengbu and identified influencing factors.

METHODS

Using cluster sampling, all Bengbu tertiary hospitals were selected, with 4-5 departments randomly chosen. A structured questionnaire assessed demographic characteristics, while the NL short-form scale (NL-SF12) evaluated NL. SPSS 26.0 and AMOS conducted statistical analysis, including confirmatory factor analysis and Cronbach's α for reliability. Chi-square tests and logistic regression analyzed group differences and influencing factors.

RESULTS

The NL-SF12 demonstrated robust reliability and validity. Of participants, 34.22% were male and 65.78% female; 41.03% were doctors and 42.16% nurses. Overall, 45.68% exhibited high NL. Females showed higher total NL (OR = 1.47, 95% CI: 1.08-1.98), cognition (OR = 1.66, 95% CI: 1.22-2.24), skills (OR = 1.48, 95% CI: 1.09-2.00), and interactive NL (OR = 2.21, 95% CI: 1.53-3.19) than males. Those with a master's or higher had higher total NL (OR = 2.20, 95% CI: 1.33-3.65) and cognition (OR = 3.23, 95% CI: 1.94-5.37) than those with an associate degree or less. Pharmacists, inspectors, and technicians had higher total NL (OR = 1.55, 95% CI: 1.06-2.26) and functional NL (OR = 1.49, 95% CI: 1.02-2.17). Gender, education level, and career were the influencing factors of nutrition literacy among medical personnel.

CONCLUSIONS

Female medical staff and those with a master's degree or higher showed higher nutrition literacy (NL), particularly in cognition and skills. Pharmacists, inspectors, and other technicians exhibited higher levels of total NL and functional NL. Gender, education level, and career were identified as significant influencing factors of nutrition literacy among medical personnel. Understanding and considering these factors are crucial for developing targeted strategies to enhance nutrition literacy among healthcare professionals. Future efforts to improve nutrition literacy through training and interventions should be tailored to the characteristics of different groups to effectively enhance the capabilities and proficiency of healthcare professionals in nutrition knowledge and practice.

Cross-cultural adaptation and validation of the short nutritional literacy scale for young adults (18-35years) and analysis of the influencing factors

OBJECTIVES

This study translated the short nutrition literacy scale for young adults (18-35 years) into Chinese, examined its reliability and validity, and analyzed its influencing factors.

METHODS

The scale was translated using a modified Brislin translation model. A convenience sample of 508 cases was selected for the survey. Content validity, structural validity, Cronbach's alpha coefficient, and test-retest reliability were used to evaluate the scale's reliability and validity. To screen the factors influencing nutrition literacy in young people.

RESULTS

The Chinese version of the Item-Level Content Validity Index (I-CVI) was 0.833 ~ 1, and the Scale-Level Content Validity Index/Average (S-CVI/Ave) was 0.908. The cumulative variance contribution of the scale was 51.029%, and the model was generally well-fitted. The Cronbach's alpha coefficient and retest reliability of the scale were 0.826 and 0.818. The results showed that the level of education, mother's education, nutrition-related courses, and frequency of attention to nutritional health information were the factors influencing the nutritional literacy of young people.

CONCLUSION

The Chinese version of the S-NutLit Scale can effectively assess the nutrients of young Chinese people. Low levels of education, low levels of education of mothers, lack of exposure to nutrition-related courses, and low frequency of attention to nutritional health information can lead to lower levels of nutritional literacy among young people.

Exploring university students' nutrition literacy in Saudi Arabia: a cross-sectional survey

Introduction

Improving individuals' nutrition literacy can be one way to promote healthy dietary behaviors, which lowers the incidence of non-communicable diseases. In Saudi Arabia, there is a limited information regarding nutrition literacy among students. Therefore, the purposes of this study was to investigate university students' nutrition literacy and identify its predictors in Saudi Arabia. Another objective was to assess how nutrition literacy is associated with eating habits among this sample.

Methods

This cross-sectional study was carried out among students attending the University of Jeddah and King Abdulaziz University (Jeddah City) in Saudi Arabia from June 2023 to September 2023. Using a convenience sampling approach, 570 students were enrolled in this study. An online-based structured survey tool including demographic details, a food frequency questionnaire, and a nutrition literacy scale was used to collect the data. Descriptive and multiple binary logistic regression analysis were performed.

Results

Approximately 40.4% of the participants exhibited poor nutrition literacy. Female students were less likely than male students to have poor nutrition literacy (adjusted odds ratio, AOR = 0.62; 95% confidence interval, CI = 0.42, 0.92). Underweight (AOR = 1.73; 95%CI = 1.22, 4.56) and overweight participants (AOR = 3.1; 95%CI = 2.77, 7.23) were at higher risk of having poor level of nutrition literacy as compared to those who had normal weight. Students who did not take any nutrition-related courses had a 1.3 times higher probability of having a poor level of nutrition literacy compared to their counterparts (AOR = 1.3; 95%CI = 1.05, 3.74). Moreover, poor nutrition literacy was associated with higher weekly consumption frequencies of red meat, processed foods, funk foods and sugar-sweetened beverages.

Conclusion

A higher percentage of university students had poor nutrition literacy, which was associated with gender, self-reported BMI status, nutrition-related courses and unhealthy eating habits. These findings can assist university administrators and policymakers in implementing effective measures to enhance students' nutrition literacy rates in Saudi Arabia.

How may we effectively motivate people to reduce the consumption of meat? Results of a meta-analysis of randomized clinical trials

PURPOSE

Excessive meat consumption (MC) is associated with multiple health risks. Additionally, it can undermine environmental sustainability and affect the potential improvement of animal welfare. The aim of this study was to assess the efficacy of literacy interventions (LIs) in reducing MC.

METHODS

Studies assessing the efficacy of LIs addressing health risks, environmental sustainability and/or animal welfare in reducing MC were searched. We used random-effects meta-analysis to estimate the overall efficacy and conducted subgroup analyses to identify the most effective information contents. Additionally, meta-regression analyses investigated participants' age, LI duration, and follow-up length influence on LIs' efficacy.

RESULTS

Fourteen studies involving more than ten thousand subjects were meta-analyzed. The pooled estimate showed that LIs had a small (Hedges's g = 0.15; 95%CI: 0.06-0.25) but statistically significant effect in reducing MC. Subgroup analysis showed that the highest efficacy was achieved when subjects were alarmed about health risks (g = 0.29; 95% CI: -0.02, 0.60), compared to informing about the risks for the environment (g = 0.18; 95% CI: -0.15, 0.51) and for animal welfare (g = 0.02; 95%CI: -0.08, 0.11). The meta-regression analysis indicated that LIs had greater efficacy in younger individuals and when the intervention duration was longer. Conversely, it was suggested that efficacy improves as the length of follow-up increases.

CONCLUSIONS

Informing about health risks related to MC temporarily decreased its intake, while informing about the impact on environmental sustainability or animal welfare was ineffective. Furthermore, long-lasting LIs achieve long-term dietary change toward MC.

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.

Association between nutritional literacy and nutrition label use in Chinese community residents

Introduction

Nutritional literacy (NL) has a critical influence on food choices. The objective of the present study was to examine the association of NL with nutrition label use.

Methods

A cross-sectional study was conducted in Bengbu, China. In total, 955 adults were interviewed using a questionnaire designed for the present study to collect information on demographics, lifestyle, nutrition label use, and NL. Binary logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for nutrition label use and its predictive variables.

Results

In total, 40.4% of the participants reported looking at nutrition label when purchasing prepackaged foods. NL was significantly positively associated with nutrition label use and specifically with checking nutrition facts table, purported nutrition benefits and purported health benefits. In terms of specific facets of NL, nutrition knowledge, applying skills, and critical skills were associated with nutrition label use. After stratification by monthly income and education, the association between NL and nutrition label use was discovered only in individuals with low monthly income. Additionally, nutrition knowledge was associated with nutrition label use only in adults with high education level, whereas applying skills were associated with nutrition label use only in those with low education level.

Conclusion

The use of nutrition label remains low among Chinese community residents, especially the purported nutritional benefits and purported health benefits. NL is positively associated with nutrition label use, especially with respect to functional and critical NL, with differences based on socioeconomic status. The findings highlight the need for NL interventions targeting individuals with different levels of education and income to encourage use of nutrition label in China.

Fathers Nutrition Knowledge and Child Feeding Practices Associated with Childhood Overweight and Obesity: A Scoping Review of Literature From 2000 to 2023

Objective. Childhood overweight/obesity is a serious global public health issue, demanding parental involvement to reverse trends. Despite fathers' crucial parenting roles, research on fathers and childhood overweight/obesity is limited. This scoping review examines the literature on fathers' nutrition knowledge and feeding practices with childhood overweight/obesity. Methods. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and Arksey and O'Malley (2005) framework, multiple databases were searched. Eligible father-child related studies focused on fathers' nutrition knowledge, feeding practices, and childhood overweight/obesity. Results. Of 26 eligible articles, 52% originated from the United States, and 44% focused on father-child dyads. Most studies were cross-sectional (64%) and survey-based (68%). Further, 11.5% assessed fathers' nutrition knowledge, and child feeding practices (53.4%). Conclusion. Literature on fathers' nutrition knowledge and feeding practices concerning childhood overweight/obesity is limited. Scaling-up fathers' inclusion in childhood nutrition research is encouraged for the design of holistic interventions.

Developing a Personalized Meal Recommendation System for Chinese Older Adults: Observational Cohort Study

BACKGROUND

China's older population is facing serious health challenges, including malnutrition and multiple chronic conditions. There is a critical need for tailored food recommendation systems. Knowledge graph-based food recommendations offer considerable promise in delivering personalized nutritional support. However, the integration of disease-based nutritional principles and preference-related requirements needs to be optimized in current recommendation processes.

OBJECTIVE

This study aims to develop a knowledge graph-based personalized meal recommendation system for community-dwelling older adults and to conduct preliminary effectiveness testing.

METHODS

We developed ElCombo, a personalized meal recommendation system driven by user profiles and food knowledge graphs. User profiles were established from a survey of 96 community-dwelling older adults. Food knowledge graphs were supported by data from websites of Chinese cuisine recipes and eating history, consisting of 5 entity classes: dishes, ingredients, category of ingredients, nutrients, and diseases, along with their attributes and interrelations. A personalized meal recommendation algorithm was then developed to synthesize this information to generate packaged meals as outputs, considering disease-related nutritional constraints and personal dietary preferences. Furthermore, a validation study using a real-world data set collected from 96 community-dwelling older adults was conducted to assess ElCombo's effectiveness in modifying their dietary habits over a 1-month intervention, using simulated data for impact analysis.

RESULTS

Our recommendation system, ElCombo, was evaluated by comparing the dietary diversity and diet quality of its recommended meals with those of the autonomous choices of 96 eligible community-dwelling older adults. Participants were grouped based on whether they had a recorded eating history, with 34 (35%) having and 62 (65%) lacking such data. Simulation experiments based on retrospective data over a 30-day evaluation revealed that ElCombo's meal recommendations consistently had significantly higher diet quality and dietary diversity compared to the older adults' own selections (P<.001). In addition, case studies of 2 older adults, 1 with and 1 without prior eating records, showcased ElCombo's ability to fulfill complex nutritional requirements associated with multiple morbidities, personalized to each individual's health profile and dietary requirements.

CONCLUSIONS

ElCombo has shown enhanced potential for improving dietary quality and diversity among community-dwelling older adults in simulation tests. The evaluation metrics suggest that the food choices supported by the personalized meal recommendation system surpass autonomous selections. Future research will focus on validating and refining ElCombo's performance in real-world settings, emphasizing the robust management of complex health data. The system's scalability and adaptability pinpoint its potential for making a meaningful impact on the nutritional health of older adults.

The association between interactive health literacy and dietary behaviors among Chinese college students: a large-scale cross-sectional study

Background

The association between health literacy and healthy dietary behaviors has been explored in the European population. However, there is currently no evidence available specifically pertaining to Chinese college students particularly for interactive health literacy.

Aims

The objective of this study was to investigate the association between interactive health literacy (IHL) and dietary behaviors in Chinese college students.

Methods

This study included 11,856 Chinese college students (mean age = 18.8 years, SD = 1.2 years). We defined nine healthy dietary behaviors as consumption of water, egg, milk and milk products, vegetables, fruit, red meat, soy and soy products, seafood, and sugar-sweetened beverages. For each food group, participants who met the criterion for being a regular consumer of the item were assigned a score of 1, and otherwise were assigned a score of 0. Thus, the dietary behaviors score ranged from 0 to 9, with higher scores indicating healthier dietary behaviors. We used the revised 28-item Chinese Adolescent Interactive Health Literacy Questionnaire (CAIHLQ) to evaluate IHL; a higher score on this scale indicates a greater health literacy. Multivariate logistic regression was used to analyze the association between IHL level and frequency of different numbers of dietary behaviors.

Results

After adjusting for sex, age, annual family income, place of residence, father's education level, and mother's education level, there was a clear and significant positive association between IHL and the likelihood of exhibiting diverse dietary behaviors. The adjusted odds ratio (95% CI) of exhibiting given nine dietary behaviors with reference to tertile 1 according to categories of IHL was as follows: 1.055 (0.694, 1.603) for tertile 2 and 1.849 (1.269, 2.696) for tertile 3 (p for trend = 0.001). Similarly, there are significant positive associations between IHL and the likelihood of exhibiting 2-8 dietary behaviors, except for exhibiting any one dietary behavior. We further found that, in addition to the health awareness factor, there were significant positive associations between physical activity and nutrition factors, and healthier dietary behaviors. Further, there was a significant negative association between interpersonal relationships and dietary behavior.

Conclusion

The findings indicate a positive relationship between IHL and dietary behavior, such that the higher the level of IHL among college students, the healthier the dietary behavior they tend to adopt in their daily lives. These findings suggest the importance of developing stages of change-based educational interventions, which could help individuals with limited IHL to not only acquire necessary health-related knowledge but also to strengthen their motivation to engage in healthy dietary behaviors. Future studies should employ longitudinal prospective designs or randomized controlled trials to establish a causal association between IHL and healthy dietary behaviors.

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.

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.

Effectiveness of personalized meal recommendation in improving dietary behaviors of Chinese community-dwelling elders: study protocol for a cluster randomized controlled trial

BACKGROUND

Inappropriate eating behaviors, particularly a lack of food diversity and poor diet quality, have a significant impact on the prognosis of certain chronic conditions and exacerbate these conditions in the community-dwelling elderly population. Current dietary interventions for the elderly have not adequately considered the nutritional needs associated with multiple chronic conditions and personal dietary preferences of elderly individuals. A personalized recommendation system has been recognized as a promising approach to address this gap. However, its effectiveness as a component of an elderly-targeted dietary intervention in real-world settings remains unknown. Additionally, it is unclear whether this intervention approach will be user-friendly for the elderly. Therefore, this study aims to examine the effectiveness of a personalized meal recommendation system designed to improve dietary behavior in community-dwelling elders. The implementation process in terms of System usability and satisfaction will also be assessed.

METHODS

The trial has been designed as a 6-month, non-blinded, parallel two-arm trial. One hundred fifty community-dwelling elders who meet the eligibility criteria will be enrolled. Subjects will be allocated to either the intervention group, receiving personalized meal recommendations and access to corresponding food provided as one component of the intervention, as well as health education on elder nutrition topics, or the control group, which will receive nutritional health education lectures. Outcomes will be measured at three time points: baseline at 0 months, 3 months, and 6 months. The primary outcomes will include dietary diversity (DDS) and diet quality (CDGI-E) of enrolled community-dwelling elders, representing their dietary behavior improvement, along with dietary behavior adherence to recommended meals. Secondary outcomes will measure the perceived acceptability and usability of the personalized meal recommendation system for the intervention group. Exploratory outcomes will include changes in the nutritional status and anthropometric measurements of the community-dwelling elders.

DISCUSSION

This study aims to examine the effectiveness, acceptability, and usability of a personalized meal recommendation system as a data-driven dietary intervention to benefit community-dwelling elders. The successful implementation will inform the future development and integration of digital health strategies in daily nutrition support for the elderly.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2300074912. Registered on August 20, 2023, https://www.chictr.org.cn/showproj.html?proj=127583.

The Effect of Sociodemographic and Anthropometric Variables on Nutritional Knowledge and Nutrition Literacy

Nutrition literacy, which is one of the important components of health literacy, includes basic nutritional information and understanding, interpreting and having the ability to make healthy decisions on nutrition-related issues. This study aims to dwell upon the relationship between sociodemographic and anthropometric variables and nutritional knowledge and nutrition literacy. A total of 1600 people aged 19-64 years, 934 women and 666 men, voluntarily participated in the research in the capital city of Turkey. The mean age is 28.2 ± 10.9 years. More than half of the participants (57.4%) have a university graduate/postgraduate education level, and 66.2% are unemployed. This cross-sectional study evaluated demographic information, anthropometric measurements, nutritional information and nutrition literacy. Nearly all the respondents (94.6%) were determined to have sufficient nutrition literacy. Body mass index (BMI) and age were negatively associated with nutrition literacy, whilst nutrition knowledge was positively associated. Respondents with nutrition education at school had the highest nutrition knowledge and nutrition literacy scores, and primary school graduates had the lowest. Participants who received nutrition education scored higher in all the subgroups of the GNKQ. Age, gender, marital status, education status, employment status, BMI and nutrition education were significantly associated with nutrition literacy. The results will be useful in developing food and nutrition policies that will pave the way for making decisions on the most useful themes of health and nutrition campaigns.

Status and associated factors of food and nutrition literacy among young adults aged 15-44 years in Shenzhen City, China

Background

Food and nutrition literacy (FNL) plays an important role in young adults' dietary habits and nutrition. This study aimed to investigate FNL status and its associated factors among young adults aged 15-44 years in Shenzhen.

Methods

A cross-sectional survey of 5,390 participants was conducted in June 2021. FNL was measured using the Food and Nutrition Literacy Questionnaire for Chinese Adults (FNLQ). A generalized linear model was employed to analyze the factors associated with FNL.

Results

The median FNL score (total score = 100) was 68.00, which was below the adequate level of 80. FNL was divided into the two different domains of knowledge and skills, with significantly different scoring rate of 85.30 and 67.77%, respectively. The overall proportion of respondents with adequate FNL was 19.52%. The FNL score was significantly higher among the participants who were female (β = 2.665; 95% confidence interval [CI]: 2.031-3.299) and with higher education levels (β ranging from 5.632 [CI: 3.845-7.419] to 10.756 [CI: 8.973-12.538]), healthcare-related work experience (β = 4.197; CI: 3.557-4.837) and a higher economic status (β ranging from 0.753 [CI: 0.079-1.426] to 6.217 [CI: 5.208-7.227]). Those who were divorced or with an unknown marital status (β = -8.438; CI: -9.701, -7.175), abnormal body mass index (thin [β = -2.115; CI: -3.063, -1.166], overweight [β = -1.427; CI: -2.254, -0.600]), and suffering from chronic diseases (single disease [β = -3.483; CI: -4.485, -2.480], multimorbidity [β = -5.119; CI: -5.912, -4.327]) had significantly lower FNL scores.

Conclusion

Generally, the level of FNL among young adults in Shenzhen, China, was relatively low. Thus, nutrition education programs targeted at promoting improved FNL status call for additional emphasis, especially in subgroups with lower scores.

Dietary knowledge assessment among the patients with type 2 diabetes in Madinah: A cross-sectional study

Background

There is a huge burden of nutrition-related non-communicable diseases, and diabetes is one of the leading chronic nutrition-related diseases affecting more than 500 million people globally. Collecting information regarding the awareness of dietary and nutrition knowledge among diabetic patients is the first step to developing a disease prevention program. Thus, this study primarily aims at assessing the dietary awareness of diabetes patients attending the diabetic centre in Madinah governorate, Saudi Arabia.

Methods

The study was started in November 2020 and ended in October 2021. The study participants (315) were type 2 diabetes mellitus (T2DM) patients attending a diabetic centre in Madinah, Saudi Arabia. A self-prepared dietary knowledge questionnaire (DKQ) was used in this research. The variables include balanced diet, food type, food choice, carbohydrate, protein, and fat. Knowledge score was, and the total score was levelled/categorized into 'good', 'average', and 'poor'. Data were analysed by SPSS v.26.

Results

The study results identified the current knowledge of T2DM patients about different dietary items. The knowledge score of 62.2% of participants showed an average level of dietary knowledge, which is statistically significant. When we separately evaluated their understanding of different dietary components, we found that T2DM patients had poor knowledge of carbohydrates (30.15%), fat, food choices (47.7%), and type (34.6%). However, they had acceptable knowledge of proteins (56.5%).

Conclusion

Our participants exhibited acceptable knowledge about proteins but poorer knowledge of other food groups. A healthy, well-balanced diet is essential for excellent glycaemic control. Educating and arranging a health education program regarding dietary knowledge is recommended, specially designed for diabetic patients so that patients can opt for a healthier lifestyle.

Assessing the relationship between nutrition literacy and eating behaviors among nursing students: a cross-sectional study

BACKGROUND

Eating behavior is an essential aspect of life that can have long-term effects on health outcomes. Nutrition literacy is crucial for better health and well-being. It empowers individuals to make informed decisions about their nutrition and take control of their eating habits.

OBJECTIVES

This study aimed to assess the relationship between nutritional literacy and eating behavior among nursing students at the nursing faculties of Ardabil University of medical sciences.

METHODS

A cross-sectional correlational study was conducted in Ardabil province, northwest Iran. The study collected data through simple random sampling at nursing schools in Ardabil province, with 224 nursing students participating. The study collected data from a demographic information form, the nutritional literacy self-assessment questionnaire for students (NL-SF12), and the adult eating behavior questionnaire (AEBQ). The data were analyzed using SPSS version 14.0 software.

RESULTS

Based on the results, nutritional literacy explains 44% of the variance in eating behavior and shows significant explanatory power in two sub-scales of eating behavior. The adjusted R2 values for food approach and food avoidance scales were 0.33 and 0.27, respectively.

CONCLUSION

Given the significant relationship between nutritional literacy and eating behaviors among nursing students, nursing faculty managers and health policymakers should develop new public health strategies to increase nutritional literacy among nursing students.

Preliminary evaluation of a scenario-based nutrition literacy online programme for college students: a pilot study

OBJECTIVE

This study aimed to develop and evaluate a scenario-based nutrition literacy (NL) online programme for Taiwanese college students.

DESIGN

A randomised pilot trial design was used in this study.

SETTING

The study was conducted at a university in Taiwan. The intervention consisted of a five-unit web-based NL programme including videos of real-life scenario-based stories, situational analysis teaching and after-unit quizzes. Theme-related website information and smartphone apps (both iOS and Android systems) were offered for reference in every unit. The NL measure consisted of a self-rated scale, a scenario-based test and a healthy eating behaviour survey. Paired sample t-tests and ANCOVA were performed to test the effects on NL and healthy eating behaviour.

PARTICIPANTS

Participants were ninety-eight students, with a retention rate of 98 %. The ratio of men to women was 0·2:1. Most students were freshmen (48 %).

RESULTS

Compared with the control group, the experimental group showed significant post-intervention improvements in the NL and healthy eating behaviours after controlling for pretest scores.

CONCLUSIONS

This pilot study offers preliminary evidence of the potential positive effects of implementing a scenario-based NL online programme for college students. It offers a possibly novel strategy to enhance health-promoting behaviours in Taiwanese universities. Further research with larger sample sizes and more rigorous designs is warranted to confirm and build upon these initial findings.

Memory Abilities Are Selectively Related to Food Label and Numeracy Nutrition Skills

OBJECTIVE

We investigated the relationship between nutrition literacy, diet quality, carotenoid status, and cognition.

METHODS

Adults aged 37.5 ± 17.0 years (n = 52) completed the 42-item Nutrition Literacy Assessment Instrument (NLit). The Dietary History Questionnaire III was analyzed to determine the Healthy Eating Index. Skin carotenoids were assessed as a diet quality biomarker. Selective attention, relational memory, and pattern separation abilities were assessed using the flanker, spatial reconstruction, and mnemonic similarity tasks, respectively. Statistical adjustments included age, sex, education, and body mass index.

RESULTS

No correlations were observed for NLit scores and NLit subscales with Healthy Eating Index and skin carotenoid status. However, the NLit's food label and numeracy subscale was related to greater pattern separation abilities (ρ = 0.33, r2 = 0.11, P = 0.03).

CONCLUSIONS AND IMPLICATIONS

Comprehension of food labels and numeracy information was associated with memory abilities. Future work is needed to test whether targeting working memory and attentional processes during memory retrieval in larger samples may facilitate the acquisition of nutrition knowledge.

Nutrition literacy status and its association with adherence to the Mediterranean diet, anthropometric parameters and lifestyle behaviours among early adolescents

OBJECTIVE

To evaluate nutrition literacy status and its association with adherence to the Mediterranean diet (MD), anthropometric parameters and lifestyle behaviours among early adolescents.

DESIGN

This is a cross-sectional study. Nutrition literacy was evaluated using the 'Adolescent Nutrition Literacy Scale'. Dietary intake was assessed by 24-h food recall. The 'Mediterranean Diet Quality Index' was used to evaluate adolescents' adherence to the MD. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). Body weight, height, waist, hip and neck circumference were measured.

SETTING

Four secondary schools in İzmir, Türkiye.

PARTICIPANTS

The study included 1074 secondary school students.

RESULTS

Adolescents' nutrition literacy was at a moderate level. Nutrition literacy scores were significantly lower in those who skip main meals. Adolescents with high nutrition literacy had higher intakes of fibre, protein, protein, Ca, K, Mg, P, vitamin C, folate and Fe intake than those with low and moderate nutrition literacy (P < 0·05). According to IPAQ, active adolescents had higher nutrition literacy scores than inactive adolescents. There was no significant difference in BMI and anthropometric measurements of the adolescents according to their nutrition literacy level. Linear regression analysis showed that each unit increase in nutrition literacy increased adherence to the MD by 0·286 points (β = 0·286) and decreased total screen time by 0·182 points (β = -0·182).

CONCLUSIONS

These findings showed that nutrition literacy among early adolescents was not optimal, and a higher nutrition literacy score was significantly associated with higher MD adherence, and healthy eating habits and lifestyle behaviours.

Health literacy and nutrition literacy among mother with preschool children: What factors are effective?

Children's obesity behaviors are associated with parents' low health literacy. Nutrition Literacy (NL) is an essential component to enhancing nutrition quality, as well as health and well-being. The study's objective was to determine health literacy (HL) and NL among mothers with children preschool children (under 7 years old in Zanjan city, Iran). Participants in this cross-sectional were 162 mothers with preschool children referred to Ayatollah Mousavi Hospital's pediatric clinic in Zanjan, Iran, during July and August 2022. The sample technique was convenient. In IBM SPSS 20 software, a two-step cluster analysis, the Chi-square\ Fisher exact, and Man-Whitney tests were used. HL and NL had a mean ± SD of 71.26 ± 15.84 and 71.78 ± 11.86, respectively. The two-step cluster analysis identified two clusters, with mothers in cluster 1 (n = 141) having sufficient HL and NL and mothers in cluster 2 (n = 21) having insufficient HL and NL. Cluster 1 mothers were older, had a college degree, lived in a city, were employed, and had a better financial situation. They obtained health and nutrition information from the Internet, either alone or in conjunction with other sources. Based on clustering analysis, it was observed that the low level of education, living in the village and being a housewife of the mothers, is related to the low level of HL and NL. By increasing the level of education of mothers, it is possible to help protect children from malnutrition or overfeeding in the future. Also, providing suitable job opportunities for mothers can help in this matter.

The Nutritional Content of Meal Images in Free-Living Conditions-Automatic Assessment with goFOODTM

A healthy diet can help to prevent or manage many important conditions and diseases, particularly obesity, malnutrition, and diabetes. Recent advancements in artificial intelligence and smartphone technologies have enabled applications to conduct automatic nutritional assessment from meal images, providing a convenient, efficient, and accurate method for continuous diet evaluation. We now extend the goFOODTM automatic system to perform food segmentation, recognition, volume, as well as calorie and macro-nutrient estimation from single images that are captured by a smartphone. In order to assess our system's performance, we conducted a feasibility study with 50 participants from Switzerland. We recorded their meals for one day and then dietitians carried out a 24 h recall. We retrospectively analysed the collected images to assess the nutritional content of the meals. By comparing our results with the dietitians' estimations, we demonstrated that the newly introduced system has comparable energy and macronutrient estimation performance with the previous method; however, it only requires a single image instead of two. The system can be applied in a real-life scenarios, and it can be easily used to assess dietary intake. This system could help individuals gain a better understanding of their dietary consumption. Additionally, it could serve as a valuable resource for dietitians, and could contribute to nutritional research.

Acquisition behaviours for nutrition-related information based on a health promotion model for older adults in a long-term care facility

AIM

To explore the acquisition behaviours for nutrition-related information of older adults in a long-term care facility.

DESIGN

A qualitative descriptive design was used in this study.

METHODS

Sixteen older adults in a long-term care facility were recruited using purposive sampling between March and May 2021. Data were collected via face-to-face semi-structured interviews, based on open questions regarding acquisition behaviours for nutrition-related information and flexible question formulation, and the data were analysed using an inductive-deductive method. A health promotion model was used as a conceptual framework to regulate the refinement of themes.

RESULTS

Three themes were identified in this study. The first theme discussed the individual characteristics and experiences of older adults that contributed to their acquisition behaviours for nutrition-related information. The second theme described behaviour-specific cognitions of and the effects on the participants regarding the influencing factors involving various internal individual elements and external physical environment. The third theme explored the positive behavioural outcomes of the participants resulting from these acquisition behaviours.

CONCLUSION

Acquisition behaviours for nutrition-related information of older adults in long-term care facilities were affected by both individual characteristics and external physical environment factors. Access to nutritional information can help older adults cultivate a healthy diet. Although they exhibited a significant interest in nutrition, the participants still encountered several difficulties. Based on the actual care needs of the older people, appropriate nutritional information interventions should be provided by healthcare providers working in long-term care facilities so as to improve the ability of the older people to acquire information independently.

PATIENT OR PUBLIC CONTRIBUTION

All 16 participants actively participated in the interview process and the preliminary preparation of the article.

Nutrition Literacy Is Not Sufficient to Induce Needed Dietary Changes in Nonalcoholic Fatty Liver Disease

INTRODUCTION

Dietary and lifestyle changes are the first line of therapy for nonalcoholic fatty liver disease (NAFLD), the most prevalent liver disease in the western world. Nutrition literacy is the ability to understand nutrition information and implement that knowledge. We aimed to compare indicators of nutrition literacy in subjects with and without NAFLD in a representative US cohort.

METHODS

In a cross-sectional study using data from the National Health and Nutrition Examination Survey 2017-2018 cycle, we included 2,938 adult subjects with complete dietary and vibration-controlled transient elastography data and no alternative reason for hepatic steatosis. Nutrition literacy was assessed using questionnaires. Diet perception accuracy was assessed by comparing self-reported diet quality with objective diet quality scores-the Healthy Eating Index and alternative Mediterranean diet score-to assess real-world application of nutrition knowledge.

RESULTS

Nutrition literacy was not different between subjects with or without NAFLD ( P = 0.17): more than 90% of subjects reported using nutrition labels, and most of them correctly identified the meaning of daily value. Subjects with NAFLD had a lower-quality diet (Healthy Eating Index, P = 0.018; alternative Mediterranean diet, P = 0.013) and rated their diet as poorer ( P < 0.001). On self-assessment, only 27.8% of subjects overestimated their diet quality, while 37.5% consumed more calories than their self-assessed needs. Both accuracy measures were similar between subjects with NAFLD and those without ( P = 0.71 and 0.63, respectively). Subjects with NAFLD were more likely to report being advised to lose weight (42.1% vs 16.5%, P < 0.001) or to attempt losing weight (71.9% vs 60.9%, P < 0.001). Diet quality was not better in subjects with NAFLD who received dietary recommendations.

DISCUSSION

Subjects with NAFLD have poor diet quality despite receiving medical recommendations to lose weight and having nutrition literacy and perception that are comparable with subjects without NAFLD. Educational approaches may not be sufficient to promote weight loss and improve diet quality in NAFLD.

Examining Predictors of Nutritional Risk among Older Adults: A Needs Assessment

Older adults are the fastest growing population in the United States. This group is at risk for developing chronic diseases resulting from high nutritional risk. The objective of this study was to assess nutritional risks and their key predictors among older adults. In this cross-sectional study, the Dietary Screening Tool, the Nutrition Self-efficacy Scale, food security, perceived health, and sociodemographics were measured. A total of 475, English-speaking adults, 50 years of age or older, residing in Maryland and attending senior congregate sites, participated in the study (urban n = 215, rural n = 260). Results showed 88.8% of participants were classified as being nutritionally 'at risk' or 'possible' risk. Higher education level, higher nutrition self-efficacy, and food security were significant predictors associated with lower nutritional risk among older adults. Implementing suitable and effective nutrition interventions requires assessing diet and identifying the needs specific to older adult populations. Utilizing appropriate screening tools is an important step in improving overall diets and may reduce barriers to adopting healthy eating behaviors in this population.

Demographic Dynamics and the Changing Faces of Nutrition Literacy in India: A Tryst with the Transition among Communities Over Two Decades

Aims and Objective

The development of a nation depends on well-nourished individuals. A country's economic independence also depends on adequate food supply for all sections of its population and the proper selection of the right kinds of food, called nutritional literacy. This review will show the transition of dietary selection and practices across India over the last two decades and its impact on health.

Materials and Methods

We conducted a literature search to review the evidence of the last two decades. The literature search was done using the PubMed search engine and the MeSH words "Nutrition Literacy, Dietary Practices, Diet Transition, Nutrition transition, India and Food pattern." Evidence from the last two decades was collectively reviewed, and observations on the transition in nutrition literacy were summated.

Results

The literature search revealed 18 articles, out of which 13 articles were included in this review based on inclusion-exclusion criteria. Nine were review articles, and five were cross-sectional studies. The studies done over the last two decades on nutrition culture revealed that most of the studies related to transition have been done during the second decade of the twenty-first century. Most have found that the shift has been happening more among the urban poor and rural rich people. Indian diets have diversified and shifted away from cereals towards processed food.

Conclusion

It was found that there is a shift in feeding preferences in diet-deprived sections in India. The findings are similar in rural and urban areas where the poor fall prey to the food fads, make poor nutrition choices, and gradually develop chronic ailments. Such a transition over the years clearly shows that a malnourished child, having faulty feeding practices, becomes prey to the triple burden of hidden hunger, lack of nutrition, and repercussions of chronic non-communicable diseases, including dental ailments.

Exploring the Impact of Sociodemographic Characteristics and Health Literacy on Adherence to Dietary Recommendations and Food Literacy

This study investigates food literacy-related abilities and adherence to dietary recommendations in relation to sociodemographic characteristics and health-related features (health literacy, self-rated health and morbidity) in the North-Western region of Romania. This is a secondary analysis of cross-sectional data collected in 2019 from a representative and randomised sample of 1572 individuals. A questionnaire was employed to record participants' sociodemographic characteristics, food-related and health-related features. Most participants were non-adherent to dietary recommendations for fruit and vegetables (83.5%), fish and seafood (61.3%), and water intake (67.9%). However, most participants reported an adequate ability to understand the connection between nutrition and health (89.1%), to distinguish between healthy and less healthy options (84.4%), and to acquire nutrition information (75.6%). Non-adherence to dietary recommendations and low food literacy abilities were more prevalent in disadvantaged groups (older age, rural settings, retirement or social welfare, low educational attainment, formerly married). Health literacy was negatively associated with not adhering to dietary recommendations and poor self-rated food literacy abilities. The study suggests that low socioeconomic status negatively impacts food literacy and adherence to dietary recommendations among Romanian adults. Identifying target populations to improve food-related abilities and health literacy can aid public health services in improving health outcomes.

High nutrition literacy linked with low frequency of take-out food consumption in chinese college students

BACKGROUND

The excessive consumption of take-out food has increased the risk of nutrition-related chronic diseases. Nutrition literacy (NL) is an important influencing factor of food choice. This study aimed to explore the relationship between nutrition literacy and take-out food consumption.

METHODS

A cross-sectional study was conducted on 2130 college students in Bengbu, China. A self-reported questionnaire that included demographic information, lifestyle behavior, take-out food consumption, and nutrition literacy scale was used. Ordinal logistic regression models were used to analyze the association between nutrition literacy and take-out food consumption.

RESULTS

Of the students surveyed, 61.5% consumed take-out food at least once a week. NL was significantly associated with the frequency of take-out food consumption ≥ 4 times/week (OR = 0.995, 95% CI = 0.990-1.000); the difference specifically was discovered for applying skills, interactive skills, and critical skills. Moreover, students with high level NL ate less (Spicy) hot pot (OR = 0.996, 95% CI = 0.992-1.000), but more vegetable and fruit salad (OR = 1.009, 95% CI = 1.002-1.015).

CONCLUSIONS

NL, especially in applying skills, interactive skills, and critical skills, is not only associated with consumption frequency of take-out food among college students, but also links with types of take-out food consumption. Our findings emphasize that targeted interventions on nutritional skills literacy should be needed to improve dietary behaviors for student's good health.

Nutrition literacy mediates the relationship between self-efficacy and eating behavior in young tuberculosis patients: A cross-sectional study

Objective

To assess the associations between self-efficacy, nutrition literacy and eating behavior, and to examine if nutrition literacy mediates the relationship between self-efficacy and eating behavior in young tuberculosis patients.

Methods

This cross-sectional study used a convenience sampling strategy to select 230 young tuberculosis patients at the Second Hospital of Nanjing (Public Health Medical Center of Nanjing), China, from June 2022 to August 2022. The data were collected using a demographic data form, the Eating Behavior Scale, the Food and Nutrition Literacy Questionnaire and the Tuberculosis Self-Efficacy Scale. Descriptive statistics, Pearson bivariate correlation analysis, Pearson partial correlation analysis, hierarchical multiple regression, and mediation analysis were conducted in the study.

Results

The mean self-efficacy score for young tuberculosis patients was 92.56 (SD = 9.89, range = 21 ∼ 105). The average nutrition literacy score for young tuberculosis patients was 68.24（SD = 6.75, range = 0 ∼ 100). The bivariate correlation analysis and partial correlation analysis found that self-efficacy was positively correlated with nutrition literacy (P < 0.01). The regression analysis showed that self-efficacy (F = 5.186, β = 0.233, P < 0.001)and nutrition literacy (F = 7.749, β = 0.545, P < 0.001) significantly predicted eating behavior. The three dimensions of nutrition literacy including nutritional knowledge (mediation effect ratio = 13.1%, 95% CI =  - 0.089; -0.005), preparing food (mediation effect ratio = 17.4%, 95 %CI = 0.011; 0.077) and eating (mediation effect ratio = 54.7%, 95 %CI = 0.070; 0.192) mediated the relationship between self-efficacy and eating behavior in young tuberculosis patients.

Conclusion

Nutrition literacy mediated the relationship between self-efficacy and eating behavior. To promote healthy eating behavior among young tuberculosis patients, interventions aimed at improving self-efficacy and nutrition literacy should be conducted.

Nutrition Literacy Level in Bank Employees: The Case of a Large Brazilian Company

Nutrition Literacy (NL) positively impacts diet quality and has the potential to promote health and prevent nutrition-related chronic diseases. Brazil is one of the countries with the highest rates of nutrition-related chronic diseases. Nevertheless, in Brazil, few studies have explored the NL levels of its population. To provide remote access to the Nutrition Literacy Assessment Instrument for Brazilians (NLit-Br) and assess Brazilian bank employees, we conducted a study to estimate the validity of the NLit-Br online and to investigate whether bank employees have an adequate NL level. In the first step, we randomly assigned 21 employees from three financial institution branches to two groups to complete NLit-Br paper and online versions. After an interval period, both groups completed the NLit-Br with an opposite delivery method (paper vs. online). We compared the validity of the digital and paper versions of the NLit-Br by the Intraclass Correlation Coefficient (ICC), and the reliability by Kuder-Richardson formula 20. Second, we evaluated 1174 bank employees using the NLit-Br online version. We found an excellent absolute agreement (ICC ≥ 0.75) between the paper and online versions. The questionnaire had good internal consistency (KR-20 = 0.64). The sample was characterized as mostly male (61.0%), married/cohabitant (73.8%), and white (69.8%), with high household income (85.2%), and graduated or postgraduate (97.4%). The mean age of the population was 42.1 (SD = 7.6) years. Subjects predominantly had possibly inadequate NL (62.3%). The online NLit-Br total score was significantly associated with gender, age, and household income (p < 0.05). Women and individuals with higher incomes had a higher degree of NL. Subjects over 50 years old had a lower degree of NL. There was no significant association between the NLit-Br score and the participants' education. The NLit-Br online is a valid instrument to assess NL remotely. The population studied showed a high prevalence of inadequacy of the NL. Therefore, there is a need for targeted actions to improve the NL of bank employees.

Nutritional literacy levels of university academic and administrative staff: A cross-sectional study from Turkey

AIM

This study aimed to evaluate the nutritional literacy levels of university academic and administrative staff.

METHODS

Data were collected with a questionnaire including sociodemographic variables, some eating habits, and the Nutritional Literacy Assessment Tool of Adults. A total of 413 individuals, 211 women (51.1%) and 202 men (48.9%), aged 23-64 (mean: 37.41 ± 10.04 years), were included in the study. The data obtained were evaluated with the SPSS 25.0 statistical package program.

RESULTS

It was found that the nutritional literacy level of 18.15% of the participants is at the borderline, 81.85 are sufficient. Women's nutrition literacy scores are significantly higher than men's (p = 0.034). A significant relationship was found between nutritional literacy, socioeconomic status, and some eating habits (p < 0.05). The average daily water consumption of individuals with sufficient nutritional literacy is statistically significantly higher than those with borderline nutritional literacy (p < 0.001). It was determined that individuals with borderline nutritional literacy skipped meals more frequently (p < 0.05).

CONCLUSION

The present study suggests that nutritional literacy may be effective in developing healthy eating behaviors. The study's results can guide the determination of methods that will improve nutritional literacy and increase awareness in the future.

Adherence to Mediterranean Diet in Individuals on Renal Replacement Therapy

Patients on renal replacement therapy are typically subject to several dietary restrictions; however, this approach has been questioned in recent years, with some suggesting that the Mediterranean diet might be beneficial. Data on the adherence to this diet and factors that influence it are scarce. We conducted a web survey among individuals on renal replacement therapy (dialysis or kidney transplant, KT) using the MEDI-LITE questionnaire to assess adherence to the Mediterranean diet and dietary habits in this population. Adherence to the Mediterranean diet was generally low, and significantly lower among participants on dialysis versus KT recipients (19.4% vs. 44.7%, p < 0.001). Being on dialysis, adopting fluid restrictions, and having a basic level of education were predictors of low adherence to the Mediterranean diet. Consumption of foods typically included in the Mediterranean diet, including fruit, legumes, fish, and vegetables, was generally low, particularly among those on dialysis. There is a need for strategies to improve both the adherence to and the quality of the diet among individuals on renal replacement therapy. This should be a shared responsibility between registered dietitians, physicians, and the patient.

The relationship between nutrition literacy and nutrition information seeking attitudes and healthy eating patterns among a group of palestinians

INTRODUCTION

Nutrition literacy is crucial because it gives people information and drives them to take responsibility for their eating habits. Prior research on three categories of nutrition literacy among Palestinians was lacking: functional literacy (FNL), interactive literacy (INL), and critical literacy (CNL).

AIMS

(1) Describe three types of nutrition literacy-FNL, INL, and CNL-among a group of Palestinians was one of the study's primary objectives. (2) To investigate the connections between various nutrition literacy levels, eating habits, and the habit of seeking out nutrition-related information.

METHODS

149 Palestinians were chosen at random to take part in the study in the fall of 2020. Data on sociodemographic variables were gathered through an online survey that was disseminated across social and educational internet sites. Nutrition literacy data was gathered using a translated questionnaire, while diet behavior data was gathered using the Short Format of the Diet Health and Knowledge Survey (SFDHKS). The data were examined using SPSS 21.

RESULTS

This study included young people (20.4 ± 4.9 years old), 78% of whom were female. The majorities of participants had bachelor's degrees or were already enrolled in school to obtain them. FNL had a mean of 2.8 ± 0.5, INL of 3.3 ± 0.5, and CNL of 3.6 ± 0.5. The connection between CNL and INL was significant (p 0.05). Significant correlations were found between many aspects of diet behavior, the usage of food labels, and nutrition literacy.

CONCLUSION

Participants from the Palestinian community are willing to learn about and comprehend nutrition facts and how it relates to diet behavior in 2021.

What is the level of nutrition literacy of Saudi adolescents? A national wide exploratory cross-sectional study

Background

Despite being a prolific research topic, studies evaluating nutrition literacy in the Arab world are scant and still nonexistent in the Kingdom of Saudi Arabia. Therefore, a national study was launched with the aim to (1) assess nutrition literacy among Saudi adolescents aged 10-19 years old and (2) determine its correlates.

Methods

A cross-sectional study was launched across all Saudi provinces between 29 April and 6 June 2022, enrolling a convenience sample of 2,115 adolescents (mean age = 16.8 ± 2.5; girls: 48.7%). An online self-administered questionnaire was disseminated to eligible participants to collect relevant data.

Results

Study findings showed that nearly half of the adolescents (44.6%) had poor nutrition literacy. The male gender doubled the risk of adolescents having poor nutrition literacy (OR = 2.0, CI = 1.5-2.5, p < 0.001). Northern border residents were 14 times more likely to be nutritionally illiterate, in contrast to adolescents residing in Riyadh (OR = 14.0, CI = 7.3-28.0, p < 0.001). Adolescents were more likely to be nutritionally illiterate if they were underweight or overweight (OR = 2.7, CI = 1.6-4.7, p < 0.001; OR = 2.2, CI = 1.7-2.9, p < 0.001). School students had 2 times more risk of having poor nutrition literacy, in contrast to those who were enrolled in universities (OR = 1.8, CI = 1.4-2.4, p < 0.001). Nutrition illiteracy was 4 times higher among adolescents having caregivers else than their parents (OR = 3.9, CI = 2.2-6.9, p < 0.001). Parental education level also contributed to determining adolescents' nutrition literacy status.

Conclusions

It has become essential to courage the development of supportive school environments in Saudi Arabia to promote nutrition education and improve adolescents' nutrition literacy. Without a doubt, this calls for taking a holistic approach on the part of education and health ministries, nutrition professionals, educators, parents, and, most importantly, the teenagers themselves, who must have the desire and motivation to learn.

Development and validation of a short nutrition literacy scale for young adults

Background

Due to their high media use, young adults are frequently exposed to contradictory or even erroneous nutrition information. To properly handle and critically assess nutrition information, young adults (both general population and patient populations) need adequate levels of nutrition literacy. Currently there is a lack of suitable instruments to measure nutrition literacy in young adults (18-25 years). Therefore the aim of this study was to develop and validate a Short Nutrition Literacy (S-NutLit) scale for use in this age group.

Methods

Development and validation of the S-NutLit consisted of six phases: (1) item generation based on literature, (2) expert assessments to evaluate content validity, (3) cognitive interviews with the target population to assess face validity and readability, (4) pre-test to reduce the number of items, (5) validation survey to assess dimensionality with exploratory factor analyses, internal reliability with Cronbach alpha, construct and criterion validity by examining associations with age, gender, education level, health literacy, general literacy, dietary behaviors and physical activity with correlations, ANOVAs, and t-tests, (6) two-week follow-up survey to assess test-retest reliability with intra-class correlations.

Results

Starting from an initial pool of 53 items, expert assessments and cognitive interviews led to the reformulation, removal, and construction of items. Young adults aged 18-25 years participated in cognitive interviews (n = 12), pre-test (n = 101), validation survey (n = 300), and reliability survey (n = 92). The final S-NutLit consisted of 11 items rated on a 5-point scale distributed across two subscales (i.e., information skills and expert skills). Cronbach alpha values ranged from 0.79 to 0.83 and intraclass correlations from 0.61-0.79 (p < 0.001). Significant associations were observed with health literacy (r = 0.27, p < 0.001), general literacy and numeracy (r_s = 0.12, p = 0.046), and education level (r_s = 0.13, p = 0.025).

Conclusion

Findings indicate that the S-NutLit is a valid and reliable tool to assess nutrition literacy among young adults. The S-NutLit fills a gap in the field by offering a short measure of nutrition literacy and may be incorporated in digital technology to support the nutrition care process.

Understanding Nutritional Knowledge and Experiences in Families With a Child Newly Diagnosed With Type 1 Diabetes

Nutrition is an integral part of diabetes management. Caregiver nutritional knowledge has been implicated in glycemic management of youth with type 1 diabetes. This study assessed the nutritional knowledge of parents/caregivers of children newly diagnosed with type 1 diabetes. Findings suggest there is a need for more targeted support and training during the initial diagnosis and a desire for more technology-related resources such as virtual nutritionist-guided grocery shopping visits. Integrating these interventions into routine care for children with type 1 diabetes will help address the current gaps in caregiver nutritional literacy and their ability to provide appropriate care.

Nutrition literacy differs based on demographics among University students in Bengbu, China

Background

Nutrition literacy (NL) encompasses the knowledge and skills that inform individuals' food choices. This cross-sectional study explored factors associated with NL among Chinese university students in Bengbu, China.

Methods

A cross-sectional survey was carried out. Two thousand one hundred thirty-three university students were selected by stratified cluster sampling. A 43-item NL questionnaire was used to assess NL. Binary logistic regression was used to determine odds ratios (ORs) along with 95% confidence intervals (CIs) for NL and to test the interaction effects of multiple factors on total NL and its six dimensions.

Results

Of these participants, 1,399 (65.6%) were women and 734 (34.4%) were men. Students who were from urban areas (OR = 1.36, 95% CI: 1.08-1.72), were living with both parents (OR = 1.30, 95% CI: 1.02-1.65), and had high academic performance (OR = 1.85, 95% CI: 1.34-2.57) were more likely to report higher NL levels than did other students. The ORs for NL (OR = 1.60, 95% CI: 1.06-2.41), nutrition knowledge (OR = 1.51, 95% CI: 1.00-2.26), obtaining skills (OR = 1.76, 95% CI: 1.16-2.65), and critical skills (OR = 1.59, 95% CI: 1.05-2.39) were higher for medical students who had received nutrition education than for other students. The ORs for NL (OR = 2.42, 95% CI: 1.21-4.84), nutrition understanding (OR = 2.59, 95% CI: 1.28-5.25), and interactive skills (OR = 2.06, 95% CI: 1.04-4.08) were higher for only-child students and those with a monthly expenditure of >¥1500.

Conclusions

NL of university students differed in terms of place of origin, living arrangement, nutrition education, academic performance, and household income, and the findings imply that universities should have all students take a basic nutrition course to improve their NL.

Determinants of Changes in the Diet Quality of Japanese Adults during the Coronavirus Disease 2019 Pandemic

This study evaluated changes in diet quality during the coronavirus disease 2019 (COVID-19) pandemic and its association with variations in attitudes or behavior, as well as health status changes. Participants were Japanese adults aged 20-69 years who resided in 13 prefectures where specific cautions were announced to prevent the spread of the virus. An online survey was conducted in September 2021, and participants were those who shopped for food or prepared meals more than twice a week during the survey. Overall, 2101 participants were analyzed. An improved or worsened diet quality was determined based on changes in food consumption patterns, and participants were categorized into three groups (improved diet quality (IDQ), worsened diet quality (WDQ), and others). The IDQ group participants (10.2%) improved their dietary consciousness during COVID-19, cooked almost everything from ingredients, and increased their balanced meal eating frequency. However, the WDQ participants (11.1%) had worsened dietary consciousness and increased consumption of takeaway meals and alcohol but decreased balanced meal consumption. Cooking frequency changes were not independent determinants of variations in diet quality. Our results show that the diet quality changes during COVID-19 were possibly caused by changes in dietary consciousness or different levels of meal preparation practices.

Association between Nutrition Literacy and Bangladeshi Adults' Healthy Eating Behaviors: Evidence from the Nutrition Literacy Study 2021

This study investigated the association between healthy eating behaviors and nutrition literacy in a sample of Bangladeshi adults. A cross-sectional survey was conducted among 400 adults from two districts of Bangladesh (Dhaka and Chattogram). Data were generated by in-person interviews using a structured questionnaire. The Nutrition Literacy Scale and National Dietary Guidelines for Bangladesh were used to assess nutrition literacy and healthy eating behaviors, respectively. Multiple linear regression models were used to observe the association. The mean score for healthy eating behavior was 21.8 (SD = 4.8, Range: 5−33) on a scale of 34. A moderate positive correlation was found between nutrition literacy and healthy eating behavior of participants (r = 0.28, p < 0.001). The adjusted regression model showed that a 1 unit increase in nutrition literacy reflected an increase in the healthy eating behavior score of participants by 0.22 units (β = 0.223, p < 0.001). Findings showed an association between nutrition literacy and eating behaviors in Bangladeshi adults. Future research could be carried out to establish a causal relationship that may help inform the necessity of educational interventions for Bangladeshi adults to assist with meeting national nutrition-related targets.

Suitability and Allocation of Protein-Containing Foods According to Protein Tolerance in PKU: A 2022 UK National Consensus

Introduction: There is little practical guidance about suitable food choices for higher natural protein tolerances in patients with phenylketonuria (PKU). This is particularly important to consider with the introduction of adjunct pharmaceutical treatments that may improve protein tolerance. Aim: To develop a set of guidelines for the introduction of higher protein foods into the diets of patients with PKU who tolerate >10 g/day of protein. Methods: In January 2022, a 26-item food group questionnaire, listing a range of foods containing protein from 5 to >20 g/100 g, was sent to all British Inherited Metabolic Disease Group (BIMDG) dietitians (n = 80; 26 Inherited Metabolic Disease [IMD] centres). They were asked to consider within their IMD dietetic team when they would recommend introducing each of the 26 protein-containing food groups into a patient’s diet who tolerated >10 g to 60 g/day of protein. The patient protein tolerance for each food group that received the majority vote from IMD dietetic teams was chosen as its tolerance threshold for introduction. A virtual meeting was held using Delphi methodology in March 2022 to discuss and agree final consensus. Results: Responses were received from dietitians from 22/26 IMD centres (85%) (11 paediatric, 11 adult). For patients tolerating protein ≥15 g/day, the following foods were agreed for inclusion: gluten-free pastas, gluten-free flours, regular bread, cheese spreads, soft cheese, and lentils in brine; for protein tolerance ≥20 g/day: nuts, hard cheeses, regular flours, meat/fish, and plant-based alternative products (containing 5−10 g/100 g protein), regular pasta, seeds, eggs, dried legumes, and yeast extract spreads were added; for protein tolerance ≥30 g/day: meat/fish and plant-based alternative products (containing >10−20 g/100 g protein) were added; and for protein tolerance ≥40 g/day: meat/fish and plant-based alternatives (containing >20 g/100 g protein) were added. Conclusion: This UK consensus by IMD dietitians from 22 UK centres describes for the first time the suitability and allocation of higher protein foods according to individual patient protein tolerance. It provides valuable guidance for health professionals to enable them to standardize practice and give rational advice to patients.

The Nutrition Literacy Assessment Instrument for Brazilians, NLit-Br: An Exploratory Cross-Cultural Validity Study

This study aimed to test the validity of the cross-cultural adapted Nutrition Literacy Assessment Instrument for Brazilians (NLit-Br). An observational cross-sectional study was performed in chronic disease clinics from the Brazilian Public Health System in two phases: (1) linguistic and cultural adaptation and (2) validity testing. Six registered dietitians and thirty adult patients diagnosed with at least one chronic disease participated in the study using the nutrition literacy assessment instrument (NLit-Br) and the short assessment of health literacy for Portuguese-speaking adults (SAHLPA-18). Sample descriptive variables: age, sex, race, income, education, and occupation. To adapt the instrument to the Brazilian Portuguese and Brazilian culture, we tested cognitive interviewing and the Scale Content Validity Index (S-CVI) with a group of dietitians and patients. To test the tool’s validity, health literacy (SAHLPA-18) was used as a construct that presents similarities and differences with nutrition literacy (NLit-Br). The correlation of NLit-Br and the SAHLPA-18 was tested (Spearman’s Rho). Internal consistency was measured by Kuder−Richardson Formula 20 (KR-20). The NLit-Br content validity (S-CVI = 0.85) and internal consistency (KR-20 = 0.868) were confirmed. Additionally, NLit-Br presented a significant and robust correlation with SAHLPA-18 (r = 0.665, p < 0.001). Therefore, the NLit-Br was considered a linguistic, cultural, and valid instrument to measure Brazilian’s nutrition literacy.

Virtual Reality and Powerpoint Grocery Store Tours: Equally Effective in Improving Self-efficacy in Randomised Control Trial

PURPOSE

Compare computer-based virtual reality (CBVR) and voice-over PowerPoint (PP) grocery store tours (GST) on adult nutrition literacy (NL) and healthful food purchasing self-efficacy (HFPSE).

DESIGN

Participants (n = 68) recruited from University worksite wellness program and randomly assigned to CBVR or PP (CBVR = 35; PP = 33).

INTERVENTION

Four-week culinary/nutrition education program. Initial three weeks provided identical education for both groups. Week four implemented GST intervention using CBVR or PP.

MEASURES

NL and HFPSE surveys before, after, and three-months post from the start of program.

ANALYSIS

Intent-to-treat (ITT) analysis with RMANOVA (95% confidence intervals [CI] and effect sizes) to examine change in NL and HFPSE between CBVR and PP groups over 4-week intervention and 3-month retention period.

RESULTS

43 of 68 participants [CBVR (n = 19) and PP (n = 24)] were included in analyses. Both groups significantly improved HFPSE over time (P<.001, CBVR = 46.23% PP = 33.34%), but there were no differences between groups (P = .21) or group by time interaction (P = .31). NL did not change for either group (P = .83, CBVR = 1.11%; PP = .12%) nor were there differences between groups (P = .07).

CONCLUSIONS

CBVR and PP GST significantly improved and maintained higher HFPSE scores.

Nutrition Literacy Among Latina/x People During Pregnancy Is Associated With Socioeconomic Position

BACKGROUND

During pregnancy, Latina/x people experience nutrition and nutrition-related health inequities. Nutrition literacy is a potential factor impacted by these inequities. However, the nutrition literacy level of Latina/x people during pregnancy is not well investigated.

OBJECTIVES

The study aimed to assess the nutrition literacy level of Latina/x people during pregnancy and explore the association of nutrition literacy with socioeconomic position.

DESIGN

This was a cross-sectional study of data collected from 2016 to 2018 within the double-blinded, randomized clinical trial Assessment of Docosahexaenoic Acid on Reducing Early Preterm Birth.

PARTICIPANTS/SETTING

A total of 112 Latina/x people during pregnancy from the Kansas City metro area were included in this study.

MAIN OUTCOME MEASURES

Nutrition literacy level assessed between 12 and 20 gestational weeks using the Nutrition Literacy Assessment Instrument, both in English and Spanish.

STATISTICAL ANALYSES PERFORMED

Descriptive measures were used to describe the nutrition literacy level during pregnancy. Multiple logistic regression models were used to examine the association between low nutrition literacy and socioeconomic position, adjusting for age and race.

RESULTS

In this study, most participants demonstrated low nutrition literacy during pregnancy. Those with low nutrition literacy were 2 times more likely to have low annual household income (odds ratio [OR] = 2.74, 95% confidence interval [CI]: 0.99-7.59), 3 times more likely to prefer Spanish as their primary language of communication (OR = 3.03, 95% CI: 0.95-9.67), and 7 times more likely to be uninsured (OR = 7.47; 95% CI: 1.57-35.64).

CONCLUSIONS

Nutrition literacy scores during pregnancy were associated with variables of socioeconomic position. Future research should focus on nutrition literacy associations with health outcomes during pregnancy and interventions to improve the nutrition literacy level of primarily Spanish-speaking people who have low household incomes and are uninsured.

Trends and Factors Associated with Obesity Prevalence in Rural Australian Adults-Comparative Analysis of the Crossroads Studies in Victoria over 15 Years

This study examined the changes in the prevalence of obesity and associated lifestyle factors using data from repeated cross-sectional, self-reported surveys (Crossroads I: 2001-2003 and Crossroads II: 2016-2018, studies) and clinic anthropometric measurements collected from regional and rural towns in the Goulburn Valley, Victoria. Given that past community studies have only focused categorically on dietary intake, or assessed caloric energy intake, we examined the difference in broad dietary practices at two different times. Clinical assessments from randomly selected household participants aged ≥18 years were analyzed. Differences in obesity prevalence were calculated for each individual variable. Logistic regression was used to determine the odds ratios (95% confidence intervals (CI)) with and without adjustment for key lifestyle factors. There were 5258 participants in Crossroads I and 2649 in Crossroads II surveys. Obesity prevalence increased from 28.2% to 30.8% over 15 years, more among those who ate fried food, but decreased significantly among rural dwellers (31.7: 27.0, 36.8% versus 25.1: 22.9, 27.5%) and those who had adequate fruit intake (28.5: 25.0, 32.3% to 23.9: 21.8, 26.2%). Obesity was associated with older age (≥35 years), use of fat-based spreads for bread (adjusted odds ratio, aOR:1.26: 1.07, 1.48) and physical inactivity. The increase in obesity prevalence especially in the rural towns, was associated with unhealthy dietary behaviour which persisted over 15 years. Understanding and addressing the upstream determinants of dietary intake and choices would assist in the development of future health promotion Programs.

Higher Diet Quality in Latina Women during Pregnancy May Be Associated with Sociodemographic Factors

Acculturation contributes to low diet quality and can foster health inequities for Latina women during pregnancy. Conversely, nutrition literacy (NL) increases diet quality and could promote health equity. This study assessed the associations between the diet quality, acculturation, and NL of Latina women (n = 99) participating in the Assessment of Docosahexaenoic Acid On Reducing Early Preterm Birth (ADORE) study. Acculturation and nutrition literacy factored together tended to modify diet quality, but this was not statistically significant. Diet quality was associated with acculturation, age, and nativity. Most (76.8%) demonstrated low nutrition literacy. Women who were bicultural and were born in Latin American countries other than Mexico had lower diet quality scores than women who had lower acculturation and were born in Mexico. Women who were 35 years or older had better diet quality than those who were younger. Future studies are needed to explore diet quality differences for pregnant Latina women with high nutrition literacy and high acculturation, as well as for women from the Caribbean, Central and South American countries living in the US, to promote nutrition and maternal health for Latina women.

Level of dietary adherence and determinants among type 2 diabetes population in Ethiopian: A systemic review with meta-analysis

BACKGROUND

The beneficial effect of the dietary practice is significant reduction in the risk of developing diabetes related complication. Dietary practice among type 2 diabetes is not well-implemented in Ethiopia. Up to now, in the nation, several primary observational studies have been done on dietary adherence level and its determinants among type 2 diabetes. However, a comprehensive review that would have a lot of strong evidence for designing intervention is lacking. So, this review with a meta-analysis was conducted to bridge this gap.

METHODS

A systematic review of an observational study is conducted following the PRISMA checklist. Three reviewers have been searched and extracted from the World Health Organization- Hinari portal (SCOPUS, African Index Medicus, and African Journals Online databases), PubMed, Google Scholar and EMBASE. Articles' quality was assessed using the Newcastle-Ottawa Scale by two independent reviewers, and only studies with low and moderate risk were included in the final analysis. The review presented the pooled proportion dietary adherence among type2 diabetes and the odds ratios of risk factors favor to dietary adherence after checking for heterogeneity and publication bias. The review has been registered in PROSPERO with protocol number CRD42020149475.

RESULTS

We included 19 primary studies (with 6, 308 participants) in this meta-analysis. The pooled proportion of dietary adherence in the type 2 diabetes population was 41.05% (95% CI: 34.86-47.24, I2 = 93.1%). Educational level (Pooled Odds Ratio (POR): 3.29; 95%CI: 1.41-5.16; I2 = 91.1%), monthly income (POR: 2.50; 95%CI: 1.41-3.52; I2 = 0.0%), and who had dietary knowledge (POR: 2.19; 95%CI: 1.59-2.79; I2 = 0.0%) were statistically significant factors of dietary adherence.

CONCLUSION

The overall pooled proportion of dietary adherence among type 2 diabetes in Ethiopia was below half. Further works would be needed to improve dietary adherence in the type 2 diabetes population. So, factors that were identified might help to revise the plan set by the country, and further research might be required to health facility fidelity and dietary education according to diabetes recommended dietary guideline.

Adherence to Mediterranean diet among Lithuanian and Croatian students during COVID-19 pandemic and its health behavior correlates

Maintaining healthy behavior, especially in times of crisis like the COVID-19 pandemic, is particularly important for staying healthy. Nutrition is an everyday behavior and along with other health-related behaviors is associated with many health outcomes. The aim of this study was to assess and compare adherence to the Mediterranean diet (MedDiet) and particular food choices among the Mediterranean and non-Mediterranean populations of university students and identify its lifestyle correlates at the outburst of the COVID-19 pandemic. In total, self-reported data on health-related behavior and sociodemographic characteristics were collected from 1,388 study participants, 66.4% were Lithuanians, and 33.6% were Croatians. Results revealed that vegetables, olive oil, fruits, nuts, legumes, and fish were remarkably underconsumed among university students in the Mediterranean and non-Mediterranean countries during the COVID-19 pandemic, and the composite diet is similar between countries. The higher adherence to MedDiet is associated with physical activity (β = 0.15) and non-smoking (β = 0.08). In times of crisis, public health entities should provide knowledge, skills, and tools for healthy nutrition specifying them by age and subpopulation. Interventions at the university should be implemented to build infrastructure and provide an access to health behavior-friendly environments.