Association between health literacy and dietary intake of sugar, fat and salt: a systematic review

Development and validation of a nomogram for predicting anorexia of aging in older people

BACKGROUND

Anorexia of aging (AA) is a common geriatric syndrome that seriously endangers the health of older adults. Early identification of populations at risk of AAand the implementation of appropriate intervention measures hold significant public health importance. This study aimed to develop a nomogram for predicting the risk of AA among older people.

METHODS

We conducted a cross-sectional study involving 2144 community-dwelling older adults to evaluate the AA using the Simplified Nutritional Appetite Questionnaire. We utilized the Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression analysis to select variables and develop a nomogram prediction model. The predictive performance of the nomogram was evaluated using the Receiver Operating Characteristic (ROC) curves, calibration curves, Decision Curve Analysis (DCA), and internal validation.

RESULTS

The prevalence of AA among Chinese older adults was 21.7% (95%CI: 20.0%-23.5%). Age, sex, family economic level, smoking status, dysphagia, loneliness, depressive symptoms, living alone, health literacy, life satisfaction, and body mass index have been identified as predictive factors for AA among older people. The nomogram constructed based on these predictive factors showed an area under the curve (AUC) of 0.766 (95%CI: 0.742-0.791), indicating good calibration and discrimination ability. Additionally, the results obtained from the 10-fold cross-validation process confirmed the nomogram's good predictive capabilities. Furthermore, the DCA results showed that the nomogram has clinical utility.

CONCLUSION

The nomogram constructed in this study serves as an effective tool for predicting anorexia of aging among community-dwelling older adults. Its implementation can help community healthcare workers evaluate the risk of AA in this population and identify high-risk groups.

A cross-sectional study of the association between food literacy and dietary intake among Danish adolescents

Food literacy is theorized to be associated with healthy dietary intake. However, empirical knowledge on the association between adolescents' food literacy and dietary intake is limited. The aim of this study was to investigate the association between food literacy and dietary intake among Danish schoolchildren aged 11-13 years. The study applied a cross-sectional design using baseline data from a cluster-based quasi-experimental controlled study in a sample (n = 377) of Danish school children. Mixed model analyses were performed to investigate the associations between overall food literacy as well as its five competencies ("to know", "to do", "to sense", "to care", and "to want") and dietary intake of vegetables, fruit, fish, meat, discretionary foods, and sugar-sweetened beverages. Positive associations were found between overall food literacy (E = 1.493, p = 0.002) as well as the competencies "to know" (E = 1.249, p = 0.027), "to do" (E = 1.236, p = 0.028), "to sense" (E = 1.183, p = 0.029), and "to care" (E = 1.249, p = 0.018) and intake of vegetables. The study also found a positive association between the competency "to want" and intake of fruit (E = 13.50, p = 0.037), "to care" and intake of fish (E = 2.050, p < 0.001), and a negative association between the competency "to want" and intake of meat (E = 0.748, p = 0.003) and sugar-sweetened beverages (E = 0.576, p = 0.0021). No associations were found between overall food literacy or any of its five competencies and intake of discretionary foods. These findings suggest that improving specific aspects of food literacy may have a potential to promote healthier dietary intake, though additional research is needed.

The potential of orally exposed risk factors and constituents aggravating food allergy: Possible mechanism and target cells

Food allergy is a significant concern for the health of humans worldwide. In addition to dietary exposure of food allergens, genetic and environmental factors also play an important role in the development of food allergy. However, only the tip of the iceberg of risk factors in food allergy has been identified. The importance of food allergy caused by orally exposed risk factors and constituents, including veterinary drugs, pesticides, processed foods/derivatives, nanoparticles, microplastics, pathogens, toxins, food additives, dietary intake of salt/sugar/total fat, vitamin D, and therapeutic drugs, are highlighted and discussed in this review. Moreover, the epithelial barrier hypothesis, which is closely associated with the occurrence of food allergy, is also introduced. Additionally, several orally exposed risk factors and constituents that have been reported to disrupt the epithelial barrier are elucidated. Finally, the possible mechanisms and key immune cells of orally exposed risk factors and constituents in aggravating food allergy are overviewed. Further work should be conducted to define the specific mechanism by which these risk factors and constituents are driving food allergy, which will be of central importance to the targeted therapy of food allergy.

The association between oral health literacy and oral health-related behaviours among female adolescents in the Kingdom of Saudi Arabia: A cross-sectional study

Objectives

Oral health literacy (OHL) is suggested as an important denominator of oral health. This study aimed to identify ways to improve oral health by exploring the association between oral health literacy and oral health-related behaviours among female adolescents in the Eastern Province of the Kingdom of Saudi Arabia (KSA).

Methods

This cross-sectional study assessed OHL among 1,889 10th grade female students in the Eastern Province of the KSA. OHL was assessed using an Arabic version of the short version of the Health Literacy in Dentistry scale (A-HeLD-14). Self-reported socio-demographic information and oral health-related behaviours (toothbrushing, dental attendance, and sugary diet consumption) were also collected. The relationship between OHL and oral health-related behaviours was investigated using binary logistic regression, adjusted for socio-demographic information.

Results

The binary logistic regression analyses showed that poor OHL was significantly associated with infrequent toothbrushing (p < 0.001) and irregular dental attendance (p = 0.005) but not with consumption of sugary diets. All A-HeLD-14 domains were significantly associated with infrequent toothbrushing, and the domains concerning access, receptivity, and financial barriers were significantly associated with irregular dental attendance. The highest odds ratios (ORs) for infrequent toothbrushing were found in the domains of receptivity (OR = 4.19) and understanding (OR = 3.85) and for irregular dental attendance in the financial barriers (OR = 1.61) and access (OR = 1.49) domains, followed by the receptivity domain (OR = 1.35).

Conclusion

Poor OHL was significantly associated with infrequent toothbrushing and irregular dental attendance. Interventions focusing on OHL are warranted to improve oral health-related behaviours and thereby oral health in the population. The aspects that seem most vital to target are improved access to dental care, including the reduction of economic barriers, as well as increased awareness of oral health in the population.

Le comportement alimentaire des étudiants de l'Université de Yaoundé I, Cameroun : entre la littératie alimentaire, la littératie en santé et l'e-littératie alimentaire

CONTEXTE

Il est connu que les maladies non transmissibles s'originent dans les habitudes et les choix alimentaires, et la littératie en santé est le meilleur déterminant de la santé d'un individu au 21e siècle. Or, cet aspect reste peu exploré en contexte camerounais. Dès lors, cette étude examine la relation entre la littératie en santé, la littératie alimentaire, la littératie alimentaire numérique et le comportement alimentaire des étudiants de l'Université de Yaoundé I.

MÉTHODES

Un total de 240 étudiants âgés de 18 à 48 ans (M = 21,97 ans, ET = 7,03), dont 149 (62,1 %) femmes, sélectionnés par commodité, ont rempli un questionnaire composite comprenant des échelles de mesure de la littératie en santé (Health Literacy Survey European Union Questionnaire Short Form), de la littératie alimentaire (Short Food Literacy Questionnaire), de la littératie alimentaire numérique (eHealth Literacy Scale) et du comportement alimentaire (General Dietary Behavior Inventory). Les données ont été analysées grâce au logiciel SPSS, v.20, en utilisant des tests de Mann-Whitney, de Kruskal-Wallis, de Spearman et des modèles linéaires généralisés.

RÉSULTATS

Les résultats ont montré que le comportement alimentaire n'est pas associé aux caractéristiques sociodémographiques des étudiants. L'analyse des modèles linéaires généralisés a démontré que le comportement alimentaire des étudiants est influencé par la littératie alimentaire (β = 1,503, p < 0,001), la littératie en santé (β = 1,191, p < 0,05) et la littératie alimentaire numérique (β = 1,263, p < 0,001). De même, prises ensemble, elles entrainent une variation de 6,929 sur le comportement alimentaire (χ²(3) = 63,070, β = 6,929, p < 0,001).

CONCLUSION

L'étude suggère que plus de recherches sur d'autres sous-groupes de population sont nécessaires afin de fournir des données pour des interventions en faveur d'une alimentation saine.

Dietary behaviors of rural residents in northeastern China: implications for designing intervention information and targeting high-risk population

Background

Dietary behavior is a pivotal modifiable determinant in reducing the occurrence of obesity/overweight and chronic non-communicable diseases. Improving the dietary behavior of rural residents in China is imminent due to the poor performance of their dietary behavior. Nutrition knowledge and health literacy are considered as elements that are linked intimately to healthy dietary behaviors but lack research in the Chinese setting.

Purpose

The study is designed to explore the relationship between nutritional knowledge, health literacy and dietary behaviors and to analyze the performance under different demographic characteristics.

Methods

A face-to-face survey of 400 rural residents on their nutrition knowledge, functional health literacy and dietary intake of five food categories consisting of 32 items was conducted based on a validated questionnaire. Descriptive analysis, difference test including ANOVA, t-test and non-parametric test, and multivariate linear regression were used for data analysis.

Results

The results indicate that declarative nutrition knowledge, individuals' information application capacity, and dietary behaviors, especially the intake of fruits, dairy and beans, and vegetable are not ideal and requires improvement. Male, elder, low-income, unmarried, and low-education populations performed significantly worse and were the high-risk group. Procedural nutrition knowledge, information access capacity, information understanding capacity, and information application capacity have remarkable effects on better dietary behavior.

Conclusion

This study provides evidence-based guidance for prioritizing information and populations for healthy dietary interventions.

Assessing Dietary Salt Intake and Pilot-Testing a Home-Based Intervention to Lower Salt Intake Among Filipino College Students

PURPOSE

To assess the knowledge, attitude, and behaviors related to dietary salt intake and develop a home-based intervention that helps lower salt intake among Filipino college students.

DESIGN

Two-phase program development study utilizing descriptive and quasi-experimental design.

METHODS

Phase 1 determined the knowledge, attitude, and behaviors alongside the frequency of dietary salt intake of a consecutive sample (n = 118). Phase 2 involved the development and pilot-testing of a home-based intervention wherein a random sample (n = 35) selected from Phase 1 joined for pilot-testing. The study was conducted from October - November 2021 and utilized valid and reliable measures to test the knowledge, attitude, and behavior of the participants.

FINDINGS

Initial assessment showed knowledge regarding health risks of high salt intake and positive attitude toward health-promoting behaviors. Post-intervention showed improvement in attitude (p = 0.0004) and behavior (p = 0.001) related to dietary salt intake alongside health literacy (p = 0.036). There was no significant change in knowledge (p = 0.054).

CONCLUSION

The home-based intervention involving the use of health education materials is successful in improving dietary salt intake patterns.

CLINICAL EVIDENCE

Community health nurses may utilize home-based interventions to help develop health-promoting behaviors among young adults.

Nutrition Education Models for Patients With Chronic Kidney Disease

Nutrition is an integral component in the management of chronic kidney disease (CKD), and kidney health professionals play a crucial role in educating patients on dietary interventions for CKD. Several dietary modifications are indicated for CKD that require frequent adaptations with CKD progression and with underlying metabolic disturbances. However, poor adherence to dietary interventions is not uncommon among patients with CKD. An effective education program on nutrition intervention consists of providing knowledge and developing skills that are necessary to support behavioral change. The application of theoretical models of behavioral change such as social cognitive theory and the transtheoretical model in nutrition intervention has been reported to be effective in promoting changes in dietary habits. This review summarizes the evidence supporting the application of theoretical models as strategies to enhance nutrition education for patients with CKD. In addition, digital technologies are gaining interest in empowering patients and facilitating nutrition management in patients with CKD. This review also examines the applications of the latest digital technologies guided by behavioral theory in facilitating patients' changes in dietary intake patterns and lifestyle habits.

Specificity of the Associations between Indices of Cardiovascular Health with Health Literacy and Physical Literacy; A Cross-Sectional Study in Older Adolescents

Background and Objectives: Cardiovascular health status (CVHS) is an important determinant of health, while it is theorized that health literacy (HL) and physical literacy (PL) could be directly related to CVHS. The aim of this study was to evaluate gender-specific associations between PL and HL and indices of CVHS in adolescence. Materials and Methods: The participants were 247 adolescents (177 females) from Split-Dalmatia county in Croatia who were tested on HL, PL, and CVHS (physical activity level (PAL) and lipid profile). The lipid profile included total cholesterol, triglycerides, high-density lipoproteins, non-high-density lipoprotein-cholesterol, and low-density lipoproteins. Gender-stratified multivariate cluster analysis (K-means clustering) was used to group participants into three homogenous groups on the basis of their HL and PL, while differences between clusters in CVHS were evidenced by analysis of the variance and consecutive post-hoc tests. Results: The lipid profile was better in girls with higher HL scores. Additionally, clusters consisting of participants with a better PL were characterized by higher PAL. We have found no evidence that HL is associated with PAL, while PL was not associated with the lipid profile. Conclusions: HL was specifically associated with direct indicators of health status (lipid profile) in girls, while PL was associated with PAL as a particular behavioral health indicator in both genders. The study highlights the necessity of including education of HL and PL in schools.

Are Health Literacy and Physical Literacy Independent Concepts? A Gender-Stratified Analysis in Medical School Students from Croatia

Health literacy (HL) and physical literacy (PL) are concepts responsible for achieving and maintaining positive health behaviors. This study aimed to investigate gender-specific associations: (i) between PL and HL; and (ii) among HL, PL, and body composition. We observed 253 students attending health-area high schools from southern Croatia (181 girls; 16.9 ± 1.4 years). HL was assessed by the European Health Literacy Survey Questionnaire, PL by the PLAYself questionnaire, and body composition by bioimpedance analysis. The t-test was used to assess the differences between genders, and Pearson’s correlation coefficients were calculated to establish the associations between variables. The results showed a similar level of HL (t-test = 0.2; p = 0.83) and PL (t-test = 0.01; p = 0.99) in boys and girls. Significant but small correlations were identified between HL and PL only in the girls (<10% of common variance). The body composition indices were significantly correlated with PL only in the boys (15−20% of common variance). Our research highlights the necessity of the independent evaluation of HL and PL in adolescence. Further studies evaluating other indices of health status in relation to PL and HL are warranted.

Health literacy and cardiovascular disease prevention: a systematic scoping review protocol

INTRODUCTION

Health literacy is 'The skills and resources of a person to access, understand and use information to make decisions, and take action on their own health and healthcare'. Literature investigating cardiovascular disease (CVD) prevention and health literacy often exist in silos, only exploring one element of prevention. This protocol aims to establish a scoping method of articles investigating health literacy and CVD preventive practices or knowledge in lay populations.

METHODS AND ANALYSIS

A scoping review was deemed the most appropriate study design. The topic was conceptualised, with preliminary searching informing subsequent development of search strings. A search of the following databases will be conducted on 31 January 2022: MEDLINE, Global Health, PubMed, Embase, PsycINFO and CINAHL. Studies included will be published in English, of appropriate design, measuring health literacy and some aspect of primary CVD prevention in lay-populations. These criteria will be tested against 25 'pilot' articles from the results, undergoing necessary review before screening commences. A secondary author will screen 10% of abstracts, with a third subject-matter expert reviewing conflicts.

ETHICS AND DISSEMINATION

This review will be disseminated through peer-reviewed scholarly networks, most likely including journal publication and conference presentation.

ARTICLE SUMMARY

CVD is the leading cause of death around the world. This paper proposes an exploration of health literacy's relationship with CVD prevention as a whole, contrasting with the more segmented reviews currently published.

Current Knowledge and Behavior towards Salt Reduction among Hong Kong Citizens: A Cross-Sectional Survey

Excessive dietary salt intake is prevalent in the Hong Kong community. Over the last decade, the Hong Kong Special Administrative Region Government has been actively promoting community participation to reduce salt intake. The aim of this study was to investigate the current knowledge levels and behaviors relating to dietary salt intake among Hong Kong adults. This cross-sectional survey involved 426 adults in Hong Kong. The findings of this study identified areas of knowledge deficit in the recommended upper limit of daily salt intake for an adult set by World Health Organization (n = 295, 69.2%) indicated a lack of awareness that the overconsumption of salt could cause coronary heart disease (n = 233, 54.7%). Disengagement with salt reduction behavior, such as rarely/never checking the sodium or salt content listed on the food label (n = 252, 59.2%) and rarely/never purchasing food labelled with low salt or no salt content (n = 292, 68.9%), was reported. Excessive salt intake in dietary habits remains an under-recognized non-communicable disease threat by Hong Kong citizens, indicating ineffective responsive risk communication. There is a need to refine existing salt reduction initiatives to aid in making appropriate decisions regarding dietary salt intake among Hong Kong citizens.

Applying a Multi-Dimensional Digital Food and Nutrition Literacy Model to Inform Research and Policies to Enable Adults in the U.S. Supplemental Nutrition Assistance Program to Make Healthy Purchases in the Online Food Retail Ecosystem

The United States (U.S.) Department of Agriculture (USDA)-administered Supplemental Nutrition Assistance Program (SNAP) made substantial changes in response to the coronavirus disease 2019 (COVID-19) pandemic. These changes highlight the need to identify the digital literacy skills and capacities of SNAP adults to purchase healthy groceries online. We conducted a scoping review of four electronic databases, Google and Google Scholar to identify studies that measured food and nutrition literacy outcomes for U.S. adults. We applied a multi-dimensional digital food and nutrition literacy (MDFNL) model to assess six literacy levels and components. Of 18 studies published from 2006-2021, all measured functional and interactive literacy but no study measured communicative, critical, translational, or digital literacy. Six studies examined SNAP or SNAP-Education outcomes. Adults with higher food or nutrition literacy scores had better cognitive, behavioral, food security and health outcomes. We suggest how these findings may inform research, policies, and actions to strengthen the multi-dimensional literacy skills of SNAP participants and SNAP-eligible adults to support healthy purchases in the online food retail ecosystem.

Association between Mobile Phone Addiction Index and Sugar-Sweetened Food Intake in Medical College Students Stratified by Sex from Shanghai, China

This study’s objective was to depict sugar-sweetened food (SSF) consumption in medical college students stratified by sex from Shanghai, China, and to explore the association between the Mobile Phone Addiction Index (MPAI) and SSF intake. The data were obtained from 1121 medical college students from the Fudan University, Shanghai, China, who took an online questionnaire investigation in December 2020. Data included demographics, the MPAI, the Nutrition Literacy Assessment Questionnaire (NLAQ), total and food expenditure per month, the International Physical Activity Questionnaire (IPAQ), and a food frequency questionnaire (carbonated beverages (CB), other sugar-based beverages (OSBB), sugar/chocolate). We evaluated the association between the MPAI and three types of SSF intake according to multivariate logistic regression analysis stratified by sex. The mean CB, OSBB, and sugar/chocolate intakes were, respectively, 65.66 mL/d, 74.20 mL/d, and 4.96 g/d in men and 30.42 mL/d, 71.48 mL/d, and 4.99 g/d in women. The MPAI was positively associated with SSF intake, regardless of sex. In men, the CB and OSBB odds ratios (ORs) were, respectively, 1.023 (95% CI: 1.004–1.042), 1.019 (95% CI: 1.001–1.038); and in women, the CB, OSBB, and sugar/chocolate ORs were, respectively, 1.026 (95% CI: 1.013–1.039), 1.020 (95% CI: 1.007–1.033), and 1.019 (95% CI: 1.006–1.032). Age, NLAQ, total expenditure, food expenditure, and total physical activity also were related to SSF intake. Age and the application capacity of the NLAQ were negatively associated with SSF intake, whereas comprehension capacity of the NLAQ, total and food expenditure, and total physical activity were positively associated with SSF intake. This study confirmed that SSF intake is widespread among medical college students from Shanghai, China, even if they have relatively high nutrition health literacy. From a public health perspective, it is necessary to reduce SSF intake in medical college students by decreasing the MPAI, controlling the total and food expenditure per month in high-consumption areas, and improving the application ability of the NLAQ. Further studies are needed to explore the MPAI and other potential factors that may influence SSF intake of college students by expanding the sample size of college students throughout China, and the causal association between them.