Towards the Implementation of a Conceptual Framework of Food and Nutrition Literacy: Providing Healthy Eating for the Population

Brief instruments for measuring nutrition literacy - the Nutrition Health Literacy Scale and the Self-Perceived Food Literacy Scale Short Form

BACKGROUND

A healthy diet is a critical factor in maintaining long-term health. In addition to a health-promoting food environment, the nutrition health literacy (NHL) and food literacy (FL) of the population are important in this context. This paper describes the development and validation of two short instruments to measure the nutrition literacy of the population, used in the Austrian Nutrition Literacy Survey 2021.

METHODS

An instrument to measure NHL (Nutrition Health Literacy Scale; NHLS) has been adapted and further developed. To measure FL, the Self-perceived Food Literacy Scale by Poelman et al. has been modified and shortened (SPFL-SF). Validation of the instruments was based on data from a web survey conducted in Austria in 2021 with almost 3,000 participants aged 18 years and older. Exploratory and confirmatory factor analyses were performed to assess the factorial validity/dimensionality of the instruments. Additionally, internal consistency was assessed using Cronbach's alpha, ordinal alpha, and McDonald's omega.

RESULTS

Both instruments demonstrate excellent data-model fit. The NHLS also shows excellent internal consistency (α = 0.91), while the SPFL-SF displays a sufficient internal consistency for all (α between 0.70 and 0.89) but one sub-dimension (resisting temptation α = 0.61). Furthermore, the distribution of the items indicates that the measures are understandable and suitable, as evidenced by the absence of missing values in the sample. In addition, the items of both instruments differ in their level of difficulty or agreement.

CONCLUSIONS

The NHLS and SPFL-SF are reliable and valid instruments for measuring NHL and FL in the general adult population. The brief instruments measuring the different aspects of nutrition literacy can be easily used in nutritional or evaluation studies. Further work is required to investigate other aspects of validity.

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.

Self-perceived food literacy in relation to the quality of overall diet and main meals: A cross-sectional study in Japanese adults

This cross-sectional study aimed to assess the relationship between self-perceived food literacy (SPFL) and quality of overall diet and main meals in Japanese adults. In total, 5998 adults aged 20-79 years were included in this analysis. The SPFL was assessed using the Japanese version of the 29-item Dutch SPFL scale (score range 1-5). Using validated dietary information, the Healthy Eating Index-2015 (HEI-2015) was calculated (score range 0-100). The mean SPFL was 3.18; the internal consistency of the overall scale was considered good (Cronbach's alpha: 0.80). The mean HEI-2015 for overall diet was 50.4. The SPFL was significantly and positively associated with the HEI-2015. Using multiple linear regression, one point increase of SPFL corresponded to an increase in HEI-2015 by a point of 4.8 for overall diet, 6.2 for breakfast, 4.6 for lunch, and 3.6 for dinner (all P < 0.0001). Six of the eight domains of SPFL (i.e., food preparation skills, resilience and resistance, healthy snack styles, examining food labels, healthy budgeting, and healthy food stockpiling) were significantly associated with the HEI-2015 for overall diet. When the HEI-2015 for each meal was examined, the domains showing significant associations with all three meals included food preparation skills, healthy snack styles, and healthy budgeting. The healthy food stockpiling was associated with the HEI-2015 for breakfast and lunch, but not dinner. The social and conscious eating and daily food planning were associated with the breakfast HEI-2015 only, with the resilience and resistance associated with the dinner HEI-2015 only. In conclusion, the SPFL was cross-sectionally associated with the quality of overall diet and main meals in Japanese adults. Further observation and intervention studies are needed to confirm the associations observed here.

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.

Predicting willingness to consume healthy brand foods using the theory of planned behavior: the role of nutritional literacy

Introduction

The willingness to consume healthy foods has highlighted the growing importance of health, even more so when it comes to food choice, and predicting the willingness to consume foods of a healthy brand represents an action that leads to the practice of conscious eating habits, but what is behind this willingness? To answer this question and based on previous studies such as the theory of planned behavior and nutritional literacy, this study aimed to build a predictive model through an empirical study to examine the influence of nutritional literacy (NL) on attitude (ATT), subjective norm (SN) and perceived behavioral control (PBC), as well as to determine the influence of the three variables of the theory of planned behavior (TPB) on the willingness to consume healthy brand foods (WCHBF) in the Peruvian market.

Methods

The research focused on the population that stated that they were consumers of the Unión brand (a brand whose value proposition is the sale of healthy foods), obtaining 482 consumers. The study was conducted under a quantitative, non-experimental, cross-sectional design approach.

Results

The results support the existence of a positive and significant effect of NL on ATT, SN, and PBC, finding the exact behavior of SN and PBC in WCHBF; however, in the proposed model, it is observed that ATT has no impact on WCHBF.

Conclusion

Applying strategies that lead to a change in consumer behavior towards healthy brands is a matter of time and will. In this context, the findings indicate that nutritional literacy plays an essential role in the willingness to consume healthy foods, which sheds more light on the design of educational interventions and awareness campaigns that independently inform about nutritional benefits and empower consumers, allowing them to make informed and healthy choices.

Development of food literacy in children and adolescents: implications for the design of strategies to promote healthier and more sustainable diets

Food literacy has emerged as a key individual trait to promote the transformation of food systems toward healthy and sustainable diets. Childhood and adolescence are key periods for establishing the foundations of eating habits. Different food literacy competencies are acquired as children develop different cognitive abilities, skills, and experiences, contributing to the development of critical tools that allow them to navigate a complex food system. Thus, the design and implementation of programs to support the development of food literacy from early childhood can contribute to healthier and more sustainable eating habits. In this context, the aim of the present narrative review is to provide an in-depth description of how different food literacy competencies are developed in childhood and adolescence, integrating the extensive body of evidence on cognitive, social, and food-related development. Implications for the development of multisectoral strategies to target the multidimensional nature of food literacy and promote the development of the 3 types of competencies (relational, functional, and critical) are discussed.

Food healthiness judgements among Brazilian and German lay adults

This study investigated which foods are most saliently judged as healthy and unhealthy in Brazil and Germany and the reasons for these judgements. Dietary guidelines in the two countries differ in that those in Brazil are based on a food processing classification rather than nutrient profiling, whereas dietary guidelines in Germany do not include the processing level of food. In an online study with 355 lay adults (Brazil n = 205, Germany n = 150), we explored which foods are listed as healthy and unhealthy using a free-listing method. The main reasons for these healthiness judgements were then identified with a one or two-word phrase and compared between countries. Saliency analysis was conducted to identify the 15 most salient healthy and unhealthy foods in each country. Principles of content analysis were used to assess the reasons why these 15 items were listed as most salient by the participants. Results showed that both Brazilians and Germans listed mostly natural or minimally processed food (e.g. fruits, vegetables, grains, fish and milk) as healthy, whereas types of convenience and fast food, sweets and other ultra-processed foods (e.g. chocolate, soda, French fries, pizza and hamburger) were the most salient unhealthy items listed in both countries. Differences in culturally relevant items listed in each country are discussed. Further, in both countries, despite differences in their dietary guidelines, food healthiness judgements for the most salient items listed relied heavily on the nutritional content of food, reinforced the 'good/healthy' and 'bad/unhealthy' dichotomy, and were centred on benefits or harms to the body (e.g. prevention or cause of diseases and weight control). The similarity of food healthiness judgements between the two countries, together with their agreement with conventional health claims and dietary guidelines, suggest that lay Brazilian and German adults are knowledgeable about the general concepts of 'healthy' and 'unhealthy' food. Finally, these findings suggest that rather than just providing more nutritional information, policymakers and health professionals need to take into account the multiple psychosocial and environmental determinants of eating in these countries.

Nutrition and Food Literacy: Framing the Challenges to Health Communication

Nutrition and food literacy are two important concepts that are often used interchangeably, but they are not synonymous. Nutrition refers to the study of how food affects the body, while food literacy refers to the knowledge, skills, and attitudes necessary to make informed decisions about food and its impact on health. Despite the growing awareness of the importance of food literacy, food illiteracy remains a global issue, affecting people of all ages, backgrounds, and socioeconomic status. Food illiteracy has serious health implications as it contributes to health inequities, particularly among vulnerable populations. In addition, food literacy is a complex and multidisciplinary field, and there are numerous challenges to health communication that must be addressed to effectively promote food literacy and improve health outcomes. Addressing food illiteracy and the challenges to health communication is essential to promote health equity and improve health outcomes for all populations.

A scoping review of food and nutrition literacy programs

The impact of food literacy (FL) and nutrition literacy (NL) programs on lifestyles and health is recognized in the literature, yet few studies systematize it. This study aims to deepen the understanding of FL/NL from the characterization of programs in terms of (i) theoretical foundations, conceptualization and measuring instruments; (ii) characterization of the FL/NL programs and results and (iii) limitations and future directions declared. A scoping review of original articles addressing FL/NL programs from the Web of Science, Scopus and PubMed databases published between 2015 and 2023. There was a somewhat restricted view of the construct and the absence of a clear boundary between FL and NL. Half of the studies reported theoretical foundations. The most used model was Social Cognitive Learning Theory. More significant development of programs was observed in Australia, using quasi-experimental designs. Most of the studies informed positive results. Limitations of the studies related to the sampling process, absence of a control group and lack of follow-up. It is suggested that long-term interventions consider economic, social and cultural factors. Despite that theoretical and empirical aspects should be revised, FL/NL programs are a suitable strategy to mitigate the social and health effects of inadequate nutrition.

Turkish version of the 'food and nutrition literacy questionnaire for Chinese school-age children' for school-age adolescents: a validity and reliability study

BACKGROUND

In this study, it was aimed to examine the psychometric characteristics of the scale named 'Food and Nutrition Literacy Questionnaire for Chinese School-age Children (FNLQ-SC)' in Turkish school age adolescents.

METHODS

The research was carried out with 341 school-age adolescents aged 10 to 17 years. The Cronbach's α coefficient was used to evaluate internal consistency reliability and the test-retest method was applied. The construct validity was assessed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and the content validity was assessed by the Pearson correlation coefficient.

RESULTS

EFA indicated that the Turkish version of FNLQ-SC had three factorial structures that accounted for 42.0% of the total variance. The overall Turkish version of FNLQ-SC questionnaire had acceptable internal consistency (Cronbach's α = 0.679). The dimensional structure obtained in the EFA was controlled by CFA and the three-factor model showed acceptable goodness-of-fit indices (χ2/df = 1.924, RMSEA = 0.052, CFI = 0.864, GFI = 0.949). The Pearson correlation coefficients between each dimension and the overall questionnaire ranged from 0.300 to 0.842. Multiple linear regression analysis indicated that age, gender, grade of class, being an only child and discussing nutrition information with families had an effect on food and nutrition literacy (R2 = 0.312; p < 0.001).

CONCLUSION

The Turkish version of FNLQ-SC has good reliability and construct validity to assess the food and nutrition literacy of Turkish school age adolescents.

Vaccination as a social practice: towards a definition of personal, community, population, and organizational vaccine literacy

BACKGROUND

A comprehensive and agreed-upon definition of vaccine literacy (VL) could support the understanding of vaccination and help policy-makers and individuals make informed decisions about vaccines.

METHODS

To shed some light on this debate and provide clarity, a scoping review was conducted to collect, summarize, and analyse available definitions of VL. Based on the findings of the scoping review, a new and comprehensive definition was proposed by a panel of experts.

RESULTS

Fifty-three articles were included, and two of them appeared to be the milestones around which the other definitions were grouped. The new definition proposed by the panel of experts included not only the personal perspective, but also the community, population, and organizational perspectives. Moreover, due to the increasing complexity of the social context with respect to the ability to navigate, understand, and use information and services, the definition of organizational vaccine literacy and the attributes of a vaccine literate healthcare organization have been proposed.

CONCLUSION

The new definition can contribute to the overall paradigm of health literacy and its distinct component of vaccine literacy, possibly improving the implementation of public health strategies to allow vaccination to be understood as a social practice by the entire community. This study describes the conceptual foundations, the competencies, and the civic orientation to be considered when developing measurement tools devoted to assessing VL at the different levels and in different contexts.

Food literacy competencies in youth - a mini-review

Introduction

Young people's transition into adulthood is an opportunity in the life course to establish adequate eating behaviors, hence exploring food literacy competencies in this period of life is especially important. Food literacy has recently gained increased attention in adults, adolescents, and younger children, but less is published about youth. This paper aims to summarize what tools have been used to measure food literacy and the sub-competence nutrition literacy in youth aged 16-24 years in the previous 5 years.

Methods

A mini-literature review was conducted in MEDLINE and EMBASE via Ovid, in September 2022. Study eligible criteria; had to be an original article, using a tool to quantitatively assess food literacy and/or nutrition literacy, including participants between 16-24 years, full text available in English, published between 2017-2022.

Results

A total of 958 articles were identified, of which 385 duplicates were removed. Thus, 573 articles were screened by title/abstract. Finally, nine articles were eligible for data extraction of which four proposed a tool to measure food literacy and five proposed a tool to measure nutrition literacy.

Discussion and conclusion

Although four studies claimed to measure food literacy, none of these used tools comprehensive enough to measure all aspects of food literacy, and only one was validated in young people. This study shows that only few tools exist for the measurement of food literacy in youth, and those available are scant. Further work is needed to develop a food literacy tool for youth.

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.

Nutrition in City Ecosystems (NICE): Protocol of a multi-sectoral development project to improve food and nutrition security of secondary city populations in Bangladesh, Kenya and Rwanda

Background

Secondary cities tend to be better linked with local food systems than primate cities, acting as important platforms to trade agricultural produce with rural surrounding. COVID-19, conflicts and climate change continue to expose inefficiencies in food systems and have further exacerbated malnutrition, calling for substantial food systems transformations. However, tackling current food systems' challenges requires new approaches to ensure food and nutrition security. Nutritious and agroecologically produced food offer the potential to transform food systems by improving diets and alleviating pressure on the environment, as well as by creating jobs and reducing poverty. This paper describes the design of a project by a Swiss public-private consortium to improve food and nutrition security and to reduce poverty in city ecosystems in six secondary cities in Bangladesh, Kenya and Rwanda through governance/policy and supply and demand side interventions.

Methods

The Nutrition in City Ecosystems (NICE) project promotes well-balanced nutrition for city populations through interdisciplinary agricultural, food, and health sector collaborations along city-specific value chains. Adopting a transdiciplinary systems approach, the main interventions of NICE are (i) advocacy and policy dialogue, (ii) building of decentralized institutional capacity in multi-sectoral collaborations, (iii) support of data-driven planning, coordination and resource mobilization, (iv) anchoring of innovations and new approaches in city-level partnerships, (v) capacity building in the agricultural, retail, health and education sectors, as well as (vi) evidence generation from putting policies into practice at the local level. NICE is coordinated by in-country partners and local offices of the Swiss public-private consortium partners.

Discussion

The NICE project seeks to contribute to urban food system resilience and enhanced sustainable nutrition for city populations by (A) strengthening urban governance structures involving key stakeholders including women and youth, (B) generating income for producers along the supply chain, (C) triggering change in producers' and consumers' behavior such that nutritious and agroecologically produced foods are both in demand as well as available and affordable in urban markets, and (D) allowing a scale up of successful approaches to other national and international cities and city networks.

The Connection between Non-Alcoholic Fatty-Liver Disease, Dietary Behavior, and Food Literacy in German Working Adults

(1) Background: German working adults are particularly at risk of non-alcoholic fatty-liver disease (NAFLD), which is connected to increased cardiovascular and overall morbidity and mortality. Dietary behavior (DB) and health knowledge are crucial factors in the conceptual NAFLD model, which can directly influence this disease. These two factors largely align with the concept of food literacy (FL), which deals with proficiency in food-related skills and knowledge to promote healthy DB and prevent NAFLD. However, the potential of FL for NAFLD prevention remains unknown, because FL has not been tested in connection with DB and NAFLD. Therefore, the current study examined the direct and indirect connections between FL, DB, and NAFLD in a mediation model. (2) Methods: A total of 372 working adults (38% female) participated in a cross-sectional study by completing self-report questionnaires on FL and DB. In addition, an independent physician assessed the fatty-liver index (FLI) as an indicator of NAFLD in an occupational health checkup. (3) Results: The mediation model revealed that FL had a direct moderate connection with DB (β = 0.25, p < 0.01), but no direct connection with the FLI (β = -0.05, p = 0.36). However, DB showed a small to moderate connection with the FLI (β = -0.14, p = 0.01), which could indicate the indirect-only mediation of the relationship between FL and NAFLD via DB. (4) Conclusion: These results confirm the value of DB for the prevention of NAFLD. In addition, FL might be a vital component for improving DB and thereby function as a resource in the prevention of NAFLD. However, future longitudinal research is needed to substantiate the value of FL with respect to NAFLD.

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.

Food Literacy and Dietary Intake in German Office Workers: A Longitudinal Intervention Study

Widespread patterns of poor dietary behavior are a key factor causing the increasing prevalence of chronic diseases around the world. Research has provided initial insights into the potential of food literacy (FL) to empower individuals to improve their dietary behavior. However, studies on FL interventions in working adults are scarce. The intervention delivered in this study was a comprehensive 3-week full time education-based workplace health promotion program (WHPP) that provided the participants with in-depth knowledge and skills regarding nutrition and health. We aimed to investigate the short- and long-term effects of the WHPP on FL and dietary intake (DI) and to examine the association between FL and DI in a sample of 144 German office workers (30.0% female). Using two random intercept mixed linear regression models, we found significant strong improvements for both FL (β = 0.52, p < 0.0001) and DI (β = 0.63, p < 0.0001) after the WHPP when compared to baseline. Significant long-term improvements at 18 months were strong for FL (β = 0.55, p < 0.0001) and weak for DI (β = 0.10, p < 0.0001). FL showed a significant moderate effect on DI across all measurement time points (β = 0.24, p < 0.0001). We conclude that well-designed WHPPs can induce long-term improvements in FL and DI, and that FL can be viewed as an asset to further expand food-related knowledge and skills and to enhance dietary behavior. Our study fills a gap of long-term findings regarding the role of FL in WHPPs and supports the idea of implementing FL in the development of comprehensive WHPPs to improve DI.

A Proposed Conceptual Sport Nutrition Approach for Athlete Development and Assessment: The Athlete Nutrition Development Approach

Appropriate dietary intake can improve athletes' health and sport performance and is a direct result of eating behaviours. Therefore, assessing and shaping athletes' eating behaviours and dietary intake is critical to the provision of sport nutrition services. As such, nutrition practitioners must also consider the determinants of eating behaviours. However, dietary intake, eating behaviours, and its determinants are inconsistently defined in the literature, requiring nutrition practitioners to navigate a complicated landscape of concepts and terminology. This is further complicated by limitations in practically measuring and influencing eating behaviours and dietary intake. The proposed Athlete Nutrition Development Approach was developed to aid practitioners in servicing decisions through the athlete development process, through a three-tiered approach to sport nutrition service delivery. Tier 1 addresses the determinants of eating behaviours, Tier 2 directly addresses eating behaviours and dietary intake, and Tier 3 addresses the consequences of dietary intake in relation to health and sport performance. Each tier includes tools for assessment and development.

Healthy Eats-Evaluation of a Social Marketing Program Delivered in Primary School Settings in Queensland

One in four school children in Australia are overweight or obese. In response, the Healthy Eats program was developed, piloted, and delivered using a whole-of-school approach underpinned by the socio-ecological model to increase fruit and vegetable consumption among children aged 8-10 years in regional Queensland, Australia. This research presents an outcome evaluation of the Healthy Eats program using pre-post data collected throughout 2021 (cross-sectional for knowledge and longitudinal for behaviour) from 19 schools to assess whether changes occurred in students' nutritional knowledge (n = 1868 (pre = 933, post = 935)) and fruit and vegetable consumption (n = 1042 (pre = 521, post = 521)). Knowledge data was collected via self-reports two weeks prior and immediately after the Nutrition Module. Behavioural data on daily fruit and vegetable consumption was gathered via student passports (i.e., surveys) one week before and for four consecutive weeks after the Nutrition Module. Chi-Square Difference tests and t-Tests were conducted with a significance level set at p < 0.05. Across all 19 schools, knowledge of the daily recommended serves of fruit and vegetables improved significantly following participation in the program, aligning knowledge closer to the Australian dietary guidelines. Behavioural results for fruit consumption were favourable, with clear improvements reported. Increases in vegetable consumption were demonstrated in two of the eight schools. A discussion on the knowledge-action gap is provided, including recommendations for future iterations of the Healthy Eats program.

Effects of school-based interventions on Food and Nutrition Literacy (FNLIT) in primary-school-age children: a systematic review

This study systematically reviewed the evidence on interventions seeking to improve Food and Nutrition Literacy (FNLIT) functional, interactive and critical skills in primary school-aged children. Electronic databases, including PubMed/MEDLINE, SCOPUS, Web of Science, Cochrane, Pro-Quest and Google Scholar were systematically searched. Randomised and non-randomised controlled trials, pre-/post-test and case-control designs were included. The primary outcomes were three levels of FNLIT: functional, interactive and critical. All citations, full-text articles and abstract data were screened by two independent reviewers. Any conflicts were then resolved through discussion. The quality of the included studies was individually evaluated using the Effective Public Health Practice Project (EPHPP) quality assessment tool. Two reviewers extracted data from the included studies, and a descriptive analysis was performed. The quality of all eligible studies (n 19) was rated as moderate/weak. A wide variety of skill-building activities were introduced by programmes, including recipe skills/food preparation, food label literacy, food tasting, gardening harvesting, and supporting cultural practices and ethnic foods. Only four studies measured food literacy (FL) (food label literacy) via a valid measure. Most interventions focused on the functional level of FL, except for two programmes (one scored weak and one scored moderate). In most of the studies, delivery of intervention content was facilitated by teachers (n 15). Promising interventions were tailored to the needs and interests of students, incorporated into the existing curriculum and facilitated by teachers. The successful intervention strategies led to improvements in functional, partly interactive and critical skills. Future interventions should focus, holistically, on all aspects of FNLIT, especially interactive and critical skills.

The Relationships between Food Literacy, Health Promotion Literacy and Healthy Eating Habits among Young Adults in South Korea

The obesity problem has reached a critical level and is threatening not only personal health but also public health systems around the world. Obesity in young adults is especially rapidly growing and many studies have confirmed that the best prevention is developing healthy eating habits with the improvement of food and health promotion literacy competencies. In this context, this study diagnoses the present levels of food literacy and health promotion literacy among young adults and explores the relationships between both literacies and their healthy eating habits. A total of 325 young adults in South Korea participated in this research, and the results are as follows. First, all food literacy components, which are food and nutrition knowledge, food skills, and resilience, are positively associated with healthy eating habits. Second, health promotion literacy is also positively associated with young adults’ healthy eating habits. Lastly, unlike the primary information sources, gender has a moderating effect on the relationships between both literacies and healthy eating habits. This indicates that the government and educational sectors should propose more policy supports and solid education systems in order to help young adults develop their food and health promotion literacies for overall well-being in the future.

The Effects of Food Taxes and Subsidies on Promoting Healthier Diets in Iranian Households

Background and Aim

Price, as a key driver of food purchasing, has an important role in determining the consumer demand. This study is aimed to estimate the effect of food taxes and subsidies on purchasing patterns of Iranian households (HHs).

Methods

This study was performed in two phases. In phase one, a two-round Delphi study was conducted to determine and prioritize food-related fiscal policies; and in the second phase, using the Iranian Household Income and Expenditure Survey (HIES), we estimated an almost ideal demand system (AIDS) and simulated changes in purchases, nutrient intake, and consumer welfare under six different policy scenarios: (1) 20% subsidy on vegetables, (2) 20% subsidy on fruits, (3) 30% subsidy on legumes, (4) 25% tax on sugar and sweets, (5) 30% tax on sweetened beverages, and (6) 30% tax on hydrogenated oil and animal fats.

Results

The highest calorie reduction was detected in sugar and sweets tax, which has resulted in 949.67, 971.68, and 1,148.03 kilocalories decrease in energy intake per Adult Male Equivalent (AME) in all HHs, low-income HHs, and high-income HHs, respectively. In terms of welfare changes, high-income HHs will experience a lower change in welfare (−0.81 to 0.11%) relative to their income when compared with low-income HHs (−0.88 to 0.28%) due to fiscal policies.

Conclusion

Fiscal policies in Iran can be a potential way to improve dietary choices. The findings provide essential information for decision makers for the implementation of food-related fiscal policies.

Does Exposure to Health-related Information and Peer Effects Affect the Nutritional Status of Adolescents in Urban and Rural Areas?

BACKGROUND: The influence of health information exposure particularly from peer influences on the health and nutrition of adolescents and its effect on the nutritional status of female adolescents. AIM: The purpose of this research is to acknowledge the health information exposure and peer influences on female adolescents in urban and rural areas. METHODS: This study used a cross-sectional study design. The sample was 96 female adolescents with 44 from State Junior High School 1 Purwokerto representative of the urban area and 52 female adolescents from State Junior High School 1 Patikraja as representative from rural area. Exposure data and health information sources were collected using a questionnaire, peer influences measurement using Peer Influence Scale (PIS) questionnaire, and nutrition status measurement using Body Mass Index per age. The Statistics Test used in this study was Chi-square and Fisher Exact with 5% accuracy. RESULTS: No significant association was found between health information exposure and peer influences with nutrition status in female adolescents (p = 0.29; 0.77 > 0.05) and there was also no significant difference in acceptance source and health nutrition information topic of female adolescents in urban and rural areas. However, there was a significant difference between peer influences in female adolescents in urban and rural areas (p = 0.00 < 0.05). CONCLUSION: In both groups of female adolescents from urban and rural, there was comparable acceptance in their sources of information regarding health and nutrition. There was a significant difference in the effect of peer influences between female adolescents in urban and rural areas. However, peer influences does not have any effect on their nutrition status.

Effects of University Students’ Perceived Food Literacy on Ecological Eating Behavior towards Sustainability

Due to the COVID-19 pandemic and industrialized food systems, people’s eating behavior has become seriously restricted. Especially, university students have started to overly depend on processed foods and carnivorous diets, and it places a huge burden on society by inducing the deterioration of health and environmental sustainability. Therefore, this study was undertaken to examine the effects of university students’ perceived food literacy on ecological eating behavior towards sustainability. A total of 395 university students in South Korea participated in this research. First, students’ food literacy components, which are reading labels and budgeting, healthy snack styles, healthy food stockpiling and resilience and resistance, exert positive influences on ecological eating behavior; second, the other two components, which are food preparation skills and social and conscious eating, have no positive impact on ecological eating behavior. Finally, the influences of food literacy on ecological behavior are significantly moderated by gender differences. This suggests that strengthening university students’ food literacy through education is necessary to promote ecological eating behaviors and advance the development of sustainable society.

A systematic scoping review of the literacy literature to develop a digital food and nutrition literacy model for low-income adults to make healthy choices in the online food retail ecosystem to reduce obesity risk

Adults with lower incomes are disproportionately affected by poverty, food insecurity, obesity, and diet-related non-communicable diseases (NCDs). In 2020-2021 amid the coronavirus disease 2019 (COVID-19) pandemic, the United States Department of Agriculture (USDA) expanded the Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot program to enable eligible participants to purchase groceries online in 47 states. This expansion underscores the need for SNAP adults to have digital literacy skills to make healthy dietary choices online. Currently, a digital literacy model does not exist to help guide USDA nutrition assistance policies and programs, such as SNAP. We conducted a systematic scoping review of the academic and gray literature to identify food, nutrition, health, media, financial, and digital literacy models. The search yielded 40 literacy models and frameworks that we analyzed to develop a Multi-dimensional Digital Food and Nutrition Literacy (MDFNL) model with five literacy levels (i.e., functional, interactive, communicative, critical, and translational) and a cross-cutting digital literacy component. Utilization of the MDFNL model within nutrition assistance policies and programs may improve cognitive, behavioral, food security, and health outcomes and support equity, well-being, digital inclusion, and healthy communities to reduce obesity and NCD risks.

Exploration of the definition and components of food and nutrition literacy among junior secondary school students: a qualitative study

Background

Food and nutrition literacy (FANLit) has been proposed to promote healthy diet behaviour and is believed to decrease the prevalence of overweight, obesity and chronic disease. However, the perspective of junior secondary school students, aged 12–15 years and stakeholders towards FANLit is not well-defined. Thus, this study aims to explore the definition and components of FANLit.

Methods

This qualitative study was carried out in Health region 2 including Phitsanulok, Sukhothai, Tak, Uttradit and Pethchboon. 49 participants from national and regional levels of Thailand were recruited. Data were collected by in-depth interview and focus group discussion using semi-structured questionnaire. Interview data were transcribed verbatim and analysed using thematic analysis.

Results

FANLit is defined as an individual’s level of knowledge and skills (fundamental, interactive and critical) that relates to food and nutrition for appropriate selection of food and nutrient. Four themes of FANLit were identified as follows: 1) food and nutrition knowledge (Subthemes: food knowledge, food understanding, nutrition knowledge and nutrition understanding), 2) functional food and nutrition literacy (Subthemes: accessing to food and nutrition information, food selection, food preparation, daily food and nutrition planning and management), 3) interactive food and nutrition literacy (Subthemes: communication with others, sharing and discussion), and 4) critical food and nutrition literacy (Subthemes: information used in decision making, healthy food selection and effective budgeting).

Conclusion

The results presented beneficial information regarding FANLit definition which is the initial stage to develop the assessing instrument and the intervention to improve FANlit in the adolescent group.

What Is the Impact of Nutrition Literacy Interventions on Children's Food Habits and Nutrition Security? A Scoping Review of the Literature

Introduction: Nutrition literacy is a relatively new concept that seems to have a relevant role on the quality of people’s diets; however, we do not know the role of nutrition literacy interventions on children’s food habits and nutrition security. Methods: We conducted a literature review on four databases (PubMed, Embase, Web of Science, and Cochrane) and we considered studies describing the impact of interventions aimed at improving the quality of children’s diet. Results: A total of six articles were finally included. The total number of participants included in the studies was 4016, and the median study size was equal to 224 participants. Studies included in the review reflected a broad heterogeneity of interventions. Conclusions: The results were contrasting and revealed that the most effective type of nutrition literacy interventions included the following characteristics: technological components, involvement with multiple modalities, duration of more than 4 weeks, and face to face sessions.

FOODLIT-Trial: Protocol of a Randomised Controlled Digital Intervention to Promote Food Literacy and Sustainability Behaviours in Adults Using the Health Action Process Approach and the Behaviour Change Techniques Taxonomy during the COVID-19 Pandemic

Dietary quality and sustainability are central matters to the international community, emphasised by the burden of the COVID-19 pandemic. To promote healthier and more sustainable food-related practices, the protocol of a web-based intervention to enhance adults' food literacy is presented. The FOODLIT-Trial is a two-arm, parallel, experimental, and single-blinded randomised controlled trial delivered over 11 weeks. Based on the Food Literacy Wheel framework and supported by the Health Action Process Approach (HAPA) and the Behaviour Change Techniques Taxonomy, weekly content with customised behaviour change techniques (experimental group) is hypothesised to be more effective to promote food behaviour change when compared to a single-time and non-customised delivery of food-related international guidelines, with no theoretically informed approaches (comparison group). Primary outcome is food literacy, including food-related knowledge, skills, and behaviours, assessed with the FOODLIT-Tool; a secondary outcome includes psychological mechanisms that efficaciously predict change in participants' food literacy, measured with HAPA-driven items. Enlisted through online sources, participants will be assessed across five time points (baseline, post-intervention, and 3-, 6-, and 9-month follow-ups, i.e., T0-T4). A randomisation check will be conducted, analyses will follow an intention-to-treat approach, and linear two-level models within- (T0-T4) and between-level (nested in participants) will be computed, together with a longitudinal mediation analysis. If effective, the FOODLIT-Trial will provide for a multidimensional and cost-effective intervention to enable healthier and more sustainable food practices over the long term.

Nutrition Literacy and Healthy Diet: Findings from the Validation of a Short Seniors-Oriented Screening Tool, the Spanish Myths-NL

A good level of nutrition literacy (NL) is proposed as a determinant factor for following a healthy diet. Improving seniors’ NL might be particularly pertinent to enhance the quality of their diets. This study aimed to systematically design and validate a short seniors-oriented questionnaire as a screening tool to evaluate NL. We developed the Myths-NL questionnaire, composed of 10 widespread nutrition myths, and checked for its content and face validity. An observational cross-sectional study was conducted to explore the validity and the test–retest reliability, involving a community-dwelling group of 316 individuals aged 65 years and over. Construct validity was proved by establishing both discriminant and convergent validity. Cronbach α = 0.61 and Spearman r = 0.79 (p = 0.02) demonstrated internal consistency and test–retest reliability. Participants who had secondary/university studies scored significantly higher compared with those with primary (p < 0.001), and a significant linear relationship (R2 = 0.044, p = 0.001) with a positive slope (β = 0.209) between Mediterranean Diet Adherence Screener (MEDAS) and Myths-NL scores was observed, proving construct validity. In conclusion, the Myths-NL questionnaire is a valid and reliable tool to screen NL in Spanish seniors and it might be useful as an assessment NL tool for designing and implementing lifestyle interventions to promote healthy eating.

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.

Health Literacy and Food Literacy for K-12 Schools in the COVID-19 Pandemic

BACKGROUND

Food literacy, a sub-area of health literacy, is achieving attention in schools, academia, research, health care, businesses, and governments worldwide. Against the current COVID-19 pandemic backdrop, the relevance of food literacy's interconnected attributes such as nutritional knowledge, food skills, and food environment is gaining traction. Enhancing health and food literacy in the K-12 school environment are important empowerment tools with the potential to reduce health inequalities as vulnerable people are at risk of limited health literacy.

METHODS

We aim to clarify the meaning of food literacy and its relationship to health literacy and other factors influencing eating behavior.

RESULTS

We offer a proposed conceptual model depicting connections between relevant theories and constructs in the field of health and nutrition. Concrete actions are offered that contemporary schools can take guided by the utility of the model.

CONCLUSIONS

This visual can help guide schools' multidimensional health and food literacy efforts while considering the realities of the current COVID-19 pandemic context and beyond. This model will provide an overarching reference for schools to consider key constructs to support practice, research, policy, and intervention efforts to advance their health and food literacy agendas.

Food and health promotion literacy among employees with a low and medium level of education in the Netherlands

BACKGROUND

Prior research indicates a positive association between socioeconomic position and health literacy levels. We hypothesize comparable socioeconomic gradients for food literacy. This study aims to determine the level of self-perceived food literacy and health promotion literacy among adults with a low and medium level of education and from various subgroups, as well as the association between these food and health literacy levels. Furthermore, this study aims to explore the associations of self-perceived food literacy (SPFL) and health promotion literacy (HPL) in BMI.

METHODS

A cross-sectional study was conducted among employees with a low and medium level of education. Descriptive analyses were performed to compute SPFL and HPL levels. Analyses of variance were performed to test differences between subgroups. The correlation between SPFL and HPL was computed by Pearson's r. Multivariate linear regression analyses were used to explore 1) the association between SPFL and HPL adjusted for demographic characteristics 2) the associations between SPFL and HPL in BMI.

RESULTS

The majority (63.1%) of all participants (n = 222) scored low on SPFL and 34.5% scored inadequate or problematic on HPL. No significant educational or weight-status differences were found in SPFL or HPL levels. On most levels, women compared to men and older compared to younger employees scored significantly higher. A small positive correlation between the two mean levels was found, r = .25, P < .001 (n = 203). Multivariate linear regression analyses showed a significant association between SPFL and HPL (B = .31, 95% CI = .15-.48). No significant associations between SPFL and HPL in BMI were found.

CONCLUSIONS

This study suggests there is room for improvement in SPFL and HPL among adults with a low and medium level of education. Future research should consider comparing low and middle socioeconomic with high socioeconomic groups when exploring food and health literacy. Regarding health promotion activities for adults with a low and medium level of education, it is recommended to focus on improving both food and health literacy. Furthermore, more research is needed to explore direct proxies of weight-status to better understand the role of food and health literacy in overweight patterns.

Insights into the Predictors of Attitude toward Entomophagy: The Potential Role of Health Literacy: A Cross-Sectional Study Conducted in a Sample of Students of the University of Florence

In Western countries, one of the main barriers to entomophagy is repulsion toward insects. Few studies have investigated the factors that influence attitudes toward entomophagy. Therefore, we conducted a cross-sectional study involving a sample of 248 university students, focusing on disgust and other potential attributes that can influence insect consumption, including health literacy. We used a 17-item self-administered questionnaire. Consistent with the literature, two items were chosen as outcome variables to evaluate the predictors of the propensity to consume insects: "Have you ever eaten insects or insect-based products?" and "How disgusting do you find eating insects?" The data analysis shows that having already eaten insects is inversely associated with the level of disgust (OR: 0.1, p < 0.01); and it is positively associated with higher levels of health literacy (OR: 3.66, p > 0.01). Additionally, having some knowledge and information about entomophagy is inversely associated with a higher level of disgust (OR: 0.44, p = 0.03 and OR: 0.25, p = 0.03, respectively), while being female is positively associated with disgust (OR: 3.26, p < 0.01). Our results suggest the potential role of health literacy, in addition to other factors, in influencing the willingness to taste insects. However, further studies involving larger and non-convenience samples are needed to confirm our hypothesis.

Exploring the relationship between health literacy and fast food consumption: a population-based study from southern Iran

Background

Health literacy (HL) may affect the consumption of fast food. We aimed to evaluate the effect of HL on fast food consumption among adult populations in Iran.

Methods

We evaluated HL and fast food consumption in 421 adult participants with age range of 18–65 years old in Fasa, Fars Province, southern Iran. Two-step cluster and systematic sampling was performed to recruit the study sample. Data were collected using a fast food consumption checklist, and the Health Literacy Instrument for Adults (HELIA) by face-to-face interviews. Population data across groups with and without fast food intake were compared.

Results

Most participants used fast food every few months (49.9%). People with low or unstable income consumed more fast food than others (P < 0.05). Sandwich and hotdog were the most consumed fast food (60.8%) followed by pizza (34.9%). Sausage and soda were the most seasoning food (66.7%). Most participants used fast food as dinner (67.9%) and with family (72.2%), suggesting the institutionalized consumption of this type of food in the family. Fun was the most frequent reason for the use of fast food (66.5%). Most participants completely knew about the raw materials for fast food and their adverse effects. Finally, we found that overall health literacy was lower among those who used fast food than those who did not. Consumed fast food (68.16 ± 23.85 vs. 73.15 ± 20.15; p = 0.021). This difference was also observed for some components of health literacy including reading skills, and decision-making subscales.

Conclusions

The findings suggest there is a negative relationship between general health literacy and fast food consumption indicating that who possess lower level of health literacy is likely to consume more fast food. Specifically, the findings suggest that reading skills, and decision-making (behavioral intention) are more associated with decreased or increased fast food intake.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10763-3.

The concept of alimentation and transdisciplinary research

Although the term 'alimentation' has existed in the English language since the late 16th century, its use is infrequent. In Latin languages, particularly French, 'alimentation' conveys a holistic notion of the process by which humans produce, procure, prepare, share, indulge in, and digest their foods. Thus, the concept of alimentation encompasses and integrates human, technological, sociocultural, and environmental domains. This article delves into the origins of the term 'alimentation' and its use in the foreign scientific literature, and particularly in the social sciences. Unlike 'food and nutrition', alimentation provides a broader frame for the grand challenges of what, how, and with whom we eat. This approach should lead to transdisciplinary research (TDR) interfacing several knowledge domains (e.g., environmental, technological, socio-cultural, nutritional, etc.) and involving key stakeholders. Possible outcomes of TDR in alimentation are inspiring and meaningful collaborations, innovative methodologies for integrating knowledge, transformative learning of researchers, enriched educational experiences for students, focused community action, and improved public policy. The term 'alimentation' is appropriately used in French and other Latin languages. Alimentation embraces human, technological, sociocultural, and environmental issues This holistic concept views agriculture, food, and nutrition as parts of a broader process Transdisciplinary research interfaces several dimensions of food and eating. © 2020 Society of Chemical Industry.

The Nutrition Literacy Assessment Instrument for Italian Subjects, NLit-IT: Exploring Validity and Reliability

The aim of this study was to test validity and reliability of the adapted version of the Nutrition Literacy Assessment Instrument (NLit) for Italian people (NLit-IT). An observational cross-sectional study was conducted, involving a convenience sample of adults (n = 74). To explore the validity of the tool, we considered both diet quality as an outcome of NL, and health literacy (HL) as a construct that presents similarities and differences with NL. Diet quality was measured by adherence to the Mediterranean Diet (Med diet) through the validated Mediterranean Diet Literature-based adherence score (MEDI-Lite). The relationship between NL level and adherence to Med diet was assessed by linear regression analysis and computing correlations between NLit-IT and MEDI-Lite scores (Spearman's Rho). Additionally, we evaluated the correlation between NLit-IT score and the level of HL (Spearman's Rho). Internal consistency and reliability were measured by Cronbach's alpha and intraclass correlation coefficient (ICC) respectively. Internal consistency (ρT = 0.78; 95% CI, 0.69-0.84) and reliability (ICC = 0.68, 95% CI, 0.46-0.85) were confirmed. In addition, NLit-IT total score was correlated with MEDI-Lite score (Rho = 0.25; p-value = 0.031) and multivariate regression analysis confirmed that NL significantly contributed to MEDI-Lite score (R² = 0.13; β = 0.13; p-value = 0.008). There was no significant association between the level of HL and NL. In conclusion, NLit-IT showed validity and reliability as a measure of NL for Italian people.

Health literacy as a determinant of childhood and adult obesity: a systematic review

OBJECTIVES

To assess whether Health Literacy (HL) acts as a determinant of obesity in adults and children by synthesizing the results of recent scientific evidence.

CONTENT

This is a systematic qualitative review following the MOOSE guidelines. A systematic, computer-assisted literature search via PubMed scientific database, between January 1st, 2000, and September 30th 2020, was conducted. Only cross-sectional epidemiologic research studies that were published in the English language, investigating HL's possible role as a determinant of childhood and adult obesity, were included.

SUMMARY

After screening 725 citations from the PubMed database, 39 (n=39) studies in total were included in this literature review; Four (n=4) studies were conducted in the children population, seven (n=7) studies were performed in children-parent/caregiver dyads, and 28 studies (n=28) enrolled adults. There is significant evidence that HL knowledge and skills determine the consequent management of obesity and BMI rates in children and adult populations.

OUTLOOK

Despite policies and action plans put in place by countries globally, overweight and obesity continue to be a pressing public health issue and one of the critical drivers of non-communicable diseases, constituting a health, social and economic burden worldwide. Health Literacy as an essential health policy and promotion agenda item and a critical empowerment strategy could increase children's and adults' control over their overall health and awareness to overcome obesity issues. Initiatives to improve HL levels could be useful tools in managing the obesity epidemic, starting from integrating HL in the school curriculum and further in family and community action plans.

Food Next Door: From Food Literacy to Citizenship on a College Campus

Industrial agriculture and food corporations have produced an abundance of food that is highly processed, nutritionally poor, and environmentally burdensome. As part of a healthy campus initiative, generated to address these and other food production and consumption dilemmas, a student-run “local and sustainable” food establishment called Food Next Door (FND) was created. This intrinsic case study evaluated food literacy in health science students, faculty, and staff first as a pilot to build the case for FND and further explicated customers’, volunteers’, and leads’ experiences with FND, identifying potential pathways from food literacy to citizenship. Ten returning customers, eight recurring nutrition student volunteers, and three graduate student leads participated in interviews that were analyzed for themes and subthemes. The findings show a progression in themes. Customers’ experiences highlight FND’s fresh, flavorful food, smiling and supportive staff, and personal transformation. Volunteers’ themes identified greater awareness of new foods and plant-based eating, acquiring new knowledge and skills in commercial kitchens, and deepening their connection to food, each other, and to where food comes from. Leads’ themes show opportunities to gain managerial skills, a deeper understanding of food and skills from being immersed in value-based food systems, and confidence in peer teaching. Experiencing and becoming part of the food value chain through FND built food literacy, shifted values, and transformed students into food citizens.

A Conceptual Model Map on Health and Nutrition Behavior (CMMHB/NB)

The Conceptual Model Map (CMM) presented here is intended to show the connections between different theories and constructs in the field of health and nutrition behavior (including literacy models, the knowledge–attitude(s)–practice(s) survey structure (KAP), behavior change theories, and Maslow’s pyramid of needs). The CMM can be used as a map to locate existing and future studies, to show their range of effect as well as their limitations. In this context, the CMM also reveals reasons for the attitude/intention–behavior gap.

Does Masticatory Ability Contribute to Nutritional Status in Older Individuals?

Mastication plays a primary role in the process of eating. Hence, compromised masticatory ability may affect the nutrition and quality of life, which are particularly important concerns among older individuals. It remains unclear how is the masticatory ability assessed regarding the nutritional status. We examined the effect of various oral factors on three masticatory ability tests conducted among older individuals. A total of 100 older individuals were enrolled in this study. Body mass index (BMI) as an indicator of nutritional status; and age, sex, and the number of occlusal and molar occlusal supports as clinical attributes were recorded. Three masticatory ability tests (masticatory efficiency, masticatory score, and satisfaction with mastication) were conducted, and tongue pressure, cheek pressure, and occlusal force were assessed as oral functions. A significant but weak correlation was found between masticatory efficiency and the masticatory score, but not between masticatory efficiency and satisfaction score. Objective masticatory efficiency was strongly associated with objective oral factors, whereas subjective assessments of masticatory ability (masticatory score and satisfaction score) were not. Furthermore, BMI was significantly associated with subjective assessments of masticatory ability but not with objective masticatory efficiency. Both subjective and objective assessments of masticatory ability, along with considerations of nutritional formulations, are required for the maintenance and improvement of nutritional status in older individuals.

FOODLIT-PRO: conceptual and empirical development of the food literacy wheel

Pursuing food systems' sustainability is crucial. Given the risk constituted by unhealthy diets, scarce research on food-related adjacent fields, and inconsistency across food literacy conceptualizations, this study aims to explore the constructs' definition and develop a conceptual and empirical framework of food literacy. A quantitative approach was taken on previously obtained qualitative outcomes from 30 interviews with experts from food-related fields. Food literacy was defined by a four-dimension model: Cooking Skills, Preserve and Analyse, Choice and Acquisition, Search and Plan. The framework Food Literacy Wheel integrates the construct definition, food literacy determinants (Internal, External) and influential factors (Nutritional, Psychological, Health, Learning Contexts, Policy, Industry, Sustainability, Social and Cultural). Allowing a broader perspective of food literacy within major food systems, this study contributes with new insights for future instruments and interventions, paving the way to develop/implement food literacy-related multi-sectorial and multilevel actions.

School-based interventions for promoting food and nutrition literacy (FNLIT) in elementary school children: a systematic review protocol

BACKGROUND

Food and nutrition literacy is a newly emerged concept to connect food-related knowledge and skills to healthy diets. Its promotion is important to protect children as they eat too many low-nutrient, high-energy foods. Food and nutrition literacy promotion needs multi-dimensional interventions. In the process of developing an intervention to promote food and nutrition literacy, the present review protocol aims to critically examine the evidence in the area of school-based interventions for promoting food and nutrition literacy (FNLIT) in elementary school children.

METHODS

We will search PubMed/MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest (from inception onwards). Additional studies will be identified through manual searching of reference lists. Quantitative studies (e.g., randomized controlled trial, quasi-randomized trials, and cluster randomized trials) evaluating the effect of interventions to promote food and nutrition literacy in elementary school children (5-12 years old) will be included. Main outcomes will be food and nutrition literacy at functional, interactive, and critical levels. Secondary outcomes will be dietary intake indicators (e.g., healthy eating index, DDS) and health outcome measures (e.g., reduction in BMI and less weight gain). Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using appropriate tools. If feasible, we will conduct random effects meta-analysis. The quality of the included studies will separately evaluate using the validated Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project (EPHPP). Data will be extracted by two reviewers from the identified relevant literature. Standard data synthesis and analysis will be used for the review.

DISCUSSION

This systematic review will summarize the evidence regarding the components, implementation methods, and effectiveness of the interventions of food and nutrition literacy promotion in elementary school children. The results of this review will provide a useful reference for policymakers and curriculum developers to assess education curricula and develop practical learning and teaching strategies to improve students' food and nutrition literacy.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42019135118).