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.

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

OBJECTIVES: This study translated the short nutrition literacy scale for young adults (18-35 years) into Chinese, examined its reliability and validity, and analyzed its influencing factors. METHODS: The scale was translated using a modified Brislin translation model. A convenience sample of 508 cases was selected for the survey. Content validity, structural validity, Cronbach's alpha coefficient, and test-retest reliability were used to evaluate the scale's reliability and validity. To screen the factors influencing nutrition literacy in young people. RESULTS: The Chinese version of the Item-Level Content Validity Index (I-CVI) was 0.833 ~ 1, and the Scale-Level Content Validity Index/Average (S-CVI/Ave) was 0.908. The cumulative variance contribution of the scale was 51.029%, and the model was generally well-fitted. The Cronbach's alpha coefficient and retest reliability of the scale were 0.826 and 0.818. The results showed that the level of education, mother's education, nutrition-related courses, and frequency of attention to nutritional health information were the factors influencing the nutritional literacy of young people. CONCLUSION: The Chinese version of the S-NutLit Scale can effectively assess the nutrients of young Chinese people. Low levels of education, low levels of education of mothers, lack of exposure to nutrition-related courses, and low frequency of attention to nutritional health information can lead to lower levels of nutritional literacy among young people.

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.

Development and Implementation of a Novel Approach to Dietary Education for People With Inadequate Health Literacy and Advanced Kidney Disease.

OBJECTIVE: To describe the process of developing and implementing a novel approach to renal diet education by changing from a nutrient-based food list to a pictorial meal compilation approach through the skill steps: plan, select, cook, eat. DESIGN AND METHODS: The skill-based teaching method accommodates low literacy levels and respects cultural values. This teaching style aligns the complex renal diet guidelines with family living. Each meal plan is based on a balanced diet and includes family preferences. Appropriate cooking methods and food swaps that match renal diet specifications are included. The accompanying Cook for Life cookbook demonstrates how to prepare the new kidney-friendly family meal. Recipes were supplied by a local Maori elder and his whanau and tested by the dietitian. The cookbook is provided to all patients receiving renal dietetic education. The teaching method has undergone several iterations to accommodate feedback from dietitians, nurses, doctors, and patients. This included patient engagement to develop the Storybook, a pictorial representation of typical meals consumed in the community with a corresponding food substitution to illustrate how to compile kidney-friendly meals. RESULTS: Analysis of feedback regarding this approach indicates high levels of acceptance and engagement with this new teaching style. CONCLUSION: This practical skill-based dietary education teaching style appears to be a feasible, acceptable, culturally sensitive, and appropriate approach to dietary education for people who live with kidney disease. Patient engagement in the design of this approach supports effective learning and behavior change.

The Status of Food and Nutrition Literacy and its determinants among Elementary School students in Egypt: community nursing-led design.

AIM: To assess food and nutrition literacy status and its determinants among elementary school students in El-Beheira Governorate, Egypt. BACKGROUND: Developing strategies to enhance food and nutrition literacy necessitates a deeper understanding of the food and nutrition literacy situation among elementary school students and associated factors. DESIGN: A cross-sectional descriptive research design was adopted. METHODS: A final sample of 400 primary school students (aged 6-12 years) at Itay El Barud public elementary schools in El-Beheira Governorate were administered (1) a socio-demographic characteristics and anthropometric measurements questionnaire developed by the researchers, and (2) the Food and Nutrition Literacy Scale. The derived data were analyzed using descriptive and non-parametric tests. RESULTS: The majority (61%) of students had low food and nutrition literacy scores. The results have shown that overall socio-demographic variables were significant in predicting understanding food and nutrition information, nutritional health knowledge, interactive functional and nutritional literacy, critical food and nutritional literacy, and food labeling. CONCLUSION: The study reveals that elementary school students in Egypt have poor knowledge and skills in food and nutrition literacy, largely due to a lack of nutrition education and family awareness. Factors like residential location, income, and education level also contribute to this disparity. IMPLICATIONS FOR THE PROFESSION: To improve nutrition literacy among students, a nursing approach involving community stakeholders and school nurses is recommended. This includes integrating nutrition-related topics into the school curriculum, organizing workshops, and conducting age-appropriate health education sessions. Active engagement between community health and school nurses is crucial for raising awareness about healthy nutritional choices. IMPACT: These findings hold an important impact on the education system and those designing curricula, emphasizing the need for significant incorporation of knowledge and skills related to food and nutrition within schools. REPORTING METHOD: Compliance with the STROBE checklist for cross-sectional studies was maintained throughout the research. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

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

OBJECTIVE: To evaluate nutrition literacy status and its association with adherence to the Mediterranean diet (MD), anthropometric parameters and lifestyle behaviours among early adolescents. DESIGN: This is a cross-sectional study. Nutrition literacy was evaluated using the 'Adolescent Nutrition Literacy Scale'. Dietary intake was assessed by 24-h food recall. The 'Mediterranean Diet Quality Index' was used to evaluate adolescents' adherence to the MD. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). Body weight, height, waist, hip and neck circumference were measured. SETTING: Four secondary schools in Izmir, Türkiye. PARTICIPANTS: The study included 1074 secondary school students. RESULTS: Adolescents' nutrition literacy was at a moderate level. Nutrition literacy scores were significantly lower in those who skip main meals. Adolescents with high nutrition literacy had higher intakes of fibre, protein, protein, Ca, K, Mg, P, vitamin C, folate and Fe intake than those with low and moderate nutrition literacy (P < 0·05). According to IPAQ, active adolescents had higher nutrition literacy scores than inactive adolescents. There was no significant difference in BMI and anthropometric measurements of the adolescents according to their nutrition literacy level. Linear regression analysis showed that each unit increase in nutrition literacy increased adherence to the MD by 0·286 points (ß = 0·286) and decreased total screen time by 0·182 points (ß = -0·182). CONCLUSIONS: These findings showed that nutrition literacy among early adolescents was not optimal, and a higher nutrition literacy score was significantly associated with higher MD adherence, and healthy eating habits and lifestyle behaviours.

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

OBJECTIVE: This study aimed to develop and evaluate a scenario-based nutrition literacy (NL) online programme for Taiwanese college students. DESIGN: A randomised pilot trial design was used in this study. SETTING: The study was conducted at a university in Taiwan. The intervention consisted of a five-unit web-based NL programme including videos of real-life scenario-based stories, situational analysis teaching and after-unit quizzes. Theme-related website information and smartphone apps (both iOS and Android systems) were offered for reference in every unit. The NL measure consisted of a self-rated scale, a scenario-based test and a healthy eating behaviour survey. Paired sample t-tests and ANCOVA were performed to test the effects on NL and healthy eating behaviour. PARTICIPANTS: Participants were ninety-eight students, with a retention rate of 98 %. The ratio of men to women was 0·2:1. Most students were freshmen (48 %). RESULTS: Compared with the control group, the experimental group showed significant post-intervention improvements in the NL and healthy eating behaviours after controlling for pretest scores. CONCLUSIONS: This pilot study offers preliminary evidence of the potential positive effects of implementing a scenario-based NL online programme for college students. It offers a possibly novel strategy to enhance health-promoting behaviours in Taiwanese universities. Further research with larger sample sizes and more rigorous designs is warranted to confirm and build upon these initial findings.

Food literacy and diet quality in young vegans, lacto-ovo vegetarians, pescatarians, flexitarians and omnivores.

OBJECTIVE: To investigate whether food literacy competencies and diet quality vary between 16-to-24-year-olds vegans, lacto-ovo vegetarians, pescatarians, flexitarians and omnivores and to assess whether food literacy is associated with diet quality. DESIGN: Cross-sectional study. Food literacy (general nutrition knowledge, critical nutrition literacy and food skills) and diet quality were measured using an electronic questionnaire. SETTING: Southern Norway, September 2021 - March 2022. PARTICIPANTS: Healthy 16-24-year-olds (n 165). RESULTS: Overall, the mean general nutrition knowledge score was moderate (48·0 out of 67·0); the lowest mean score was found in omnivores and the highest in flexitarians (45·6 v. 51·5) (P = 0·034). The mean score of critical nutrition literacy was also moderate (3·7 out of 5·0); vegans showed higher scores compared to other dietary practices (P = 0·018). No difference was observed in food skills between the different dietary practices. The overall median diet quality score was 46·0 out of 80·0, lowest in omnivores and highest in vegans (42·0 v. 56·0) (P =< 0·001). In multivariate regression analyses, general nutrition knowledge, food skills and vegan dietary practice were significantly associated with higher diet quality. CONCLUSIONS: We found moderate levels of food literacy across all dietary practices. The food literacy competencies, general nutrition knowledge and food skills were associated with higher diet quality in our sample. Omnivores showed both the lowest general nutrition knowledge level and lowest diet quality scores. In contrast, both flexitarians and vegans scored highest on general nutrition knowledge and diet quality scores, despite being one of the less restrictive and one of the strictest plant-based dietary practices, respectively.

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.

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.

Evaluation of the nutrition literacy assessment questionnaire for college students and identification of the influencing factors of their nutrition literacy.

BACKGROUND: Nutrition health has become a major public health issue in both high and middle-income countries. Nutrition literacy is an important indicator to evaluate the effect of public health intervention and one of the important concepts in health promotion. Thus, this study aimed to verify the reliability and validity of a nutrition literacy assessment questionnaire (NLAQ) and investigate the associated factors of nutrition literacy among college students. METHODS: We conducted a cross-sectional online survey of college students from April to November 2022 in Wuhan (N = 774). We employed the Cronbach's alpha coefficient, exploratory and confirmatory factor analysis to evaluate the reliability and validity. We used latent profile analysis to classify the nutrition literacy. We conducted Chi-square test and binary logistic regression to identify the influencing factors. RESULTS: The Cronbach's alpha coefficient of the NLAQ and its dimension was ranging from 0.837 to 0.909. The common factors were consistent with the original dimensions. All indicators met the requirements (χ2/df = 6.16 < 8, GFI = 0.929, NFI = 0.939, CFI = 0.948, RMSEA = 0.082 < 0.1). College students' disciplines (χ2 = 7.769, P = 0.021), mothers' education level (χ2 = 26.599, P < 0.001), and fathers' occupation type (χ2 = 11.218, P = 0.024) had impacts on nutrition literacy. CONCLUSION: The NLAQ has good reliability and validity, and could be used as a measurement tool to evaluate college students' nutrition literacy. Schools and families should take targeted measures to improve the college students' nutrition literacy.

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

BACKGROUND: The excessive consumption of take-out food has increased the risk of nutrition-related chronic diseases. Nutrition literacy (NL) is an important influencing factor of food choice. This study aimed to explore the relationship between nutrition literacy and take-out food consumption. METHODS: A cross-sectional study was conducted on 2130 college students in Bengbu, China. A self-reported questionnaire that included demographic information, lifestyle behavior, take-out food consumption, and nutrition literacy scale was used. Ordinal logistic regression models were used to analyze the association between nutrition literacy and take-out food consumption. RESULTS: Of the students surveyed, 61.5% consumed take-out food at least once a week. NL was significantly associated with the frequency of take-out food consumption ≥ 4 times/week (OR = 0.995, 95% CI = 0.990-1.000); the difference specifically was discovered for applying skills, interactive skills, and critical skills. Moreover, students with high level NL ate less (Spicy) hot pot (OR = 0.996, 95% CI = 0.992-1.000), but more vegetable and fruit salad (OR = 1.009, 95% CI = 1.002-1.015). CONCLUSIONS: NL, especially in applying skills, interactive skills, and critical skills, is not only associated with consumption frequency of take-out food among college students, but also links with types of take-out food consumption. Our findings emphasize that targeted interventions on nutritional skills literacy should be needed to improve dietary behaviors for student's good health.

Development and assessment of a nutrition literacy scale for patients with end-stage kidney disease undergoing dialysis and its correlation with quality of life.

OBJECTIVES: To construct a valid and reliable Nutritional Literacy Scale for patients with end-stage kidney disease (ESKD) receiving dialysis and evaluate associations between nutrition literacy and quality of life. METHODS: A total of 208 ESKD patients receiving dialysis were selected for this study. Nutrition literacy evaluation items were drafted based on dietary guidelines for chronic kidney disease (CKD), Literature reviews and expert consultation. Scale reliability and validity were then assessed. Factors influencing nutrition literacy and the associations among nutrition literacy, nutritional status, and quality of life were evaluated. RESULTS: The scale consists of 28 items with a scale-level content validity index of 0.91 and item-level content validity indices ranging from 0.83 to 1.00. Factor analysis identified 4 common factors (dimensions) named nutrition knowledge, cognitive attitude, behavioral practice, and information acquisition ability that collectively explained 56.31% of literacy score variation. The overall Cronbach's α coefficient of the scale was 0.83, the dimensional Cronbach's α coefficients ranged from 0.79 to 0.87, and the retest reliability was r = 0.73 (p < 0.05). Age, education level, residence (urban vs. Rural) , occupational status and dialysis modalities were significant factors influencing nutrition literacy. Nutrition literacy score was negatively correlated with SGA score and positively correlated with serum albumin and prealbumin concen- trations, and with SF-36 quality of life score (all p < 0.05). CONCLUSIONS: This new Nutrition Literacy Scale demonstrates high reliability and validity for Chinese ESKD patients undergoing dialysis. The nutrition literacy is influenced by age, education level, residence, occupational status and dialysis modalities, associated not only with nutritional status but also with quality of life.

Nutrition literacy levels of mothers with children aged five and below and the body mass index of their children.

This study aims to investigate the nutrition literacy levels of mothers with children aged five and below and the body mass index of their children (BMI). This descriptive study was carried out in a city located in eastern Turkey between June and August 2021. The sample was composed of 235 women who were calculated using the sampling method with an unknown target population, and participants were included in the sample using the convenience sampling method. Data collection tools were the Socio-demographic Form and Evaluation Instrument of Nutrition Literacy in Adults. Data were analyzed in SPSS, using descriptive statistics, Kolmogorov Smirnov test, Mann Whitney U-test, and Kruskal Wallis test. While 92 percent of participating mothers had a sufficient level of nutrition literacy, 46 percent of children had normal BMI. The Evaluation Instrument of Nutrition Literacy on Adults mean score was higher in those who had a high socio-economic level, had a disease that required regular medicine use, reported having sufficient knowledge about nutrition, and accept health workers as a reliable source of information (p < .05). This study found that nutrition literacy was affected by variables such as socio-economic level, knowledge about nutrition, and the sources of information chosen. In addition, it was determined that the BMI of the children was not affected by the nutritional literacy level of their mothers.

The relationship between the nutritional literacy level and heart health attitudes of adolescents.

PURPOSE: It was aimed to evaluate the effect of adolescents' nutritional literacy level on their heart health attitudes. METHODS: This is a descriptive and cross-sectional study. Data from 416 adolescents were obtained in the study. The Adolescent Nutrition Literacy Scale (ANLS) and the Cardiovascular Health Behavior Scale for Children (CHBSC) were completed by participants. The adolescents' demographic information, lifestyle, and diet habits were collected. The results were analyzed using descriptive statistics and multivariable regression. RESULTS: The participants' mean scores of the ANLS and the CHBSC were as 68.30 ± 8.68 and 67.55 ± 8.45, respectively. It was determined that 88.7% of the adolescents had moderate attitudes towards heart health and that there was a weak and negative correlation between the ANLS and CHBSC scores (r = -0,207; p < 0.001). It was determined that there was a statistically significant difference in ANLS and CHBSC scores in terms of gender, Body Mass Index (BMI), fast food consumption frequency, what they primarily pay attention to in food, weekly exercise frequency, the amount of daily water consumption, general health status and reading the label of packaged products (p < 0.05). It was determined that exercising, general state of health, BMI, consumption of fast food, and reading the label of packaged products were key predictors of CHBSC scores. Additionally, exercising, consumption of fast food, and reading the label of packaged products were identified as key predictors of ANLS scores. CONCLUSIONS: Our analysis suggests that higher levels of nutritional literacy are related to more positive attitudes towards heart health in adolescents. Additionally, our analysis identifies key predictors of both nutrition literacy and heart health behaviors. PRACTICE IMPLICATIONS: School health nurses should consider the variables influencing these parameters to improve attitudes towards nutritional literacy and heart health in adolescents.

Evaluation of a Media Training Workshop for Nutrition Students and Trainees in Nova Scotia.

Gaps in communication training have been identified in Canadian and international academic and practicum dietetics programs. A workshop was developed to pilot supplementary media training to nutrition students/trainees studying in Nova Scotia. Students, interns, and faculty from two universities participated in the workshop. Data on perceived learning, media knowledge/skill use, and workshop feedback were collected immediately post-workshop using a mixed-form questionnaire. A modified questionnaire was administered eight months post-workshop to obtain information on utility of the perceived acquired knowledge/skills. Closed-ended responses underwent descriptive analysis, while open-ended responses underwent thematic analysis. Twenty-eight participants completed the questionnaire post-workshop, and six completed it at follow-up. All participants rated the workshop positively (7-point Likert scale) and reported learning something new (perceived). Perceived learning emphasized general media knowledge/skills and communication skills. Follow-up data suggested participants had applied perceived media knowledge/skills in message development and media and job interviews. These data suggest that nutrition students/trainees may benefit from supplementary communications and media training and provide a stimulus for ongoing curriculum review and discussion.

Validity of a modified food and nutrition literacy questionnaire in primary school children in Iran.

The present study aimed to assess the relative validity and reliability of a modified Food and Nutrition Literacy (M-FNLIT) questionnaire in primary school children in the city of Mashhad. The study was conducted in four phases. In the first step, the content and face validity of the questionnaire were evaluated by Delphi consensus as well as interviewing the students. Then, construct validity was examined using Confirmatory Factor Analysis (CFA). The internal consistency and reliability of the questionnaire were also assessed using Cronbach α and Intraclass Correlation Coefficient (ICC), respectively. Finally, a receiver operating characteristic analysis was performed to detect the cut-off scores of the M-FNLIT scale. Findings of two rounds of Delphi showed satisfactory levels of Content Validity Ratio: 0·72 and 0·92, Content Validity Index (CVI): 0·92 and 0·98, respectively. The results of CFA for domains and subscales of the M-FNLIT questionnaire including cognitive domain (understanding food and nutrition information and nutritional health knowledge) and skill domain (functional, food choice, interactive, and critical skills) indicated acceptable fit indices. M-FNLIT subscale-specific Cronbach α values ranged between 0·68 and 0·8 and ICC was 0·95 (95 % CI 0·93, 96). The final questionnaire included forty items (thirty-six Likert-type and four true-false items). FNLIT scores were categorized as low (≤ 58), medium (> 58­< 81), and high (≥ 81). The M-FNLIT questionnaire has a good level of validity and reliability to measure food and nutrition literacy in primary school children. The questionnaire can be applied in the evaluation of nutritional interventions in this age group.

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 association and mediation role of Food and Nutrition Literacy (FNLIT) with eating behaviors, academic achievement and overweight in 10-12 years old students: a structural equation modeling.

BACKGROUND: Food and nutrition literacy is a key factor in shaping healthy dietary behaviors and may result in decreasing decrease the prevalence of overweight. Empirical research on food and nutrition literacy and its outcomes is limited, especially among children and adolescents. Thus, this study investigates the link between Food and Nutrition Literacy (FNLIT) with eating behaviors, academic performance, and overweight in 10-12 years old students in Tehran, Iran. METHODS: This study was performed through two phases: 1) Proposing a conceptual model of the relationship between FNLIT and its determinants and outcomes, based on the existing evidence and previous models, and 2) Testing the proposed FNLIT model through a cross-sectional study on 803 primary school students (419 boys and 384 girls, from 34 public and 10 private primary schools), aged 10-12 years using structural equation modeling. Demographic, socio-economic, and household food security characteristics were collected by interviewing the students and their mothers/caregivers using a questionnaire. FNLIT was measured by a self-administered, locally designed, and validated questionnaire. RESULTS: The fit indices suggested a reasonably adequate fit of the data to the hypothesized model (χ2/df = 2.03, p < 0.001, goodness of fit index (GFI) = 0.90, adjusted goodness of fit index (AGFI) = 0.88, comparative fit index (CFI) = 0.91, incremental fit index (IFI) = 0.91, root mean square error of approximation (RMSEA) = 0.04, standardized root mean residual (SRMR) = 0.06). SES was directly and positively related to FNLIT and its subscale in students. FNLIT score had a positive direct (non-mediated) relationship with healthy eating behavior and academic performance. This pattern was strongly reversed in unhealthy eating behavior. There was a full mediation relationship between FNLIT and overweight/obesity via healthy eating behaviors. SES predicted academic performance partially through the mediating effect of Food Label Literacy (FLL). The results indicated that despite the direct relationship between SES and academic performance, an indirect but negative relationship existed with food insecurity. The finding also revealed the fully mediating role of Food Choice Literacy (FCL) in the relationship between demographic factors and healthy eating behaviors. Our study also found that Interactive Food and Nutrition Literacy (IFNL) protected unhealthy eating behaviors, and FCL predicted healthy eating behaviors in children. CONCLUSION: Our study draws attention to FNLIT, especially the skills domain, including IFNL, FCL, and FLL, as the most important determinant of healthy eating behavior, academic performance, and weight status in school-age children reduces social inequalities in children's development. To ensure an adequate level of FNLIT, educators should assess and plan to enhance food literacy skills in children and adolescents.

Parental health literacy and nutrition literacy affect child feeding practices: A cross-sectional study.

BACKGROUND: Health literacy (HL) and nutrition literacy (NL) are important issues to consider, in the provision of health care to children and the establishment of healthy eating behaviors. AIM: The study investigates the possible role of HL and NL levels of Greek parents, in parental Feeding Practices (PFP). METHODS: This is a cross-sectional study which was conducted in the urban area of the Attica region, Greece. The sample consisted of 402 parents (68.4% mothers). Parents completed the Greek version of Comprehensive Parental Feeding Questionnaire, the European Health Literacy Questionnaire 47 and the Greek version of the Nutrition Literacy Scale. Sociodemographic and anthropometric characteristics were also assessed. The non-parametric tests Mann-Whitney and Kruskal Wallis, the chi-square test and linear regression models were applied. RESULTS: The median for HL and NL were 33.69 and 24.00, respectively. Mothers applied the "child control" practice more frequently than fathers (p = 0.015). Linear regression analysis revealed that HL was associated positively with "healthy eating guidance" and "monitoring" (p = 0.009 and p < 0.0001, respectively) and negatively with "emotion regulation/food as reward" and "child control" (p = 0.037 and p = 0.015, respectively). NL was associated positively only with "healthy eating guidance" (p = 0.009), positively but marginally with "monitoring" (p = 0.051) and negatively with "emotion regulation/food as reward" (p = 0.020). CONCLUSIONS: Higher parental levels of HL and NL are significantly positively associated with better parental feeding practices in Greece.