Impact of Weight Management on Obesity-Driven Biomarkers of Prostate Cancer Progression.

PURPOSE: Excess body and visceral fat increase the risk of death from prostate cancer (PCa). This phase II study aimed to test whether weight reduction by > 5% total body weight counteracts obesity-driven PCa biomarkers. MATERIALS AND METHODS: Forty men scheduled for prostatectomy were randomized into intervention (n = 20) or control (n = 20) arms. Intervention participants followed a weight management program for 4 to 16 weeks before and 6 months after surgery. Control participants received standardized educational materials. All participants attended visits at baseline, 1 week before surgery, and 6 months after surgery. Circulating immune cells, cytokines, and chemokines were evaluated. Weight loss, body composition/distribution, quality of life, and nutrition literacy were assessed. Prostate tissue samples obtained from biopsy and surgery were analyzed. RESULTS: From baseline to surgery (mean = 5 weeks), the intervention group achieved 5.5% of weight loss (95% CI, 4%-7%). Compared to the control, the intervention also reduced insulin, total cholesterol, LDL cholesterol, leptin, leptin:adiponectin ratio, and visceral adipose tissue. The intervention group had reduced c-peptide, plasminogen-activator-inhibitor-1, and T cell count from baseline to surgery. Myeloid-derived suppressor cells were not statistically different by group. Intervention group anthropometrics improved, including visceral and overall fat loss. No prostate tissue markers changed significantly. Quality of life measures of general and emotional health improved in the intervention group. The intervention group maintained or kept losing to a net loss of 11% initial body weight (95% CI, 8%-14%) at the study end. CONCLUSIONS: Our study demonstrated improvements in body composition, PCa biomarkers, and quality of life with a weight management intervention.

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

OBJECTIVE: We investigated the relationship between nutrition literacy, diet quality, carotenoid status, and cognition. METHODS: Adults aged 37.5 ± 17.0 years (n = 52) completed the 42-item Nutrition Literacy Assessment Instrument (NLit). The Dietary History Questionnaire III was analyzed to determine the Healthy Eating Index. Skin carotenoids were assessed as a diet quality biomarker. Selective attention, relational memory, and pattern separation abilities were assessed using the flanker, spatial reconstruction, and mnemonic similarity tasks, respectively. Statistical adjustments included age, sex, education, and body mass index. RESULTS: No correlations were observed for NLit scores and NLit subscales with Healthy Eating Index and skin carotenoid status. However, the NLit's food label and numeracy subscale was related to greater pattern separation abilities (ρ = 0.33, r2 = 0.11, P = 0.03). CONCLUSIONS AND IMPLICATIONS: Comprehension of food labels and numeracy information was associated with memory abilities. Future work is needed to test whether targeting working memory and attentional processes during memory retrieval in larger samples may facilitate the acquisition of nutrition knowledge.

The SPEER: An interprofessional team behavior rubric to optimize geriatric clinical care.

Geriatric patients with complex health care needs can benefit from interprofessional (IP) care; however, a major gap in health professional education is determining how to prepare future providers for IP collaboration. Effective IP team behavior assessment tools are needed to teach, implement, and evaluate IP practice skills. After review of IP evaluation tools, the Standardized Patient Encounter Evaluation Rubric (SPEER) was created to evaluate team dynamics in IP practice sites.Independent sample t-tests between faculty and learner SPEER scores showed learners scored themselves 15 points higher than their faculty scores (p < .001). Cronbach's α showed high internal consistency (α = 0.91). Paired t-tests found that learners identified improvements in the team's ability to address the patient's education needs and to allow the patients to voice their expectations. Faculty identified improvements in the teams' ability to make recommendations. Faculty evaluations of learner teams showed improvements in raw ratings on all but two items. Qualitative data analysis for emergent themes showed learners desired team functioning feedback and how teamwork could improve to provide optimal IP care.In conclusion, the SPEER can help faculty and learners identify growth in their teams' ability to perform key IP skills in clinical sites.

Pilot randomized, controlled, preoperative intervention for nutrition trial in head and neck cancer.

BACKGROUND: Several prospective studies report improved outcomes with pretreatment nutrition interventions prior to radiation therapy for head and neck cancer (HNC), but none have assessed similar interventions before surgery for HNC. METHODS: POINT, a pilot randomized controlled trial, was conducted to evaluate a multimodal nutrition intervention. Patients undergoing primary surgery with free flap reconstruction for HNC were randomly assigned to the control arm or a preoperative multimodal nutrition intervention. RESULTS: POINT included 49 patients. Nutrition risk scores did not change significantly for either the intervention or control group. Control patients had a significant decrease in body weight in the preoperative period (p < 0.001). Conversely, weight among intervention patients did not significantly decrease (p = 0.680). The intervention mitigated weight loss in patients with dysphagia (p = 0.001). CONCLUSIONS: Preoperative nutrition optimization shows potential to reduce weight loss normally experienced by patients with head and neck cancer prior to surgical extirpation, especially among those with subjective dysphagia.

Prenatal interventions and the development of childhood obesity.

BACKGROUND: Excess maternal adiposity during pregnancy has lasting effects on child outcomes including increased risk of overweight/obesity, which drives disease development. Prenatal interventions are a potential avenue to curb childhood obesity rates, but little is known on their long-term influence on offspring adiposity. OBJECTIVE: Review the evidence for lasting effects of prenatal interventions on child adiposity. METHODS: Three databases were searched for follow-up studies of completed prenatal RCTs that involved a diet, exercise, or combined (diet and exercise) intervention, and assessed offspring adiposity-related outcomes beyond birth. RESULTS: A total of 18 follow-up studies describing 4277 offspring were included. Anthropometrics were collected in all studies while body composition was measured in 15 of the studies. Diet or exercise interventions did not have a consistent significant effect on child adiposity. Three combined interventions resulted in lower levels of child adiposity at 3, 6, and 12 months. CONCLUSIONS: No strong association was found between prenatal diet, exercise, or combined interventions and child adiposity. Data are limited due to 63.6% overall retention rate for the follow-up studies and heterogeneity of intervention approach and child adiposity measures. Findings suggest combined interventions initiated early in pregnancy may decrease offspring adiposity in the first year of life.

The Development of a Video-based Nutrition Education Curriculum for Patients Undergoing Radical Cystectomy.

BACKGROUND: The treatment for patients with muscle-invasive bladder cancer includes neoadjuvant chemotherapy followed by radical cystectomy. The American Urological Association guidelines stress the optimization of patient performance status in the perioperative setting. Therefore, implementation of nutrition education is critical for the multi-disciplinary care of this vulnerable patient population and wide distribution of information is critical. OBJECTIVE: The goal of our study was to create a nutrition-based video education series for patients undergoing chemotherapy and radical cystectomy for bladder cancer. METHODS: Scripts for the videos were developed through an iterative process by experts in nutrition, urology, and communication. Providers and patient advocates were recruited to perform semi-structured interviews and surveys for additional feedback. Performer facial emotion recognition (Noldus™) was used to assess displayed emotion by the presenters. Mangold VisionPlayer software was used for participant eye movement tracking of the video content. A knowledge survey was created, and Item Content Validity Index (I-CVI) was calculated with a nutrition expert advisory board. Participants were recruited for cognitive interviewing to understand the mental processes and interpretations while answering questions. RESULTS: The video series is available to the public on the Bladder Cancer Advocate Network (BCAN) website at the following URL: https://bcan.org/facing-bladder-cancer/nutrition-bladder-cancer/eating-healthy-bladder-cancer/. Cinematic filming methods, (smaller depth of field, lighting, and camera movement) enhanced message delivery along with music and text on screen to anchor important concepts. CONCLUSIONS: This study can be a framework for the development of a patient education video library accessible through electronic medical records, health care applications, and patient advocacy websites.

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

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

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

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

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

BACKGROUND: During pregnancy, Latina/x people experience nutrition and nutrition-related health inequities. Nutrition literacy is a potential factor impacted by these inequities. However, the nutrition literacy level of Latina/x people during pregnancy is not well investigated. OBJECTIVES: The study aimed to assess the nutrition literacy level of Latina/x people during pregnancy and explore the association of nutrition literacy with socioeconomic position. DESIGN: This was a cross-sectional study of data collected from 2016 to 2018 within the double-blinded, randomized clinical trial Assessment of Docosahexaenoic Acid on Reducing Early Preterm Birth. PARTICIPANTS/SETTING: A total of 112 Latina/x people during pregnancy from the Kansas City metro area were included in this study. MAIN OUTCOME MEASURES: Nutrition literacy level assessed between 12 and 20 gestational weeks using the Nutrition Literacy Assessment Instrument, both in English and Spanish. STATISTICAL ANALYSES PERFORMED: Descriptive measures were used to describe the nutrition literacy level during pregnancy. Multiple logistic regression models were used to examine the association between low nutrition literacy and socioeconomic position, adjusting for age and race. RESULTS: In this study, most participants demonstrated low nutrition literacy during pregnancy. Those with low nutrition literacy were 2 times more likely to have low annual household income (odds ratio [OR] = 2.74, 95% confidence interval [CI]: 0.99-7.59), 3 times more likely to prefer Spanish as their primary language of communication (OR = 3.03, 95% CI: 0.95-9.67), and 7 times more likely to be uninsured (OR = 7.47; 95% CI: 1.57-35.64). CONCLUSIONS: Nutrition literacy scores during pregnancy were associated with variables of socioeconomic position. Future research should focus on nutrition literacy associations with health outcomes during pregnancy and interventions to improve the nutrition literacy level of primarily Spanish-speaking people who have low household incomes and are uninsured.

Nutrition Literacy Tailored Interventions May Improve Diet Behaviors in Outpatient Nutrition Clinics.

OBJECTIVES: Nutrition literacy examines the intersection of nutrition knowledge and skills; however, no evidence shows interventions tailored to nutrition literacy deficits affect diet behaviors. This study examined the effects of nutrition interventions tailored to individual nutrition literacy deficits on improving diet-related behaviors. METHODS: Five outpatient clinics were randomized to 2 arms. The nutrition literacy and diet behaviors of patients were assessed before intervention with a dietitian and again 1 month later. Intervention-arm dietitians received patient nutrition literacy levels and tailored interventions toward nutrition literacy weaknesses. Differences in diet behaviors between arms were analyzed using Mann-Whitney U-tests and within-arms using Wilcoxon signed-rank tests. RESULTS: Intervention-arm patients improved 10 of 25 measured diet behaviors; control-arm patients improved 6 behaviors. Similarly, intervention-arm patients reported increased green vegetable consumption from baseline to follow-up (z = 2.00; P = 0.04). CONCLUSIONS AND IMPLICATIONS: Nutrition interventions tailored toward nutrition literacy deficits may play an important role in improving patient diet behaviors.

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; ß = 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.

Feasibility of a Weight Management Program Tailored for Overweight Men with Localized Prostate Cancer - A Pilot Study.

BACKGROUND: Overweight men with prostate cancer are more likely to suffer from recurrence and death following prostatectomy compared with healthy weight men. This study tested the feasibility of delivering a comprehensive program to foster weight loss before and weight maintenance after surgery in overweight men with localized prostate cancer. METHODS: Twenty overweight men scheduled for prostatectomy elected either the intervention (n = 15) or the nonintervention (n = 5). Anthropometrics, biomarkers, diet quality, nutrition literacy, quality of life, and long-term follow-up were assessed in both groups. RESULTS: The intervention led to 5.55 kg of weight loss including 3.88 kg of fat loss from baseline to surgery (mean = 8.3 weeks). The intervention significantly increased fiber, protein, fruit, nut, and vegetable intake; and decreased trans fats intake during weight loss. The intervention significantly reduced insulin, C-peptide, systolic blood pressure, leptin:adiponectin ratio, and visceral adiposity compared to the nonintervention. Post-surgically, weight loss was maintained. Changes in lipid profiles, nutrition literacy, and follow-up were not statistically significant in either group. CONCLUSION: Significant weight loss (≥5%) is feasible with a coaching intervention in overweight men preparing for prostatectomy and is associated with favorable cardiometabolic effects. This study is registered under NCT02252484 (www.clinicaltrials.gov).

Rural breast cancer survivors are able to maintain diet quality improvements during a weight loss maintenance intervention.

PURPOSE: Obesity and poor diet quality (DQ) are associated with increased risk of morbidity/mortality among breast cancer survivors. This study explored DQ changes during a weight loss maintenance intervention in a cohort of rural female breast cancer survivors (n = 131) who lost ≥ 5% body weight in a weight loss intervention. Previous analyses demonstrated significant DQ improvements during weight loss. METHODS: DQ was calculated using the alternate Healthy Eating Index (aHEI)-2010. Differences in scores across time for the cohort and between those that maintained weight loss within 5% (low regainers) and those that regained > 5% (high regainers) were analyzed by linear mixed models. RESULTS: Significant improvements in aHEI total score were observed from baseline (M = 52.3 ± 11) to 6 months (M = 60.7 ± 8; p < 0.001); these improvements were sustained from 6 to 18 months (M = 58.4 ± 11; p = 0.16). Total aHEI-2010 score at 18 months was higher in low regainers, compared with high regainers (60.7 vs. 56.0, p = 0.03), with healthier component scores for red meat (p = 0.01) and fruit (p = 0.04), and a trend for a healthier score for sugar-sweetened beverages (p = 0.08). CONCLUSIONS: Overall DQ improvements made during a weight loss intervention for rural breast cancer survivors were sustained during a weight loss maintenance intervention; this intervention was effective in helping low regainers maintain healthier scores in fruit, red meat, and sugar-sweetened beverage components. IMPLICATIONS FOR CANCER SURVIVORS: Maintaining higher DQ may help breast cancer survivors maintain weight loss, thereby reducing risk of breast cancer recurrence and premature death from comorbidities.

Simulations for Teaching and Evaluating Nutrition-Focused Physical Exam Skills.

OBJECTIVE: To develop, implement, and evaluate a patient simulation to assess Nutrition-Focused Physical Exam (NFPE) skills among dietetics students. METHODS: Three student cohorts (n = 47) in a combined internship and master's program participated. Curricula included: (1) formal instruction with practice resources, (2) baseline NFPE evaluation performed on a classmate, and (3) final NFPE evaluation performed on a standardized patient. Trained observers evaluated students using the NFPE Skills Assessment tool. Self-rated performance was assessed by the 8-item survey completed at baseline and after the final evaluation. Paired t tests analyzed differences in observed NFPE skill, and 1-tailed Wilcoxon signed-rank test analyzed differences in survey responses. RESULTS: Nutrition-Focused Physical Exam skill improvements were observed for each cohort (P < .05). Surveys demonstrated increased comfort touching patients (P < .001), and improved self-rated abilities to assess subcutaneous fat, muscle stores, fluid accumulation, and micronutrient deficiency (P < .001). CONCLUSIONS AND IMPLICATIONS: Simulations were an effective method for increasing observed and perceived NFPE skills among dietetics students. These findings justify the investigation of these methods within a larger sample of students from multiple programs with rigorous study design.

The effect of high dietary fiber intake on gestational weight gain, fat accrual, and postpartum weight retention: a randomized clinical trial.

BACKGROUND: Interventions to prevent excessive gestational weight gain (GWG) have had limited success This pilot study examined the effectiveness of a single goal (SG) high dietary fiber intervention to prevent excessive GWG. METHODS: Twelve weekly lessons focused on consuming a high fiber diet (≥30 g/day). Snacks containing 10-12 g of dietary fiber were given for the first 6 weeks only. Body composition was measured at baseline and at the end of the intervention. At one-year postpartum, body weight retention and dietary practices were assessed. A p-value is reported for the primary analysis only. For all other comparisons, Cohen's d is reported to indicate effect size. RESULTS: The SG group increased fiber intake during the study (32 g/day at 6 weeks, 27 g/day at 12 weeks), whereas the UC group did not (~ 17 g/day). No differences were found for the proportion of women classified as excessive gainers (p = 0.13). During the intervention, the SG group gained less body weight (- 4.1 kg) and less fat mass (- 2.8 kg) (d = 1.3). At 1 year postpartum, the SG group retained less weight (0.35 vs. 4.4 kg, respectively, d = 1.8), and reported trying to currently eat high fiber foods. CONCLUSION: The SG intervention resulted in less weight gain, fat accrual, and weight retention at 1 year postpartum. A residual intervention effect was detected postpartum with the participants reporting continued efforts to consume a high fiber diet. TRIAL REGISTRATION: NCT03984630; Trial registered June 13, 2019 (retrospectively registered).

Validity of an updated nutrition literacy assessment instrument with the new nutrition facts panel.

The Nutrition Literacy Assessment Instrument (NLit) measures nutrition literacy, including a subscale for ability to interpret nutrition fact panels (NFP). Recent redesign of the NFP in the US was issued to improve usability. This study aimed to determine reliability of the NLit subscale using two NFP versions. A 35-item survey was administered to 48 attendees with very low incomes. Surveys included previously validated NLit numeracy questions referencing the Current NFP (C-NFP), demographic and financial literacy questions, and the same NLit numeracy questions referencing the New NFP (N-NFP). NLit numeracy between the C-NFP and N-NFP were related (r = 0.842, p < .001), and N-NFP showed excellent reliability (Cronbach-α = 0.815). Mean NLit numeracy scores for the C-NFP and N-NFP were 53.5% and 55.5%, respectively (p = .437). Exchanging the N-NFP for the C-NFP in the NLit maintains strong reliability. Similar numeracy scores between C-NFP and N-NFP suggest the redesign may not be easier to read.

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

OBJECTIVE: To describe the relationship between adherence to distinct dietary patterns and nutrition literacy. DESIGN: We identified distinct dietary patterns using principal covariates regression (PCovR) and principal components analysis (PCA) from the Diet History Questionnaire II. Nutrition literacy was assessed using the Nutrition Literacy Assessment Instrument (NLit). Cross-sectional relationships between dietary pattern adherence and global and domain-specific NLit scores were tested by multiple linear regression. Mean differences in diet pattern adherence among three predefined nutrition literacy performance categories were tested by ANOVA. SETTING: Metropolitan Kansas City, USA. PARTICIPANTS: Adults (n 386) with at least one of four diet-related diseases. RESULTS: Three diet patterns of interest were derived: a PCovR prudent pattern and PCA-derived Western and Mediterranean patterns. After controlling for age, sex, BMI, race, household income, education level and diabetes status, PCovR prudent pattern adherence positively related to global NLit score (P < 0·001, ß = 0·36), indicating more intake of prudent diet foods with improved nutrition literacy. Validating the PCovR findings, PCA Western pattern adherence inversely related to global NLit (P = 0·003, ß = -0·13) while PCA Mediterranean pattern positively related to global NLit (P = 0·02, ß = 0·12). Using predefined cut points, those with poor nutrition literacy consumed more foods associated with the Western diet (fried foods, sugar-sweetened beverages, red meat, processed foods) while those with good nutrition literacy consumed more foods associated with prudent and Mediterranean diets (vegetables, olive oil, nuts). CONCLUSIONS: Nutrition literacy predicted adherence to healthy/unhealthy diet patterns. These findings warrant future research to determine if improving nutrition literacy effectively improves eating patterns.

Preliminary Investigation of a Mobile Nutrition Literacy Website for Parents and Young Children.

Parental nutrition literacy (PNL) correlates positively with child diet quality, but interventions for improving PNL are lacking. "Nutricity" is a novel bilingual (English/Spanish) mobile tool designed by the research team to engage parents and young children to interact with nutrition information to make nutrition decisions. The purpose of this study was to inform a future intervention through (1) assessing parental likability of Nutricity, and (2) collecting perceptions of pediatric clinic personnel on the feasibility of introducing Nutricity in pediatric clinics. PNL scores and feedback about Nutricity were collected using mixed methods from 15 English-speaking and 15 Spanish-speaking parents of 1-5 year-old children. Three parents from each language group provided additional feedback via semi-structured interviews. Interviews with 11 pediatric clinic personnel were also conducted to anticipate barriers and formulate strategies for implementing Nutricity as a clinic-based intervention. Nutricity was liked by both language groups and across all PNL levels, with a mean rating of 4.6 on a 5-point scale. Clinic personnel interviews affirmed need for and feasibility of offering Nutricity in clinics.

Measuring Nutrition Literacy in Spanish-Speaking Latinos: An Exploratory Validation Study.

Nutrition is important for preventing and treating chronic diseases highly prevalent among Latinos, yet no tool exists for measuring nutrition literacy among Spanish speakers. This study aimed to adapt the validated Nutrition Literacy Assessment Instrument for Spanish-speaking Latinos. This study was developed in two phases: adaptation and validity testing. Adaptation included translation, expert item content review, and interviews with Spanish speakers. For validity testing, 51 participants completed the Short Assessment of Health Literacy-Spanish (SAHL-S), the Nutrition Literacy Assessment Instrument in Spanish (NLit-S), and socio-demographic questionnaire. Validity and reliability statistics were analyzed. Content validity was confirmed with a Scale Content Validity Index of 0.96. Validity testing demonstrated NLit-S scores were strongly correlated with SAHL-S scores (r = 0.52, p < 0.001). Entire reliability was substantial at 0.994 (CI 0.992-0.996) and internal consistency was excellent (Cronbach's α = 0.92). The NLit-S demonstrates validity and reliability for measuring nutrition literacy among Spanish-speakers.

The Nutrition Literacy Assessment Instrument is a Valid and Reliable Measure of Nutrition Literacy in Adults with Chronic Disease.

OBJECTIVE: To test the reliability and validity of the Nutrition Literacy Assessment Instrument (NLit) in adult primary care and identify the relationship between nutrition literacy and diet quality. DESIGN: This instrument validation study included a cross-sectional sample participating in up to 2 visits 1 month apart. SETTING/PARTICIPANTS: A total of 429 adults with nutrition-related chronic disease were recruited from clinics and a patient registry affiliated with a Midwestern university medical center. MAIN OUTCOME MEASURES: Nutrition literacy was measured by the NLit, which was composed of 6 subscales: nutrition and health, energy sources in food, food label and numeracy, household food measurement, food groups, and consumer skills. Diet quality was measured by Healthy Eating Index-2010 with nutrient data from Diet History Questionnaire II surveys. ANALYSIS: The researchers measured factor validity and reliability by using binary confirmatory factor analysis; test-retest reliability was measured by Pearson r and the intraclass correlation coefficient, and relationships between nutrition literacy and diet quality were analyzed by linear regression. RESULTS: The NLit demonstrated substantial factor validity and reliability (0.97; confidence interval, 0.96-0.98) and test-retest reliability (0.88; confidence interval, 0.85-0.90). Nutrition literacy was the most significant predictor of diet quality (ß = .17; multivariate coefficient = 0.10; P < .001). CONCLUSIONS: The NLit is a valid and reliable tool for measuring nutrition literacy in adult primary care patients.