Systematic review of 17 studies in adults shows health, food, and nutritional literacy are interrelated and shape dietary behavior.

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Frontiers in Medicine Published April 9, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Note that health, food, and nutritional literacy are interrelated constructs shaping dietary behavior, but measurement heterogeneity limits causal conclusions.

A systematic review analyzed 17 studies involving adult populations to investigate the associations between health literacy (HL), food literacy (FL), and nutritional literacy (NL). The primary outcomes assessed included the prediction of one literacy type by another, as well as their relationship to dietary behavior, nutritional knowledge, and food-related decision-making. The review found that HL, FL, and NL were consistently associated with these outcomes. Some evidence suggested a mutual influence exists between HL and FL/NL, though specific effect sizes and absolute numbers were not reported in the source data.

The multidimensional nature of FL and NL was rarely captured comprehensively across the included studies. Most investigations focused on specific components rather than the whole constructs, which complicates the interpretation of results. Furthermore, the heterogeneity of measurement tools used in the 17 studies limited the ability to draw firm conclusions about the direction of prediction between these literacy types.

No adverse events, serious adverse events, discontinuations, or tolerability data were reported, as these were not applicable to this observational synthesis of literacy constructs. Key limitations include the inability to determine causal directions and the frequent failure to treat FL and NL as distinct constructs versus shared competencies. Practice relevance suggests that literacy-sensitive and context-aware interventions addressing both individual capacities and structural factors can improve diet quality and health outcomes, depending on baseline literacy and socioeconomic context.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedApr 2026

View Original Abstract ↓

ObjectivesHealth-promoting behaviors play a key role in maintaining well-being. Health literacy (HL), food literacy (FL), and nutritional literacy (NL) encompass the knowledge, skills, and attitudes needed to make informed health and dietary choices, influencing outcomes beyond direct medical interventions. However, the interrelationships among HL, FL, and NL remain unclear. This systematic review aimed to identify and synthesize the current evidence on whether HL and FL (including NL as a related construct) are associated and whether one can predict the other. Studies were included only if they assessed at least two of these literacies.MethodsThe review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) protocol, using eligibility criteria derived from the Population, Interest, and Context (PICo) framework (Population: adults; Interest: HL, FL, and NL; Context: health outcomes and dietary behavior). Searches were performed in MEDLINE (PubMed) and Scopus (Elsevier) using controlled vocabulary and free-text terms covering the key concepts of adults, HL, FL, and NL, as well as health or dietary outcomes. Study quality and potential bias were assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist (QCC).ResultsThe search yielded 1,491 records; after removing 194 duplicates, 1,297 studies were screened by title, abstract, and keywords. Following stepwise exclusions for irrelevance, missing data, or methodological shortcomings, 17 studies met all inclusion criteria. Across these studies, HL, FL, and NL were consistently associated with dietary behavior, nutritional knowledge, and food-related decision-making. However, the multidimensional nature of FL and NL was rarely captured comprehensively, as most studies focused on specific components rather than the whole constructs. Although some evidence suggested mutual influence between HL and FL/NL, the heterogeneity of measurement tools limited conclusions about the direction of prediction.Discussion and conclusionThe findings indicate that HL, FL, and NL are interrelated and together shape dietary behavior. Literacy-sensitive and context-aware interventions that address both individual capacities and structural factors can improve diet quality and health outcomes, depending on baseline literacy and socioeconomic context. While FL and NL share core competencies with HL, the evidence supports treating them as distinct constructs. Harmonization of measurement instruments and conceptual frameworks is needed to clarify their respective roles in predicting health outcomes in health promotion.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420250652344, identifier PROSPERO (CRD420250652344).

Systematic review of 17 studies in adults shows health, food, and nutritional literacy are interrelated and shape dietary behavior.

Study Details

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Systematic review of 17 studies in adults shows health, food, and nutritional literacy are interrelated and shape dietary behavior.

Study Details

Digital serious games improved public health knowledge and attitudes versus traditional education in 19 countries

Digital games boost health knowledge and attitudes in nonprofessional participants

Clinical research that matters. Delivered to your inbox.

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