Nutrition Literacy

Definition

Nutrition literacy refers to the set of abilities needed to obtain, process, and understand information on the importance of good nutrition in maintaining health and preventing chronic disease.

Purpose

Nutrient content claims

Claim

Definition

Nutrient

“Free” or “Fat free”

No amount of or only trivial amounts.

Fat

Saturated fat

Cholesterol

Sodium

Sugars

Calories

“Very low” “Low”

Not an overall definition. May be used on foods that can be eaten frequently without exceeding dietary guidelines.

Amount varies depending on the nutrient.

Sodium

Fat

Saturated fat Sodium

Cholesterol Calorie

“Lean” and “Extra lean”

Used to describe fat in meat, poultry, seafood, and game meats.

Fat

“High”

May be used if the food contains 20% or more of the Daily Value per serving.

Vitamins and minerals Dietary fiber Protein

“Good source”

May be used if the food contains 10% to 19% of the Daily Value per serving.

Vitamins and minerals Dietary fiber Protein

“Reduced”

Nutritionally altered to contain at least 25% less of a nutrient, or of calories, than the reference food. Reduced claim cannot be made if it is already labeled low.

Fat

Saturated fat Sodium Cholesterol Calorie

“Less”

Contains 25% less of a nutrient, or of calories, than the reference food.

Fat

Saturated fat Sodium Cholesterol Calorie

“Light” or “Lite”

One-third fewer calories, or half the fat, of the reference food. If the food derives 50% or more of calories from fat, the reduction must be 50%.

Calories

Fat

“Light in sodium”

Sodium has been reduced by at least 50%.

Sodium

“More”

Contains at least 10% of the Daily Value of the nutrient present in reference food. “Fortified,” “enriched,” “added,” “extra,” and “plus” are all synonyms of “more.”

Vitamins and minerals Dietary fiber Protein

Description

Nutrition literacy extends beyond the basic skills of reading, writing, speaking, and listening to include skills required by a person to understand and interpret the often complex information about nutrition. It also includes learning how to use this information when making dietary choices. Because nutrition information—both true and false—is widely distributed in media, a crucial component of nutrition literacy involves learning how to process information.

In the last decades of the twentieth century, nutrition literacy was highly focused on concerns about dietary excesses of macronutrients (such as fats) and on the relationship between diet and disease. This resulted in an overall perception that nutrition was the most effective way of maintaining health. However, many of the diseases associated with dietary excess, such as high cholesterol, are now understood to also have a genetic component. Additionally, nondietary lifestyle factors have been shown to be very important, leading to a realization that diets that may be helpful to some people may only be part of the solution for others. Technology and social changes have significantly influenced the variety of food available and the understanding of how food provides nutrients to the body. It is now agreed that one of the most fundamental principles of healthy nutrition is variety: the need to consume a wide range of different foods on a regular basis. Provided that a person is eating normal quantities of food, a varied diet is likely to provide all of the nutrients required by the body. The current prevailing view of good nutrition is that each person should consume the most appropriate balance of nutrients for maintenance of individual good health, and this requires a higher level of nutrition literacy than in the past.

Consumers benefit from an unprecedented diversity of food products. Information is also widely available to help ensure that the foods consumed are nutritious. A high level of nutrition literacy accordingly comprises several issues, including:

Recommended nutrition literacy sources

There are many resources available to help people achieve nutrition literacy. The most useful include:

KEY TERMS
Amino acid—
There are 20 amino acids. The body can synthesize 11 from components within the body, but the 9 essential amino acids must be consumed in the diet.
Blood cholesterol—
Cholesterol is a molecule from which hormones, steroids, and nerve cells are made. It is an essential molecule for the human body and circulates in the bloodstream. Between 75% and 80% of the cholesterol that circulates in a person's bloodstream is made in that person's liver. The remainder is acquired from animal dietary sources. It is not found in plants. Normal blood cholesterol level is a number obtained from blood tests. A normal cholesterol level is defined as less than 200 mg of cholesterol per deciliter of blood.
Calorie—
A unit of food energy. In nutrition terms, the word calorie is used instead of the scientific term kilocalorie, which represents the amount of energy required to raise the temperature of one liter of water by one degree centigrade at sea level. In nutrition, a calorie of food energy refers to a kilocalorie and is therefore equal to 1,000 true calories of energy.
Cloze tests—
Tests of language proficiency and what they measure.
Fatty acid—
A chemical unit that occurs naturally, either singly or combined, and consists of strongly linked carbon and hydrogen atoms in a chain-like structure. The end of the chain contains a reactive acid group made up of carbon, hydrogen, and oxygen.
Language Experience Approach—
An approach to teaching reading based on activities and stories developed from the personal experiences of the learner.
Nutrition facts labels—
Labels affixed to foods sold throughout the United States. Usually on the back or the side of the bottle, package, or bag, the label specifies the amount of calories provided by the contents as well as the amount of nutrients, vitamins, and supplements.
Trace minerals—
Minerals needed by the body in small amounts. They include: selenium, iron, zinc, copper, manganese, molybdenum, chromium, arsenic, germanium, lithium, rubidium, and tin.
Distributors of nutrition education materials

There are several organizations and agencies that distribute nutrition information as printed matter (books, booklets, brochures, fact sheets) or on their websites. They may also organize conferences and lectures.

U.S. DEPARTMENT OF AGRICULTURE (USDA). Through its Food and Nutrition Information Center (FNIC), the USDA has distributed a wealth of food and human nutrition information since 1971. It provides credible and accurate information, as well as practical resources for nutrition and health professionals, educators, government personnel, and consumers. It maintains the website for MyPlate, ChooseMyPlate.gov, to help people of all age groups make smart food choices, balance food intake and physical activity, and stay within recommended daily calorie needs.

ACADEMY OF NUTRITION AND DIETETICS. The Academy of Nutrition and Dietetics—formerly the American Dietetic Association—has the goal of linking nutrition and health. It is the largest organization of food and nutrition professionals in the United States. It offers a wide variety of food and nutrition information distributed in many forms, including:

U.S. FOOD AND DRUG ADMINISTRATION (FDA). The FDA is responsible for protecting public health by regulating the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, the nation's food supply, cosmetics, and products that emit radiation. The FDA is also responsible for advancing the public health by helping the public obtain the information they need to use medicines and foods to improve their health. It regularly issues and updates food information on product safety, recalls, warnings and approvals. The FDA website also provides brochures, newsletters, articles, and other information on nutrition-related issues on its website, http://www.fda.gov .

AMERICAN DIABETES ASSOCIATION (ADA). The ADA distributes nutritional information related to diabetes and health. Its bookstore has award-winning books on nutrition, cooking, weight loss, meal planning, and more. Titles include Diabetes Meal Planning Made Easy, The Complete Guide to Carb Counting, and Healthy Calendar Diabetic Cooking.

Complications

There are presently two major issues affecting nutrition literacy: illiteracy and the technical nature of nutrition information. Estimates of the prevalence of illiteracy in the United States vary according to the sources and criteria used to define it, but it is generally agreed that economic, social, and cultural factors all contribute to higher rates of illiteracy. Results from the 2003 National Assessment of Adult Literacy (NAAL) included assessment tasks designed specifically to measure the health literacy of adults living in the United States. Health literacy was reported using four performance levels: below basic, basic, intermediate, and proficient. The majority of adults (53%) were found to have intermediate health literacy; 22% had basic and 14% had below basic health literacy. The relationship between health literacy and factors such as educational level, age, race, and ethnicity was also examined. It was found that adults with below basic or basic health literacy were less likely than adults with higher health literacy to obtain information about health issues from written sources (newspapers, magazines, books, brochures, or the Internet) and more likely than adults with higher health literacy to get information about health issues from radio and television.

Since important nutrition materials are often written at levels that are too difficult for low-literacy readers, efforts are now directed at presenting nutrition information that can match the reading abilities and learning styles of the intended audiences, or to use graphics and symbols to represent key nutritional terms. Increasingly, research is being performed on the overall readability of nutrition information. Techniques such as Cloze tests and the Language Experience Approach have been adapted to help develop materials for specific low-literacy target groups. Low-literacy materials and guides for educators are also becoming more available. A recent study reported that 68% of a group of nutrition publications representative of material commonly distributed to the public were written at ninth-grade level or higher; 11% were at the sixth-grade level or below, and only two publications were written at the third-grade level. The conclusion is that many nutrition publications can be read and understood by literate Americans, but very few can be understood by the millions that have limited literacy skills.

QUESTIONS TO ASK YOUR DOCTOR

Parental concerns

It is important for parents and other caregivers to have a moderate to high level of nutrition literacy so that they can teach their children how to use nutritional information to develop good eating habits. Resources are increasingly available to help parents develop nutrition literacy in their children. Major federal agencies such as the FDA and the USDA maintain websites that have pages specifically designed to develop health and nutrition literacy in kids, such as MyPlate.

Resources

BOOKS

Allen, Janet. Tools for Teaching Content Literacy. Portland, ME: Stenhouse, 2004.

Berdanier, Carolyn D. CRC Desk Reference for Nutrition. 3rd ed. Boca Raton, FL: CRC Press, 2011.

Bijlefeld, Marjolijn, and Sharon K. Zoumbaris. Food and You: A Guide to Healthy Habits for Teens. Westport, CT: Greenwood Press, 2001.

Contento, Isobel R. Nutrition Education: Linking Research, Theory, and Practice. 3rd ed. Burlington, MA: Jones & Bartlett Learning, 2016.

Cullen, Rowena. Health Information on the Internet: A Study of Providers, Quality, and Users. Westport, CT: Praeger, 2006.

Duyff, Roberta Larson. Academy of Nutrition and Dietetics Complete Food and Nutrition Guide. 5th ed. Boston: Houghton Mifflin Harcourt, 2017.

Evers, Connie Liakos. How to Teach Nutrition to Kids. 4th ed. Portland, OR: 24 Carrot Press, 2012.

Rees, Alan M., ed. Consumer Health Information Source Book, 7th ed. Westport, CT: Greenwood Press, 2003.

Willett, Walter C., and Patrick J. Skerrett. Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating. Rev. and exp. ed. New York: Free Press, 2017.

Zarcadoolas, Christina., Andrew F. Pleasant, and David S. Greer. Advancing Health Literacy: A Framework for Understanding and Action. San Fransisco, CA: Jossey-Bass, 2006.

PERIODICALS

Escott-Stump, S. A. “Our Nutrition Literacy Challenge: Making the 2010 Dietary Guidelines Relevant for Consumers.” Journal of the American Dietetic Association 111, no. 7 (July 2011): 979.

Silk, K. J., et al. “Increasing Nutrition Literacy: Testing the Effectiveness of Print, Web Site, and Game Modalities.” Journal of Nutrition Education and Behavior 40, no. 1 (January–February 2008): 3–10.

WEBSITES

Academy of Nutrition and Dietetics. “Home Food Safety.” atright.org . https://www.eatright.org/homefoodsafety (accessed April 12, 2018).

U.S. Department of Agriculture. “MyPlate.” ChooseMy Plate.gov . http://www.choosemyplate.gov (accessed April 12, 2018).

U.S. Department of Agriculture, National Agricultural Library. “DRI Tables and Application Reports.” Food and Nutrition Information Center. https://www.nal.usda.gov/fnic/dri-tables-and-application-reports (accessed March 15, 2018).

U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th ed. December 2015. http://health.gov/dietaryguidelines/2015/guidelines/ (accessed May 1, 2018).

U.S. Food and Drug Administration. “Food Safety & Nutrition Information for Kids and Teens.” www.fda.gov/food/resourcesforyou/consumers/ucm2006971.htm (accessed April 12, 2018).

U.S. Food and Drug Administration. “Labeling & Nutrition.” http://www.fda.gov/Food/LabelingNutrition/default.htm (accessed April 12, 2018).

ORGANIZATIONS

Academy of Nutrition and Dietetics, 120 South Riverside Plz., Ste. 2000, Chicago, IL, 60606-6995, (312) 899-0040, (800) 877-1600, amacmunn@eatright.org, http://www.eatright.org .

American Diabetes Association, 1701 North Beauregard St., Alexandria, VA, 22311, (800) DIABETES (342-2383), askADA@diabetes.org, http://www.diabetes.org .

American Heart Association, 7272 Greenville Ave., Dallas, TX, 75231, (800) 242-8721, http://www.americanheart.org .

American Society for Nutrition, 9650 Rockville Pike, Bethesda, MD, 20814, (301) 634-7050, Fax: (301) 634-7894, http://www.nutrition.org .

British Nutrition Foundation, High Holborn House, 52-54 High Holborn, London, UK, WC1V 6RQ, +44 20 7404 6504, Fax: +44 20 7404 6747, postbox@nutrition.org.uk, http://www.nutrition.org.uk .

Center for Nutrition Policy and Promotion, U.S. Department of Agriculture, 3101 Park Center Drive, 10th Fl., Alexandria, VA 22302, (703) 305-7600, Fax: (703) 305-3300, support@cnpp.usda.gov, http://www.cnpp.usda.gov .

Dietitians Association of Australia, 1/8 Phipps Close, Deakin, Australia, ACT 2600, +61 2 6163 5200, (800) 812-942, Fax: +61 2 6282 9888, nationaloffice@daa.asn.au, http://daa.asn.au .

Dietitians of Canada, 480 University Ave., Ste. 604, Toronto Ontario, Canada, M5G 1V2, (416) 596-0857, Fax: (416) 596-0603, centralinfo@dietitians.ca, http://www.dietitians.ca .

Food and Nutrition Information Center, National Agricultural Library, 10301 Baltimore Ave., Rm. 105, Beltsville, MD, 20705, (301) 504-5414, Fax: (301) 504-6409, fnic@ars.usda.gov, http://fnic.nal.usda.gov .

International Food Information Council Foundation, 1100 Connecticut Ave., NW Ste. 430, Washington, DC, 20036, (202) 296-6540, info@foodinsight.org, http://www.foodinsight.org .

U.S. Department of Agriculture, 1400 Independence Ave. SW, Washington, DC, 20250, (202) 720-2791, http://www.usda.gov .

U.S. Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD, 20993-0002, (888) INFO-FDA (463-6332), http://www.fda.gov .

Monique Laberge, PhD
Revised by Megan Porter, RD

  This information is not a tool for self-diagnosis or a substitute for professional care.