Nutrition Literacy

Definition

Purpose

Description

Nutrition literacy resources

Distributors of nutrition education materials

Nutrition literacy issues

Parental concerns

Resources

Definition

Nutrition literacy refers to the set of abilities needed to understand the importance of good nutrition in maintaining health.

Purpose

The first purpose of nutrition literacy is to understand food so that people improve their ability to make informed decisions concerning which foods, and in what quantities, are required to maintain health. This also includes an awareness of which foods to avoid and why. Today’s consumers benefit from an unprecedented diversity of food products. Information about food is also widely available to help ensure that diets are nutritious. Nutrition literacy is accordingly based on being informed on several issues that include:

• Food and health: People require energy and certain essential nutrients. Energy is provided by food that contains macronutrients, required in large amounts (protein, carbohydrate, fats). Essential nutrients are essential because the body cannot make them on its own and must obtain them from food. They include micronutients such as vitamins, minerals, required in small amounts and certain amino acids and fatty

Nutrient content claims

(Illustration by GGS Information Services/Thomson Gale.)

acids. Foods also contain fiber and other components that are important for health. Nutrition literacy provides an understanding of the basic nutrient classes and explains their respective roles in maintaining health as well as their dietary sources. This is often commonly referred to as the ‘‘Food Pyramid’’.

• Food interactions: Many food nutrients have a specific function in the body but most need to interact with each other for maximum health benefits. For example, people need calcium for strong bones, but many other nutrients also take part in building and maintaining bones, such as proteins, phosphorus, magnesium and vitamin D. Tannins in tea can inhibit the absorption of iron. Zinc supplements, an essential trace mineral, should not be taken at the same time as certain antibiotics, such as tetracyclines and quino-lones, as it may decrease the action of the antibiotic. Nutrition literacy seeks to explain the interactions of nutrients with each other and also with medications.
• Food and disease: Good food choices can help to prevent diseases, such as heart disease, certain cancers, diabetes, stroke and osteoporosis, that are leading causes of death and disability in the United States. Many genetic, environmental, behavioral and cultural factors can affect health. Understanding the family history of disease and risk factors, such as body weight and fat distribution, blood pressure and blood cholesterol, can help people make more informed decisions about how to improve health. Nutrition literacy promotes good food choices and diets that lead to improving health while also reducing major risk factors for chronic diseases, such as obesity, high blood pressure and high blood cholesterol. By explaining how food is chemically converted into nutrients that can be absorbed and used by the body (digestion), it also promotes digestive system health.
• Understanding fast foods: Today’s lifestyles are very different from those of the past. The fast pace of modern lifestyles and the increase of single-parent households or families where both parents work have significantly changed food consumption habits. This has led to the emergence of convenient foods and important advances in food technology. There are more than 300,000 fast food outlets in the United States and fast food has now become common in the busy American lifestyle. However, a negative consequence has also been a significant increase in ready-to-eat foods of low nutritional value (junk food), because it is often high in calories, sodium, fat and cholesterol. Nutritional literacy provides information on fast foods and how they can be part of a balanced, healthy diet in small quantities.
• Understanding food supplements: Nutrition literacy also provides information on food supplements, such as vitamins, minerals, fiber and phytonutrients that may be required in some instances to meet nutritional needs. However, supplements do not supply the balance of important nutrients present in whole foods, and they can be harmful if taken regularly in excessive amounts. Daily vitamin and mineral supplements at or below the Recommended Dietary Allowances are considered safe but are rarely needed by people who eat the variety of foods recommended for example by the Food Pyramid. Supplements are usually needed only to meet specific nutrient requirements. For example, older people with little exposure to sunlight may need a vitamin D supplement. And pregnant women may benefit from folic acid and iron supplements.
• Eating disorders awareness: Nutrition literacy also includes providing information on eating disorders, that include anorexia nervosa, bulimia, and binge eating disorder. They are illnesses with a biological basis that are influenced by emotional and cultural factors.

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 foods and their nutrients. Nowadays, these skills must necessarily include information-processing literacy because nutrition information is now widely and increasingly distributed on the Internet.

The social and technological developments of the past decades have also significantly influenced the variety of food available, and also our 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, it is now recognized that a varied diet is likely to provide enough of all nutrients required by the body. 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 specific diseases such as heart disease and cancer. 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 are now understood to also have a major genetic component. Additionally, non-dietary lifestyle factors have been shown to be very important, leading to a realization that diets which may be helpful to some people may only be part of the solution for others. The prevailing view of good nutrition is now that each person should consume the most appropriate balance of nutrients for maintenance of individual good health, and this requires a higher level of literacy than in the past.

Nutrition literacy resources

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

• Nutrition Facts labels: These are the labels found on the packaging of some fresh foods and most processed foods. They provide detailed information on specific nutritional content. People can learn a lot about the composition of foods from reading these labels. The labels can also be useful for learning to predict what the composition of restaurant or takeout food might be. For example, the label of a frozen supermarket pizza can be used as a guide to the calories and nutrients that a restaurant pizza is likely to contain.
• Nutrition handouts: Health care practitioners usually have handy sheet material concerning nutritional advice in their waiting rooms. Dentists commonly provide people with dietary tips on how to avoid tooth decay and maintain oral hygiene. Supermarkets also regularly distribute nutritional information on foods at checkouts and in special displays.
• Nutrition classes and lectures: Medical foundations, community colleges, and consumer groups organize lectures that are open to the general public in many communities across the United States. Online nutrition classes and webcasts are also available on the Internet.
• Patient handouts: These contain detailed dietary information for specific health conditions as well as recommendations on foods that may help recovery and foods that should be avoided.
• Recommended Dietary Allowances (RDAs ): RDAs recommend the average daily level of a nutrient that is sufficient to provide its adequate requirement for nearly all individuals in a life stage and gender group. RDAs are widely provided in almost all diets and nutrition advice material.
• Food Guide Pyramid: The Food Guide Pyramid is provided and updated by the United Stated Department of Agriculture (USDA) and represents a popular way for people to understand how to eat healthy. It was designed to help kids and parents understand dietary guidelines. A rainbow of colored stripes represents the five food groups to make it easy to select the foods providing the nutrients and other substances needed for good health. Most of the daily servings of food should be selected from the food groups that are the largest in the picture and closest to the base of the pyramid. The pyramid shows that foods from the grain group, along with vegetables and fruits, are the basis of healthful diets.
• Expanded Food and Nutrition Education Program (EFNEP): The USDA Expanded Food and Nutrition Education Program (EFNEP) is designed to assist limited resource audiences in acquiring the knowledge, skills, attitudes, and behavior necessary for nutritionally sound diets, and to contribute to their personal development and the improvement of the total family diet and nutritional well-being. It provides reputable sources of scientific and consumer nutrition information for consumers and professionals in the form of newsletters, publications, and Internet links.
• Family nutrition programs (FNP). Often sponsored by the USDA Food Stamp Program, these programs provide nutrition education to limited resource individuals and families in almost all states. They are managed by departments of Human Nutrition or of Social Services and by health associations and foundations.

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 also organize conferences and lectures. Some of the most trusted are listed below.

United Stated Department of Agriculture (USDA)

Through its Food and Nutrition Information Center (FNIC), the USDA distributes a wealth of food and human nutrition information since 1971. It provides credible, accurate, as well as practical resources for nutrition and health professionals, educators, government personnel and consumers. It also maintains a popular website called MyPyramid.gov for people of all age groups to help them make smart choices from every food group, balance food and physical activity, and to stay within recommended daily calorie needs.

American Dietetic Association

The 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 numerous food and nutrition information distributed in many forms. Examples are:

• Nutrition fact sheets (Nutrition for Everyone, Weight Management, Kid’s Nutrition Needs)
• The good nutrition reading list (365 Days of Healthy Eating from the American Dietetic Association, The College Student’s Guide to Eating Well on Campus, A Healthier You: Based on the Dietary Guidelines for Americans)

KEY TERMS

Amino acid— There are 20 amino acids. The body can synthesize 11from components with in the body, but the nine called essential amino acids must be consumed in the diet.

Binge eating disorder (BED)— Eating disorder characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.

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 blood stream. 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 1000 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.

Food Stamp Program (FSP)— The Food Stamp Program provides a basic safety net to millions of people. The program was born in the late 1930s, with a limited program in effect from 1939 to 1943. It was revived as a pilot program in 1961 and was extended nationwide in 1974. The current program was implemented in 1977 with the goal of alleviating hunger and malnutrition by permitting low-income households to obtain a more nutritious diet through normal channels of trade.

Language Experience Approach— An approach to reading instruction based on activities and stories developed from personal experiences of the learner.

Nutrition Facts label— 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.

Phytochemicals— Chemicals extracted from plants that have health-enhancing effects.

Stroke— The sudden death of some brain cells due to a lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery.

Trace minerals— Minerals needed by the body in small amounts. They include: selenium, iron, zinc, copper, manganese, molybdenum, chromium, arsenic, germanium, lithium, rubidium, tin.

Webcast— The delivery of live or delayed sound or video broadcasts using web technologies. The sound or video is captured by conventional video or audio systems. It is then digitized and streamed on a web server.

• Daily nutrition tips (A Variety of Options with Chicken, Add more Calcium to your Daily Routine)
• Consumer nutrition brochures (Healthy Habits for Healthy Kids - a Nutrition and Activity Guide for Parents, Start Healthy: the Guide to Teaching Your Little One Good Eating Habits, From the Surgeon General: Improving Bone Health.
• Popular diets reviews. Every year brings a new popular diet that quickly becomes a best-selling book. The ADA reviews them for consumers.
• Home food safety. This is a national public education initiative called ‘‘Home Food Safety…It’s in Your Hands’’. It raises consumer awareness on the importance of practicing food safety at home, while communicating easy solutions so people can take control and handle food safely in their own kitchens.

United States 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 get the accurate, science-based 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. This information is made public in almost all media:

• FDA Consumer. This is the official magazine of the FDA. It is a good source for the latest information on FDA-related issues, gathered from FDA news releases and other sources.
• Consumer print publications. Almost 100 short brochures on nutrition-related issues are available on request or downloadable from the FDA website.
• FDA & You. An electronic newsletter for teens, parents, and educators with current information on many of the FDA medical product and health topics.
• Quick Information for Your Health. Easy-to-read health information. Some titles are available as printable forms from the FDA website or as printed brochures for ordering.

American Diabetes Association

The association distributes nutritional information related to diabetes and health. Its bookstore has award-winning books on nutrition, recipes, weight loss, meal planning and more. Examples are:

• Diabetes Meal Planning Made Easy
• The Complete Guide to Carb Counting
• Healthy Calendar Diabetic Cooking

Nutrition literacy issues

There are presently two major issues affecting nutrition literacy. The most serious is illiteracy, followed by the difficult readability of some nutrition information:

• Illiteracy: 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 in some population groups. Results from the 2003 National Assessment of Adult Literacy (NAAL) included health literacy results. The results were based on 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. Some 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, sources of information about health issues were 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.
• Readability of nutrition information: Since important nutrition materials are often written at levels that are too difficult for low-literate readers, efforts are now directed at presenting nutrition information that can match the reading abilities and learning styles of the intended audience. Increasing research is being performed on the overall readability nutrition information. Techniques such as Cloze tests and the Language Experience Approach have been adapted to help develop materials for specific low-literate target groups. Low-literacy materials and guides for educators are also becoming increasingly available. Professionals that survey nutrition education have recommended materials that are low-cost, and of the type mostly used in patient education. 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. Another study reviewed the readability of books recommended to consumers by professional nutrition and dietetic organizations. The grade level required to read the recommended books was the tenth grade and more than 40% required a reading level that exceeds that of popular magazines. Only one recommended book was written at a level that was understandable by adults with low-literacy skills.

Parental concerns

Nutrition literacy is important for parents so that they may first of all understand how food helps maintain health and prevent disease. It is also important so that they can teach their kids how to use nutritional information to develop good eating habits. Fortunately, as a result of our living in the ‘‘information age’’, 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 now have pages specifically designed to develop health and nutrition literacy in kids. Two examples are the FDA Kids Page and the USDA MyPyramid page. These are very useful tools to help kids learn how to vary the foods they eat, while obtaining sound nutrition and health-related knowledge. There is now an unprecedented amount of information about food, to help ensure that diets are nutritious so that consumers understand the nutritional content of the foods they purchase. While many options exist about the relative merits of various foods, there is increasing evidence that the traditional concept of a balanced diet containing a wide variety of foods should be a guiding nutrition principle. At the same time, however, with the growing number of fast food products widely available, it is becoming increasingly important for consumers to have nutrition literacy. Only with this information can people make intelligent judgments about the food they eat.

Resources

BOOKS

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

Cullen, R. Health Information on the Internet: A Study of Providers, Quality, and Users. New York, NY: Praeger Paperback, 2005.

D’Elgin, T. What Should I Eat?: A Complete Guide to the New Food Pyramid. New York, NY: Ballantine Books, 2005.

DK Publishing My Food Pyramid. New York, NY: DK Publishing, 2007.

Fischer, D. B., Frey, N. Food and You: A Guide to Healthy Habits for Teens. Westport, CT: Greenwood Press, 2001.

Garrison, R., Somer, E. The Nutrition Desk Reference. New York, NY: McGraw-Hill, 1998.

Gralla, P. How the Internet Works (8th Edition. Indiana polis, IN: Que Publishing, 2006.

Hock, R. The Extreme Searcher’s Internet Handbook: A Guide for the Serious Searcher. Medford, NJ: Information Today, Inc., 2007.

Larson Duyff, R. ADA Complete Food and Nutrition Guide, 3rd ed. Chicago, IL: American Dietetic Association, 2006.

Rees, A. M., ed. Consumer Health Information Source Book: Seventh Edition. Westport, CT: Greenwood Press;, 2003.

Willett, W., Skerrett, P. J. Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating. New York, NY: Free Press Trade Pbk, 2005.

Zarcadoolas, C., Pleasant, A., Greer, D.S. Advancing Health Literacy: A Framework for Understanding and Action. New York, NY: Jossey-Bass, 2006.

ORGANIZATIONS

American Diabetes Association. 1701 North Beauregard St., Alexandria, VA 22311. 1-800-342-2383. www.diabetes.org.

American Dietetic Association. 216 W. Jackson Blvd, Chicago, IL 60606-6995. 1-800-877-1600 ext. 5000.www.eatright.org.

American Society for Nutrition (ASN). 9650 Rockville Pike, Bethesda, MD 20814. (301) 634-7050. www.nutrition.org.

Food and Drug Administration, Center for Food Safety and Applied Nutrition. 5100 Paint Branch Parkway, College Park, MD 20740-3835. 1-888-723-3663.vm.cfsan.fda.gov.

Food and Nutrition Information Center. 10301 Baltimore Avenue, Beltsville, MD 20705-2351. www.nutrition.gov.

USDA Center for Nutrition Policy and Promotion (CNPP). 3101 Park Center Drive, 10th Floor, Alexandria, VA 22302-1594.<> (703) 305-7600. www.cnpp.usda.org.

Monique Laberge, Ph.D.