Mapping the research landscape on food and nutritional literacy: a bibliometric analysis

Abstract

Purpose

The study aims to analyze research trends and hotspots in the field of food and nutrition literacy to inform evidence-based policymaking, and promote the health and well-being of the general population.

Design/methodology/approach

The Scopus database was used to retrieve relevant research articles using specific keywords related to food or nutritional literacy.

Findings

The analysis included 341 research articles, predominantly authored by scholars from the USA. Growth pattern of publications indicated recent evolution of the food and nutrition literacy concepts. The research hotspots identified included the development of tools to assess literacy, assessing food and nutritional literacy competencies among school children and adolescents and finally, cross-sectional survey studies on various international cultures to assess food and nutritional literacy. The top cited articles in the field focused on the operational definition and difference between nutrition literacy and food literacy.

Research limitations/implications

The findings underscore the need for comparative studies across countries, and advocacy for policy change to advance food and nutrition literacy among school students and vulnerable populations.

Practical implications

Policymakers, public health officials and practitioners can use the research findings to inform the development of evidence-based policy frameworks and interventions aimed at addressing the gaps in food and nutrition literacy.

Social implications

By promoting and advocating for policy reforms, and addressing gaps in food and nutrition literacy, the study contributes to fostering global future public health.

Originality/value

The study provides insights into the evolving research landscape on food and nutrition literacy, emphasizing the growing scholarly interest in understanding the concept and its public health impact.

Citation

Sweileh, W. (2024), "Mapping the research landscape on food and nutritional literacy: a bibliometric analysis", Health Education, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/HE-03-2024-0043

Introduction

Nutrition literacy refers to the understanding and application of essential nutritional concepts, including but not limited to macronutrients, micronutrients, dietary guidelines, and their impact on health outcomes (Carbone and Zoellner, 2012; Krause et al., 2018). It involves the ability to interpret and evaluate nutrition information, such as food labels, dietary recommendations, and nutritional claims, in order to make informed decisions about food choices and dietary patterns. Nutrition literacy encompasses not only knowledge about nutrition but also the practical skills needed to plan and prepare balanced meals, interpret nutrition-related media messages, and navigate food environments effectively (Velardo, 2015). Food literacy, on the other hand, extends beyond nutrition literacy to encompass a broader range of competencies related to food systems, food production, and culinary skills. In addition to understanding the nutritional value of foods, food literacy includes knowledge about food sourcing, sustainability, food safety, food culture, and food preparation techniques (Cullen et al., 2015; Doustmohammadian et al., 2022; Krause et al., 2018; Park et al., 2019; Samruayruen and Kitreerawutiwong, 2022; Truman et al., 2017). Food literacy emphasizes the practical aspects of food consumption, such as meal planning, cooking skills, grocery shopping, and food budgeting, as well as the social and cultural dimensions of food and eating habits.

The significance of food and nutrition literacy (FNL) cannot be overstated, as it directly impacts individuals' health outcomes and well-being (Leblanc et al., 2022; Vaitkeviciute et al., 2015; Lee et al., 2022). For the general public, possessing adequate FNL empowers individuals to make healthier dietary choices, leading to improved overall health and reduced risk of chronic diseases such as obesity, diabetes, and cardiovascular disorders (Silva, 2023; Qi et al., 2023; Kalkan, 2019; Silva et al., 2023; Taylor et al., 2019). Moreover, the importance of FNL extends to vulnerable populations and patients navigating complex health conditions. For individuals with chronic diseases such as diabetes or hypertension, FNL plays a crucial role in managing their condition effectively (Itzkovitz et al., 2022; Abrams et al., 2023; Rivera Rivero et al., 2021; Mokaya et al., 2023). Patients with diabetes or cardiovascular diseases may benefit from FNL interventions aimed at reducing unhealthy food practices (Wall et al., 2014; Deek et al., 2021; Topan et al., 2023).

In the realm of academic inquiry, understanding the landscape of research on FNL is paramount for advancing knowledge and informing evidence-based interventions. Bibliometric analysis, a quantitative method used to analyze patterns of scholarly publications within a specific field or discipline, offers a comprehensive overview of the existing body of literature on nutrition literacy (Ninkov et al., 2022; Manoj Kumar et al., 2023). By systematically mapping the volume, impact, and trends of research articles, bibliometric reviews provide valuable insights into the evolution of knowledge and research areas within the domain of nutrition literacy. Moreover, bibliometric analysis enables researchers and policymakers to identify key contributors, influential journals, and thematic clusters, thus guiding future research directions and resource allocation to address critical public health challenges related to FNL.

Method

Study design

This research adopted an observational, descriptive cross-sectional design to investigate the research trends and patterns on FNL.

Settings

The study encompassed all research papers pertaining to FNL available in the Scopus database. Scopus, renowned for its comprehensive coverage, incorporates PubMed and features a larger index of journals compared to Web of Science, justifying its sole utilization for maximum publication retrieval (Elsevier, 2023).

Selection of research papers

In adherence to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the study employed a rigorous selection process to include high-quality research papers (Page et al., 2021). A PISMA-adapted flow diagram, as presented in Supplementary material, delineates the stepwise retrieval and screening process, inclusive of the keywords employed in the search query. Only journal research articles written in English were considered, while other document types such as editorials, notes, letters, conference abstracts, books, book chapters, and traditional reviews were excluded.

Investigated variables

The study addressed several variables, including the (1) annual number of publications, (2) key contributors such as core journals, countries, institutions, and authors, (3) research hotspots identified through frequently encountered terms in the retrieved publications, and (4) content analysis of the top 10 cited articles.

Data management and visualization

Retrieved publications were exported from Scopus to Microsoft Excel and the VOSviewer program for comprehensive analysis and mapping (Van Eck and Waltman, 2010). VOSviewer facilitated the visualization of research hotspots, representing terms as nodes with varying sizes denoting their frequency of occurrence. Clusters of closely related terms were identified, aiding in delineating research hotspots. Additionally, Microsoft Excel was utilized for mapping the worldwide geographic distribution of publications.

Bias

To ensure the absence of bias, retrieved articles were scrutinized based on their citation counts, with the top 30 cited articles reviewed to confirm alignment with the scope of nutritional literacy or food literacy. Furthermore, the correlation between the number of articles published by each top author and their actual contribution to the field was tested, validating the absence of bias regarding false-positive and false-negative results (Sweileh et al., 2018).

Statistical methods

Descriptive statistics and graphical representations were conducted using Microsoft Excel and the Statistical Package for Social Sciences. For citation analysis, metrics such as Hirsch index (H-index) was employed (Hirsch, 2005). VOSviewer facilitated the mapping of retrieved literature content, with node size, color, and connecting line thickness reflecting frequency of occurrence, relatedness, and strength of relatedness, respectively (Van Eck and Waltman, 2010).

Results

Research evolution, trends and key contributors

Utilizing the search strategy in the Scopus database, the cumulative count of research articles addressing FNL amounted to 341 over the study span from 1982 to 2023. Specifically, within the most recent five-year interval from 2019 to 2023, approximately 80.0% (n = 273) articles were published. The peak number of publications was recorded in 2023 (n = 75), which is more than 19-fold greater than the number of publications a decade ago in 2014 (n = 4). Detailed information on the annual number of publications is provided in Figure 1. Of the retrieved articles, none was published as randomized clinical trial. The top actively involved institutions in the field are dispersed across different countries. The Kansas University (the USA) was the most prolific with 15 publications, followed by Shahid Beheshti University (Iran) with 13 publications in the field. The retrieved articles obtained an H-index of 35, with a citation range spanning from 0 to 437. A scrutiny of authorship patterns suggests that Gibbs, H.D. (USA) emerged as potential leading contributor, followed by Begley, A. (Australia), and Doustmohammadian, A. (Iran), and Omidvar, N. (Iran). The retrieved articles on FNL were disseminated through 152 different journals. The Nutrients journal claimed the top spot, publishing 29 (8.5%) articles, followed by the International Journal of Environmental Research and Public Health (n = 24; 6.9%). Table 1 details the top five journals. The majority of the journals in the active list operate within the field of nutrition and a few within the field of public health. Academics from 54 countries actively contributed to the authorship of the retrieved articles. The breakdown of research output by country is presented in Table 2. Scholars from the United States took the lead with the highest contribution (n = 71, 20.8%), followed by Australia and China.

Research themes

A network visualization map showing the most frequently used terms in the titles and abstracts of the retrieved articles revealed three major research themes within the field of food and nutrition literacy (FNL) (Figure 2). The largest research theme (red cluster) discussed FNL in the context of school health and school education. For example, research conducted in Australia sheds light on the importance of food literacy education in secondary schools and the challenges faced in its implementation (Ronto et al., 2016b). Studies explored the perspectives of home economics teachers (HETs) regarding the significance of food literacy, curriculum content, self-efficacy, and school food environments (Ronto et al., 2017a, b). HETs emphasized the importance of teaching aspects such as food preparation, healthy food knowledge, and food safety practices but highlighted challenges related to curriculum priorities, limited resources, and non-supportive school food environments. Moreover, studies in Iran and China examined the relationship between FNL and dietary behaviors among school-age children (Ashoori et al., 2021). A study found that low FNL was associated with lower dietary diversity and nutrient adequacy among Iranian school children, highlighting the crucial role of FNL in shaping dietary habits (Doustmohammadian et al., 2020). These studies underscore the importance of promoting FNL among school-age children globally to improve dietary behaviors and overall health outcomes.

The second largest research theme (blue cluster) investigated the development, validation and reliability testing of various instruments for assessing nutritional or food literacy. For example, a study in the Netherlands aimed to create and validate the Self-Perceived Food Literacy (SPFL) scale among adults, emphasizing knowledge, skills, and behaviors related to healthy eating (Poelman et al., 2018). Results showed that higher SPFL scores were associated with greater self-control, less impulsiveness, and healthier food consumption patterns, highlighting the importance of food literacy in promoting healthy dietary habits. Similarly, a study in the United States developed the Nutritional Literacy Scale (NLS) to assess adults' ability to comprehend nutritional information, demonstrating acceptable internal consistency and construct validity (Diamond, 2007). This scale fills a critical gap in assessing literacy skills related to nutrition, which is essential for managing chronic conditions such as hypertension and diabetes. Additionally, studies in Iran and China focused on developing valid and reliable questionnaires to measure FNL among elementary school children, laying the groundwork for tailored interventions to promote healthy eating habits from an early age (Doustmohammadian et al., 2017; Liu et al., 2021). Another study in Denmark expanded the concept of food literacy to include competencies beyond knowledge and skills, such as sensory awareness and citizenship, developing a comprehensive instrument for assessing food literacy in adolescents (Stjernqvist et al., 2021). Furthermore, efforts have been made to develop international food literacy surveys, aiming to capture the complexity of food literacy across diverse populations and settings (Michou et al., 2019; Fingland et al., 2021). Similarly, Liu et al. (2021) developed and validated the Food and Nutrition Literacy Questionnaire for Chinese School-age Children (FNLQ-SC), revealing significant predictors of FNL, including socio-demographic factors and the home food environment (Liu et al., 2021). These studies contribute to the advancement of research on food and nutrition literacy, providing valuable tools for evaluating interventions and promoting healthy eating behaviors globally.

The last research theme (green cluster) involved various cross-sectional studies to assess nutritional literacy among patients and the general public. One study conducted in Iran aimed to assess the association between nutrition literacy and diet quality among young adolescents found that higher levels of total nutrition literacy, interactive nutrition literacy, and critical nutrition literacy were associated with enhanced diet quality, particularly among boys (Joulaei et al., 2018). Another study in Iran explored the relationship between household food insecurity and food and nutrition literacy (FNLIT) among children aged 9–12 (Khorramrouz et al., 2020). The findings revealed a negative association between household food insecurity and FNLIT, with food-insecure children demonstrating lower levels of FNLIT compared to their food-secure counterparts. Similarly, a study conducted in Taiwan investigated the mediating role of nutrition literacy in influencing healthy eating behavior among college students (Lai et al., 2021). The results indicated that nutrition literacy significantly predicted healthy eating behavior and mediated the effects of various multi-level factors identified from the social-ecological model. Moreover, a study in China examined the nutrition literacy of middle school students and its influencing factors, revealing disparities in nutrition literacy scores based on demographic and socioeconomic factors (Zeng et al., 2022). Another study in Greece explored the relationship between parental health literacy, nutrition literacy, and feeding practices among children, highlighting the positive association between higher levels of parental health and nutrition literacy and better parental feeding practices (Costarelli et al., 2022). Additionally, a study in Bangladesh investigated the association between adults' nutrition literacy, demographics, and personal beliefs, revealing significant associations between higher nutrition literacy scores and factors such as higher education levels, higher family income, and completion of nutrition-related courses (Banna et al., 2022). Finally, a study in Japan examined the associations of food choice values and food literacy with overall diet quality, revealing significant associations between specific food choice values, food literacy components, and diet quality among Japanese adults (Murakami et al., 2023). Overall, these studies underscore the importance of nutrition literacy in influencing dietary behaviors and health outcomes across diverse populations, emphasizing the need for targeted interventions to enhance nutrition literacy and promote healthier dietary habits.

Analysis of top 10 cited articles

The top 10 cited articles on nutritional literacy encompass various aspects of understanding, defining, and measuring food literacy and its impact on dietary behaviors. Different research designs were used in the top 10 cited articles, mainly cross-sectional surveys, scoping reviews, and concept analysis. They include studies such as “Defining food literacy and its components,” (Vidgen and Gallegos, 2014) which explores the practicalities associated with healthy eating through expert and individual perspectives, and “The Nuances of Health Literacy, Nutrition Literacy, and Food Literacy,” (Velardo, 2015) which argues for a comprehensive conceptualization of nutrition literacy within broader health and food literacy constructs. Other studies like “Increasing Nutrition Literacy” examine the effectiveness of different modalities for delivering nutrition education, emphasizing the importance of tailored approaches (Silk et al., 2008). “Just a subtle difference? Findings from a systematic review on definitions of nutrition literacy and food literacy” compares definitions to highlight distinctions between the two concepts (Krause et al., 2018). Meanwhile, “Food literacy: Definition and framework for action” proposes a comprehensive definition and framework for food literacy, emphasizing its social, cultural, and environmental aspects (Cullen et al., 2015). “Defining food literacy: A scoping review” establishes the scope of food literacy research, identifying key themes and domains (Truman et al., 2017). “Nutrition literacy status and preferred nutrition communication channels among adults in the lower Mississippi Delta” examines the association between nutrition literacy status and preferred communication channels among adults in rural communities (Zoellner et al., 2009). “Towards the measurement of food literacy with respect to healthy eating” (Poelman et al., 2018) develops and validates a self-perceived food literacy scale, while “A short food literacy questionnaire (SFLQ) for adults” evaluates the measurement properties of a short food literacy questionnaire (Gréa Krause et al., 2018). Finally, “Adolescents’ perspectives on food literacy and its impact on their dietary behaviors” explores adolescents’ views on food literacy and its potential influence on dietary behaviors, emphasizing the importance of integrating food literacy education into high school settings (Ronto et al., 2016a).

Discussion

While the concept of understanding nutrition and its importance for health has been recognized for decades, the specific terms “nutritional literacy”/“food literacy” began to gain prominence in scholarly literature in the past two decades and has since evolved in its definition and application (Mohsen et al., 2022). The steep increase in research publications on FNL in the past decade can be attributed to several factors. Firstly, there is a growing recognition of the importance of nutrition in public health (Sim and Mackie, 2016), with an increasing emphasis on preventive measures to combat diet-related diseases and promote overall well-being (Narimatsu and Yaguchi, 2022; Alwarith et al., 2020). As dietary behaviors play a significant role in maintaining a healthy lifestyle, there is heightened awareness among researchers, healthcare professionals, policymakers, and the general public about the impact of food choices on health outcomes (Locke et al., 2018; Roberts et al., 2021; Toi et al., 2020). Additionally, the rising prevalence of chronic diseases such as diabetes mellitus and hypertension has underscored the critical role of FNL in disease prevention and management. Moreover, the expansion of the scholarly community and the proliferation of journals in the field of nutrition have provided platforms for researchers to disseminate their findings and contribute to the collective understanding of FNL. Furthermore, advancements in research methodologies and technologies have facilitated the investigation of complex relationships between diet, health, and behavior, driving further interest and investment in this area of study. Overall, the convergence of these factors has fueled the surge in research publications on nutritional and food literacy, reflecting a growing commitment to promoting healthier dietary practices and improving public health outcomes.

The emphasis in the top 10 cited articles on defining nutrition literacy and food literacy likely stems from the ongoing debate and evolution of these concepts within the scholarly community (Vidgen and Gallegos, 2014; Samruayruen and Kitreerawutiwong, 2022; Cullen et al., 2015; Park et al., 2019; Krause et al., 2018). As our understanding of health, nutrition, and behavior evolves, so too do the definitions and conceptualizations of nutritional literacy and food literacy, reflecting the complexities of dietary behaviors and their impact on health outcomes. There's a discussion about whether nutrition literacy and food literacy should be integrated into the broader framework of health literacy or treated as distinct constructs. This integration debate reflects the complex relationship between nutritional literacy, food literacy, and health literacy, prompting ongoing discussions about their interplay and boundaries. Clarity in terminology is crucial for developing effective interventions and informing policy decisions in public health and nutrition education, highlighting the importance of consensus within the field. Overall, the high citation counts of articles focusing on nutritional literacy and food literacy definitions underscore the complexity and significance of these concepts, driving researchers to seek clarity and consensus to advance knowledge and improve health outcomes related to nutrition and food literacy.

The abundance of articles focusing on assessing FNL among students and adolescents in schools reflects the recognition of the critical role that education plays in shaping dietary behaviors and promoting lifelong health. Adolescence is a formative period characterized by significant physical, cognitive, and social development, making it an opportune time to instill healthy eating habits and nutrition knowledge. By targeting schools as a setting for assessing nutritional and food literacy, researchers can reach a large and diverse population of young individuals during a pivotal stage of their lives. These studies are important for several reasons. Firstly, they provide insights into the current level of FNL among adolescents, allowing researchers to identify gaps in knowledge and areas for intervention. For example, assessments might reveal deficiencies in understanding basic nutrition concepts or practical skills related to meal preparation and food selection. Understanding these gaps enables educators and policymakers to tailor educational interventions to address specific needs effectively. Furthermore, research conducted in schools can evaluate the effectiveness of existing nutrition education programs or interventions aimed at improving FNL. For instance, studies might assess changes in students' knowledge, attitudes, and behaviors following the implementation of a school-based nutrition curriculum or policy changes in the school environment. By measuring outcomes over time, researchers can determine the impact of interventions and identify best practices for promoting healthy eating habits among adolescents. The significance of assessing FNL in schools extends beyond individual health outcomes to broader public health implications. Poor dietary habits established during adolescence can persist into adulthood and contribute to the development of chronic diseases such as obesity, diabetes, and cardiovascular disease (Craigie et al., 2011; Nicklas et al., 2001). Therefore, interventions aimed at improving FNL among adolescents have the potential to reduce the prevalence of these diseases and alleviate the burden on healthcare systems. In the future, research in this area will continue to be vital for informing evidence-based strategies to promote healthy eating behaviors and prevent diet-related diseases. As the landscape of nutrition education evolves, there will be a growing emphasis on implementing comprehensive and culturally relevant interventions in school settings. Additionally, advancements in technology and educational approaches may offer new opportunities for engaging adolescents and enhancing the effectiveness of nutrition education programs. Ultimately, investing in FNL among students and adolescents is an investment in the long-term health and well-being of future generations.

The abundance of articles focusing on the development of instruments to measure FNL in the current bibliometric study underscores the critical importance of accurate assessment in understanding individuals' knowledge, skills, and behaviors related to food and nutrition. These instruments play a pivotal role in advancing research and practice in several key ways. Firstly, valid and reliable measurement tools enable researchers to systematically evaluate the level of FNL among diverse populations, including adolescents, patients, elderly individuals, and various cultural groups. By assessing FNL comprehensively, researchers can identify gaps in knowledge and skills, pinpoint areas for intervention, and tailor educational programs to specific needs. For example, instruments like the Food Literacy Assessment Tool (FLAT) assess multiple dimensions of food literacy, including knowledge, skills, and behaviors, among adults (Hemmer et al., 2021; Tabacchi et al., 2020). Similarly, the Nutritional Literacy Survey measures individuals' ability to understand and apply nutrition information in real-life contexts (Hawkins et al., 2022). Moreover, the development of valid measurement tools facilitates the evaluation of interventions aimed at improving FNL and promoting healthier dietary behaviors. Researchers can use these instruments to assess the effectiveness of educational programs, interventions, and policy initiatives designed to enhance food-related knowledge, skills, and behaviors (Rees et al., 2022; Elsborg et al., 2022; West et al., 2020). For instance, a study used a validated food literacy questionnaire to evaluate the impact of a nutrition education intervention on the food literacy of college students. The findings demonstrated significant improvements in food literacy scores among participants who received the intervention compared to those in the control group (Yan et al., 2023). Looking ahead, the continued refinement and validation of FNL measurement tools hold significant implications for public health. Accurate assessment of FNL can inform the development of evidence-based interventions and policies aimed at promoting healthy eating habits, preventing diet-related diseases, and reducing health disparities. Furthermore, as nutrition literacy becomes increasingly recognized as a determinant of health outcomes, there is a growing need for standardized, culturally sensitive measurement tools that can be applied across diverse populations and settings. By investing in the development of robust measurement instruments, researchers and policymakers can better understand the complex interplay between food literacy, dietary behaviors, and health outcomes, ultimately contributing to improved public health outcomes and well-being.

Limitations within this study encompass various factors that may have influenced the comprehensiveness and interpretation of the findings. Firstly, in terms of database selection, reliance solely on the Scopus database might have overlooked relevant publications available in other databases such as Web of Science, potentially limiting the inclusivity of the study. Additionally, the exclusion of non-English research papers may have introduced language bias, possibly neglecting valuable insights from studies conducted in languages other than English and restricting the generalizability of the results. Moreover, the focus solely on journal research articles excluded other document types like editorials, conference abstracts, and review articles, potentially underrepresenting certain perspectives and methodologies. Geographic bias may also have influenced the findings, with a concentration of research activities in certain regions possibly overshadowing contributions from underrepresented areas. Temporal bias is another consideration, with older publications potentially receiving less attention or citation compared to recent ones, affecting the interpretation of research trends over time. Finally, methodological limitations associated with bibliometric analysis, such as citation practices and self-citation bias, may have impacted the accuracy and interpretation of the results, potentially influencing the identification of key contributors and research themes.

Conclusion

This bibliometric analysis provides valuable insights into the evolution of research trends, key contributors, and thematic clusters within the field of FNL. The findings highlight the growing interest and investment in understanding the complex interplay between nutrition knowledge, skills, and behaviors, as well as the importance of comprehensive approaches to food literacy education across diverse populations and settings. The study identified three major research themes within the field of FNL, including the assessment of FNL among students and adolescents in school settings, the development and validation of measurement instruments for assessing FNL, and cross-sectional studies examining the associations between FNL, dietary behaviors, and health outcomes among various populations. These research themes reflect the multifaceted nature of FNL and underscore the need for tailored interventions and policies to address knowledge gaps, promote healthy eating habits, and reduce the burden of diet-related diseases. Overall, this bibliometric analysis contributes to our understanding of the current landscape of research on FNL and provides a foundation for future studies aimed at advancing knowledge, informing evidence-based interventions, and addressing critical public health challenges related to nutrition literacy. By prioritizing FNL research and investing in education, policy, and practice, we can empower individuals and communities to make informed dietary choices, improve health outcomes, and enhance overall well-being.

Figures

Figure 1

Annual growth of publications on food and nutritional literacy

Figure 2

Research hotspots in the field of food and nutritional literacy

Table 1

Top five active journals in publishing articles on food and nutrition literacy

Source title	Number of publications	% (N = 341)
Nutrients	29	8.5
International Journal of Environmental Research and Public Health	24	7.0
Journal of Nutrition Education and Behavior	19	5.6
Frontiers in Nutrition	14	4.1
Public Health Nutrition	12	3.5

Source(s): Author’s own work

Table 2

Top five active countries in publishing articles on food and nutrition literacy

Country	Number of publications	% (N = 341)
United States	71	20.8
Australia	52	15.2
China	29	8.5
Iran	29	8.5
Canada	24	7.0

Source(s): Author’s own work

Availability of data and materials: all data presented in this manuscript are available on the Scopus database using the search query listed in the methodology section.

Competing interests: The author declares that he has no competing interest of any type.

Supplementary material Adapted PRISMA 2020 framework of the search strategy