Exploring the relationship between food literacy and food insecurity: a systematic review

As global mortality from chronic diseases such as obesity and diabetes continues to rise, the importance of dietary management for disease prevention is being increasingly emphasized [1, 2]. However, modern dietary patterns are characterized by a higher consumption of calorie-dense yet nutrient-poor foods, the normalization of processed foods and eating out, and a general decline in the overall dietary quality [3, 4]. While the intake of fruits, vegetables, and whole grains has decreased, the consumption of sodium and saturated fat has increased [5, 6]. Nutritional imbalances resulting from these dietary changes reportedly account for over 50% of diet-related deaths and approximately 66% of disability-adjusted life years [5]. According to the World Health Organization (WHO), major chronic diseases such as cardiovascular disease, hypertension, and diabetes are closely associated with dietary intake, and dietary improvement can prevent approximately 20% of deaths worldwide [7].

Among the various approaches to addressing modern dietary challenges, growing global attention has been directed toward food security (FS) [8, 9]. FS refers to “a state in which all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food to meet their dietary needs for an active and healthy life” [10]. The Committee on World Food Security emphasizes that achieving FS requires adequate sanitation, health services, and social infrastructure [11]. However, when individuals face barriers, such as low income, limited transportation, or insufficient social support, the stable access to desired food becomes difficult, consequently leading to food insecurity (FI) [12]. The United States Department of Agriculture (USDA) defines FI as “the limited or uncertain availability of nutritionally adequate and safe foods, or the inability to acquire such foods in socially acceptable ways” [13]. FI decreases access to nutritious foods, reduces dietary quality, and contributes to nutritional imbalance. It also serves as a socioeconomic inequality and health status indicator beyond mere income deprivation [14, 15]. Through the Sustainable Development Goals, the United Nations designated the elimination of FI and the achievement of FS as global priorities [16]. According to the State of Food Security and Nutrition in the World 2023, jointly published by the Food and Agriculture Organization (FAO), International Fund for Agricultural Development, United Nations Children's Fund, World Food Programme, and WHO [17], approximately 30.4% of the global population experiences severe FI [18]. This finding highlights that FI remains a critical global issue despite international efforts.

In this context, food literacy (FL) has gained attention as a core competency for alleviating FI and promoting healthy eating behaviors [19, 20, 21]. Numerous studies have reported a close association between these 2 concepts [2, 22, 23]. FL is derived from the concept of health literacy which refers to the ability to access, understand, evaluate, and apply health-related information for the maintenance and promotion of health, disease prevention, and healthcare utilization [24, 25]. Health literacy encompasses the subdomains of nutrition literacy and FL. While nutrition literacy primarily focuses on knowledge acquisition and information interpretation, FL emphasizes behavior-oriented competencies, including food preparation, cooking, and consumption [26, 27]. Higher levels of FL are associated with greater consumption of fruits and vegetables, reduced intake of processed foods, improved dietary quality, and better overall nutritional and health outcomes [20, 28, 29]. FL, thus, contributes to enabling individuals, households, and communities to sustain and strengthen healthy eating practices, thereby could play a important role in mitigating the experience of FI [22, 30].

Previous studies have suggested that FL and FI interrelated. One study found that individuals experiencing higher FI levels were more likely to engage in less healthy dietary behaviors, such as consuming energy-dense, nutrient-poor foods; irregular eating patterns; or binge eating [31]. Lower levels of FL have also been observed alongside poorer dietary behaviors and nutritional status, particularly among socioeconomically vulnerable populations such as young adults and older adults [22, 31]. FL is recognized as a modifiable competency that can be improved through education and may be conceptually related to the relationship between FI and dietary behaviors. However, inconsistencies in the measurement tools, conceptual definitions, and study designs across existing research make it difficult to establish coherence in interpretation. Moreover, findings have been accumulated in fragmented forms under different contexts and study frameworks, consequently limiting the comprehensive understanding of the overall relationship between the 2 variables. Therefore, this systematic review aimed:

This study was conducted as a systematic review to synthesize evidence on the association between FL and FI, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines [32]. The research question guiding this review was: “How is food literacy associated with food insecurity across diverse population groups?” Given the substantial heterogeneity in study designs, populations, measurement tools, and outcome measures among the included studies, findings were synthesized using a narrative synthesis approach rather than statistical meta-analysis [33].

Study selection process

The initial database search identified 191 records. After removing duplicates, titles and abstracts were screened, and 151 studies were excluded because they measured only 1 of the 2 variables or focused on related concepts. During full-text review, an additional 24 studies were excluded for not being original research or for not addressing both variables as primary outcomes, and 7 studies were excluded for not aligning with the study objectives. Ultimately, 9 studies were included in the final analysis. The study selection process is illustrated in the PRISMA flow diagram (Fig. 1).

Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of search.
FL, food literacy; FI, food insecurity.

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This review synthesized studies conducted across various countries and population groups to examine the relationship between FL and FI. Multiple cross-sectional studies [22, 35, 38, 41] reported that lower levels of FL were associated with a higher likelihood of FI, with key risk factors including lack of cooking confidence, difficulties in budget management, and inadequate food selection behaviors. Hoteit et al. [38] further identified associations between parental education, income, FL levels, and children’s FI. Previous research has also reported that sociodemographic and economic characteristics are significantly associated with both FL and FI, suggesting that these factors should be considered as potential confounders in the observed association between the 2 variables. Single-parent and large-family households were particularly vulnerable to FI compared with other groups, and family eating culture and parental eating habits were found to shape adolescents’ food choice behaviors [42]. In low-income households, higher levels of FI were associated with lower dietary quality and more frequent consumption of processed or energy-dense, nutrient-poor foods. Moreover, low-income areas are often categorized as “food deserts,” where limited access to supermarkets or fresh food markets constrains food choices, even among individuals with high FL [43, 44]. Older adults, those with low educational attainment, and rural residents were also identified as having lower FL levels [45].

However, Hanbazaza et al. [36] found no significant relationship between the 2 variables. The authors attributed this finding to the sociocultural context of Saudi Arabia, including patriarchal family structures, women’s economic dependency, and unstable income among younger adults, which collectively influence food access and dietary practices. Cultural background has thus been identified as another important factor shaping the relationship between FL and FI [46]. In immigrant households, language barriers and dietary acculturation challenges tend to lower FL and increase vulnerability to FI [47], Similarly, in multicultural families, parental cultural background and eating habits directly affect children’s FL, while conflicts arising during cultural adaptation may exacerbate FI [48]. The effectiveness of FL education also varies depending on social networks and community culture, suggesting that FL is not solely determined by individual knowledge or skills but is moderated by broader social and cultural contexts [22]. These findings collectively indicate that FL extends beyond the individual level and is influenced by socioeconomic structures and cultural environments, which are also closely associated with the risk of FI.

Intervention studies [37, 39, 40] reported improvements in FL and reductions in FI and suggested that long-term interventions may contribute to the alleviation of FI. Educational programs strengthened practical food-related competencies such as budgeting, meal planning, cooking, and storage skills, while encouraging participants to apply these skills through community engagement. As a result, participants not only improved their eating behaviors but also enhanced their food utilization and budgeting abilities, contributing to the dissemination of healthier dietary practices within their communities. These findings may suggest that integrating skill-based education and community participation into FL programs can be a potential strategy for reducing FI.

Nevertheless, economic constraints continued to act as barriers to behavioral implementation. In West et al. [2], although FI improved following FL intervention, food costs and household income remained limiting factors. This highlights the vulnerability of low-income populations to FI due to insufficient income, unemployment, and limited resources. Therefore, mitigating FI among socioeconomically disadvantaged groups requires not only FL education but also broader improvements in social determinants such as economic stability, educational attainment, and local environments [45, 49]. In particular, given the strong association between economic factors and FI, the importance of direct food assistance and price subsidy policies should not be overlooked alongside FL enhancement [50, 51].

Encouragingly, various programs and policies that address these factors have shown positive results in alleviating FI. For example, community-based garden programs have been reported to improve both social connectedness and food access, thereby reducing FI [52]. Nutrition education initiatives such as the Supplemental Nutrition Assistance Program Education and the Expanded Food and Nutrition Education Program for low-income households have improved budgeting and cooking skills and contributed to long-term reductions in FI [53, 54]. In Bangladesh, the “Graduation” program provided asset transfers, skills training, and education for ultra-poor households, demonstrating sustainable improvements in FS in follow-up assessments [55]. These cases illustrate that strategies to enhance FL can be most effective when combined with structural interventions that address socioeconomic inequalities.

The studies included in this review employed diverse statistical techniques—such as ROC analysis, structural equation modeling, and multigroup analysis—to more precisely examine the relationship between the 2 variables. They also identified major risk factors by categorizing FL into specific domains including knowledge, skills, attitudes, and behaviors. Cross-sectional studies frequently identified associations between FI and FL domains related to budgeting and financial management, with lower scores observed food-insecure groups. In contrast, intervention studies more commonly reported improvements in cooking confidence and food preparation behaviors alongside changes in FI indicators. Together, these findings demonstrate that different study designs can illuminate distinct domain-level aspects of FL associated with FI, highlighting the analytical value of examining FL beyond composite scores. Furthermore, the inclusion of cross-sectional, intervention, and longitudinal designs, the reviewed studies provided multidimensional insights into the association between FL and FI, offering both theoretical and practical implications. Consequently, this review underscores the need for FL education and policy-based interventions, providing an evidence base for future public health strategies and community practices.

However, several limitations should be noted. First, the included studies employed diverse instruments to assess FL and FI, which limited direct comparisons and hindered consistent interpretation across studies. Although many studies referred to the FL framework proposed by Vidgen and Gallegos [30], substantial heterogeneity existed in operational definitions and domain composition. Variations in included domains—such as budgeting, cooking confidence, and knowledge-based components— as well as the indirect assessment of FL through dietary indicators (e.g., fruit and vegetable intake in Royer et al. [39]) may have influenced interpretation of the reported associations between FL and FI. Second, the predominance of cross-sectional designs (n = 5) constrained causal inference, and in some intervention studies, relatively small sample sizes or the absence of randomization may have limited internal validity. Third, the small number of studies incorporating follow-up assessments (n = 1) restricted evaluation of the long-term sustainability of intervention effects, and the frequent reliance on self-reported questionnaires may have introduced subjective bias. In addition, heterogeneity in study designs, populations, and outcome measures precluded quantitative synthesis, necessitating a narrative synthesis approach. Although methodological quality was systematically appraised using standardized criteria, some studies exhibited insufficient reporting of key methodological elements, which was considered during interpretation rather than used as a basis for study exclusion.

Future research should include adequately powered intervention and longitudinal studies to further examine the relationship between FL and FI [28]. Community-based controlled trials are also needed to rigorously evaluate the intervention effects of FL education. As discussed above, improving FI among vulnerable populations cannot be achieved solely through educational approaches; rather, combining educational strategies with structural interventions—such as food assistance and price subsidies—while employing standardized measurement tools will enhance cross-study comparability. Such efforts will help clarify the directionality and mechanisms underlying the observed association between FL and FI.

In conclusion, the available evidence indicates a consistent association between FL and FI across diverse populations and contexts. However, due to the predominance of cross-sectional designs and methodological variability, causal direction and potential pathways remain uncertain. Clarifying these relationships through rigorous future research will be essential for informing effective and sustainable public health strategies. Within broader efforts to address the structural determinants of FI, strengthening FL may serve as a complementary and potentially sustainable component rather than a standalone solution.

Supplementary Table 1

Domain-specific findings on FL