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id="article-front-meta" class="row no-gutters my-3"> 367<div class="d-flex"> 368<div id="article-front-meta-left" class="w-100"> 369<div>Nutr Res Pract. 2026 Aug;20(4):557-570. English.<br>Published online May 20, 2026.<br><a class="article-meta-doi-link" href="https://doi.org/10.4162/nrp.2026.20.4.557">https://doi.org/10.4162/nrp.2026.20.4.557</a> 370</div> 371<div>©2026 The Korean Nutrition Society and the Korean Society of Community Nutrition 372 373</div> 374</div> 375<div id="article-front-meta-right" class="flex-shrink-1"><div><div id="crossref-crossmark" style="display:none;"><a data-target="crossmark"></a></div></div></div> 376</div> 377<div class="clearfix"></div> 378</div></div> 379<div id="article-front-bibliographic"> 380<div class="article-type">Review</div> 381<div class="article-title"><h1 class="content-title">Exploring the relationship between food literacy and food insecurity: a systematic review 382</h1></div> 383<div class="article-contrib"> 384<span class="capture-id"><span id="ORCID_0009-0009-5408-4792" class="ORCID"><a href="ORCID/0009-0009-5408-4792">Eunseo Lee</a></span><a href="https://orcid.org/0009-0009-5408-4792" target="_blank"><img style="vertical-align:middle; margin-left:0.2em; margin-right:0.05em; padding-bottom: 0.5em;" src="/image/icon-orcid.jpg"></a>,<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>*</sup></span> 385<span class="capture-id"><span id="ORCID_0009-0005-0686-1666" class="ORCID"><a href="ORCID/0009-0005-0686-1666">Minjeong Jeong</a></span><a href="https://orcid.org/0009-0005-0686-1666" target="_blank"><img style="vertical-align:middle; margin-left:0.2em; margin-right:0.05em; padding-bottom: 0.5em;" src="/image/icon-orcid.jpg"></a>,<sup>1</sup><sup>,</sup><sup>2</sup><sup>,</sup><sup>*</sup></span> 386<span class="capture-id"><span id="ORCID_0009-0002-4825-3114" class="ORCID"><a href="ORCID/0009-0002-4825-3114">Jinhyun Kim</a></span><a href="https://orcid.org/0009-0002-4825-3114" target="_blank"><img style="vertical-align:middle; margin-left:0.2em; margin-right:0.05em; padding-bottom: 0.5em;" src="/image/icon-orcid.jpg"></a>,<sup>1</sup><sup>,</sup><sup>2</sup></span> 387<span class="capture-id"><span id="ORCID_0009-0007-2939-9210" class="ORCID"><a href="ORCID/0009-0007-2939-9210">Dahye Han</a></span><a href="https://orcid.org/0009-0007-2939-9210" target="_blank"><img style="vertical-align:middle; margin-left:0.2em; margin-right:0.05em; padding-bottom: 0.5em;" src="/image/icon-orcid.jpg"></a>,<sup>1</sup><sup>,</sup><sup>2</sup></span> 388<span class="capture-id"><span id="ORCID_0009-0004-7621-3800" class="ORCID"><a href="ORCID/0009-0004-7621-3800">Junhyeok Jang</a></span><a href="https://orcid.org/0009-0004-7621-3800" target="_blank"><img style="vertical-align:middle; margin-left:0.2em; margin-right:0.05em; padding-bottom: 0.5em;" src="/image/icon-orcid.jpg"></a>,<sup>3</sup></span> 389<span class="capture-id"><span id="ORCID_0000-0003-3926-4575" class="ORCID"><a href="ORCID/0000-0003-3926-4575">Eunjin Jang</a></span><a href="https://orcid.org/0000-0003-3926-4575" target="_blank"><img style="vertical-align:middle; margin-left:0.2em; margin-right:0.05em; padding-bottom: 0.5em;" src="/image/icon-orcid.jpg"></a>,<sup>2</sup></span> 390 and <span class="capture-id"><span id="ORCID_0000-0001-6009-1002" class="ORCID"><a href="ORCID/0000-0001-6009-1002">Sohyun Park</a></span><a href="https://orcid.org/0000-0001-6009-1002" target="_blank"><img style="vertical-align:middle; margin-left:0.2em; margin-right:0.05em; padding-bottom: 0.5em;" src="/image/icon-orcid.jpg"></a><span class="article-icon-corresp"></span><sup>1</sup><sup>,</sup><sup>2</sup></span> 391</div> 392<div class="article-front-meta-sub-tab mt-3 mb-0"><div class="d-inline-flex flex-wrap"> 393<div class=""><a class="btn btn-outline-article" data-bs-toggle="collapse" href="#article-front-meta-id-aurthorinfo" role="button" aria-expanded="false" aria-controls="article-front-meta-id-aurthorinfo">Author information</a></div> 394<div class=""><a class="btn btn-outline-article" data-bs-toggle="collapse" href="#article-front-meta-id-articlehistory" role="button" aria-expanded="false" aria-controls="article-front-meta-id-articlehistory">Author notes</a></div> 395<div class=""><a class="btn btn-outline-article" data-bs-toggle="collapse" href="#article-front-meta-id-license" role="button" aria-expanded="false" aria-controls="article-front-meta-id-license">Copyright and License</a></div> 396</div></div> 397<div class="article-front-meta-sub"> 398<div class="collapse multi-collapse" id="article-front-meta-id-aurthorinfo"><div class="card card-body"><ul class="list-group list-group-flush"> 399<li class="list-group-item"><div class="article-afilliations"><ul> 400<li> 401<sup>1</sup>Department of Food Science and Nutrition, Hallym University, Chuncheon 24252, Korea.<br> 402</li> 403<li> 404<sup>2</sup>The Korean Institute of Nutrition, Hallym University, Chuncheon 24252, Korea.<br> 405</li> 406<li> 407<sup>3</sup>School of Multidisciplinary Studies, Hallym University, Chuncheon 24252, Korea.<br> 408</li> 409</ul></div></li> 410<li class="list-group-item"><div class="article-author-notes"><span class="capture-id"><div> 411<span class="gen"></span><span class="article-icon-corresp"></span>Corresponding Author: Sohyun Park. Department of Food Science and Nutrition, Hallym University, 1 Hallymdaehak-gil, Chuncheon 24252, Korea. Tel. +82-33-248-2134, Fax. +82-33-256-3420, <span class="author-email">
411Email: <A href="mailto:[email protected]">[email protected]</A></span> 412 413</div> 414<div class="fm-footnote" id="FN1"><div class="p p-first"><span class="capture-id"><p></p> 415<sup>*</sup>Eunseo Lee and Minjeong Jeong contributed equally to this work.</span></div></div></span></div></li> 416</ul></div></div> 417<div class="collapse multi-collapse" id="article-front-meta-id-articlehistory"><div class="card card-body"><div class="article-received-accepted-date">Received January 05, 2026; Revised February 24, 2026; Accepted March 31, 2026.</div></div></div> 418<div class="collapse multi-collapse" id="article-front-meta-id-license"><div class="card card-body"><div class="article-license"> 419<p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<a href="https://creativecommons.org/licenses/by-nc/4.0/" target="_blank">https://creativecommons.org/licenses/by-<wbr/>nc/4.0/</a>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> 420</div></div></div> 421<div id="article-citedby"></div> 422<div id="article-relate-articles"></div> 423</div> 424 425 426<div><div class="article-abstract"> 427<div class="article-section-header"> 428<div class="__SECTION__" id="__ID_SECTION_0" data-section-name="Abstract"><div class="dropdown"> 429<a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_0" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_0"></div> 430</div></div> 431<h2>Abstract</h2> 432</div> 433<div> 434<h3>BACKGROUND/OBJECTIVES</h3> 435<p>Interest in food insecurity (FI) has intensified amid global efforts to address dietary and nutritional issues. Food literacy (FL) has emerged as a key competency for promoting healthy eating behaviors and potentially mitigating FI. This systematic review synthesized evidence on the relationship between FL and FI by summarizing their definitions and components, comparing measurement tools, and examining overall trends and characteristics of their association.</p> 436</div> 437<div> 438<h3>MATERIALS/METHODS</h3> 439<p>This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and the Joanna Briggs Institute (JBI) framework. Studies examining FL and FI as primary variables were identified from PubMed, Web of Science, and Google Scholar. Nine studies published between 2019 and 2025 were included. Methodological quality was assessed using JBI checklists, and findings were synthesized narratively due to study heterogeneity.</p> 440</div> 441<div> 442<h3>RESULTS</h3> 443<p>The included studies employed cross-sectional, quasi-experimental (preâpost), mixed-methods, and cluster randomized controlled designs. FI was primarily assessed using definitions proposed by the Food and Agriculture Organization or the United States Department of Agriculture. FL was commonly measured using frameworks based on Vidgen and Gallegos (2014). Most cross-sectional studies reported an inverse relationship between FI and FL. However, one cross-sectional study found no significant relationship, suggesting that sociocultural and economic factors may influence this association. Intervention studies generally showed improvements in FL and reductions in FI or related behaviors.</p> 444</div> 445<div> 446<h3>CONCLUSION</h3> 447<p>Most studies indicated that individual FL levels were associated with FI status. In some studies, this relationship appeared to be influenced by sociodemographic, economic, and cultural factors, although these findings were not consistently reported. The findings suggested that combining FL education with structural strategies may more effectively alleviate FI. Future research should use standardized measurement tools and longitudinal or randomized controlled designs to clarify the observed associations and potential mechanisms underlying the relationship between FL and FI.</p> 448</div> 449 450</div></div> 451</div> 452</div> 453 454<div id="article-level-0-end-metadata" class="fm"> 455<div class="my-3"><div> 456<div class="article-keyword-group-title">Keywords</div> 457<div> 458<span class="capture-id">Food</span>; <span class="capture-id">literacy</span>; <span class="capture-id">food insecurity</span>; <span class="capture-id">systematic review</span> 459</div> 460</div></div> 461 462</div> 463 464<div id="article-level-0-body" class="body"> 465 466<div> 467<div><div class="article-section-header"> 468<div class="__SECTION__" id="__ID_SECTION_1" data-section-name="INTRODUCTION"><div class="dropdown"> 469<a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_1" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_1"></div> 470</div></div> 471<h2>INTRODUCTION</h2> 472</div></div> 473<p>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 [<span class="xref"><span id="XREF_B1" class="ref-destination-back"></span><a href="#B1" data-id="XREF_B1" data-toggle="ref-popover" data-trigger="manual" data-placement="right">1</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B2" class="ref-destination-back"></span><a href="#B2" data-id="XREF_B2" data-toggle="ref-popover" data-trigger="manual" data-placement="right">2</a></span>]. 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 [<span class="xref"><span id="XREF_B3" class="ref-destination-back"></span><a href="#B3" data-id="XREF_B3" data-toggle="ref-popover" data-trigger="manual" data-placement="right">3</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B4" class="ref-destination-back"></span><a href="#B4" data-id="XREF_B4" data-toggle="ref-popover" data-trigger="manual" data-placement="right">4</a></span>]. While the intake of fruits, vegetables, and whole grains has decreased, the consumption of sodium and saturated fat has increased [<span class="xref"><span id="XREF_B5" class="ref-destination-back"></span><a href="#B5" data-id="XREF_B5" data-toggle="ref-popover" data-trigger="manual" data-placement="right">5</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B6" class="ref-destination-back"></span><a href="#B6" data-id="XREF_B6" data-toggle="ref-popover" data-trigger="manual" data-placement="right">6</a></span>]. Nutritional imbalances resulting from these dietary changes reportedly account for over 50% of diet-related deaths and approximately 66% of disability-adjusted life years [<span class="xref"><span id="XREF_B5" class="ref-destination-back"></span><a href="#B5" data-id="XREF_B5" data-toggle="ref-popover" data-trigger="manual" data-placement="right">5</a></span>]. 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 [<span class="xref"><span id="XREF_B7" class="ref-destination-back"></span><a href="#B7" data-id="XREF_B7" data-toggle="ref-popover" data-trigger="manual" data-placement="right">7</a></span>].</p> 474<p>Among the various approaches to addressing modern dietary challenges, growing global attention has been directed toward food security (FS) [<span class="xref"><span id="XREF_B8" class="ref-destination-back"></span><a href="#B8" data-id="XREF_B8" data-toggle="ref-popover" data-trigger="manual" data-placement="right">8</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B9" class="ref-destination-back"></span><a href="#B9" data-id="XREF_B9" data-toggle="ref-popover" data-trigger="manual" data-placement="right">9</a></span>]. FS refers to âa 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 lifeâ [<span class="xref"><span id="XREF_B10" class="ref-destination-back"></span><a href="#B10" data-id="XREF_B10" data-toggle="ref-popover" data-trigger="manual" data-placement="right">10</a></span>]. The Committee on World Food Security emphasizes that achieving FS requires adequate sanitation, health services, and social infrastru
474cture [<span class="xref"><span id="XREF_B11" class="ref-destination-back"></span><a href="#B11" data-id="XREF_B11" data-toggle="ref-popover" data-trigger="manual" data-placement="right">11</a></span>]. 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) [<span class="xref"><span id="XREF_B12" class="ref-destination-back"></span><a href="#B12" data-id="XREF_B12" data-toggle="ref-popover" data-trigger="manual" data-placement="right">12</a></span>]. The United States Department of Agriculture (USDA) defines FI as âthe limited or uncertain availability of nutritionally adequate and safe foods, or the inability to acquire such foods in socially acceptable waysâ [<span class="xref"><span id="XREF_B13" class="ref-destination-back"></span><a href="#B13" data-id="XREF_B13" data-toggle="ref-popover" data-trigger="manual" data-placement="right">13</a></span>]. 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 [<span class="xref"><span id="XREF_B14" class="ref-destination-back"></span><a href="#B14" data-id="XREF_B14" data-toggle="ref-popover" data-trigger="manual" data-placement="right">14</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B15" class="ref-destination-back"></span><a href="#B15" data-id="XREF_B15" data-toggle="ref-popover" data-trigger="manual" data-placement="right">15</a></span>]. Through the Sustainable Development Goals, the United Nations designated the elimination of FI and the achievement of FS as global priorities [<span class="xref"><span id="XREF_B16" class="ref-destination-back"></span><a href="#B16" data-id="XREF_B16" data-toggle="ref-popover" data-trigger="manual" data-placement="right">16</a></span>]. 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 [<span class="xref"><span id="XREF_B17" class="ref-destination-back"></span><a href="#B17" data-id="XREF_B17" data-toggle="ref-popover" data-trigger="manual" data-placement="right">17</a></span>], approximately 30.4% of the global population experiences severe FI [<span class="xref"><span id="XREF_B18" class="ref-destination-back"></span><a href="#B18" data-id="XREF_B18" data-toggle="ref-popover" data-trigger="manual" data-placement="right">18</a></span>]. This finding highlights that FI remains a critical global issue despite international efforts.</p> 475<p>In this context, food literacy (FL) has gained attention as a core competency for alleviating FI and promoting healthy eating behaviors [<span class="xref"><span id="XREF_B19" class="ref-destination-back"></span><a href="#B19" data-id="XREF_B19" data-toggle="ref-popover" data-trigger="manual" data-placement="right">19</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B20" class="ref-destination-back"></span><a href="#B20" data-id="XREF_B20" data-toggle="ref-popover" data-trigger="manual" data-placement="right">20</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B21" class="ref-destination-back"></span><a href="#B21" data-id="XREF_B21" data-toggle="ref-popover" data-trigger="manual" data-placement="right">21</a></span>]. Numerous studies have reported a close association between these 2 concepts [<span class="xref"><span id="XREF_B2" class="ref-destination-back"></span><a href="#B2" data-id="XREF_B2" data-toggle="ref-popover" data-trigger="manual" data-placement="right">2</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B23" class="ref-destination-back"></span><a href="#B23" data-id="XREF_B23" data-toggle="ref-popover" data-trigger="manual" data-placement="right">23</a></span>]. 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 [<span class="xref"><span id="XREF_B24" class="ref-destination-back"></span><a href="#B24" data-id="XREF_B24" data-toggle="ref-popover" data-trigger="manual" data-placement="right">24</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B25" class="ref-destination-back"></span><a href="#B25" data-id="XREF_B25" data-toggle="ref-popover" data-trigger="manual" data-placement="right">25</a></span>]. 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 [<span class="xref"><span id="XREF_B26" class="ref-destination-back"></span><a href="#B26" data-id="XREF_B26" data-toggle="ref-popover" data-trigger="manual" data-placement="right">26</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B27" class="ref-destination-back"></span><a href="#B27" data-id="XREF_B27" data-toggle="ref-popover" data-trigger="manual" data-placement="right">27</a></span>]. 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 [<span class="xref"><span id="XREF_B20" class="ref-destination-back"></span><a href="#B20" data-id="XREF_B20" data-toggle="ref-popover" data-trigger="manual" data-placement="right">20</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B28" class="ref-destination-back"></span><a href="#B28" data-id="XREF_B28" data-toggle="ref-popover" data-trigger="manual" data-placement="right">28</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B29" class="ref-destination-back"></span><a href="#B29" data-id="XREF_B29" data-toggle="ref-popover" data-trigger="manual" data-placement="right">29</a></span>]. 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 [<span class="xref"><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B30" class="ref-destination-back"></span><a href="#B30" data-id="XREF_B30" data-toggle="ref-popover" data-trigger="manual" data-placement="right">30</a></span>].</p> 476<p>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 [<span class="xref"><span id="XREF_B31" class="ref-destination-back"></span><a href="#B31" data-id="XREF_B31" data-toggle="ref-popover" data-trigger="manual" data-placement="right">31</a></span>]. 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 [<span class="xref"><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B31" class="ref-destination-back"></span><a href="#B31" data-id="XREF_B31" data-toggle="ref-popover" data-trigger="manual" data-placement="right">31</a></span>]. 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 c
476ontexts and study frameworks, consequently limiting the comprehensive understanding of the overall relationship between the 2 variables. Therefore, this systematic review aimed:</p> 477<div> 478<a name="L1"></a><ul class="listitem" style="list-style-type: none;"> 479 480<li class="listitem"><p>1) to review previous studies on FL and FI and summarize the definitions and key components of both concepts, and</p></li> 481 482<li class="listitem"><p>2) to compare and analyze the major measurement tools and findings used in the existing studies and examine the trends and characteristics of the relationship between FL and FI.</p></li> 483 484</ul> 485</div> 486</div> 487 488<div> 489<div><div class="article-section-header"> 490<div class="__SECTION__" id="__ID_SECTION_2" data-section-name="MATERIALS AND METHODS"><div class="dropdown"> 491<a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_2" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_2"></div> 492</div></div> 493<h2>MATERIALS AND METHODS</h2> 494</div></div> 495<p>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 [<span class="xref"><span id="XREF_B32" class="ref-destination-back"></span><a href="#B32" data-id="XREF_B32" data-toggle="ref-popover" data-trigger="manual" data-placement="right">32</a></span>]. The research question guiding this review was: âHow is food literacy associated with food insecurity across diverse population groups?â 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 [<span class="xref"><span id="XREF_B33" class="ref-destination-back"></span><a href="#B33" data-id="XREF_B33" data-toggle="ref-popover" data-trigger="manual" data-placement="right">33</a></span>].</p> 496<div> 497<p class="article-section-sub-title article-section-sub-title-level-2"><h3>Information sources and search strategy</h3></p> 498<p>A comprehensive literature search was conducted between July and September 2025 using the PubMed, Web of Science, and Google Scholar databases. The following search strategy was applied: âfood literacyâ AND (âfood insecurityâ OR âfood securityâ). As studies jointly examining FL and FI have emerged relatively recently, no restrictions on publication year were applied to minimize the risk of omitting relevant evidence.</p> 499</div> 500<div> 501<p class="article-section-sub-title article-section-sub-title-level-2"><h3>Eligibility criteria</h3></p> 502<p>Studies were eligible for inclusion if they were original research articles that assessed both FL and FI as primary variables and reported their relationship using quantitative and/or qualitative methods. No restrictions were placed on participantsâ age or country of origin. Studies were excluded if they assessed only 1 of the 2 variables, focused solely on related concepts such as nutrition literacy or health literacy, or were not original research (e.g., reviews, editorials, or commentaries). In addition, theoretical papers or exploratory studies that were not directly aligned with the research question were excluded.</p> 503</div> 504<div> 505<p class="article-section-sub-title article-section-sub-title-level-2"><h3>Study selection process</h3></p> 506<p>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 (<span class="fig-table-link"><a href="#F1">Fig. 1</a></span>).<div class="image-at-section"></div></p> 507<p><div class="article-fig image-at-section"><div class="article-figure-table" id="F1"><div class="article-figure-table-card" id="FIGURE-F1" data-type="F" data-afn="161_NRP_20_4_557" data-fn="nrp-20-557-g001_0161NRP"><div class="card border-0 my-3"><div class="row no-gutters"> 508<div class="col-md-4 mx-auto d-flex justify-content-center flex-wrap align-middle"><div class="card-body"> 509<a href="#" class="article-figure-table-btn" data-type="F"><img class="align-top" src="/ArticleImage/0161NRP/nrp-20-557-g001-m.jpg"></a> 510</div></div> 511<div class="col-md-8"><div class="card-body"> 512<p class="card-text"><span class="label"><a href="#" class="article-figure-table-btn" data-type="F">Fig. 1</a> 513</span><span class="capture-id"><br><span class="capture-id">Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of search.</span><br><span class="capture-id">FL, food literacy; FI, food insecurity.</span></span></p> 514<ul class="list-inline"> 515<li class="list-inline-item">
515<a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="F">Click for larger image</a></li> 516<li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm" href="ViewImagePopup.php?Type=FP&id=F1&afn=161_NRP_20_4_557&fn=nrp-20-557-g001_0161NRP" target="_blank">Download as PowerPoint slide</a></li> 517</ul> 518</div></div> 519</div></div></div></div></div></p> 520</div> 521<div> 522<p class="article-section-sub-title article-section-sub-title-level-2"><h3>Quality appraisal</h3></p> 523<p>The methodological quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklists [<span class="xref"><span id="XREF_B34" class="ref-destination-back"></span><a href="#B34" data-id="XREF_B34" data-toggle="ref-popover" data-trigger="manual" data-placement="right">34</a></span>], with tools selected according to study design. Specifically, the checklist for analytical cross-sectional studies (8 items), quasi-experimental studies (9 items), and randomized controlled trials (RCTs; 13 items) were applied as appropriate. Each item was rated as Yes, No, Unclear, or Not applicable. Quality appraisal was conducted independently by 2 reviewers. To ensure consistency, assessment criteria were agreed upon in advance. Unclear was assigned when an item may have been addressed but was insufficiently reported, whereas No was used only when the item was clearly absent or structurally not feasible given the study design. Discrepancies between reviewers were resolved through discussion and re-examination of the original articles, with consultation from a third reviewer when necessary. Overall methodological quality was categorized as High, Moderate, or Low based on the extent to which key methodological criteria were met.</p> 524</div> 525<div> 526<p class="article-section-sub-title article-section-sub-title-level-2"><h3>Data extraction and synthesis</h3></p> 527<p>Data were extracted using a standardized form and included information on authors, year of publication, country of study, study objectives, definitions and measurement tools for FL and FI, and key findings. Data extraction was performed by one reviewer and cross-checked by a second reviewer to ensure accuracy. Due to heterogeneity in study designs, measurement instruments, and outcome measures, a meta-analysis was not conducted. Instead, results were synthesized narratively. Studies were first grouped by study design and then compared according to conceptual definitions and components of FL and FI, characteristics of measurement tools, the direction and consistency of associations or intervention effects, and study populations and contexts. Common patterns, differences, and contextual factors across studies were identified and integrated narratively. Key findings are summarized in tables, with similarities and differences across studies described in the text.</p> 528</div> 529</div> 530 531<div> 532<div><div class="article-section-header"> 533<div class="__SECTION__" id="__ID_SECTION_3" data-section-name="RESULTS"><div class="dropdown"> 534<a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_3" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_3"></div> 535</div></div> 536<h2>RESULTS</h2> 537</div></div> 538<div> 539<p class="article-section-sub-title article-section-sub-title-level-2"><h3>Summary of the included studies</h3></p> 540<p> 541<span class="fig-table-link"><a href="#T1">Table 1</a></span> summarizes the main characteristics of the 9 studies meeting the inclusion criteria. These studies published between 2019 and 2025 were conducted across diverse cultural and regional contexts, including Australia, the United States, Iran, Lebanon, Saudi Arabia, and South Korea. All studies examined the relationship between FL and FI. The study designs varied and comprised cross-sectional design (n = 5), mixed-methods design incorporating surveys and interviews (n = 1), quasi-experimental analysis with preâpost designs (n = 2), and cluster RCT design (n = 1). Five studies analyzed the correlations between the FL and FI; 3 assessed the effects of FL interventions by examining the preâpost changes; and 1 explored the relationship between FL and food consumption behaviors. The samples were recruited through community organizations (n = 5), schools (n = 2), and nationally stratified sampling (n = 2). The study durations ranged from 4 to 6 weeks (n = 3) to over 2 yrs (n = 1), with one program interrupted by coronavirus disease 2019 and resumed after approximately 3 yrs. The participant groups included low-income adults, elementary school students, university students, older adults, youthâparent dyads, and household food purchasers, with sample sizes ranging from 38 to 3,321. The primary variables measured were FL and FI, along with the subcomponents such as eating behaviors, cooking confidence, nutrition knowledge, and food consumption frequency.<div class="image-at-section"></div></p> 542<p><div class="article-table image-at-section"><div class="article-figure-table" id="T1"><div class="article-figure-table-card" id="TABLE-T1" data-type="T" data-afn="161_NRP_20_4_557" data-fn="nrp-20-557-i001_0161NRP"><div class="card border-0 my-3"><div class="row no-gutters"> 543<div class="col-md-4 mx-auto d-flex justify-content-center flex-wrap align-middle"><div class="card-body"> 544<a href="#" class="article-figure-table-btn" data-type="TH"><img class="align-top" src="/ArticleImage/0161NRP/nrp-20-557-i001-m.jpg"></a> 545</div></div> 546<div class="col-md-8"><div class="card-body"> 547<p class="card-text"><span class="label"><a href="#" class="article-figure-table-btn" data-type="T">Table 1</a> 548</span><span class="capture-id"><br><span class="capture-id">
548Summary of included studies</span></span></p> 549<ul class="list-inline"> 550<li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="T">Click for larger image</a></li> 551<li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="TH">Click for full table</a></li> 552<li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm" href="ViewImagePopup.php?Type=TX&id=T1&afn=161_NRP_20_4_557&fn=nrp-20-557-i001_0161NRP" target="_blank">Download as Excel file</a></li> 553</ul> 554</div></div> 555</div></div></div></div></div></p> 556</div> 557<div> 558<p class="article-section-sub-title article-section-sub-title-level-2"><h3>Definitions of FI and FL</h3></p> 559<p> 560<span class="fig-table-link"><a href="#T2">Table 2</a></span> presents the FI and FL definitions used in the 9 studies included in this systematic review. Most studies based their conceptualization of FI on the definitions proposed by the FAO or the USDA. Some adapted these definitions to fit their specific research purposes. Studies following the FAO definition [<span class="xref"><span id="XREF_B2" class="ref-destination-back"></span><a href="#B2" data-id="XREF_B2" data-toggle="ref-popover" data-trigger="manual" data-placement="right">2</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B35" class="ref-destination-back"></span><a href="#B35" data-id="XREF_B35" data-toggle="ref-popover" data-trigger="manual" data-placement="right">35</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B36" class="ref-destination-back"></span><a href="#B36" data-id="XREF_B36" data-toggle="ref-popover" data-trigger="manual" data-placement="right">36</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B37" class="ref-destination-back"></span><a href="#B37" data-id="XREF_B37" data-toggle="ref-popover" data-trigger="manual" data-placement="right">37</a></span>] described FI as a condition in which oneâs physical, social, or economic access to adequate and safe food is limited or uncertain. Those adopting the USDA definition [<span class="xref"><span id="XREF_B38" class="ref-destination-back"></span><a href="#B38" data-id="XREF_B38" data-toggle="ref-popover" data-trigger="manual" data-placement="right">38</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B39" class="ref-destination-back"></span><a href="#B39" data-id="XREF_B39" data-toggle="ref-popover" data-trigger="manual" data-placement="right">39</a></span>] conceptualized FI as an economic and social condition that is characterized by a limited or uncertain access to sufficient quantities and quality of food. Morgan <i>et al</i>. [<span class="xref"><span id="XREF_B40" class="ref-destination-back"></span><a href="#B40" data-id="XREF_B40" data-toggle="ref-popover" data-trigger="manual" data-placement="right">40</a></span>] emphasized the lack of âsufficient quantity of foodâ whereas Nam <i>et al</i>. [<span class="xref"><span id="XREF_B41" class="ref-destination-back"></span><a href="#B41" data-id="XREF_B41" data-toggle="ref-popover" data-trigger="manual" data-placement="right">41</a></span>] highlighted âlimited access to and instability of nutritionally adequate foodâ succinctly capturing the essential elements of the existing definitions.<div class="image-at-section"></div></p> 561<p><div class="article-table image-at-section"><div class="article-figure-table" id="T2"><div class="article-figure-table-card" id="TABLE-T2" data-type="T" data-afn="161_NRP_20_4_557" data-fn="nrp-20-557-i002_0161NRP"><div class="card border-0 my-3"><div class="row no-gutters"> 562<div class="col-md-4 mx-auto d-flex justify-content-center flex-wrap align-middle"><div class="card-body"> 563<a href="#" class="article-figure-table-btn" data-type="TH"><img class="align-top" src="/ArticleImage/0161NRP/nrp-20-557-i002-m.jpg"></a> 564</div></div> 565<div class="col-md-8"><div class="card-body"> 566<p class="card-text"><span class="label"><a href="#" class="article-figure-table-btn" data-type="T">Table 2</a> 567</span><span class="capture-id"><br><span class="capture-id">
567Definitions of FI and FL in the included studies</span></span></p> 568<ul class="list-inline"> 569<li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="T">Click for larger image</a></li> 570<li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="TH">Click for full table</a></li> 571<li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm" href="ViewImagePopup.php?Type=TX&id=T2&afn=161_NRP_20_4_557&fn=nrp-20-557-i002_0161NRP" target="_blank">Download as Excel file</a></li> 572</ul> 573</div></div> 574</div></div></div></div></div></p> 575<p>Regarding FL, most studies adopted the definition proposed by Vidgen and Gallegos [<span class="xref"><span id="XREF_B30" class="ref-destination-back"></span><a href="#B30" data-id="XREF_B30" data-toggle="ref-popover" data-trigger="manual" data-placement="right">30</a></span>]. Based on this framework, studies [<span class="xref"><span id="XREF_B2" class="ref-destination-back"></span><a href="#B2" data-id="XREF_B2" data-toggle="ref-popover" data-trigger="manual" data-placement="right">2</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B36" class="ref-destination-back"></span><a href="#B36" data-id="XREF_B36" data-toggle="ref-popover" data-trigger="manual" data-placement="right">36</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B38" class="ref-destination-back"></span><a href="#B38" data-id="XREF_B38" data-toggle="ref-popover" data-trigger="manual" data-placement="right">38</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B40" class="ref-destination-back"></span><a href="#B40" data-id="XREF_B40" data-toggle="ref-popover" data-trigger="manual" data-placement="right">40</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B41" class="ref-destination-back"></span><a href="#B41" data-id="XREF_B41" data-toggle="ref-popover" data-trigger="manual" data-placement="right">41</a></span>] consistently defined FL as a set of knowledge, skills, and behaviors required for food planning, managing, selecting, preparing, and eating. The 4 domains outlined by Vidgen and Gallegos [<span class="xref"><span id="XREF_B30" class="ref-destination-back"></span><a href="#B30" data-id="XREF_B30" data-toggle="ref-popover" data-trigger="manual" data-placement="right">30</a></span>], namely, planning and management, selection, preparation, and eating, refer to efficient resource and time management, the ability to interpret food information and make appropriate choices, the use of safe and effective cooking techniques, and the maintenance of healthy eating practices, respectively. Kearsey <i>et al</i>. [<span class="xref"><span id="XREF_B37" class="ref-destination-back"></span><a href="#B37" data-id="XREF_B37" data-toggle="ref-popover" data-trigger="manual" data-placement="right">37</a></span>] extended this definition by emphasizing the practical competencies necessary for optimal health. In contrast, Khorramrouz <i>et al</i>. [<span class="xref"><span id="XREF_B35" class="ref-destination-back"></span><a href="#B35" data-id="XREF_B35" data-toggle="ref-popover" data-trigger="manual" data-placement="right">35</a></span>] used the term âFood and Nutrition Literacy (FNLIT)â framing it as a comprehensive concept encompassing not only caloric adequacy but also the technical, cultural, and ethical dimensions of food. Royer <i>et al</i>. [<span class="xref"><span id="XREF_B39" class="ref-destination-back"></span><a href="#B39" data-id="XREF_B39" data-toggle="ref-popover" data-trigger="manual" data-placement="right">39</a></span>] provided a more concise definition, describing FL as food-related knowledge and skill proficiency.</p> 576</div> 577<div> 578<p class="article-section-sub-title article-section-sub-title-level-2"><h3>Measurement of FI and FL</h3></p> 579<p> 580<span class="fig-table-link"><a href="#T3">Table 3</a></span> summarizes the measurement tools, items, and main findings concerning the associations between FI and FL in each work. FI was asse
580ssed using diverse approaches. Some studies employed single-item questions to directly assess whether individuals or households were able to purchase sufficient food during a recent period [<span class="xref"><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B41" class="ref-destination-back"></span><a href="#B41" data-id="XREF_B41" data-toggle="ref-popover" data-trigger="manual" data-placement="right">41</a></span>]. The structured scales included the Household Food Insecurity Access Scale, Arab Family Food Security Scale, Arabic version of the Food Insecurity Experience Scale, and self-reported adolescent scales capturing financial constraints, food depletion, deficiencies in meal quantity and quality, and experiences of hunger [<span class="xref"><span id="XREF_B35" class="ref-destination-back"></span><a href="#B35" data-id="XREF_B35" data-toggle="ref-popover" data-trigger="manual" data-placement="right">35</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B38" class="ref-destination-back"></span><a href="#B38" data-id="XREF_B38" data-toggle="ref-popover" data-trigger="manual" data-placement="right">38</a></span>]. Other studies used the USDA 6-item short form to measure FI at the individual level [<span class="xref"><span id="XREF_B2" class="ref-destination-back"></span><a href="#B2" data-id="XREF_B2" data-toggle="ref-popover" data-trigger="manual" data-placement="right">2</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B37" class="ref-destination-back"></span><a href="#B37" data-id="XREF_B37" data-toggle="ref-popover" data-trigger="manual" data-placement="right">37</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B39" class="ref-destination-back"></span><a href="#B39" data-id="XREF_B39" data-toggle="ref-popover" data-trigger="manual" data-placement="right">39</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B40" class="ref-destination-back"></span><a href="#B40" data-id="XREF_B40" data-toggle="ref-popover" data-trigger="manual" data-placement="right">40</a></span>]. FL was also assessed using various instruments depending on the study objectives and populations. Begley <i>et al</i>. [<span class="xref"><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span>] employed an FL behavior checklist, while Khorramrouz <i>et al</i>. [<span class="xref"><span id="XREF_B35" class="ref-destination-back"></span><a href="#B35" data-id="XREF_B35" data-toggle="ref-popover" data-trigger="manual" data-placement="right">35</a></span>] utilized the FNLIT tool encompassing the cognitive and skill domains. Hoteit <i>et al</i>. [<span class="xref"><span id="XREF_B38" class="ref-destination-back"></span><a href="#B38" data-id="XREF_B38" data-toggle="ref-popover" data-trigger="manual" data-placement="right">38</a></span>] and Hanbazaza <i>et al</i>. [<span class="xref"><span id="XREF_B36" class="ref-destination-back"></span><a href="#B36" data-id="XREF_B36" data-toggle="ref-popover" data-trigger="manual" data-placement="right">36</a></span>] employed the Short Food Literacy Questionnaire to evaluate the information use, dietary guideline awareness, daily application, and critical appraisal. Nam <i>et al</i>. [<span class="xref"><span id="XREF_B41" class="ref-destination-back"></span><a href="#B41" data-id="XREF_B41" data-toggle="ref-popover" data-trigger="manual" data-placement="right">41</a></span>] used a Korean version encompassing knowledge, attitudes, and behaviors, including willingness to pay more for healthy foods. West <i>et al</i>. [<span class="xref"><span id="XREF_B2" class="ref-destination-back"></span><a href="#B2" data-id="XREF_B2" data-toggle="ref-popover" data-trigger="manual" data-placement="right">2</a></span>] and Kearsey <i>et al</i>. [<span class="xref"><span id="XREF_B37" class="ref-destination-back"></span><a href="#B37" data-id="XREF_B37" data-toggle="ref-popover" data-trigger="manual" data-placement="right">37</a></span>] applied survey instruments that focus on cooking confidence, food-related behaviors, and nutrition knowledge to assess the preâpost changes following interventions. Morgan <i>et al</i>. [<span class="xref"><span id="XREF_B40" class="ref-destination-back"></span>
580<a href="#B40" data-id="XREF_B40" data-toggle="ref-popover" data-trigger="manual" data-placement="right">40</a></span>] measured skills and self-efficacy to evaluate the intervention effects, while Royer <i>et al</i>. [<span class="xref"><span id="XREF_B39" class="ref-destination-back"></span><a href="#B39" data-id="XREF_B39" data-toggle="ref-popover" data-trigger="manual" data-placement="right">39</a></span>] utilized fruit and vegetable intake frequency as an indirect indicator of changes in FL.<div class="image-at-section"></div></p> 581<p><div class="article-table image-at-section"><div class="article-figure-table" id="T3"><div class="article-figure-table-card" id="TABLE-T3" data-type="T" data-afn="161_NRP_20_4_557" data-fn="nrp-20-557-i003_0161NRP"><div class="card border-0 my-3"><div class="row no-gutters"> 582<div class="col-md-4 mx-auto d-flex justify-content-center flex-wrap align-middle"><div class="card-body"> 583<a href="#" class="article-figure-table-btn" data-type="TH"><img class="align-top" src="/ArticleImage/0161NRP/nrp-20-557-i003-m.jpg"></a> 584</div></div> 585<div class="col-md-8"><div class="card-body"> 586<p class="card-text"><span class="label"><a href="#" class="article-figure-table-btn" data-type="T">Table 3</a> 587</span><span class="capture-id"><br><span class="capture-id">Measurement of FI and FL in the included studies</span></span></p> 588<ul class="list-inline"> 589<li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="T">Click for larger image</a></li> 590<li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="TH">Click for full table</a></li> 591<li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm" href="ViewImagePopup.php?Type=TX&id=T3&afn=161_NRP_20_4_557&fn=nrp-20-557-i003_0161NRP" target="_blank">Download as Excel file</a></li> 592</ul> 593</div></div> 594</div></div></div></div></div></p> 595</div> 596<div> 597<p class="article-section-sub-title article-section-sub-title-level-2"><h3>Key findings on FL and FI</h3></p> 598<p> 599<span class="fig-table-link"><a href="#T4">Table 4</a></span> summarizes the key findings on the association between FL and FI across studies. To further examine these findings from a domain-specific perspective, additional results are presented in <span class="fig-table-link"><a href="#S1">Supplementary Table 1</a></span>. Begley <i>et al</i>. [<span class="xref"><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span>] identified low confidence in the budgeting and cooking skills as the key predictors of FI, whereas the price comparison behavior served as a protective factor. In addition, financial management capacity related to food purchasing was reported as an important factor in differentiating FI status. Khorramrouz <i>et al</i>. [<span class="xref"><span id="XREF_B35" class="ref-destination-back"></span><a href="#B35" data-id="XREF_B35" data-toggle="ref-popover" data-trigger="manual" data-placement="right">35</a></span>] and Hoteit <i>et al</i>. [<span class="xref"><span id="XREF_B38" class="ref-destination-back"></span><a href="#B38" data-id="XREF_B38" data-toggle="ref-popover" data-trigger="manual" data-placement="right">38</a></span>] found that children and adolescents from food-insecure households were significantly more likely to exhibit lower FL scores. Hoteit <i>et al</i>. [<span class="xref"><span id="XREF_B38" class="ref-destination-back"></span><a href="#B38" data-id="XREF_B38" data-toggle="ref-popover" data-trigger="manual" data-placement="right">38</a></span>] further reported that lower parental education levels, lower household income, and larger household size were significantly associated with household FI. Nam <i>et al</i>. [<span class="xref"><span id="XREF_B41" class="ref-destination-back"></span><a href="#B41" data-id="XREF_B41" data-toggle="ref-popover" data-trigger="manual" data-placement="right">41</a></span>] reported that food-insecure households scored lower in terms of knowledge, attitudes, behaviors, and willingness to pay for healthy food. Economic status was identified as an important factor influencing willingness to pay for healthier food across groups. The path from attitude to behavior was significant, but direct paths among knowledge, attitude, behavior, and willingness to pay were not. Conversely, Hanbazaza <i>et al</i>. [<span class="xref"><span id="XREF_B36" class="ref-destination-back"></span><a href="#B36" data-id="XREF_B36" data-toggle="ref-popover" data-trigger="manual" data-placement="right">36</a></span>] found no significant difference between FL and FI levels despite a high FI prevalence among participants who generally demonstrated adequate FL. Higher FI w
599as also associated with a lower consumption of the key food groups.<div class="image-at-section"></div></p> 600<p><div class="article-table image-at-section"><div class="article-figure-table" id="T4"><div class="article-figure-table-card" id="TABLE-T4" data-type="T" data-afn="161_NRP_20_4_557" data-fn="nrp-20-557-i004_0161NRP"><div class="card border-0 my-3"><div class="row no-gutters"> 601<div class="col-md-4 mx-auto d-flex justify-content-center flex-wrap align-middle"><div class="card-body"> 602<a href="#" class="article-figure-table-btn" data-type="TH"><img class="align-top" src="/ArticleImage/0161NRP/nrp-20-557-i004-m.jpg"></a> 603</div></div> 604<div class="col-md-8"><div class="card-body"> 605<p class="card-text"><span class="label"><a href="#" class="article-figure-table-btn" data-type="T">Table 4</a> 606</span><span class="capture-id"><br><span class="capture-id">Key findings on FL and FI in the included studies</span></span></p> 607<ul class="list-inline"> 608<li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="T">Click for larger image</a></li> 609<li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="TH">Click for full table</a></li> 610<li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm" href="ViewImagePopup.php?Type=TX&id=T4&afn=161_NRP_20_4_557&fn=nrp-20-557-i004_0161NRP" target="_blank">Download as Excel file</a></li> 611</ul> 612</div></div> 613</div></div></div></div></div></p> 614<p>Intervention studies generally showed that the FL improvements were linked to FI reductions. West <i>et al</i>. [<span class="xref"><span id="XREF_B2" class="ref-destination-back"></span><a href="#B2" data-id="XREF_B2" data-toggle="ref-popover" data-trigger="manual" data-placement="right">2</a></span>] found that after an educational program, the FI levels decreased, while all FL domains significantly improved, although the participants noted that budget constraints limited practical application. Participants reported that economic and budgetary constraints remained barriers to implementing newly acquired food-related skills. Kearsey <i>et al</i>. [<span class="xref"><span id="XREF_B37" class="ref-destination-back"></span><a href="#B37" data-id="XREF_B37" data-toggle="ref-popover" data-trigger="manual" data-placement="right">37</a></span>] reported increased FS and decreased FI following intervention, along with improvements in nutrition knowledge, cooking confidence, food preparation behaviors, and vegetable, fruit, and water intake. Cooking confidence and vegetable and fruit consumption remained higher at the 6-mon follow-up. Morgan <i>et al</i>. [<span class="xref"><span id="XREF_B40" class="ref-destination-back"></span><a href="#B40" data-id="XREF_B40" data-toggle="ref-popover" data-trigger="manual" data-placement="right">40</a></span>] observed no significant changes in FI but found enhanced FL skills and self-efficacy. This result suggests a potential indirect effect. Meanwhile, in a 12-mon RCT, Royer <i>et al</i>. [<span class="xref"><span id="XREF_B39" class="ref-destination-back"></span><a href="#B39" data-id="XREF_B39" data-toggle="ref-popover" data-trigger="manual" data-placement="right">39</a></span>] reported that intervention group participants showed significantly lower odds of FI, with the increased fruit and vegetable intake negatively correlated with FI.</p> 615</div> 616</div> 617 618<div> 619<div><div class="article-section-header"> 620<div class="__SECTION__" id="__ID_SECTION_4" data-section-name="DISCUSSION"><div class="dropdown"> 621<a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_4" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_4"></div> 622</div></div> 623<h2>DISCUSSION</h2> 624</div></div> 625<p>This review synthesized studies conducted across various countries and population groups to examine the relationship between FL and FI. Multiple cross-sectional studies [<span class="xref"><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B35" class="ref-destination-back"></span><a href="#B35" data-id="XREF_B35" data-toggle="ref-popover" data-trigger="manual" data-placement="right">35</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B38" class="ref-destination-back"></span><a href="#B38" data-id="XREF_B38" data-toggle="ref-popover" data-trigger="manual" data-placement="right">
62538</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B41" class="ref-destination-back"></span><a href="#B41" data-id="XREF_B41" data-toggle="ref-popover" data-trigger="manual" data-placement="right">41</a></span>] 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 <i>et al</i>. [<span class="xref"><span id="XREF_B38" class="ref-destination-back"></span><a href="#B38" data-id="XREF_B38" data-toggle="ref-popover" data-trigger="manual" data-placement="right">38</a></span>] further identified associations between parental education, income, FL levels, and childrenâs 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 adolescentsâ food choice behaviors [<span class="xref"><span id="XREF_B42" class="ref-destination-back"></span><a href="#B42" data-id="XREF_B42" data-toggle="ref-popover" data-trigger="manual" data-placement="right">42</a></span>]. 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 âfood deserts,â where limited access to supermarkets or fresh food markets constrains food choices, even among individuals with high FL [<span class="xref"><span id="XREF_B43" class="ref-destination-back"></span><a href="#B43" data-id="XREF_B43" data-toggle="ref-popover" data-trigger="manual" data-placement="right">43</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B44" class="ref-destination-back"></span><a href="#B44" data-id="XREF_B44" data-toggle="ref-popover" data-trigger="manual" data-placement="right">44</a></span>]. Older adults, those with low educational attainment, and rural residents were also identified as having lower FL levels [<span class="xref"><span id="XREF_B45" class="ref-destination-back"></span><a href="#B45" data-id="XREF_B45" data-toggle="ref-popover" data-trigger="manual" data-placement="right">45</a></span>].</p> 626<p>However, Hanbazaza <i>et al</i>. [<span class="xref"><span id="XREF_B36" class="ref-destination-back"></span><a href="#B36" data-id="XREF_B36" data-toggle="ref-popover" data-trigger="manual" data-placement="right">36</a></span>] found no significant relationship between the 2 variables. The authors attributed this finding to the sociocultural context of Saudi Arabia, including patriarchal family structures, womenâs 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 [<span class="xref"><span id="XREF_B46" class="ref-destination-back"></span><a href="#B46" data-id="XREF_B46" data-toggle="ref-popover" data-trigger="manual" data-placement="right">46</a></span>]. In immigrant households, language barriers and dietary acculturation challenges tend to lower FL and increase vulnerability to FI [<span class="xref"><span id="XREF_B47" class="ref-destination-back"></span><a href="#B47" data-id="XREF_B47" data-toggle="ref-popover" data-trigger="manual" data-placement="right">47</a></span>], Similarly, in multicultural families, parental cultural background and eating habits directly affect childrenâs FL, while conflicts arising during cultural adaptation may exacerbate FI [<span class="xref"><span id="XREF_B48" class="ref-destination-back"></span><a href="#B48" data-id="XREF_B48" data-toggle="ref-popover" data-trigger="manual" data-placement="right">48</a></span>
626]. 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 [<span class="xref"><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span>]. 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.</p> 627<p>Intervention studies [<span class="xref"><span id="XREF_B37" class="ref-destination-back"></span><a href="#B37" data-id="XREF_B37" data-toggle="ref-popover" data-trigger="manual" data-placement="right">37</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B39" class="ref-destination-back"></span><a href="#B39" data-id="XREF_B39" data-toggle="ref-popover" data-trigger="manual" data-placement="right">39</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B40" class="ref-destination-back"></span><a href="#B40" data-id="XREF_B40" data-toggle="ref-popover" data-trigger="manual" data-placement="right">40</a></span>] 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.</p> 628<p>Nevertheless, economic constraints continued to act as barriers to behavioral implementation. In West <i>et al</i>. [<span class="xref"><span id="XREF_B2" class="ref-destination-back"></span><a href="#B2" data-id="XREF_B2" data-toggle="ref-popover" data-trigger="manual" data-placement="right">2</a></span>], 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 [<span class="xref"><span id="XREF_B45" class="ref-destination-back"></span><a href="#B45" data-id="XREF_B45" data-toggle="ref-popover" data-trigger="manual" data-placement="right">45</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B49" class="ref-destination-back"></span><a href="#B49" data-id="XREF_B49" data-toggle="ref-popover" data-trigger="manual" data-placement="right">49</a></span>]. 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 [<span class="xref"><span id="XREF_B50" class="ref-destination-back"></span><a href="#B50" data-id="XREF_B50" data-toggle="ref-popover" data-trigger="manual" data-placement="right">50</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B51" class="ref-destination-back"></span><a href="#B51" data-id="XREF_B51" data-toggle="ref-popover" data-trigger="manual" data-placement="right">51</a></span>].</p> 629<p>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 [<span class="xref"><span id="XREF_B52" class="ref-destination-back"></span><a href="#B52" data-id="XREF_B52" data-toggle="ref-popover" data-trigger="manual" data-placement="right">52</a></span>]. 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 [<span class="xref"><span id="XREF_B53" class="ref-destination-back"></span><a href="#B53" data-id="XREF_B53" data-toggle="ref-popover" data-trigger="manual" data-placement="right">53</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B54" class="ref-destination-back"></span><a href="#B54" data-id="XREF_B54" data-toggle="ref-popover" data-trigger="manual" data-placement="right">54</a></span>]. In Bangladesh, the âGraduationâ program provided asset transfers, skills training, and education for ultra-poor households, demonstrating sustainable improvements in FS in follow-up asse
629ssments [<span class="xref"><span id="XREF_B55" class="ref-destination-back"></span><a href="#B55" data-id="XREF_B55" data-toggle="ref-popover" data-trigger="manual" data-placement="right">55</a></span>]. These cases illustrate that strategies to enhance FL can be most effective when combined with structural interventions that address socioeconomic inequalities.</p> 630<p>The studies included in this review employed diverse statistical techniquesâsuch as ROC analysis, structural equation modeling, and multigroup analysisâto 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.</p> 631<p>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 [<span class="xref"><span id="XREF_B30" class="ref-destination-back"></span><a href="#B30" data-id="XREF_B30" data-toggle="ref-popover" data-trigger="manual" data-placement="right">30</a></span>], substantial heterogeneity existed in operational definitions and domain composition. Variations in included domainsâsuch as budgeting, cooking confidence, and knowledge-based componentsâ as well as the indirect assessment of FL through dietary indicators (e.g., fruit and vegetable intake in Royer <i>et al</i>. [<span class="xref"><span id="XREF_B39" class="ref-destination-back"></span><a href="#B39" data-id="XREF_B39" data-toggle="ref-popover" data-trigger="manual" data-placement="right">39</a></span>]) 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.</p> 632<p>Future research should include adequately powered intervention and longitudinal studies to further examine the relationship between FL and FI [<span class="xref"><span id="XREF_B28" class="ref-destination-back"></span><a href="#B28" data-id="XREF_B28" data-toggle="ref-popover" data-trigger="manual" data-placement="right">28</a></span>]. 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 interventionsâsuch as food assistance and price subsidiesâwhile 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.</p> 633<p>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.</p> 634</div> 635 636<div id="supplementary-material"><p><a id="#supplementary-material-sec" name="#supplementary-material-sec"></a> 637<div><div class="article-section-header"> 638<div class="__SECTION__" id="__ID_SECTION_5" data-section-name="SUPPLEMENTARY MATERIAL"><div class="dropdown"> 639<a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_5" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_5"></div> 640</div></div> 641<h2>SUPPLEMENTARY MATERIAL</h2> 642</div></div> 643<p class="supplementary-material-item"><span class="capture-id"> 644<h3>Supplementary Table 1</h3> 645<p>Domain-specific findings on FL</p> 646</span><a href="DownloadSupplMaterial.php?id=10.4162/nrp.2026.20.4.557&fn=nrp-20-557-s001.xls" id="S1">Click here to view.</a><sup class="supplementary-material-media-attribute">(32K, xls)</sup> 647</p></p></div> 648</div> 649 650<div id="article-level-0-figs-and-tables" class="bm bm-figure-tables"> 651 652</div> 653 654<div id="article-level-0-back" class="bm"> 655<div class="article-section-header"> 656<div class="__SECTION__" id="__ID_SECTION_6" data-section-name="Notes"><div class="dropdown"> 657<a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_6" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_6"></div> 658</div></div> 659<div class="article-section-title">Notes</div> 660</div> 661<div id=""><p><span class="fn-label">Funding:</span>This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (RS-2021-NR060133), and the Hallym University Research Fund (HRF-202409-007). The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.</p></div> 662<div id=""><p><span class="fn-label">Conflict of Interest:</span>The authors declare no potential conflicts of interests.</p></div> 663<div id=""><p><span class="fn-label">Author Contributions:</span> 664<div> 665<ul class="listitem" style="list-style-type: none;"> 666 667<li class="listitem"><p><b>Conceptualization:</b> Lee E, Jeong M, Kim J, Han D, Jang J, Jang E, Park S.</p></li> 668 669<li class="listitem"><p><b>Formal analysis:</b> Lee E, Jeong M.</p></li> 670 671<li class="listitem"><p><b>Investigation:</b> Lee E, Jeong M.</p></li> 672 673<li class="listitem"><p><b>Validation:</b> Lee E, Park S.</p></li> 674 675<li class="listitem"><p><b>Supervision:</b> Park S.</p></li> 676 677<li class="listitem"><p><b>Writing - original draft:</b> Lee E, Jeong M.</p></li> 678 679<li class="listitem"><p><b>Writing - review & editing:</b> Lee E, Park S.</p></li> 680 681</ul> 682</div> 683</p></div> 684 685<div class="references"> 686<div class="__SECTION__" id="__ID_SECTION_7" data-section-name="References"><div class="dropdown"> 687<a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_7" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_7"></div> 688</div></div> 689<h3 class="title">References</h3> 690</div> 691<div class="bm"> 692<tr> 693<td></td> 694<td></td> 695</tr> 696<ol> 697<li><ol class="references-and-notes-list"><li class="skip-numbering" value="1"> 698<div id="B1" class="ref-destination"></div> 699<div class="ref-item"> 700<span id="XREF_B1_DATA" class="ref-data" valign="top">Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, Brinsden H, Calvillo A, De Schutter O, Devarajan R, et al. 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1227-1 col-xl-3 col-lg-4 col-xs-12 "> 1228 <!-- 1229 // 1230 // PORTLET - FORMATS 1231 // 1232 --> 1233 <div class="d-lg-none"> 1234 <hr></hr> 1235 </div> 1236 1237 <div id="PortletFormatLink" class="porlet"> 1238 <ul class="list-group list-group-flush"> 1239 <li class="list-group-item ms-0 ps-0 "> 1240 <a class="format-item icon-link CiteDialog" href="#" onclick="" data-article-id=10.4162/nrp.2026.20.4.557 data-article-citation=TGVlIEUsIEplb25nIE0sIEtpbSBKLCBIYW4gRCwgSmFuZyBKLCBKYW5nIEUsIFBhcmsgUy4gRXhwbG9yaW5nIHRoZSByZWxhdGlvbnNoaXAgYmV0d2VlbiBmb29kIGxpdGVyYWN5IGFuZCBmb29kIGluc2VjdXJpdHk6IGEgc3lzdGVtYXRpYyByZXZpZXcuIE51dHIgUmVzIFByYWN0LiAyMDI2IEF1ZzsyMCg0KTo1NTctNTcwLiA8QSBIUkVGPSJodHRwczovL2RvaS5vcmcvMTAuNDE2Mi9ucnAuMjAyNi4yMC40LjU1NyIgdGFyZ2V0PV9ibGFuaz5odHRwczovL2RvaS5vcmcvMTAuNDE2Mi9ucnAuMjAyNi4yMC40LjU1NzwvQT4=> 1241 <div> 1242 <i aria-hidden="true" class="bi bi-quote"></i> 1243 </div> 1244 <span class="align-top">Cite</span> 1245 </a> 1246 </li> 1247 1248 <li class="list-group-item ms-0 ps-0 "> 1249 <a class="format-item icon-link " href="search.php?where=aview&id=10.4162/nrp.2026.20.4.557&code=0161NRP&vmode=FULL" onclick="" > 1250 <div> 1251 <i aria-hidden="true" class="bi bi-book"></i> 1252 </div> 1253 <span class="align-top">Article</span> 1254 </a> 1255 </li> 1256 1257 <li class="list-group-item ms-0 ps-0 "> 1258 <a class="format-item icon-link " href="/pdf/10.4162/nrp.2026.20.4.557" onclick="trackDownloadLink('PDF', '10.4162/nrp.2026.20.4.557');" > 1259 <div> 1260 <i aria-hidden="true" class="bi bi-file-earmark-pdf"></i> 1261 </div> 1262 <span class="align-top">PDF</span> 1263 </a> 1264 </li> 1265 1266 1267 1268 1269 1270 <li class="list-group-item ms-0 ps-0 "> 1271 <a class="format-item icon-link " href="search.php?where=aview&id=10.4162/nrp.2026.20.4.557&code=0161NRP&vmode=SM" onclick="" > 1272 <div> 1273 <i aria-hidden="true" class="bi bi-paperclip"></i> 1274 </div> 1275 <span class="align-top">Supplementary Materials</span> 1276 </a> 1277 </li> 1278 1279 </ul> 1280 </div> 1281 1282 1283 <!-- 1284 // 1285 // PORTLET - Cited by 1286 // 1287 --> 1288 1289 1290 1291 <!-- 1292 // 1293 // PORTLET - MeSH 1294 // 1295 --> 1296 1297 1298 1299 1300 <div class="my-5 border-top porlet"> 1301 <div class="my-3"> 1302 <h5>Publication Types</h5> 1303 </div> 1304 1305 <div class="d-inline-flex flex-wrap material-chips"> 1306 <div class="chip text-truncate my-1 mr-1">Randomized Controlled Trial</div><div class="chip text-truncate my-1 mr-1">Review</div> 1307 </div> 1308 </div> 1309 1310 <div class="my-5 border-top porlet"> 1311 <div class="my-3"> 1312 <h5>MeSH Terms</h5> 1313 </div> 1314 1315 <div class="d-inline-flex flex-wrap material-chips"> 1316 <div class="chip text-truncate my-1 mr-1"><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Agriculture%22%5BMeSH+Terms%5D" target="_blank">Agriculture</a></div><div class="chip text-truncate my-1 mr-1"><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Checklist%22%5BMeSH+Terms%5D" target="_blank">Checklist</a></div><div class="chip text-truncate my-1 mr-1"><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Cross-Sectional+Studies%22%5BMeSH+Terms%5D" target="_blank">Cross-Sectional Studies</a></div><div class="chip text-truncate my-1 mr-1"><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Diet%2C+Healthy%22%5BMeSH+Terms%5D" target="_blank">Diet, Healthy</a></div><div class="chip text-truncate my-1 mr-1"><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Economic+Factors%22%5BMeSH+Terms%5D" target="_blank">Economic Factors</a></div><div class="chip text-truncate my-1 mr-1"><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Education%22%5BMeSH+Terms%5D" target="_blank">Education</a></div><div class="chip text-truncate my-1 mr-1"><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Feeding+Behavior%22%5BMeSH+Terms%5D" target="_blank">Feeding Behavior</a></div><div class="chip text-truncate my-1 mr-1"><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Food+Insecurity%2A%22%5BMeSH+Major+Topic%5D" target="_blank">Food Insecurity*</a></div><div class="chip text-truncate my-1 mr-1"><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Literacy%2A%22%5BMeSH+Major+Topic%5D" target="_blank">Literacy*</a></div><div class="chip text-truncate my-1 mr-1"><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Systematic+Review%2A%22%5BMeSH+Major+Topic%5D" target="_blank">Systematic Review*</a></div><div class="chip text-truncate my-1 mr-1"><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22United+States+Department+of+Agriculture%22%5BMeSH+Terms%5D" target="_blank">United States Department of Agriculture</a></div> 1317 </div> 1318 </div> 1319 1320 1321 1322 <!-- 1323 // 1324 // PORTLET - 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1877 1878
1878<script> 1879 1880 jQuery(document).ready(function ($) { 1881 1882 // Tooltip 1883 const tooltipTriggerList = document.querySelectorAll('[data-bs-toggle="tooltip"]'); 1884 const tooltipList = [...tooltipTriggerList].map(tooltipTriggerEl => new bootstrap.Tooltip(tooltipTriggerEl)); 1885 1886 $("#SharePermalinkText").val("https://e-nrp.org/DOIx.php?id=10.4162/nrp.2026.20.4.557"); 1887 1888 // Icons 1889 const articleIconCoressp = document.getElementsByClassName("article-icon-corresp"); 1890 for (let i = 0; i < articleIconCoressp.length; i++) { 1891 articleIconCoressp[i].classList.add('bi', 'bi-envelope' ); 1892 } 1893 1894 // Document Type 1895 document.getElementsByClassName("article-type")[0].innerHTML = "Review Article"; 1896 1897 // 1898 // Relate Articles 1899 // 1900 1901 const aRelateArticleInfo = []; 1902 const articleRelateNode = document.getElementById("article-relate-articles"); 1903 if ( articleRelateNode != null ) { 1904 articleRelateNode.classList.add('list-group', 'my-3'); 1905 for (index in aRelateArticleInfo) { 1906 let div = document.createElement('div'); 1907 div.setAttribute('class', 'list-group-item'); 1908 div.innerHTML = aRelateArticleInfo[ index ]; 1909 articleRelateNode.appendChild ( div ); 1910 } 1911 } 1912 1913 // 1914 // SCRIPTS 1915 // 1916 1917 // 1918 // for Authors and Keywords 1919 // 1920 1921 // Function to transform keywords into links 1922 function transformKeywords() { 1923 var keywordTitles = document.querySelectorAll('.article-keyword-group-title');
1924 keywordTitles.forEach(function (keywordTitle) { 1925 var keywordContainer = keywordTitle.nextElementSibling; 1926 if (keywordContainer) { 1927 var keywordElements = keywordContainer.querySelectorAll('.capture-id'); 1928 keywordElements.forEach(function (element) { 1929 var keyword = element.textContent.trim(); 1930 var link = document.createElement('a'); 1931 link.href = '/search.php?where=asummary&queryfilter=keyword&query=' + encodeURIComponent(keyword); 1932 link.textContent = keyword; 1933 element.innerHTML = ''; 1934 element.appendChild(link); 1935 element.classList.add('keyword-group-item'); 1936 }); 1937 } 1938 }); 1939 } 1940 1941 // transformKeywords(); 1942 1943 var articleContrib = document.querySelector('.article-contrib'); 1944 var nodes = articleContrib.childNodes; 1945 1946 if ($(".article-contrib .capture-id").length > 6) 1947 { 1948 for (var i = 0; i < nodes.length; i++) { 1949 if (nodes[i].nodeType === Node.TEXT_NODE && nodes[i].nodeValue.trim() === 'and') { 1950 var span = document.createElement('span'); 1951 span.style.display = 'none'; 1952 span.className = 'hidden-and-text'; 1953 span.textContent = ' and '; 1954 articleContrib.replaceChild(span, nodes[i]); 1955 break; 1956 } 1957 } 1958 } 1959 1960 function applyShowMore(selector) { 1961 $(selector + " .capture-id").each(function (index) { 1962 if (index > 5) { 1963 $(this).hide(); 1964 } 1965 }); 1966 1967 if ($(selector + " .capture-id").length > 6) { 1968 $(selector).append('<a href="#" class="show-more show-toggle">view all</a>'); 1969 } 1970 1971 $(selector).on("click", ".show-more", function (e) { 1972 e.preventDefault(); 1973 $(selector + " .capture-id:hidden").show(); 1974 if (selector === ".article-contrib") { 1975 $(".hidden-and-text").show(); 1976 } 1977 $(this).text(" view less ").removeClass("show-more").addClass("show-less"); 1978 }); 1979 1980 $(selector).on("click", ".show-less", function (e) { 1981 e.preventDefault(); 1982 $(selector + " .capture-id").slice(6).hide(); 1983 if (selector === ".article-contrib") { 1984 $(".hidden-and-text").hide(); 1985 } 1986 $(this).text("view all").removeClass("show-less").addClass("show-more"); 1987 }); 1988 } 1989 1990 applyShowMore(".article-contrib"); 1991 applyShowMore(".article-contrib-ko"); 1992 1993 1994 // 1995 // for SECTIONS 1996 // 1997 1998 var aArticleSection = new Array(); 1999 2000 $( ".__SECTION__" ).each(function( index, elem ){ 2001 aArticleSection.push( $(elem).attr('data-section-name') ); 2002 }); 2003 2004 $( ".__SECTION__" ).each(function( index, elem ){ 2005 var $dropdownMenuNode = $(elem).children(".dropdown").find(".dropdown-menu"); 2006 $( aArticleSection ).each(function( index, elem ){ 2007 $dropdownMenuNode.append('<a class="dropdown-item" href="#__ID_SECTION_'+index+'">'+ elem +'</a>'); 2008 }); 2009 }); 2010 2011 $( aArticleSection ).each(function( index, elem ){ 2012 $( '#navbar-goto-item' ).append('<li class="nav-item"><a class="nav-link" href="#__ID_SECTION_'+index+'">'+ elem +'</a></li>'); 2013 $( '#navbar-article-top-toolbar-goto' ).append('<li><a class="dropdown-item" href="#__ID_SECTION_'+index+'">'+ elem +'</a></li>'); 2014 }); 2015 2016 function moveArticleToSection( targetElement ) { 2017 var headerHeight = parseInt(getComputedStyle(document.querySelector('header')).height); 2018 var navbarArticleTopToolbarHeight = parseInt(getComputedStyle(document.querySelector('#navbar-article-top-toolbar')).height); 2019 2020 var scrollDirection = targetElement.offsetTop > window.pageYOffset ? navbarArticleTopToolbarHeight + 15 : headerHeight + 15; 2021 window.scrollTo({ 2022 top: targetElement.offsetTop - scrollDirection , 2023 behavior: 'auto' 2024 }); 2025 } 2026 2027 document.querySelectorAll('#navbar-article-top-toolbar-goto a[href^="#__ID_SECTION_"]').forEach(anchor => { 2028 anchor.addEventListener('click', function (e) { 2029 e.preventDefault(); 2030 const targetElement = document.querySelector(this.getAttribute('href')); 2031 moveArticleToSection ( targetElement ); 2032 }); 2033 }); 2034 2035 const moveArticleToSectionNode = document.querySelector('#article-move-supplement-material'); 2036 if ( moveArticleToSectionNode != null ) { 2037 moveArticleToSectionNode.addEventListener('click', function (e) { 2038 e.preventDefault(); 2039 const targetElement = document.querySelector(moveArticleToSectionNode.getAttribute('href')); 2040 moveArticleToSection ( targetElement ); 2041 }); 2042 } 2043 2044 const scrollSpyTop = new bootstrap.ScrollSpy(document.body, { 2045 target: '#navbar-article-top-toolbar', 2046 }); 2047 2048 const scrollSpyPortlet = new bootstrap.ScrollSpy(document.body, { 2049 target: '#navbar-goto', 2050 }); 2051 2052 2053 if ( aArticleSection.length > 1 ) { 2054 $(".navbar-goto-display").removeClass("d-none"); 2055 } 2056 2057 // 2058 // for CROSSMARK 2059 // 2060 2061 $( "#crossref-crossmark a" ).append('<img src="https://crossmark-cdn.crossref.org/widget/v2.0/logos/CROSSMARK_Color_square.svg" width="60" />'); 2062 $( "#crossref-crossmark" ).show(); 2063 2064 2065 // 2066 // 2067 // 2068 2069 2070 var aPageViewCount = { 2071 labels: ['Aug/2026','Sep/2026','Oct/2026'], 2072 series: [ 2073 [{meta:'Aug/2026', value: 157},{meta:'Sep/2026', value: 98},{meta:'Oct/2026', value: 9}], 2074 ] 2075 }; 2076 2077 var aPDFDownloadCount = { 2078 labels: ['Aug/2026','Sep/2026','Oct/2026'], 2079 series: [ 2080 [{meta:'Aug/2026', value: 19},{meta:'Sep/2026', value: 16},{meta:'Oct/2026', value: 0}], 2081 ] 2082 }; 2083 2084 $(".PageViewLink").on("click", function(){ 2085 2086 new Chartist.Line('#my-chart', aPageViewCount, { 2087 plugins: [ 2088 Chartist.plugins.tooltip({ 2089 pointClass: 'ct-point', 2090 tooltipOffset: { 2091 x: 15, 2092 y: 35 2093 }, 2094 transformTooltipTextFnc: function(value){ 2095 return 'Counts: ' + value; 2096 } 2097 }) 2098 ], 2099 fullWidth: false, 2100 lineSmooth: Chartist.Interpolation.cardinal({ 2101 tension: 0 2102 }), 2103 low: 0, 2104 showArea: true, 2105 axisY: { 2106 onlyInteger: true, 2107 } 2108 }); 2109
2110 $('#myModalLabel').html('Page Views'); 2111 $('#myModalTotalLinkLabel').html('<div class="d-flex">\ 2112 <div class="flex-grow-1">Total Page Views: 264</div><div><a href="/export/count/view/article/10.4162/nrp.2026.20.4.557"><img src="image/icon-excel.png"> Download as Excel file</a></div>\ 2113 </div>\ 2114 '); 2115 2116 var myModal = new bootstrap.Modal(document.getElementById('myModal')); 2117 myModal.show(); 2118 2119 return false; 2120 }); 2121 2122 $(".PDFDownloadLink").on("click", function(){ 2123 new Chartist.Line('#my-chart', aPDFDownloadCount, { 2124 fullWidth: false, 2125 low: 0, 2126 lineSmooth: Chartist.Interpolation.cardinal({ 2127 tension: 0 2128 }), 2129 showArea: true, 2130 axisY: { 2131 onlyInteger: true, 2132 }, 2133 plugins: [ 2134 Chartist.plugins.tooltip({ 2135 pointClass: 'ct-point', 2136 tooltipOffset: { 2137 x: 15, 2138 y: 35 2139 }, 2140 transformTooltipTextFnc: function(value){ 2141 return 'Counts: ' + value; 2142 } 2143 }) 2144 ], 2145 }); 2146 2147 $('#myModalLabel').html('PDF Downloads'); 2148 $('#myModalTotalLinkLabel').html('<div class="d-flex"><div class="flex-grow-1">Total PDF Downloads: 35</div><div><a href="/export/count/download/pdf/10.4162/nrp.2026.20.4.557"><img src="image/icon-excel.png"> Download as Excel file</a></div></div>'); 2149 2150 var myModal = new bootstrap.Modal(document.getElementById('myModal')); 2151 myModal.show(); 2152 2153 return false; 2154 }); 2155 2156 2157 $("#item-list li").click(function(e) { 2158 e.preventDefault(); 2159 e.stopPropagation(); 2160 }); 2161 2162 $('.bm-ref-list-ol > li').css("cursor", "pointer"); //addClass('link'); 2163 2164 $(".bm-ref-list-ol li").on( "click", function() { 2165 return false; 2166 }).children().click(function(e) { 2167 return false; 2168 }); 2169 }); 2170 2171 2172 var trackDownloadLink = function(category, doi) { 2173 gtag('event', 'download', { 2174 'event_category': category, 2175 'event_label': doi 2176 }); 2177 } 2178 2179 2180 </script>
2180 2181 2182
2182<script src="https://crossmark-cdn.crossref.org/widget/v2.0/widget.js" type="text/javascript"></script>
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2188<script type="text/javascript"> 2189 2190 2191 // pop up 2192 // function notice_getcookie( name ){ 2193 // var nameOfcookie = name + "="; 2194 // var x = 0; 2195 // while ( x <= document.cookie.length ) 2196 // { 2197 // var y = (x+nameOfcookie.length); 2198 // if ( document.cookie.substring( x, y ) == nameOfcookie ) { 2199 // if ( (endOfcookie=document.cookie.indexOf( ";", y )) == -1 ) 2200 // endOfcookie = document.cookie.length; 2201 // return unescape( document.cookie.substring( y, endOfcookie ) ); 2202 // } 2203 // x = document.cookie.indexOf( " ", x ) + 1; 2204 // if ( x == 0 ) 2205 // break; 2206 // } 2207 // return ""; 2208 // } 2209 // if ( notice_getcookie( "Notice" ) != "done" ) 2210 // { 2211 // popup1=window.open("notice_20210126.html","popup1","scrollbars=0,width=450,height=495,left=300,top=300") 2212 // } 2213 2214</script>
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