Literacy, numeracy, and portion-size estimation skills.
BACKGROUND
Portion-size estimation is an important component of weight management. Literacy and numeracy skills may be important for accurate portion-size estimation. It was hypothesized that low literacy and numeracy would be associated with decreased accuracy in portion estimation.


METHODS
A cross-sectional study of primary care patients was performed from July 2006 to August 2007; analyses were performed from January 2008 to October 2008. Literacy and numeracy were assessed with validated measures (the Rapid Estimate of Adult Literacy in Medicine and the Wide Range Achievement Test, third edition). For three solid-food items and one liquid item, participants were asked to serve both a single serving and a specified weight or volume amount representing a single serving. Portion-size estimation was considered accurate if it fell within +/-25% of a single standard serving.


RESULTS
Of 164 participants, 71% were women, 64% were white, and mean (SD) BMI was 30.6 (8.3) kg/m(2). While 91% reported completing high school, 24% had <9th-grade literacy skills and 67% had <9th-grade numeracy skills. When all items were combined, 65% of participants were accurate when asked to serve a single serving, and 62% were accurate when asked to serve a specified amount. In unadjusted analyses, both literacy and numeracy were associated with inaccurate estimation. In multivariate analyses, only lower literacy was associated with inaccuracy in serving a single serving (OR=2.54; 95% CI=1.11, 5.81).


CONCLUSIONS
In this study, many participants had poor portion-size estimation skills. Lower literacy skills were associated with less accuracy when participants were asked to serve a single serving. Opportunities may exist to improve portion-size estimation by addressing literacy.
Huizinga
Mary Margaret
MM
Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University, Baltimore, Maryland 21205, USA. mhuizin1@jhmi.edu
Carlisle
Adam J
AJ
Cavanaugh
Kerri L
KL
Davis
Dianne L
DL
Gregory
Rebecca P
RP
Schlundt
David G
DG
Rothman
Russell L
RL
D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004522:Educational Status; D005247:Feeding Behavior / Q000145:classification*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis