Health Literacy and Education Predict Nutrient Quality of Diet of Socioeconomically Diverse, Urban Adults.
BACKGROUND
Research has shown that health literacy may be a stronger predictor of health than age, employment status, education level, race, and income. Evidence supports a strong link between low health literacy and poor dietary management of chronic diseases.


OBJECTIVE
The aim was to evaluate the relationship of micronutrient quality of diet, health numeracy and health literacy in White and African American adults randomly selected from 13 Baltimore neighborhoods.


METHODS
Cross-sectional analysis of Wave 3 (2009-2013) of the longitudinal Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study initiated in 2004.


METHODS
Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Health numeracy was measured using the numeracy subscale of the Test of Functional Health Literacy in Adults (TOFHLA). Nutrient-based diet quality was measured using Mean Adequacy Ratio (MAR-S) scores calculated from 17 micronutrients from diet plus dietary supplement intake.


METHODS
The relationship of MAR-S scores to the health literacy measures were explored with multiple ordinary least square regression models, adjusting for a number of potential confounders.


RESULTS
REALM but not numeracy was associated with MAR-S; significant covariates included age, current cigarette smoking status, and energy intake. The interactions of race and educational attainment, and REALM and educational attainment were significant, with the relationship between REALM and MAR-S becoming stronger as education level increased.


CONCLUSIONS
There is a synergistic relationship between health literacy and educational attainment in predicting nutrient-based diet quality. Education was a stronger predictor for Whites compared to African Americans emphasizing the need for health professionals to focus on both education and literacy when creating and providing diet and health-related interventions and resources.
Department of Behavioral Health and Nutrition, Co-Investigator, HANDLS study, 315 McDowell Hall, University of Delaware, Newark, Delaware 19716, USA.
Marie F
MF
Kuczmarski
Department of Behavioral Health and Nutrition, 206 McDowell Hall, University of Delaware, Newark, Delaware 19716, USA.
Erica L
EL
Adams
Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware 19716, USA.
Nancy
N
Cotugna
College of Health Sciences, University of Delaware, Newark, Delaware 19716, USA.
Ryan T
RT
Pohlig
Laboratory of Epidemiology and Population Sciences, National Institute of Aging, NIH, Baltimore, MD 21224-6825, USA.
May A
MA
Beydoun
Laboratory of Epidemiology and Population Sciences, National Institute of Aging, NIH, Baltimore, MD 21224-6825, USA.
Alan B
AB
Zonderman
Laboratory of Epidemiology and Population Sciences, National Institute of Aging, NIH, Baltimore, MD 21224-6825, USA.
Michele K
MK
Evans
African Americans; Diet Quality; Dietary Supplement; Health Literacy; Numeracy