Adolescents' Ultra-processed Food Consumption Status and Its Association with Food Literacy: A Cross-sectional Study in Chongqing, China

Jiaxin Guo^1,2,3,4Ya Shi^1,2,3,4Yu Su⁵Ke Jiang^1,2,3,4Shengping Li⁶Zumin Shi⁷Liang Ran⁸YONG ZHAO^1,2,3,4,9*

• ¹College of Public Health, Chongqing Medical UniversityChina, Chongqing, China
• ²Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
• ³Nutrition Innovation Platform-Sichuan and Chongqing, China,, Chongqing, China
• ⁴Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
• ⁵Disease Control and Prevention Center, Jiulongpo District People's Hospital, Chongqing, China
• ⁶Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, Chongqing Municipality, China
• ⁷College of Health Sciences, Qatar University, Doha, Qatar
• ⁸First Affiliated Hospital of Chongqing Medical University, Chongqing, Chongqing Municipality, China
• ⁹Chongqing Key Laboratory of Child Nutrition and Health, Children’s Hospital of Chongqing Medical University, Chongqing, China

Background: Ultra-processed foods (UPFs) consumption is increasing globally and has become a prominent public health concern. We aimed to use a population-based study to examine the association between food literacy (FL) and its two subdomains with UPFs consumption in adolescents.The online survey included 7,761 adolescents aged 11-17 from Chongqing, China. UPFs consumption degree was assessed by the unhealthy eating subscale of the Healthy and Unhealthy Eating Behaviors Scale (HUEBS). FL was measured using the Food Nutrition Literacy in School-age Children (FNLQ-SC) questionnaire. FL and the two subdomains were categorized into quartiles, and linear regression was used to examine the association.In fully adjusted regression models, the regression coefficients β (95% confidence interval) were 0.00, -0.68 (95% CI: -1.12, -0.24, p = 0.003), -0.69 (95% CI:-1.14, -0.24, p = 0.003), and -0.60 (95% CI: -1.06 -0.14, p = 0.012) across the FL quartiles. An inverse association between FL and UPFs consumption score was only observed in girls but not boys. Among those with screen time >=2h/d, participants in the higher quartile of FL scores (Q3) exhibited lower scores in UPFs consumption compared with those in quartile 1 (Q1) (β (95% CI) -1.35 (-2.00, -0.71), p < 0.05).There were significant interactions between FL quartiles and gender (p for interaction < 0.001) or screen time (p for interaction = 0.003) in relation to UPFs consumption.This study suggests that high FL and the two subdomains were linked with a lower UPF consumption score in adolescents. Increasing FL among adolescents has the potential to enhance their decision-making on eating.