{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:27:19Z","timestamp":1790317639014,"version":"4.1.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:00:00Z","timestamp":1741046400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Colorectal cancer (CRC) patients often experience varying degrees of malnutrition both pre-and post-treatment, highlighting the importance of their nutritional knowledge. However, studies on nutrition literacy (NL) in this population remain scarce. This study aims to evaluate the level of NL in colorectal cancer patients and identify key factors influencing NL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 245 colorectal cancer patients participated in this study. The questionnaire included five sections: sociodemographic information, the Chinese Version of the Nutrition Literacy Assessment Instrument (CHI-NLit), the Montreal Cognitive Assessment Scale (MoCA), and the Hospital Anxiety and Depression Scale (HADS). Both univariate and multivariate analyses were performed to examine sociodemographic determinants of NL. We used Pearson and Spearman correlation coefficients to assess relationships between NL, MoCA and HADS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The overall NL level among CRC patients was moderately low, with an average score of 19.224\u202f\u00b1\u202f4.391\u2014significantly below the normative neutrophil score of 21.5. Among the assessed dimensions, food groups received the lowest scores while food label calculation achieved the highest. Significant predictors influencing NL levels included age, years of education, family annual income, in review duration of illness, number of hospitalizations, memory and attention abilities and anxiety and depress symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study provides a comprehensive examination of NL in CRC patients. The findings indicate a relatively low level of NL within this group. Younger age, higher income levels, and urban residency correlated positively with elevated NL. Factors such as illness duration, number of hospitalizations, cognitive function measured by relevant scales are also emerged as significant determinants impacting NL. To enrich the research on NL, it is essential to conduct further data collection. From a clinical perspective, this evidence-based framework enables the development of stratified nutritional intervention protocols, specifically targeting vulnerable subgroups (e.g., elderly patients, rural dwellers, and those with extended illness duration). Such precision approaches hold significant potential to optimize dietary adherence, mitigate treatment-related complications, and ultimately enhance long-term quality of life in cancer survivorship care.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2025.1526388","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T05:20:52Z","timestamp":1741065652000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Factors influencing nutrition literacy in patients of colorectal cancer: a cross-sectional study"],"prefix":"10.3389","volume":"12","author":[{"given":"Jing","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiai","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiran","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanping","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiao","family":"Hua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingyu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1053\/j.gastro.2014.12.035","article-title":"Nutrients, foods, and colorectal cancer prevention","volume":"148","author":"Song","year":"2015","journal-title":"Gastroenterology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"958","DOI":"10.3390\/nu14142958","article-title":"Nutritional factors during and after Cancer: impacts on survival and quality of life","volume":"14","author":"Salas","year":"2022","journal-title":"Nutrients"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"6881","DOI":"10.3390\/ijerph19116881","article-title":"Nutritional treatment of patients with colorectal Cancer","volume":"19","author":"Lewandowska","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e134","DOI":"10.3928\/24748307-20180625-01","article-title":"Measuring nutrition and food literacy in adults: a systematic review and appraisal of existing measurement tools","volume":"2","author":"Yuen","year":"2018","journal-title":"Health Lit Res Pract"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e12","DOI":"10.1017\/jns.2021.4","article-title":"Rapid improvement in vitamin D status with dietary 25-hydroxycholecalciferol in vitamin D insufficient dogs","volume":"10","author":"Kurzbard","year":"2021","journal-title":"J Nutr Sci"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s12889-023-17468-9","article-title":"Assessing the relationship between nutrition literacy and eating behaviors among nursing students: a cross-sectional study","volume":"24","author":"Mostafazadeh","year":"2024","journal-title":"BMC Public Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"3451","DOI":"10.3390\/nu13103451","article-title":"Nutrition literacy mediates the relationships between multi-level factors and college students\u2019 healthy eating behavior: evidence from a cross-sectional study","volume":"13","author":"Lai","year":"2021","journal-title":"Nutrients"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"962371","DOI":"10.3389\/fpubh.2022.962371","article-title":"Development and validation of a novel short-form nutrition literacy measurement tool for Chinese college students","volume":"10","author":"Mo","year":"2022","journal-title":"Front Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.jneb.2017.10.008","article-title":"The nutrition literacy assessment instrument is a valid and reliable measure of nutrition literacy in adults with chronic disease","volume":"50","author":"Gibbs","year":"2018","journal-title":"J Nutr Educ Behav"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1016\/j.jneb.2015.04.328","article-title":"The nuances of health literacy, nutrition literacy, and food literacy","volume":"47","author":"Velardo","year":"2015","journal-title":"J Nutr Educ Behav"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"2157","DOI":"10.1017\/S1368980019001289","article-title":"Nutrition literacy predicts adherence to healthy\/unhealthy diet patterns in adults with a nutrition-related chronic condition","volume":"22","author":"Taylor","year":"2019","journal-title":"Public Health Nutr"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"daw084","DOI":"10.1093\/heapro\/daw084","article-title":"Just a subtle difference? Findings from a systematic review on definitions of nutrition literacy and food literacy","volume":"33","author":"Krause","year":"2018","journal-title":"Health Promot Int"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"290","DOI":"10.24953\/turkjped.2022.607","article-title":"Food and nutrition literacy: a predictor for diet quality and nutrient density among late adolescents","volume":"65","author":"Ashoori","year":"2023","journal-title":"Turk J Pediatr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2097","DOI":"10.1016\/j.jand.2022.05.011","article-title":"Nutrition literacy among Latina\/x people during pregnancy is associated with socioeconomic position","volume":"122","author":"Camargo","year":"2022","journal-title":"J Acad Nutr Diet"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e14921","DOI":"10.1111\/dme.14921","article-title":"Nutrition and food literacy among young Canadian adults living with type 1 diabetes","volume":"39","author":"Itzkovitz","year":"2022","journal-title":"Diabet Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2127","DOI":"10.1186\/s12889-023-17062-z","article-title":"Evaluation of the nutrition literacy assessment questionnaire for college students and identification of the influencing factors of their nutrition literacy","volume":"23","author":"Yan","year":"2023","journal-title":"BMC Public Health"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e0244197","DOI":"10.1371\/journal.pone.0244197","article-title":"Development and validation of a food and nutrition literacy questionnaire for Chinese school-age children","volume":"16","author":"Liu","year":"2021","journal-title":"PLoS One"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"E109","DOI":"10.5888\/pcd10.120267","article-title":"Establishing content validity for the nutrition literacy assessment instrument","volume":"10","author":"Gibbs","year":"2013","journal-title":"Prev Chronic Dis"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"3342","DOI":"10.12114\/j.issn.1007-9572.2020.00.009","article-title":"Development, reliability and validity of the Chinese version of nutrition literacy assessment instrument in patients with diabetes based on CTT and Rasch model","volume":"23","author":"Chen","year":"2020","journal-title":"Chin Gene Pract"},{"key":"ref21","year":""},{"key":"ref22","year":""},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1007\/s13187-017-1238-z","article-title":"Nutrition literacy among Cancer survivors: feasibility results from the healthy eating and living against breast Cancer (HEAL-BCa) study: a pilot randomized controlled trial","volume":"33","author":"Parekh","year":"2018","journal-title":"J Cancer Educ"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2619","DOI":"10.2147\/DMSO.S229246","article-title":"Interactive nutrition education is more effective in terms of improved levels of glycated hemoglobin in adolescent patients with poorly controlled type 1 diabetes - a randomized study","volume":"12","author":"D\u0142u\u017cniak-Go\u0142aska","year":"2019","journal-title":"Diabetes Metab Syndr Obes"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s12937-020-00657-2","article-title":"The effects of a family-centered psychosocial-based nutrition intervention in patients with advanced cancer: the PiCNIC2 pilot randomised controlled trial","volume":"20","author":"Molassiotis","year":"2021","journal-title":"Nutr J"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"782430","DOI":"10.3389\/fnut.2022.782430","article-title":"SAlBi educa (tailored nutrition app for improving dietary habits): initial evaluation of usability","volume":"9","author":"Gonzalez-Ramirez","year":"2022","journal-title":"Front Nutr"},{"key":"ref27","volume-title":"The investigation and influence factors analysis of nutrition literacy of type 2 diabetes mellitus","author":"Chen","year":"2020"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J Am Geriatr Soc"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr Scand"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1136\/jnnp.23.1.56","article-title":"A rating scale for depression","volume":"23","author":"Hamilton","year":"1960","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1177\/0148607114525209","article-title":"What do healthcare providers know about nutrition support? A survey of the knowledge, attitudes, and practice of pharmacists and doctors toward nutrition support in Malaysia","volume":"39","author":"Karim","year":"2015","journal-title":"J Parenter Enter Nutr"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s12937-020-00564-6","article-title":"Gender differences in the relationship between dietary energy and macronutrients intake and body weight outcomes in Chinese adults","volume":"19","author":"Zhao","year":"2020","journal-title":"Nutr J"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"867926","DOI":"10.3389\/fnut.2022.867926","article-title":"The association between Bangladeshi Adults' demographics, personal beliefs, and nutrition literacy: evidence from a cross-sectional survey","volume":"9","author":"Banna","year":"2022","journal-title":"Front Nutr"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1186\/s13690-024-01350-0","article-title":"Nutrition literacy level of medical personnel in tertiary hospitals: evidence from a cross-sectional study","volume":"82","author":"Mo","year":"2024","journal-title":"Arch Public Health"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"101204","DOI":"10.1016\/j.esmoop.2023.101204","article-title":"Sex and gender perspectives in colorectal cancer","volume":"8","author":"Baraibar","year":"2023","journal-title":"ESMO Open"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"2108","DOI":"10.1017\/S1368980023001830","article-title":"Nutrition literacy status and its association with adherence to the Mediterranean diet, anthropometric parameters and lifestyle behaviours among early adolescents","volume":"26","author":"Yurtda\u015f Depboylu","year":"2023","journal-title":"Public Health Nutr"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"352","DOI":"10.4162\/nrp.2019.13.4.352","article-title":"The impact of nutrition literacy on the food habits among young adults in Turkey","volume":"13","author":"Kalkan","year":"2019","journal-title":"Nutr Res Pract"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"20180188","DOI":"10.1515\/ijamh-2018-0188","article-title":"The association between nutrition knowledge and adherence to a Mediterranean dietary pattern in Iranian female adolescents","volume":"33","author":"Neshatbini Tehrani","year":"2021","journal-title":"Int J Adolesc Med Health"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"360","DOI":"10.3390\/nu15102360","article-title":"Nutrition literacy level in Bank employees: the case of a large Brazilian company","volume":"15","author":"Chaves","year":"2023","journal-title":"Nutrients"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"346","DOI":"10.3390\/foods13020346","article-title":"The effect of sociodemographic and anthropometric variables on nutritional knowledge and nutrition literacy","volume":"13","author":"Sanlier","year":"2024","journal-title":"Food Secur"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1186\/s12889-016-3680-y","article-title":"Cross-cultural comparison of perspectives on healthy eating among Chinese and American undergraduate students","volume":"16","author":"Banna","year":"2016","journal-title":"BMC Public Health"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1080\/09637486.2019.1593951","article-title":"Socioeconomic inequalities in relation to health and nutrition literacy in Greece","volume":"70","author":"Michou","year":"2019","journal-title":"Int J Food Sci Nutr"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/heapro\/day062","article-title":"Does health literacy mediate the relationship between socioeconomic status and health disparities?","volume":"34","author":"Stormacq","year":"2019","journal-title":"Integr Rev Health Promot Int"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"e115","DOI":"10.3928\/24748307-20180503-01","article-title":"Health literacy and health service use in Germany","volume":"2","author":"Berens","year":"2018","journal-title":"Health Lit Res Pract"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1111\/acem.12476","article-title":"Is low health literacy associated with increased emergency department utilization and recidivism?","volume":"21","author":"Griffey","year":"2014","journal-title":"Acad Emerg Med"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1093\/heapro\/dax012","article-title":"Health literacy in old age: results of a German cross-sectional study","volume":"33","author":"Vogt","year":"2018","journal-title":"Health Promot Int"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"530","DOI":"10.5694\/j.1326-5377.2009.tb03304.x","article-title":"Risks associated with low functional health literacy in an Australian population","volume":"191","author":"Adams","year":"2009","journal-title":"Med J Aust"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1186\/s12913-018-3197-4","article-title":"The role of health literacy in explaining the association between educational attainment and the use of out-of-hours primary care services in chronically ill people: a survey study","volume":"18","author":"Jansen","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1177\/1010539519851674","article-title":"Social support, health literacy, and health care utilization among older adults","volume":"31","author":"Liu","year":"2019","journal-title":"Asia Pac J Public Health"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1113211","DOI":"10.3389\/fpubh.2023.1113211","article-title":"Nutrition literacy differs based on demographics among university students in Bengbu, China","volume":"11","author":"Gao","year":"2023","journal-title":"Front Public Health"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"e56","DOI":"10.1017\/jns.2021.47","article-title":"Gender differences in nutrition literacy levels among university students and employees: a descriptive study","volume":"10","author":"Svendsen","year":"2021","journal-title":"J Nutr Sci"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.clnu.2007.10.007","article-title":"Prognostic impact of disease-related malnutrition","volume":"27","author":"Norman","year":"2008","journal-title":"Clin Nutr"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"241","DOI":"10.5388\/aon.2018.18.4.241","article-title":"Factors affecting cognitive function in patients with stomach cancer","volume":"18","author":"Yu","year":"2018","journal-title":"Asian Oncolo Nurs"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2025.1526388\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T05:20:57Z","timestamp":1741065657000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2025.1526388\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,4]]},"references-count":53,"alternative-id":["10.3389\/fnut.2025.1526388"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2025.1526388","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,4]]},"article-number":"1526388"}}