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. 2025 Jul 1;11(1):115.
doi: 10.1186/s40795-025-01109-y.

Can kids identify unprocessed fruit as healthier than an ultra-processed sugar-sweetened beverage? Functional versus self-reported nutrition knowledge and dietary intake among youth from six countries: findings from the International Food Policy Study

Liza Boyar  1 , Christine M White  1 , Lana Vanderlee  2 , Jasmin Bhawra  3 , David Hammond  4
Affiliations

Can kids identify unprocessed fruit as healthier than an ultra-processed sugar-sweetened beverage? Functional versus self-reported nutrition knowledge and dietary intake among youth from six countries: findings from the International Food Policy Study

Liza Boyar et al. BMC Nutr. .

Abstract

Background: Consumption of ultra-processed foods is associated with a range of poor dietary and health outcomes. Although lower nutrition knowledge is associated with higher consumption of ultra-processed foods, few studies have directly compared nutrition knowledge among youth from countries with different food environments and nutrition policies. This study examined whether youth could identify differences in nutritional quality between a commonly consumed ultra-processed and unprocessed food.

Methods: Cross-sectional surveys were conducted with youth aged 10-17 (n = 12,489) from Australia, Canada, Chile, Mexico, United Kingdom (UK), and United States (US) as part of the 2020 International Food Policy Study. Participants were shown images of two products in random order, corresponding to "unprocessed or minimally processed" (apple) and "ultra-processed" (apple fruit drink) foods under NOVA classification system, and asked to rate the healthiness of each. Respondents who rated the apple higher than the apple fruit drink were assigned a "correct" score. Regression models examined differences in "correct" responses by country, perceived nutrition knowledge, perceived diet healthiness, intake of fruits/vegetables, and intake of less healthy foods.

Results: Mexican (96.5%) and Chilean (94.3%) youth were most likely to correctly identify the unprocessed apple as "healthier" than the ultra-processed apple fruit drink, whereas US youth were the least likely (79.6%, p < 0.001 for all). Perceived nutrition knowledge was inversely associated with correct scores (p < 0.001). Youth who reported the highest (AOR: 0.43, p < 0.001) and lowest (AOR: 0.57, p < 0.05) categories of perceived diet healthiness had the lowest odds of correct responses. Higher intake of both less healthy foods (AOR: 0.70, p < 0.001) and fruits/vegetables (AOR: 0.87, p < 0.001) were associated with lower odds of correct responses.

Conclusions: Across countries, 5-20% of youth were unable to correctly identify an unprocessed fruit as 'healthier' than an ultra-processed fruit drink, with notable country differences. Further research is needed to examine differences for a broader range of foods and levels of processing. Education campaigns should ensure that young people have basic knowledge about the relative dietary quality of commonly consumed foods, particularly in the US. Discrepancies between perceived and objective nutrition knowledge additionally highlight the need for objective measures of knowledge to be included in assessments.

Keywords: Dietary intake; Food; Nutrition knowledge; Youth.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects/patients were reviewed by and received ethics approval through a University of Waterloo Research Ethics Committee (ORE# 41477). Informed consent to participate was obtained from the parents or legal guardians of all youth participants. Additionally, all youth participants were provided with information about the study and asked to provide assent before beginning the survey. Consent for publication: N/A. Competing interests: DH has provided paid expert testimony on behalf of public health authorities in response to legal challenges from the food and beverage industry. No other competing interests are declared.

Figures

Fig. 1
Fig. 1
Images of apple and apple fruit drink, as displayed in each country survey
Fig. 2
Fig. 2
Percentage of correct responses by ethnicity and country, 2020 (weighted estimates, N = 11,232). * Majority constituted the following ethnicities: in Canada if “White (European descent)” is the only category selected; in Australia if only speak English at home; in UK and US if only the “White” category is selected; in Mexico and Chile if do not consider self Indigenous
Fig. 3
Fig. 3
Percentage of correct responses by perceived income adequacy and country, 2020 (weighted estimates, N = 11,232)
See this image and copyright information in PMC

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References

    1. Grosso G, Mistretta A, Turconi G, Cena H, Roggi C, Galvano F. Nutrition knowledge and other determinants of food intake and lifestyle habits in children and young adolescents living in a rural area of sicily, South Italy. Public Health Nutr. 2013;16(10):1827–36. - PMC - PubMed
    1. Scaglioni S, De Cosmi V, Ciappolino V, Parazzini F, Brambilla P, Agostoni C. Factors influencing children’s eating behaviours. Nutrients. 2018;10(6):706. - PMC - PubMed
    1. Kowalkowska J, Wadolowska L, Hamulka J, Wojtas N, Czlapka-Matyasik M, Kozirok W, et al. Reproducibility of a short-form, multicomponent dietary questionnaire to assess food frequency consumption, nutrition knowledge, and lifestyle (SF-FFQ4PolishChildren) in Polish children and adolescents. Nutrients. 2019;11(12):2929. - PMC - PubMed
    1. Movassagh E, Baxter-Jones A, Kontulainen S, Whiting S, Vatanparast H. Tracking dietary patterns over 20 years from childhood through adolescence into young adulthood: the Saskatchewan pediatric bone mineral accrual study. Nutrients. 2017;9(9):990. - PMC - PubMed
    1. Lin W, Yang HC, Hang CM, Pan WH. Nutrition knowledge, attitude, and behavior of Taiwanese elementary school children. Asia Pac J Clin Nutr. 2007;16(Suppl2):534–46. - PubMed

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