The association between health literacy, numeracy and diet quality in an urban population of socioeconomically diverse African American and white adults

Background: Previous research has shown that health literacy may be a stronger predictor for a person's 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.;Aim and Hypothesis: The aim of this study was to evaluate the relationship of dietary quality, health numeracy and health literacy levels of an urban population of socioeconomically diverse African American and White adults. It was hypothesized that individuals with lower levels of health literacy and numeracy would have lower quality diets based on nutrient intakes. Subjects: The final sample contained 1,818 White and African American participants from Wave 3 of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) Study.;Methods: Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM) and 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) scores based on diet alone (MAR) and nutrients from diet plus nutritional supplements (MAR-S).;Results: Results revealed that REALM and TOFHLA were not significant predictors of diet quality measured by the MAR. Age, education, current cigarette smoking status, and energy intake were all significant predictors of diet quality. Age, current cigarette smoking status, and energy intake were significantly associated with MAR-S. Significant interactions between sex and education, and between race and education were found for MAR, with education being a more important predictor of diet quality in women and Whites. Interaction models in analysis of MAR-S revealed that there were significant interactions between race and education, and REALM and education. There was a stronger relationship between REALM and MAR-S as education level increased.;Conclusion: Both education and literacy need to be considered when providing nutritional education to the public. A synergistic relationship exists between health literacy, measured by REALM, and education in predicting nutrient-based diet quality when nutrients from dietary supplements are added to nutrients from food.