Associations of health literacy, diet literacy with disability as mediated by diet quality

We examined the association of health literacy (HL), digital healthy diet literacy (DDL), and diet quality on disability, and investigated the mediating effect of diet quality on the associations of HL and DDL with disability among community-dwelling elderly individuals. A cross-sectional study was conducted on 839 participants, aged 60-85 years, from January 2023 to April 2024. Data collection includes HL (using the 12-item short form HL questionnaire), DDL (using the 4-item DDL scale), disability (using the 12-item World Health Organization Disability Assessment Schedule II). A higher HL score indicates greater health literacy, and a lower disability score indicates less disability. Diet quality was assessed using the 11-item Dietary Approaches to Stop Hypertension Quality (DASH-Q) questionnaire. Linear regression models and mediation analysis were used to examine the associations. Higher scores of HL (regression coefficient, B = -0.23; P < .001), DDL (B = -0.08; P < .001), and DASH-Q (B = -0.16; P < .001) were associated with lower disability scores. Importantly, diet quality significantly mediated the associations of HL (indirect effect: B = -0.03; P < .001)) and DDL (indirect effect: B = -0.03; P < .001) with disability. In conclusion, HL, DDL, and diet quality were associated with lowering disability. The mediating effect of diet quality between HL and DDL with disability were identified. These factors should be integrated into strategic interventions to well-being in the elderly in the community.