The most striking finding is the steep age-related decline. Among lower-grade primary school students, 80.56 percent scored at or above 75 out of 100 on a validated nutrition knowledge questionnaire, meeting the study’s threshold for adequate awareness. That figure fell to 51.39 percent for upper-grade primary students, 38.30 percent for junior high students, and a mere 22.42 percent for senior high school students. In other words, the older the student, the less likely they were to demonstrate command of basic facts about food, diet, and health — an inversion of what many observers might expect as children accumulate years of schooling.

The researchers attribute this counterintuitive pattern to the structure of nutrition education in China. Widespread food education programs launched nationally in 2023 deliver a high density of courses and activities to younger children, while academic pressure mounts in later grades and the share of nutrition-related instruction shrinks. Senior high school students also make more of their own dietary decisions, eating at school canteens or off-campus restaurants rather than under family supervision, which removes the informal, home-based nutritional teaching that younger children still receive.

The survey instrument was a versioned questionnaire tailored to four educational stages, with 24 to 26 items each covering five dimensions: dietary recommendations, food classification and characteristics, the relationship between food and growth and health, food selection, and food safety. Reliability coefficients ranged from 0.76 to 0.79 for all versions except the lower-primary version, which scored 0.54 — a limitation the authors themselves flag. Confirmatory factor analysis supported the questionnaire’s construct validity across versions, with fit indices comfortably within accepted thresholds.

Dimension-level results reveal where knowledge is strongest and weakest. Awareness in the

Dimension-level results reveal where knowledge is strongest and weakest. Awareness in the food safety dimension and in nutrition-and-health knowledge was higher among girls than boys in both lower- and upper-grade primary school, a gender gap that echoes findings from other Chinese nutrition surveys and suggests that boys may need particular attention when educators design classroom activities. The study also quantified knowledge gaps in a granular way: any questionnaire item answered correctly by fewer than a quarter of participants was counted as a gap, and the number of such items climbed steadily with age — from zero among lower-primary pupils to three among upper-primary pupils, seven among junior high students, and eight among senior high students. This pattern indicates that the decline in awareness is not merely a matter of forgetting isolated facts but reflects widening, systematic blind spots that accumulate as students progress through school.

Because the questionnaire was scored item by item, with each single-choice question treated as one knowledge point and each option in a multiple-choice question counted separately, the researchers could pinpoint precisely which concepts students failed to grasp. The five assessed dimensions — dietary recommendations, food classification and characteristics, the relationship between food and growth and health, food selection, and food safety — map onto the core competencies that national nutrition policy seeks to instill, which makes the identification of specific weak items directly actionable for curriculum planners. A student who can classify foods but cannot connect them to growth and development, for example, may lack the motivational link that turns factual knowledge into dietary behavior.

The statistical approach strengthened the credibility of the associating factors. Rather than treating the 4,980 responses as independent simple-random draws, the analysts used complex-samples procedures, designating urban or rural residence and grade as stratification variables and classroom as the cluster variable, consistent with the stratified random cluster sampling design. Complex-samples chi-square tests compared awareness rates across groups, and complex-samples binary logistic regression identified determinants of adequate awareness, with statistical significance set at the conventional threshold of 0.05. Sampling weights were set uniformly to one because post-stratification data were unavailable, a pragmatic choice the authors acknowledge, and pairwise comparisons following significant overall tests were adjusted using a Bonferroni correction to limit false-positive findings.

The logistic regression results carry practical weight. Gender, participation in school meals, boarding status, and awareness of parents’ education and employment type were each associated with the level of nutrition and health knowledge across different educational stages. These factors point to the everyday environments where nutritional information is transmitted — or fails to be. Children who eat meals provided by school are exposed to institutional food environments that may reinforce or contradict classroom lessons, while boarding students spend most of their time away from the family table, losing the parental modeling and informal teaching that shape younger children’s understanding. Parental education and employment, meanwhile, influence household food practices, the resources available for diverse diets, and the amount of time parents can devote to discussing food with their children.

The study’s sampling frame deserves attention when interpreting the findings. Six urban districts — Yuzhong, Nan’an, Jiangbei, Qijiang, Tongliang, and Hechuan — and two rural counties, Fengjie and Xiushan, were selected, and within each site two primary schools, one junior high school, and one senior high school, including vocational, secondary specialized, and technical schools, were randomly chosen. Stratification by grade proceeded in one-year intervals, producing twelve age groups, and classrooms served as the clusters from which students were drawn. After data cleaning, 4,980 of an initial 4,984 surveyed students remained in the analysis, a retention rate indicating careful quality control. Field procedures reinforced this rigor: personnel at each site received standardized training, on-site reviewers checked fifteen questionnaires daily and resolved omissions or logical inconsistencies with respondents, and unqualified questionnaires were excluded during data cleaning.

Ethical oversight was likewise documented. The study was approved by the Ethics Committee of the National Institute for Nutrition and Health at the Chinese Center for Disease Control and Prevention under approval number 2022-037, and written informed consent was obtained from all participants or their parents and guardians. The survey formed part of the Chongqing site of the 2023–2024 National Survey on Nutritional Knowledge Awareness among School-Aged Children in China, embedding the local findings within a broader national monitoring effort.

The policy context amplifies the study’s significance. Enhancing national nutritional literacy is a core objective of the Healthy China initiative, and policy documents including the Healthy China 2030 Planning Outline and the National Nutrition Plan (2017–2030) explicitly call for raising public awareness of nutritional knowledge and integrating nutrition education into school curricula. The Chongqing data provide a baseline against which progress toward those goals can be measured, and the authors argue that precision health education — targeting specific knowledge gaps and vulnerable populations rather than delivering uniform messaging — is urgently needed to comprehensively raise nutritional literacy.

Several interpretive cautions remain. The cross-sectional design captures a single moment and cannot establish whether nutrition knowledge actually declines within individuals as they age, or whether older cohorts were simply exposed to different educational conditions. The lower reliability coefficient of the lower-primary questionnaire version, at 0.54, means results for the youngest children should be read with some care, even though the confirmatory factor analysis showed good construct validity across all versions, with chi-square to degrees-of-freedom ratios between 1.30 and 1.66 and root mean square error of approximation values between 0.04 and 0.05. The uniform sampling weights, adopted because post-stratification data were unavailable, may limit the precision of population-level estimates. Finally, awareness of knowledge is a prerequisite for behavior change but not identical to it; subsequent studies linking these knowledge scores to measured dietary intake and health outcomes would strengthen the case for intervention.

Even with those caveats, the central message is difficult to dismiss: the years when nutrition education is most intensive are the years when knowledge is highest, and the transition into adolescence coincides with both declining instruction and rising autonomy over food choices. If the goal is a population that carries sound nutritional understanding into adulthood, the findings suggest that sustaining and adapting nutrition education through junior and senior high school — rather than concentrating it in early primary grades — deserves urgent attention from educators and policymakers alike.

Subject of Research: Nutrition knowledge awareness and associated factors among school-aged children in Chongqing, China

Article Title: Nutrition knowledge awareness and associating factors among school-age children in Chongqing: a 2023–2024 survey

Article References: Wang, M., Wang, D., Li, F., Huo, J., Feng, P., & Chen, J. (2026). Nutrition knowledge awareness and associating factors among school-age children in Chongqing: a 2023–2024 survey. Frontiers in Nutrition, 13, Article 1935221. https://doi.org/10.3389/fnut.2026.1935221

Image Credits: AI Generated

DOI: 10.3389/fnut.2026.1935221

Keywords: nutrition knowledge, school-aged children, Chongqing, health education, dietary recommendations, food safety, adolescents, cross-sectional survey, public health, China, nutrition literacy, food education