Low nutrition literacy among 4th-5th graders in Chongqing, China: a wake-up call for school health and factors associated with nutrition literacy.

Objective: Despite growing global recognition that nutrition literacy in childhood is a cornerstone of healthy eating and long-term wellbeing, evidence from Chinese primary school settings-particularly from inland, rapidly urbanizing regions-remains scarce. This study aimed to assess the nutrition literacy level of 4th-5th graders in chongqing, china, and to identify its key influencing factors, thereby sounding a wake-up call for school-based health promotion that holds relevance beyond the local context. Methods: A multistage stratified cluster sampling method was used to conduct a cross-sectional online survey of 1,420 elementary school students in grades 4 and 5 in Chongqing, China. The questionnaire consisted of three sections: demographic characteristics, dietary behaviors, and nutrition literacy levels (Cronbach's α = 0.752). Participants were divided into high- and low-scoring groups based on the median nutritional literacy (NL) score. Multiple linear regression analysis was used to identify factors associated with nutrition literacy scores. Results: The mean nutrition literacy score was 65.47 ± 9.79. In multivariable analysis, older age, female sex, minority ethnicity, urban residence, and higher caregiver educational attainment were independently associated with higher nutrition literacy scores (all Conclusion: Nutrition literacy among 4th-5th grade students in Chongqing was generally low and was associated with both sociodemographic characteristics and dietary behaviors. The findings highlight the importance of strengthening nutrition education and promoting practical food-related activities among school-aged children, with particular attention to children from socioeconomically disadvantaged backgrounds.