Effects of primary caregivers’ food literacy, social support, food environment, and household income on the nutritional status of school-aged children: a cross-sectional study

Objectives: The dietary habits of school-aged children play a critical role in their growth and development, and are strongly influenced by the home environment. Household income is closely associated with caregivers’ food literacy, social support, and food environment. This directly affects the nutritional status of children. This study aimed to provide evidence to inform policies and educational programs for improving dietary habits in children, and to establish a foundation for tailored support strategies for low-income families. Methods: This cross-sectional study included 846 primary caregivers of school-aged children from 17 regions across Korea, recruited through an online survey. Household income, caregivers’ food literacy, social support, and food environment were assessed. Nutritional status in children was measured using the Nutrition Quotient for Children (NQ-C). Statistical analyses included descriptive statistics, chi-square tests, one-way analysis of variance (ANOVA), analysis of covariance (ANCOVA), correlation analyses, and multiple linear regression.Results: Caregivers from higher income households demonstrated significantly greater food literacy and social support (P < 0.001). Children from these households showed high balance scores and a large proportion of these children were in the “high” NQ-C grade. The NQ-C score in children was positively correlated with food literacy (r = 0.425), social support (r = 0.471), and the food environment (r = 0.235) (P < 0.001). Multiple regression analysis showed that food literacy (β = 0.256) and social support (β = 0.348) were significant predictors of nutritional status in children.Conclusion: This study confirmed that the nutritional status in children is not only determined solely by household income but is also mediated by caregivers’ food literacy, social support, and food environment. These findings highlighted the limitations of providing only economic support. The findings underscore the need for multifaceted interventions such as strengthening parental nutrition education, expanding social support networks, and improving access to healthy foods.