Nutritional literacy among patients on maintenance hemodialysis: a scoping review

Objective To systematically review the current state of research on nutritional literacy among patients undergoing maintenance hemodialysis (MHD), summarize their levels of nutritional literacy, factors associated with nutritional literacy, relationships with health outcomes, and existing intervention measures, and provide guidance for the assessment and intervention of nutritional literacy in MHD patients. Methods A scoping review was conducted, involving a systematic search of PubMed, Web of Science, the Cochrane library, Embase, China national knowledge infrastructure (CNKI), WanFang, China science and technology journal database (VIP), and China biology medicine disk (CBM). The search covered the period from the inception of each database through July 2026. Studies were screened based on inclusion and exclusion criteria, and data were extracted and synthesized regarding the basic characteristics of the included studies, levels of nutritional literacy, factors associated with nutritional literacy, health-related outcomes, and intervention measures. Results A total of 20 studies were included, comprising 15 cross-sectional studies, 1 longitudinal study, and 4 intervention studies. Reported nutritional literacy levels varied across studies, with relatively lower performance in information acquisition and behavioral practice. Factors associated with nutritional literacy encompass multiple aspects, including sociodemographic, disease-related, psychological and behavioral, and social factors; among these, educational level, age, place of residence, social support, duration of dialysis, and underlying medical conditions have been reported in a significant number of studies. Higher nutritional literacy is associated with better treatment and dietary adherence, more favorable nutritional status, lower levels of frailty, and higher quality of life. Existing interventions primarily include nutritional care process management, multidisciplinary dietary interventions, experiential nutrition education, and nutrition education based on the health belief model; some intervention studies reported improvements in broader nutrition-related outcomes, including nutritional knowledge, dietary behavior, and nutritional status, whereas only one study directly assessed nutritional literacy and reported improvements across its dimensions. Conclusion There is still room for improvement in nutritional literacy among MHD patients, and it is associated with multiple factors. Clinicians should prioritize the assessment and identification of patients’ nutritional literacy, provide individualized and ongoing nutrition education and management tailored to each patient’s characteristics, strengthen patients’ ability to understand and apply nutritional information as well as their self-management skills, and promote the translation of nutritional knowledge into healthy behaviors. Systematic review registration This scoping review was registered on the open science frame¬work (OSF) and is available at https://doi.org/10.17605/osf.io/5td6h .