Health literacy, dietary behavior and body mass index in male and female Norwegian conscripts. A cross-sectional study.

Objectives: Health literacy (HL) is an important determinant of health behaviors, including diet. In military populations, optimal nutrition is critical for physical performance, readiness, and long-term health. In Norway, first-time military service provides a unique opportunity to influence young conscripts' health habits. This study investigates the relationship between HL and dietary patterns, body mass index (BMI), and meal adherence among Norwegian conscripts, with an emphasis on potential sex differences. Study Design: A cross-sectional study. Methods: This cross-sectional study included Norwegian conscripts completing first-time military service. HL was measured using the validated HLS-Q12 instrument. Dietary behaviors, meal patterns, and BMI were assessed using self-reported questionnaire data. A digital questionnaire was sent to Norwegian conscripts completing their first-time military service in 2022 (n=9,991). A total of 2,225 conscripts consented to participate in the study. The survey assessed dietary habits across different military settings, self-reported diet quality, and HL using the HLS-Q12 tool. BMI was calculated from self-reported height and weight. Statistical analyses included chi-square tests and Pearson correlation to explore associations between HL, diet, and BMI. Results: Significant associations were observed between HL and several dietary variables; however, most associations were weak in magnitude. Higher HL was associated with more regular meal patterns and better self-reported diet quality. Additionally, differences between sexes were observed, but effect sizes were generally small. More than half of conscripts had an adequate HL, with males scoring significantly higher than females. Conscripts with adequate HL were more likely to rate their diet as good, follow meal recommendations, and maintain a normal BMI. However, no significant association between HL and BMI was found in the total population; differences appeared in sex-stratified analyses, among female conscripts. Independently of HL, unhealthy snacking and high-sugar drink consumption were more common during field training, whereas conscripts with inadequate HL (iHL) reporting higher sugary snack intake at home. Adequate HL was weakly but significantly correlated with higher self-reported diet quality, more frequent adherence to regular meals, and lower sugary snack consumption. This could mean that HL was associated with self-reported dietary intentions but not outcomes like BMI. Conclusions: HL may be associated with dietary behaviors among conscripts. However, given the weak associations and study limitations, the findings should be interpreted with caution. Although more than half of the conscripts had adequate HL, iHL was prevalent among Norwegian conscripts. Poorer self-reported diet quality and lower adherence to regular meal patterns is associated with iHL, particularly during field training. No significant associations was found between HL and BMI. The findings suggest a need for tailored education to improve HL and behavior change, to promote healthier dietary habits during military service.