Nutrition knowledge, attitude, and practice of sustainable healthy diets: a survey of Italian college students (the KAPSULE study)
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Keywords
Abstract
A key challenge in the nutrition field is identifying strategies to encourage the adoption of sustainable healthy diets (SHD). Current evidence suggests that greater nutritional knowledge is associated with a higher likelihood of choosing a healthy diet. However, the level of knowledge, attitudes, and practices related to SHD within the Italian population has been scarcely investigated so far. The aim of the present work is to validate a questionnaire assessing knowledge, attitudes, and practices regarding SHD among college students attending the University of Milan. A total of 1,491 students completed the questionnaire, which included 26 items and was divided into 3 sections related to knowledge, attitudes, and practices of SHD. Results from the present study show that cultural and social contexts influenced both the nutritional and environmental attitudes of the consumers involved. Consequently, nutritional and environmental attitudes affect nutritional and environmental practices. The results also demonstrate that attitude indirectly affects practice through knowledge, which may play a pivotal role in fostering the transition towards SHD in the Italian population. Administering this questionnaire to a larger sample of the Italian population will help clarify which gaps prevent greater adherence to SHD and support the design of interventions to address these gaps.
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Hyldelund, N. B., Byrne, D. V., Chan, R. C. K., & Andersen, B. V. (2022). Food pleasure across nations: A comparison of the drivers between Chinese and Danish populations. Food Quality and Preference, 97, 104493. https://doi.org/10.1016/j.foodqual.2021.104493
Iaccarino Idelson, P., D’Elia, L., Cairella, G., Sabino, P., Scalfi, L., Fabbri, A., Galletti, F., Garbagnati, F., Lionetti, L., Paolella, G., Simonetti, P., & Strazzullo, P. (2020). Salt and health: Survey on knowledge and salt intake related behaviour in Italy. Nutrients, 12(2), 279. https://doi.org/10.3390/nu12020279
Jiang, K., Zhang, L., Xie, C., Li, Z., Shi, Z., Sharma, M., & Zhao, Y. (2024). Understanding the knowledge, attitudes, and practices of healthy eating among adolescents in Chongqing, China: An empirical study utilizing structural equation modeling. Nutrients, 16(1), 167. https://doi.org/10.3390/nu16010167
Kaiser, F. G., Oerke, B., & Bogner, F. X. (2007). Behavior-based environmental attitude: Development of an instrument for adolescents. Journal of Environmental Psychology, 27(3), 242–251. https://doi.org/10.1016/j.jenvp.2007.06.004
Lawrence, M. A. (2024). What are the key principles of healthy and sustainable diets? A review of 100+ national dietary guidelines. Nutrition Journal, 23(1), 35. https://doi.org/10.1186/s12937-024-01049-6
Lee, H., & Cheon, H. (2018). Exploring Korean consumers’ attitudes toward ethical consumption behavior in the light of affect and cognition. Journal of International Consumer Marketing, 30(2), 98–114. https://doi.org/10.1080/08961530.2017.1376241
Lee, H.-S., & Lopetcharat, K. (2017). Effect of culture on sensory and consumer research: Asian perspectives. Current Opinion in Food Science, 15, 22–29. https://doi.org/10.1016/j.cofs.2017.04.003
Leone, A., Battezzati, A., De Amicis, R., De Carlo, G., & Bertoli, S. (2017). Trends of adherence to the Mediterranean dietary pattern in Northern Italy from 2010 to 2016. Nutrients, 9(7), 734. https://doi.org/10.3390/nu9070734
Van Liere, K. D., & Dunlap, R. E. (1980). The social bases of environmental concern: A review of hypotheses, explanations and empirical evidence. Public Opinion Quarterly, 44(2), 181–197.
Lizcano-Prada, J., Maestre-Matos, M., Mesias, F. J., Lami, O., Giray, H., Özçiçek Dölekoğlu, C., Abdoulaye Bamoi, A. G., & Martínez-Carrasco, F. (2024). Does consumers’ cultural background affect how they perceive and engage in food sustainability? A cross-cultural study. Foods, 13(2), 311. https://doi.org/10.3390/foods13020311
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Mathras, D., Cohen, A. B., Mandel, N., & Mick, D. G. (2016). The effects of religion on consumer behavior: A conceptual framework and research agenda. Journal of Consumer Psychology, 26(2), 298–311. https://doi.org/10.1016/j.jcps.2015.08.001
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Monterrosa, E. C., Frongillo, E. A., Drewnowski, A., de Pee, S., & Vandevijvere, S. (2020). Sociocultural influences on food choices and implications for sustainable healthy diets. Food and Nutrition Bulletin, 41(2_suppl), 59S–73S. https://doi.org/10.1177/0379572120975874
Mrówczyńska-Kamińska, A., Bajan, B., Pawłowski, K. P., Genstwa, N., & Zmyślona, J. (2021). Greenhouse gas emissions intensity of food production systems and its determinants. PLOS ONE, 16(4), e0250995. https://doi.org/10.1371/journal.pone.0250995
Pachucki, M. C., & Breiger, R. L. (2018). Network theories. Cambridge University Press.
Rothe, M. (1996). Food choice, acceptance and consumption (H. J. Meiselman & H. J. H. MacFie, Eds.; 397 pp.). Blackie Academic & Professional, an imprint of Chapman & Hall. Nahrung, 40, 353. https://doi.org/10.1002/food.19960400628
Rozin, P. (2005). The meaning of food in our lives: A cross-cultural perspective on eating and well-being. Journal of Nutrition Education and Behavior, 37, S107–S112. https://doi.org/10.1016/S1499-4046(06)60209-1
Sahin, E., & Sanlier, N. (2025). Relationships among nutrition knowledge level and healthy eating obsessions in females. BMC Public Health, 25, Article 22689. https://doi.org/10.1186/s12889-025-22689-1
Sanlier, N., & Baser, F. (2020). The relationship among food safety knowledge, attitude, and behavior of young Turkish women. Journal of the American College of Nutrition, 39(3), 224–234. https://doi.org/10.1080/07315724.2019.1639084
Scalvedi, M. L., Gennaro, L., Saba, A., & Rossi, L. (2021). Relationship between nutrition knowledge and dietary intake: An assessment among a sample of Italian adults. Frontiers in Nutrition, 8, 714493. https://doi.org/10.3389/fnut.2021.714493
Shepherd, R. (1999). Social determinants of food choice. Proceedings of the Nutrition Society, 58(4), 807–812. https://doi.org/10.1017/S0029665199001093
Sibal, V. (2018). Food: Identity of culture and religion. Food and Culture, 6(46), 10908–10915.
Soini, K., & Dessein, J. (2016). Culture–sustainability relation: Towards a conceptual framework. Sustainability, 8(2), 167. https://doi.org/10.3390/su8020167
Vallée, A., Kesse-Guyot, E., & Touvier, M. (2022). Nutritional knowledge and its association with sustainable and healthy eating behaviors in a large French cohort. Frontiers in Psychology, 13, 890124. https://doi.org/10.3389/fpsyg.2024.1405414
van Bussel, L. M., Kuijsten, A., Mars, M., & van ‘t Veer, P. (2022). Consumers’ perceptions on food-related sustainability: A systematic review. Journal of Cleaner Production, 341, 130904. https://doi.org/10.1016/j.jclepro.2022.130904
Whitelock, E., & Ensaff, H. (2018). On your own: Older adults’ food choice and dietary habits. Nutrients, 10(4), 413. https://doi.org/10.3390/nu10040413
Whitmee, S., Haines, A., Beyrer, C., Boltz, F., Capon, A. G., de Souza Dias, B. F., Ezeh, A., Frumkin, H., Gong, P., Head, P., Horton, R., Mace, G. M., Marten, R., Myers, S. S., Nishtar, S., Osofsky, S. A., Pattanayak, S. K., Pongsiri, M. J., Romanelli, C., … Yach, D. (2015). Safeguarding human health in the Anthropocene epoch: Report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet, 386(10007), 1973–2028. https://doi.org/10.1016/S0140-6736(15)60901-1
World Health Organization, & Food and Agriculture Organization of the United Nations. (2019). Sustainable healthy diets: Guiding principles. World Health Organization.
Ares, G. (2018). Methodological issues in cross-cultural sensory and consumer research. Food Quality and Preference, 64, 253–263. https://doi.org/10.1016/j.foodqual.2016.10.007
Ares, G., Giménez, A., Vidal, L., Zhou, Y., Krystallis, A., Tsalis, G., Symoneaux, R., Cunha, L. M., de Moura, A. P., Claret, A., Guerrero, L., Cardello, A. V., Wright, A., Jefferies, L., Lloyd, M., Oliveira, D., & Deliza, R. (2016). Do we all perceive food-related wellbeing in the same way? Results from an exploratory cross-cultural study. Food Quality and Preference, 52, 62–73. https://doi.org/10.1016/j.foodqual.2016.03.014
Arslan, S., & Alataş, E. (2023). Evaluation of sustainable nutrition knowledge and attitudes of university students. International Journal of Health Management and Strategies Research, 9(2), 130–144.
Baraldi, L. G., Martinez Steele, E., Canella, D. S., & Monteiro, C. A. (2018). Consumption of ultra-processed foods and associated sociodemographic factors in the USA between 2007 and 2012: Evidence from a nationally representative cross-sectional study. BMJ Open, 8(3), e020574. https://doi.org/10.1136/bmjopen-2017-020574
Bradette-Laplante, M., Carbonneau, É., Provencher, V., Bégin, C., Robitaille, J., Desroches, S., Vohl, M.-C., Corneau, L., & Lemieux, S. (2017). Development and validation of a nutrition knowledge questionnaire for a Canadian population. Public Health Nutrition, 20(7), 1184–1192. https://doi.org/10.1017/S1368980016003372
Christ, S. L., Lee, D. J., Lam, B. L., & Zheng, D. D. (2014). Structural equation modeling: A framework for ocular and other medical sciences research. Ophthalmic Epidemiology, 21(1), 1–13. https://doi.org/10.3109/09286586.2013.867508
Crippa, M., Solazzo, E., Guizzardi, D., Monforti-Ferrario, F., Tubiello, F. N., & Leip, A. (2021). Food systems are responsible for a third of global anthropogenic GHG emissions. Nature Food, 2(3), 198–209. https://doi.org/10.1038/s43016-021-00225-9
Cruwys, T., Bevelander, K. E., & Hermans, R. C. J. (2015). Social modeling of eating: A review of when and why social influence affects food intake and choice. Appetite, 86, 3–18. https://doi.org/10.1016/j.appet.2014.08.035
Duerlund, M., Andersen, B. V., Wang, K., Chan, R. C. K., & Byrne, D. V. (2020). Post-ingestive sensations driving post-ingestive food pleasure: A cross-cultural consumer study comparing Denmark and China. Foods, 9(5), 617. https://doi.org/10.3390/foods9050617
ElHaffar, G., Durif, F., & Dubé, L. (2020). Towards closing the attitude–intention–behavior gap in green consumption: A narrative review of the literature and an overview of future research directions. Journal of Cleaner Production, 275, 122556. https://doi.org/10.1016/j.jclepro.2020.122556
Fautsch Macías, Y., & Glasauer, P. (2014). Guidelines for assessing nutrition-related knowledge, attitudes and practices (Food and Agriculture Organization of the United Nations, Ed.). Food and Agriculture Organization of the United Nations.
Fischler, C. (1988). Food, self and identity. Social Science Information, 27(2), 275–292. https://doi.org/10.1177/053901888027002005
Food and Agriculture Organization of the United Nation. (2021). The state of the world’s land and water resources for food and agriculture – Systems at breaking point. Food and Agriculture Organization of the United Nations.
Frawley, E. S. (2017). Veganism as a cultural phenomenon (Undergraduate thesis). Bucknell University .
Gianfredi, V., Stacchini, L., Lotti, S., Sarno, I., Sofi, F., & Dinu, M. (2024). Knowledge, attitude and behaviours towards food sustainability in a group of Italian consumers: A cross-sectional study. International Journal of Food Sciences and Nutrition, 75(5), 463–474. https://doi.org/10.1080/09637486.2024.2335524
Henseler, J., Ringle, C. M., & Sinkovics, R. R. (2009). The use of partial least squares path modeling in international marketing (pp. 277–319). https://doi.org/10.1108/S1474-7979(2009)0000020014
Hessam Zand, H., & Parisa, Y. (2013). Investigation of major factors influencing green purchasing behavior: Interactive approach. European Online Journal of Natural and Social Sciences, 2(4), 584–596.
Hyldelund, N. B., Byrne, D. V., Chan, R. C. K., & Andersen, B. V. (2022). Food pleasure across nations: A comparison of the drivers between Chinese and Danish populations. Food Quality and Preference, 97, 104493. https://doi.org/10.1016/j.foodqual.2021.104493
Iaccarino Idelson, P., D’Elia, L., Cairella, G., Sabino, P., Scalfi, L., Fabbri, A., Galletti, F., Garbagnati, F., Lionetti, L., Paolella, G., Simonetti, P., & Strazzullo, P. (2020). Salt and health: Survey on knowledge and salt intake related behaviour in Italy. Nutrients, 12(2), 279. https://doi.org/10.3390/nu12020279
Jiang, K., Zhang, L., Xie, C., Li, Z., Shi, Z., Sharma, M., & Zhao, Y. (2024). Understanding the knowledge, attitudes, and practices of healthy eating among adolescents in Chongqing, China: An empirical study utilizing structural equation modeling. Nutrients, 16(1), 167. https://doi.org/10.3390/nu16010167
Kaiser, F. G., Oerke, B., & Bogner, F. X. (2007). Behavior-based environmental attitude: Development of an instrument for adolescents. Journal of Environmental Psychology, 27(3), 242–251. https://doi.org/10.1016/j.jenvp.2007.06.004
Lawrence, M. A. (2024). What are the key principles of healthy and sustainable diets? A review of 100+ national dietary guidelines. Nutrition Journal, 23(1), 35. https://doi.org/10.1186/s12937-024-01049-6
Lee, H., & Cheon, H. (2018). Exploring Korean consumers’ attitudes toward ethical consumption behavior in the light of affect and cognition. Journal of International Consumer Marketing, 30(2), 98–114. https://doi.org/10.1080/08961530.2017.1376241
Lee, H.-S., & Lopetcharat, K. (2017). Effect of culture on sensory and consumer research: Asian perspectives. Current Opinion in Food Science, 15, 22–29. https://doi.org/10.1016/j.cofs.2017.04.003
Leone, A., Battezzati, A., De Amicis, R., De Carlo, G., & Bertoli, S. (2017). Trends of adherence to the Mediterranean dietary pattern in Northern Italy from 2010 to 2016. Nutrients, 9(7), 734. https://doi.org/10.3390/nu9070734
Van Liere, K. D., & Dunlap, R. E. (1980). The social bases of environmental concern: A review of hypotheses, explanations and empirical evidence. Public Opinion Quarterly, 44(2), 181–197.
Lizcano-Prada, J., Maestre-Matos, M., Mesias, F. J., Lami, O., Giray, H., Özçiçek Dölekoğlu, C., Abdoulaye Bamoi, A. G., & Martínez-Carrasco, F. (2024). Does consumers’ cultural background affect how they perceive and engage in food sustainability? A cross-cultural study. Foods, 13(2), 311. https://doi.org/10.3390/foods13020311
Marklinder, I., Eskhult, G., Ahlgren, R., Blücher, A., Börjesson, S.-M. E., Moazzami, M., Schelin, J., & Danielsson-Tham, M.-L. (2022). A structural equation model demonstrating the relationship between food safety background, knowledge, attitudes and behaviour among Swedish students. Foods, 11(11), 1595. https://doi.org/10.3390/foods11111595
Mathras, D., Cohen, A. B., Mandel, N., & Mick, D. G. (2016). The effects of religion on consumer behavior: A conceptual framework and research agenda. Journal of Consumer Psychology, 26(2), 298–311. https://doi.org/10.1016/j.jcps.2015.08.001
Monteleone, E., Spinelli, S., Dinnella, C., Endrizzi, I., Laureati, M., Pagliarini, E., Sinesio, F., Gasperi, F., Torri, L., Aprea, E., Bailetti, L. I., Bendini, A., Braghieri, A., Cattaneo, C., Cliceri, D., Condelli, N., Cravero, M. C., Del Caro, A., Di Monaco, R., … Tesini, F. (2017). Exploring influences on food choice in a large population sample: The Italian Taste project. Food Quality and Preference, 59, 123–140. https://doi.org/10.1016/j.foodqual.2017.02.013
Monterrosa, E. C., Frongillo, E. A., Drewnowski, A., de Pee, S., & Vandevijvere, S. (2020). Sociocultural influences on food choices and implications for sustainable healthy diets. Food and Nutrition Bulletin, 41(2_suppl), 59S–73S. https://doi.org/10.1177/0379572120975874
Mrówczyńska-Kamińska, A., Bajan, B., Pawłowski, K. P., Genstwa, N., & Zmyślona, J. (2021). Greenhouse gas emissions intensity of food production systems and its determinants. PLOS ONE, 16(4), e0250995. https://doi.org/10.1371/journal.pone.0250995
Pachucki, M. C., & Breiger, R. L. (2018). Network theories. Cambridge University Press.
Rothe, M. (1996). Food choice, acceptance and consumption (H. J. Meiselman & H. J. H. MacFie, Eds.; 397 pp.). Blackie Academic & Professional, an imprint of Chapman & Hall. Nahrung, 40, 353. https://doi.org/10.1002/food.19960400628
Rozin, P. (2005). The meaning of food in our lives: A cross-cultural perspective on eating and well-being. Journal of Nutrition Education and Behavior, 37, S107–S112. https://doi.org/10.1016/S1499-4046(06)60209-1
Sahin, E., & Sanlier, N. (2025). Relationships among nutrition knowledge level and healthy eating obsessions in females. BMC Public Health, 25, Article 22689. https://doi.org/10.1186/s12889-025-22689-1
Sanlier, N., & Baser, F. (2020). The relationship among food safety knowledge, attitude, and behavior of young Turkish women. Journal of the American College of Nutrition, 39(3), 224–234. https://doi.org/10.1080/07315724.2019.1639084
Scalvedi, M. L., Gennaro, L., Saba, A., & Rossi, L. (2021). Relationship between nutrition knowledge and dietary intake: An assessment among a sample of Italian adults. Frontiers in Nutrition, 8, 714493. https://doi.org/10.3389/fnut.2021.714493
Shepherd, R. (1999). Social determinants of food choice. Proceedings of the Nutrition Society, 58(4), 807–812. https://doi.org/10.1017/S0029665199001093
Sibal, V. (2018). Food: Identity of culture and religion. Food and Culture, 6(46), 10908–10915.
Soini, K., & Dessein, J. (2016). Culture–sustainability relation: Towards a conceptual framework. Sustainability, 8(2), 167. https://doi.org/10.3390/su8020167
Vallée, A., Kesse-Guyot, E., & Touvier, M. (2022). Nutritional knowledge and its association with sustainable and healthy eating behaviors in a large French cohort. Frontiers in Psychology, 13, 890124. https://doi.org/10.3389/fpsyg.2024.1405414
van Bussel, L. M., Kuijsten, A., Mars, M., & van ‘t Veer, P. (2022). Consumers’ perceptions on food-related sustainability: A systematic review. Journal of Cleaner Production, 341, 130904. https://doi.org/10.1016/j.jclepro.2022.130904
Whitelock, E., & Ensaff, H. (2018). On your own: Older adults’ food choice and dietary habits. Nutrients, 10(4), 413. https://doi.org/10.3390/nu10040413
Whitmee, S., Haines, A., Beyrer, C., Boltz, F., Capon, A. G., de Souza Dias, B. F., Ezeh, A., Frumkin, H., Gong, P., Head, P., Horton, R., Mace, G. M., Marten, R., Myers, S. S., Nishtar, S., Osofsky, S. A., Pattanayak, S. K., Pongsiri, M. J., Romanelli, C., … Yach, D. (2015). Safeguarding human health in the Anthropocene epoch: Report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet, 386(10007), 1973–2028. https://doi.org/10.1016/S0140-6736(15)60901-1
World Health Organization, & Food and Agriculture Organization of the United Nations. (2019). Sustainable healthy diets: Guiding principles. World Health Organization.
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De Marchi, E., Del Bo, C. ., Martini, D., & Cavaliere, A. (2026). Nutrition knowledge, attitude, and practice of sustainable healthy diets: a survey of Italian college students (the KAPSULE study). Italian Journal of Food Science, 38(1), 376–387. https://doi.org/10.15586/ijfs.v38i1.3039
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De Marchi, E., Del Bo, C. ., Martini, D., & Cavaliere, A. (2026). Nutrition knowledge, attitude, and practice of sustainable healthy diets: a survey of Italian college students (the KAPSULE study). Italian Journal of Food Science, 38(1), 376–387. https://doi.org/10.15586/ijfs.v38i1.3039