Guided by the Healthy China 2030 initiative, the nutritional health status of the population has become a key indicator for measuring national social development and public well-being (1). Childhood and adolescence represent a critical period in the life course, where nutritional status not only influences individual growth and cognitive development but also serves as a foundational element impacting a nation’s future human capital quality and public health burden (2). During this crucial stage, alongside traditional dietary intake, “nutrition literacy” is increasingly emerging as a central focus in health promotion. It extends far beyond the accumulation of static knowledge, emphasizing a set of cognitive and social skills that enable individuals to access, comprehend, evaluate, and apply nutritional information to make healthy food choices and dietary decisions (3). For primary school students, who are in a critical stage for cognitive development and habit formation, a high level of nutrition literacy acts as an intrinsic driver, guiding them to establish scientific dietary patterns, resist unhealthy food marketing, and ultimately achieve lifelong health (4, 5).

Currently, China’s child nutrition landscape presents complex and unprecedented challenges. While economic growth and material abundance have largely eradicated widespread nutritional deficiencies, new problems have emerged simultaneously. The westernization of dietary patterns, increasingly sedentary behaviors, and problematic feeding practices associated with intensive parenting have collectively contributed to the dual burden of “hidden hunger” and overweight/obesity (6, 7). According to research by Dang et al. (8), the prevalence of overweight and obesity among Chinese children and adolescents aged 7–18 years has increased dramatically from 5.3% in 1995 to 24.2% in 2019, implying the severe consequences of poor dietary behaviors during childhood. Traditional nutrition education models, predominantly focused on knowledge dissemination, have demonstrated limited effectiveness in addressing these challenges. Consequently, developing systematic approaches to enhance children’s literacy in translating nutritional knowledge into practical behaviors has become an urgent priority in tackling the current predicament.

Previous studies have established that nutrition literacy in children and adolescents is shaped by a complex interplay of factors. Socioeconomic determinants—particularly parental education, household income, and urban residence—consistently demonstrate positive correlations with nutrition literacy levels (9–11). A paradoxical trend emerges with age: as children gain greater autonomy in food selection and consumption, their nutrition literacy may paradoxically decline, potentially reflecting how increased independence outpaces the development of adequate decision-making competencies (12). Gender differences are also evident, with females generally exhibiting higher nutrition literacy than males (13). Notably, caregiver arrangement represents a significant influence, as children under the care of both parents typically demonstrate better nutrition literacy compared to those raised by single parents or other guardians (14). Furthermore, structured nutritional education interventions have been shown to substantially enhance nutrition literacy (15). These findings collectively illustrated the multifaceted nature of influences on youth nutrition literacy.

Shenzhen City, serving as a pioneering demonstration zone for China’s reform and opening-up policy, provides exemplary research setting for investigating urbanization’s impact on child health, characterized by its rapid economic growth, highly mobile population, and socio-cultural diversity. To systematically address existing gaps in understanding the status and determinants of nutrition literacy among primary school students in the modern city, we applied the Social-Ecological Model (SEM) and concentrating on Nanshan District of Shenzhen City. The SEM provides a framework that health behaviors and outcomes are shaped by a hierarchy of impact factors, ranging from intrapersonal factors (e.g., knowledge, attitudes), to interpersonal processes (e.g., family influences), organizational settings (e.g., school environment), and broader community and societal factors (16, 17). The empirical evidences generated are expected to establish a solid foundation for developing targeted, scientifically sound, and effective nutritional intervention strategies for children in urban settings like Shenzhen.

This large-scale cross-sectional study revealed a moderate level of nutrition literacy among primary school students in grades 3–5 from Nanshan District, Shenzhen City. And several key factors were associated with the adequate nutrition literacy, such as household economic status, participation in nutrition-related activities, and regular weight monitoring. These results underscore the need for comprehensive, multi-level intervention strategies that address the complex interplay of individual, familial, and institutional factors affecting children’s nutritional competencies.

Currently, research on nutrition literacy among Chinese school-aged children remains in a developmental phase, characterized by methodological limitations including inconsistent evaluation tools and lack of standardized cutoff values for determining adequate nutrition literacy. Using the same questionnaire as the present study, a median score of 71.1 was reported among primary school students in Beijing (41.9% for adequate nutrition literacy rate) (12), and 65.4 for school-aged children in Grade 3 to 9 (with 67.0 for Grade 3 to 4, and 66.5 for Grade 5 to 6) across 27 provinces of China (26). While the median of nutrition literacy was 61.68 for middle school students in Chongqing, measured by “Nutrition literacy scale for middle school students in Chongqing” (27). In this study, the level of nutrition literacy (score of 69.93, rate of 30.38%) in primary school students was similar to these findings, suggesting a relatively moderate level of nutrition literacy for urban Chinese primary students.

The observed variations in nutrition literacy can be effectively interpreted through the SEM theoretical framework for this study. Our findings align with this framework, and the following discussion is structured to examine these influences, beginning with the paradoxical role of student grade level (intrapersonal level), and then expanding to encompass the micro-system of the family (interpersonal processes) and the organizational influence of the school.

At the intrapersonal level, the results revealed that third- and fourth-grade students demonstrated significantly higher rates of adequate nutrition literacy compared with fifth-grade students, which was the same as that showed in study of Wang et al. (26). This pattern contrasts with established cognitive developmental theories, as older students exhibit more advanced logical reasoning and information integration capabilities, enabling deeper comprehension and application of complex nutritional concepts such as dietary balance and food composition (28). For lower rate of adequate nutrition literacy in higher grade, a possible explanation is associated with the unique developmental challenges of early adolescence, a critical period for health socialization where cognitive and social priorities shift (29). Additionally, older students often experience greater autonomy and exposure to diverse food environments outside school that does not conform with nutritional guidelines, which might limit the influence of school-based nutrition education received at younger grades (30, 31). Future longitudinal research is needed to disentangle the specific effects of developmental factors, and environmental influences on nutrition literacy during this transition.

Within the micro-system of the family, household economic status emerged as a significant predictor, aligning with global evidence on socioeconomic disparities in health literacy. Higher family economic status may facilitate access to diverse foods and nutrition-related resources. In contrast, the type of primary caregiver (e.g., parents vs. grandparents) was not a significant predictor in our analysis—a finding inconsistent with the earlier study by Young et al. (32). This discrepancy may stem from different types of primary caregiver distribution, i.e., there are less primary caregiver of grandparents in Shenzhen than other cities in China. However, it is important to note that the non-significant variations do not necessarily imply that family caregivers are unimportant. Within the context of China’s prevalent intergenerational parenting model in most cities, grandparents’ feeding beliefs were largely shaped during a period of relative material scarcity, which has led them to express care primarily by ensuring children are “well-fed” with energy-dense, high-fat foods. Consequently, their awareness and practice of modern nutritional principles—such as dietary diversity, salt reduction, and sugar control—are generally limited (33, 34). Moreover, grandparents often exhibit more permissive parenting behaviors, including greater tolerance toward children’s unhealthy snack choices and eating habits (35). These findings highlight the critical importance of incorporating families, particularly primary caregivers, into nutrition intervention strategies. Implementing intergenerational nutrition education programs, such as structured “grandparent classrooms,” would help modernize grandparents’ nutritional knowledge and bridge the generational gap in dietary concepts.

At the organizational level, participation in school-based nutrition activities was positively associated with the attainment of adequate nutrition literacy, a finding consistent with the earlier research by Jakobovich et al. (36). A comprehensive systematic review of school-based interventions targeting FL and NL in primary-school-age children identified that experiential strategies including hands-on food education, school gardening, kitchen classrooms, family cooking and shared activities, and culturally appropriate food practices effectively improved functional skills as well as partial interactive and critical competencies (37). This suggests that students who participate in such activities may have greater opportunities to develop practical nutrition skills and apply nutritional knowledge in real-world contexts. However, the rate of adequate nutrition literacy (30.38%) among the students in Nanshan District was below one third and more than half of the students (55.14%) reported no participation in any nutrition-related activities at school, indicating potential shortcomings in either the coverage, design or implementation of current school-based nutrition education programs. Several factors might explain this gap, such as limited school resources, inadequate teacher training in nutrition education, restrict time allocation for health promotion activities. Additionally, many programs appear to prioritize procedural compliance over substantive engagement, lacking relevance to students’ daily dietary experiences and failing to cultivate interest. The predominance of didactic instruction methods may further contribute to student disengagement and resistance (38). Such limitations not only compromise educational effectiveness but may inadvertently produce adverse outcomes. Also, in this study, regular weight monitoring was positively associated with nutrition literacy in our cross-sectional analysis. Recently, weight monitoring often remains a spontaneous behavior among caregivers and has not been effectively integrated with systematic school nutrition education. Most caregivers’ approaches to weight monitoring remain limited, failing to guide children in understanding the crucial balance between weight management, overall dietary patterns, and physical activity. Consequently, children may develop a superficial focus on body weight metrics alone, potentially leading to weight-related anxiety and psychological burden (39). Healthy weight management should derive from active lifestyle adoption rather than passive monitoring. This should involve widespread adoption of experiential and inquiry-based learning modalities, including physical activities, school gardening programs, culinary workshops, and interactive food label analysis, enabling students to discover the practical value of nutritional knowledge through firsthand experience (37, 40, 41) and integrating weight monitoring into comprehensive health education. This holistic approach will help students establish the correct understanding that “healthy weight results from balanced nutrition and appropriate physical activity”.

This study has several limitations. First, the cross-sectional design precludes definitive causal inferences regarding the identified relationships. Second, the sampling frame was restricted to a single geographic district, which may limit the generalization of findings to other regions with different socioeconomic and cultural contexts. Third, the assessment of nutrition literacy relied primarily on self-reported questionnaire data, which may be subject to social desirability and recall biases. Children may provide their answers according to the teachers or parental attitudes. Despite our on-site protocols designed to ensure independent and private responding, these biases could lead to an overestimation of nutrition literacy, particularly in behavioral domains, and may affect the strength of the observed associations. Future research would benefit from incorporating multi-informant designs or objective measures. Despite these limitations, this investigation provides valuable insights into the current status of nutrition literacy and its key determinants among primary school students in Shenzhen. The findings establish an important evidence base for developing targeted interventions and offer methodological considerations for future research in this emerging field. Future longitudinal studies incorporating objective assessment methods and more diverse sampling approaches would help validate and extend these findings.

This study demonstrates that nutrition literacy among primary school students in Nashan District, Shenzhen City requires substantial improvement, with rates of adequate nutrition literacy significantly influenced by grade level, household economic status, participation in nutrition-related activities, and regular weight monitoring. Future interventions should adopt an evidence-based, systematic approach that moves beyond traditional knowledge-transmission models. A comprehensive strategy should include: (1) developing student-centered learning experiences that connect nutrition knowledge to real-life contexts; (2) establishing robust home-school collaboration mechanisms to engage caregivers; and (3) implementing experiential activities that bridge the gap between knowledge and practice. Particular attention should be given to optimizing school-based health programs to ensure they produce meaningful outcomes. This multifaceted approach will better support the transformation of nutritional knowledge into sustainable healthy behaviors, ultimately enhancing the effectiveness of school health education initiatives.