Supplementary Material

A. The I-NK questionnaire: Italian Nutrition Knowledge questionnaire, subjective Nutrition

Knowledge, food habits

List of the questionnaire items measuring i) nutrition knowledge related to experts ‘recommendations
for a healthy diet, calories/nutrients composition of selected food products, and associations between
diet and diseases; ii) subjective knowledge; iii) eating habits

Experts’recommendations
for a healthy diet

C1. What do you think the experts recommend that people should be
eating for the following foods? (eating more; eating less; no
recommendation; I don’t know)
vegetables; sugary foods ; meat; cereals and derivates (bread,
pasta, rice, …); fatty foods; high fibre foods; fruit; salty foods

C2. How many servings of fruit and vegetables a day do you think
experts are advising people to eat? (1; 2, 5 or more; more than 10; I
don’t know)

C3. Which fats do experts recommend reducing (monounsaturated;

polyunsaturated; saturated; I don’t know)

C4. Which version of dairy foods do experts advice people to eat

(higher fat products; lower fat products; saturated; I don’t know)
Calories/nutrients
composition of selected
food products

D1. Do you think these food products are high or low in added sugar?
(high; low; I don’t know)
fruit juice; ice cream; fresh squeezed orange juice; tomato ketchup;
canned fruit in natural juice

D2. Do you think these food products are high or low in fat? (high;
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low; I don’t know)

pasta (without sauce); legumes; fried eggs; cured meat; honey;
nuts; bread; cheese; margarine

D3. Do you think these food products are part of the ‘starchy foods”
category? (yes; no; I don’t know)
cheese; pasta; butter; nuts; rice; meat

D4. Do you think these food products are high or low in salt? (high;
low; I don’t know)
sausages; pasta; canned anchovies; red meat; breakfast cereals;
cheese; frozen vegetables

D5. Do you think these food products are high or low in proteins?
(high; low; I don’t know)
chicken; cheese; fruit; legumes; butter

D6. Do you think these food products are high or low in fibre? (high;
low; I don’t know)
breakfast cereals; bananas; eggs; red meat; broccoli; nuts; fish;
potatoes; chicken

D7. Do you think these food products are high or low in saturated fat?
(high; low; I don’t know)
mackerel; whole milk; olive oil; red meat; margarine; nuts

D8. Do you think these food products are a healthy alternative to red
meat? (yes; no; I don’t know)
fish; legumes; nuts; cheese; canned meat

D9. Which of these food products mainly contain saturated fats?

(vegetable oils; dairy products; both; I do not know)

D10. Which of these breads contain most vitamins and minerals?

(white; wholegrain; potato flour bread; I do not know)

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 D11. Which one do you think is higher in calories? (butter; oil; the
same; I do not know)

D12. In your opinion, the oil with more monounsaturated fats is...?
(corn oil; sunflower oil; olive oil; peanut oil; I do not know)

D13. In your opinion, which one of the following has the most calories
for the same weight? (sugar; bread; fruit; fats; I do not know)

D14. In your opinion, polyunsaturated fats are mainly found in?

(vegetable oils; dairy products; both; I do not know)

D15. Some food products are rich in fat but not in cholesterol. (agree;
disagree; I do not know)

D16. A glass of fruit juice can replace a fruit. (agree; disagree; I do

not know)

D17. Brown sugar is a healthy alternative to white sugar. (agree;

disagree; I do not know)

D18. Margarine contains less fat than butter does. (agree; disagree; I
do not know)
Associations between diet
and diseases

E1. Do you think these eating habits help to reduce the chances of
getting certain kinds of cancer? (yes; no; I don’t know)
eating more fibre; eating less sugar; eating less fruit; eating less
salt; eating more fruit and vegetables; eating less
preservatives/additives; never drink wine and alcoholic beverages;
eat more legumes

E2. Do you think these eating habits help prevent hearth diseases?
(yes; no; I don’t know)
eating more fibre; eating less saturated fat; eating less salt; eating
more fruit and vegetables; eating less preservatives/additives;
eating more legumes; eating more fish and fishery products; eating

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nuts in a moderately way

E3. Do you think these eating habits help prevent diabetes diseases?
(yes; no; I don’t know)
eating more fibre; eating less saturated fat; eating less fruit; eating
less sugar; eating less preservatives/additives; eating more fruit
and vegetables; eating less preservatives/additives; eating more
legumes; eating more fish and fishery products
Subjective Nutrition
knowledge

A.5 People I know consider me a nutrition expert (1: extremely

disagree / 7: extremely agree)
B5. Compared to most other people, I know many things about the
nutritional properties of foods (1: extremely disagree / 7: extremely
agree)

F3. I know pretty well how to evaluate foods and their nutritional
properties (1: extremely disagree / 7: extremely agree)
Eating habits

B6. How often do you habitually consume the following foods and
drinks? (more than once per day; once per day; few times per week;
less than once a week; never)

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 B. Italian Food-based dietary guidelines: summary of recommendations

The Italian Dietary Guidelines for Healthy Eating (official name) were published in December 2019
(CREA Centro di ricerca per gli alimenti e la nutrizione (2018) Linee Guida Per Una Sana
Alimentazione Italiana. Revisione 2016. Dossier Scientifico.
https://www.crea.gov.it/en/web/alimenti-e-nutrizione/-/linee-guida-per-una-sana-alimentazione-2018
(accessed May 2021). The intended audience of the Guidelines is the general public.
Recommendations cover all age groups from infants to the elderly, including physiological
conditions such as pregnancy and lactation. There is also a focus on special requirements for people
who practice sports, as well as on providing recommendations for people at increased risk of obesity
and most common non-communicable chronic diseases (Cardiovascular diseases, cancers, diabetes).
The Guidelines are also intended to be used by health professionals who deal with nutrition, the
private sector and journalists (generalist and scientific). The main messages are intended to be the
basis for school nutrition education programs. The 13 directives have been divided into four blocks.
The first is related to balance (1). The second is dedicated to foods for which consumption needs to
be increased, such as fruits and vegetables (2-4). The third concerns critical foods in the current diet
and for which consumption should be reduced, such as fat, salt, sugar and alcohol (5-8). And the last
block is dedicated to "How to" ensure a varied, safe, healthy and sustainable diet (9-13).
The 13 directives and the main recommendations included in each directive are:
Conceptual block Directive Main recommendations
 In case of overweigh reduce intake and increase physical
activity.
1. Keep your weight
 Avoid very restrictive diets that exclude entire food
Balance under control and
groups.
always be active
 Be careful to extreme food behaviour that could be
symptoms of eating disorders.
Increase  Increase fruits and vegetable consumption limiting the
consumption 2. Eat more fruits and adding of added fats and salt.
vegetables  Choose seasonal fruit and vegetables varying colours.
 Fruits juice cannot replace a portion of fresh fruit.
 Increase consumption of fibre choosing whole grain
products.
3. Eat whole grain and  Increase legume intake as alternative to animal source
legumes foods.
 Remember the importance of fibre as protective factor
for non-communicable disease
4. Drink abundant  Water must be the preferred fluid for rehydration.

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 Drinks at least 8 glasses of water a day, more is better.

water every day
 Increase water intake during physical activity.

 Reduce intake of saturated fat choosing foods containing

5. Fats: select which unsaturated fatty acid for cardiovascular prevention.
ones and limit the  Remember that all fats have the same caloric content.
quantity  Remember that in Italy trans-fatty acids are any more
present in industrial products.

 Reduce intake of sugar in favour of starchy foods

 High intake of sweetened beverages is a risk factors for
6. Sugar, sweets and
non-communicable diseases, including diabetes and
sugar sweetened
obesity.
beverages: less is better
 Remember that brown sugar, honey and fructose are not
healthy alternative to sugar.
Reduce
consumption
 Reduce intake of salt and chose iodine fortified products.
 Remember that several industrial products are hidden
7. Salt: less is better
source of salt (e.g. breakfast cereals).
(but iodised)
 Remember that salt intake is an important risk factors for
non-communicable disease in particular heart disorders.

 Avoidance of alcohol of any source including wine and

beer, is the best for health.
 If you decide to drink alcohol it is for your pleasure not
8. Alcoholic beverages: for health; limits the quantities: not more than 1 alcoholic
the least possible unit (e.g. a glass of wine) per day for female and elderly
and 2 alcoholic units per day for males.
 No alcohol of any type to children, adolescents, pregnant
and lactating women.
 Remember that choosing variety of foods is a way to
guarantee nutritional adequacy.
 Variety does not means more foods, portions and
9. Enjoy a variety of
How to do frequencies must be adequate to energy consumption at
food choices
different ages and physiological status.
 Mediterranean Diet is the dietary pattern that inspire the
Italian FBGDs.

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  Remember that children have special needs in particular
during infancy: select foods of high quality in adequate
quantity.
 Pregnancy and breastfeeding are physiological periods
10. Follow special that require attention: best to think before and arrive to
recommendations for these moments in good health and putting in place all
target groups preventive actions needed (e.g. folic acid
supplementation).
 Elderly need to eat a little less because the metabolism
slows down but the quality of the food must be higher
without forget to maintain an active lifestyle.
 Dieting is a therapeutic acts that require trained
professionals; consumers should avoid to refer to non-
11. Be careful of qualified people.
dieting and misuse of  Loose weigh require time and constancy, everything and
dietary supplements immediately is not compatible with dieting.
 Dietary supplements could be important in case of
deficiency but never substitute a healthy diet.
 At home, be careful to good storage of food in the
refrigerator.
 At the supermarket, in the grocery cart and bags separate
fruit and vegetables from meat, poultry and fish to avoid
cross-contamination.
12. Food safety  Prepare the kitchen, clean the sink before and after
depends also on you washing and preparing fresh fruit and vegetables, use
different cutting board and preparation area for
meat/poultry/fish and fresh fruits and vegetables. Wash
especially well between preparation of meat/poultry/fish
and preparation of foods that will be eaten without
cooking.
 Avoid processed meat and reduce red meat consumption
in favour of poultry or vegetal source of protein. Select
fish from sustainable stocks, e.g. small fish from
Mediterranean see (anchovies, sardines, mackerel, etc.);
not demonise aquaculture.
13. Select a sustainable  Increase consumption of plant foods avoiding selection
diet of products that require large use of external inputs for
growing (e.g. high fertilizing, artificial light and heating
or overseas products).
 Planning, preparing, and storing food can help
consumers waste less food, save money, and eat healthier
food. Re-use old ingredients or leftovers in new dishes.