Nutritional awareness is a self-perception of the importance assigned to eating balanced meals, and classified as high, moderate, or of little importance. Initially, a General Linear Model was fit that adjusted for age, sex, country of birth, and body mass index (BMI). Furthermore, simultaneous contributions to diet quality of individual-level socioeconomic factors, education, and household income were examined across levels of nutritional awareness. Attributing high importance was associated inversely with energy density (p = 0.02), positively with both dietary diversity (p < 0.0001), and adequacy to dietary recommendations (p < 0.0001), independent of demographic factors, weight status and SES. Further adjustment for household income in the EDS-related multivariable model, reduced the β coefficient by 47% for the “moderate importance” category and 36% for the “high importance” category. Likewise, the β coefficient decreased by 13.6% and 10.7% in the DDS-related model, and by 12.5%, and 7.1% in the RCI-related model, respectively, across awareness categories. Nutritional awareness has a direct effect on diet quality, with a minor component of variance explained by improved income. The impact of nutritional awareness on diet quality seems to be a promising area for both health promotion and health policy research.

Despite the remarkable technological progress in health care and treatment, there has been a worldwide increase in lifestyle-related chronic diseases (e.g.Cancer, High blood pressure, Arthritis, type-2 diabetes, cardiovascular disease and obesity) during the last decades. These diseases represent an important cause of premature death and source of prolonged hospitalization, and disability. Cardiovascular disease (CVD) alone accounts for over 4 million deaths yearly, i.e. nearly half (49%) of all European mortality, with striking geographical variations. The rise in chronic disease incidence, prevalence and mortality calls into question the effectiveness of existing policies with regard to primary prevention measures, and educational efforts to promote healthy behaviors.

Although the etiology of obesity and chronic diseases is complicated, inappropriate dietary choices, resulting in poor diet quality, is emerging as a major modifiable risk factor. Thus far, the determinants of healthy nutrition are poorly understood, but are likely to include individual and environmental factors. In most affluent societies, food availability and easy access to highly processed foods, and sugar-sweetened soft drinks, has been associated with radical transformation of dietary patterns. These, in turn, are assumed to escalating rates of obesity and other diseases.