Open Access
Original Article, Biomed Biopharm Res., 2023; 20(1):83-92
doi: 10.19277/bbr.20.1.313; PDF version [+]; Portuguese html [PT] 



Food and Nutrition Knowledge of Elementary School Teachers in a Region of Lisbon, Portugal

Andreia Pedro 1, Cíntia Ferreira-Pêgo 2 ,  Carina Rossoni  2  & Emília Alves 2 This email address is being protected from spambots. You need JavaScript enabled to view it.

1 - School of Sciences and Health Technologies, Universidade Lusófona de Humanidades e Tecnologias, Lisboa, Portugal

2 - CBIOS - Center for Biosciences & Health Technologies, Universidade Lusófona de Humanidades e Tecnologias, Lisboa, Portugal



Children's eating habits are formed during childhood and are significantly influenced by the school environment, which is why teachers are seen as an example of behavior to imitate. For children to receive accurate information, teachers must have a solid understanding of food and nutrition. This study aimed to assess the level of food and nutrition understanding in elementary school teachers. Eighty-one teachers participated in a cross-sectional observational study. A 9-question survey was built to gauge their level of understanding about food and nutrition, with three levels established: high (≥7 points), moderate (4-6 points), and low (≤3 points). In this research, whereas 79% of instructors taught nutritional principles and 44% had a moderate degree of understanding on food and nutrition, 63% of teachers had poor levels of training in nutrition. The teachers' greatest difficulties were related to the nutritional value of foods, regardless of their years of experience. Teachers who have been teaching for less than five years have a better degree of knowledge in food and nutrition, compared to those who have been teaching longer (p<0.001). This study supports the idea that elementary school instructors need more dietary education, especially those who have been teaching for more years.

Keywords:  Food, nutrition, knowledge, elementary school teachers

To Cite: Pedro, A., Ferreira-Pêgo, C., Rossoni, C., Alves, E. (2023) Food and Nutritional Knowledge of Elementary School Teachers. Biomedical and Biopharmaceutical Research, 20(1), 83-92.

Correspondence to:  This email address is being protected from spambots. You need JavaScript enabled to view it.
Received 17/04/2023; Accepted 23/06/2023



Food-related disorders, such as obesity, have been extensively linked to bad eating practices, which may be a consequence of an inadequate level of nutritional awareness in both adults and children (1-4). Long-lasting dietary habits are developed during childhood and the dietary preferences of children are generally defined by personal experiences, observation, and education rather than the nutritional value of the meal (5-7). Children's food education is significantly influenced by the school community, both by the time the child stays and because this is a privileged place of learning, which reinforces the idea that the child's social environment can profoundly affect their eating patterns (8). As role models, elementary school teachers have the potential to influence the development of healthy eating habits that children can carry over into adulthood (5,6,9). Thus, it is crucial for educators to be knowledgeable about nutrition and food to ensure that their students are receiving accurate information (10), making it clear that educators need to increase their level of nutrition awareness (11). The literature on teachers' nutritional knowledge is scarce, so this study aimed to assess the level of food and nutritional knowledge of elementary school teachers.


Materials and methods

This research comprises of an observational, quantitative cross-sectional study of elementary school teachers to assess their degree of knowledge on food and nutrition. The participants were recruited by convenience in the school group Amadora-Oeste located in the Lisbon (Portugal) region. Recruitment was conducted between April and May 2022, using a digital survey made available via email for data collection to all teachers belonging to the school group. Eighty-one elementary school teachers answered the questionnaire and were included in the study. All participants submitted their informed consent after receiving information that all data would be kept anonymous and utilized purely and exclusively for this inquiry. The Helsinki Declaration's guiding principles and any applicable revisions were followed while conducting the study (12).

The research questionnaire was divided into three parts: an informed consent section, where the inclusion criterion was acceptance to participate; a section on general characteristics such as gender, age, number of years of teaching, training in nutrition and the inclusion of food and nutrition topics in teaching activities; and a section for assessing knowledge about food and nutrition, where a questionnaire built specifically for this study was used. This questionnaire consisted of nine questions, two of which regarded concepts of a healthy diet, one regarding healthy foods, one about good practices from the point of view of hygiene and food safety, one regarding energy value and for regarding nutritional value of foods. The responses available were “agree”, “disagree and “I am not certain”. For scoring purposes, “I am not certain” answers were counted as incorrect. Correct answers received one point and incorrect answers received zero points. Using this classification, the result could vary between 0 and 9 points and the level of knowledge was classified as high (7 points), moderate (4-6 points) or low (3 points).

Statistical Analysis

Results were expressed as mean (standard deviation, SD) or as relative frequencies. The Pearson Chi-square test was used to compare categorical variables. All analyses were performed using the SPSS statistical package version 27 (SPSS Inc., Chicago, IL, USA) with a significance level of 5%.



A sample of 81 teachers was employed in this study, of which 38.3% reported to have been teaching for less than five years, while 61.7% had been teaching for more than five years, therefore, due to these results, it was decided to divide the sample into two groups according to the number of years of teaching.

Table 1 displays the overall characteristics of the participants. Teachers who had been teaching for fewer than five years were younger, with a mean age of 30.6 (2.42) years, compared to those who had been teaching for more than five years, with a mean age of 45.1 (8.55) years (p<0.001). Overall, only 37.0% of the participants reported to have had previously participated in some form of training in the subject (lectures, workshops, or a postgraduate degree). However, 51.6% of teachers with less than five years of experience reported to not have had training in nutrition, compared with 70.0% of teachers with more than five years teaching experience (p=0.144). Additionally, it was possible to confirm that 79.0% of the teachers included topics on nutrition and food in their lesson plans. However, a comparison of the two groups revealed that teachers with less teaching experience included these themes more frequently in their lessons (96.8%) than those with more teaching experience (68.0%) (p=0.002).

Table 1 - General characteristics of the participants, according to the years of teaching.
Data expressed as mean (SD) or relative frequency (n). SD, Standard Deviation. aP values for comparisons between groups were tested by Student’s t-test or Pearson χ2 test, with a significance level of p<0.05 


Finally, regarding the knowledge on food and nutrition, Table 2 demonstrates that 30.9% of the participants presented a high level, 44.4% a moderate level, and 24.7% a low level. Those presenting a low level of knowledge were all teachers with more than five years of teaching, which represented 40.0% these group. Among teachers with less than five years of experience 67.7% presented a high degree of knowledge and none presented a low level. (p<0.001).

We highlight the fact that, globally, 61.7% of the participants answered incorrectly to at least one of the questions related to the nutritional content of foods and the question about their energy value.

Table 2 - Evaluation of knowledge about food and nutrition according to the years teaching.
Food and nutrition knowledge categorized into three groups: high (≥7 points); medium (4-6 points) and low (≤3 points). aComparisons between groups tested by Pearson χ2 test, with a significance level of p<0.05. Questionnaire in Appendix.



This study revealed that, despite covering nutrition-related subjects in their lesson plans, elementary school teachers showed a low degree of training in food and nutrition. Data showed that the level of knowledge about food and nutrition that most teachers had was moderate,, however, teachers with less teaching experience had a higher degree of understanding of these topics, which is in agreement with the literature (10,12) and is justified by the professors' characteristics, such as prior experience or expertise, motivation, and interest, in addition to the accessibility of thorough instructional resources and teacher preparation (13). Time restrictions and professional demands are the main barriers reported regarding this form of training, thus supporting the teacher’s difficulty in the acquisition of nutritional education (14). Additionally, questions related to nutritional topics, such as the energy value or nutritional content of foods, represented the greatest difficulties in response for teachers, thus identifying the greatest gaps in their knowledge and possible areas of training needs for these professionals. In Portugal, the academic training of primary school teachers does not include training in food and nutrition in its syllabus (15), which may explain some of the results obtained.

Regardless of their level of training, most of the participants in this study reported teaching classes on nutrition and food. Identical results were reported by Falkenbach et al. (16) evaluating the inclusion of food-related themes in preschoolers, which demonstrated that the difficulties and facilitations encountere by teachers had a substantial influence on the implementation of school-based nutrition interventions. Additionally, a study conducted by Rosário et al. (17) in Portugal examining the effects of a program using classroom teachers as dedicated interventionists to deliver obesity prevention interventions found that the beneficial effects of an educational program produced significant effects on child overweight prevention. Albuquerque et al. (18) conducted a study on teachers' perception on food and nutritional education in a school setting. Teachers expressed a desire to study the topic but also a fear that they would not be able to teach something they were unfamiliar with effectively. Most teachers carried out nutrition education activities ostensibly based on common beliefs and sources, due to lack of training, which can encourage students to consume inappropriate foods, making the need for training in nutrition education for teachers clear (13,18).

In this work, elementary school teachers demonstrated a moderate to low level of understanding of food and nutrition. These results are supported by the work of Parlak et al. (19), who assessed 280 teachers' nutritional knowledge and found that more than half of the teachers had a moderate level of nutritional knowledge. Bezerra et al. (20) came to similar conclusions, reporting a moderate score regarding teachers' nutritional knowledge. Significant gaps in teachers' knowledge of nutrition-related subjects were found in a recent study evaluating their nutritional knowledge, highlighting the importance of conducting training exercises on this topic to raise awareness, boost teachers' confidence, and enable them to promote healthy lifestyles in their students (5). Literature shows that improving food and nutrition literacy can improve eating behaviors, food and nutrition knowledge, self-efficacy in these areas, and diet quality (20), thus complying with the WHO recommendations stating the inclusion of both dietary and physical activity components in the school curriculum, taught by qualified teachers (21).

Teachers with five or fewer years of teaching experience were younger, more knowledgeable about food and nutrition, and more likely to incorporate these topics into lesson plans. Shimabukuro et al. (22) reported that college-educated educators under the age of 38 had greater knowledge, which is consistent with our findings. Teachers' ages are known to be one of the major determinants of their interest in food and nutrition topics, as well as their nutritional knowledge, with younger teachers being more aware of issues connected to food and health (23,24). In contrast, the analysis of Fernandez et al. (25) of 288 teachers revealed a strong relationship between age and food group knowledge, with teachers older than 33 years exhibiting greater performance.

This study's innovative nature is demonstrated by being the first to compare the duration of the educators' teaching careers to the depth of their understanding of nutrition and food. However, several limitations must be considered, such as the use of a small convenience sample collected only in the Lisbon area and thus not representative of the population, as well as the lack of a validated questionnaire.



This study showed that the surveyed elementary school teachers lack training in food and nutrition even though this is a subject that most teachers discuss. In this sample, teachers with fewer years of experience tended to know more about food and nutrition than those with more years of experience.

Our findings highlight the need for more research in this area, given the enormous influence elementary school teachers have on children's behavior and attitudes.


Author contributions

EA, CR and CFP, conceptualization and study design; AP, experimental implementation; AP and EA, data analysis; AP, CR and EA, drafting, editing and reviewing; AP, figures; EA, supervision and final writing.


Conflict of Interests

The authors involved in this project confirm that there is no conflict of interest.



1. Weihrauch-Blüher, S., & Wiegand, S. Risk Factors and Implications of Childhood Obesity. (2018). Current Obesity Reports. 7(4), 254–259.

2. Sanyaolu, A., Okorie, C., Qi, X., Locke, J., & Rehman, S. (2019). Childhood and Adolescent Obesity in the United States: A Public Health Concern. Global pediatric health, 6, 2333794X19891305.

3. Frade, F., Carteiro, D., Pereira, F., Marques, J., & Frade, J. (2020). Prevalence of Childhood Obesity in Portugal: A Narrative Review of the Literature. Portuguese Journal of Public Health,38(2), 119–128.

4. Gregório, M. J., & Karger, S. (2018). Obesity as a Major Public Health Problem in Portugal: Achievements and Challenges. Portuguese Journal of Public Health, 36(3), I–II.

5. Katsagoni, C. N., Apostolou, A., Georgoulis, M., Psarra, G., Bathrellou, E., Filippou, C., Panagiotakos, D. B., & Sidossis, L. S. (2019). Schoolteachers' Nutrition Knowledge, Beliefs, and Attitudes Before and After an E-Learning Program. Journal of nutrition education and behavior, 51(9), 1088–1098.

6. Scaglioni, S., de Cosmi, V., Ciappolino, V., Parazzini, F., Brambilla, P., & Agostoni, C. (2018). Factors Influencing Children’s Eating Behaviours. Nutrients, 10(6).

7. Love, P., Booth, A., Margerison, C., Nowson, C., & Grimes, C. (2020). Food and nutrition education opportunities within Australian primary schools. Health Promotion International, 35(6), 1291–1301.

8. Jung, T., Huang, J., Eagan, L., & Oldenburg, D. (2019). Influence of school-based nutrition education program on healthy eating literacy and healthy food choice among primary school children.International Journal of Health Promotion and Education.  57(2):67–81. doi: 10.1080/14635240.2018.1552177. 

9. Dudley, D. A., Cotton, W. G., & Peralta, L. R. (2015). Teaching approaches and strategies that promote healthy eating in primary school children: a systematic review and meta-analysis. The international journal of behavioral nutrition and physical activity, 12, 28.

10. Follong, B. M., Prieto-Rodriguez, E., Miller, A., Collins, C. E., & Bucher, T. (2022). Evaluating an integrated nutrition and mathematics curriculum: primary school teachers’ and students’ experiences. Public health nutrition, 25(8), 1–12. Advance online publication.

11. Wang, S. J., Wang, T. T., & Wang, J. B. (2020). Nutritional knowledge, attitudes and dietary behaviors of teachers and students in a medical college in Beijing and their influencing factors.Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences, 52 (5), 881–885.

12. World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194.

13. Pérez-Rodrigo, C & Aranceta, J. (2003). Nutrition education in schools: experiences and challenges.European Journal of Clinical Nutrition, 57, S82–S85.

14. Hall, E., Chai, W., & Albrecht, J.A. (2016). A Qualitative Phenomenological Exploration of Teachers' Experience with Nutrition Education. American Journal of Health Education, 47:3, 136-148, DOI: 10.1080/19325037.2016.1157532.

15. Decreto-Lei n.º 79/2014, de 14 de maio. Decreto-Lei nº 79/2014 de 14 de Maio do Ministério da Educação e Ciência. Diário da República: I Série, n.º 92 (2014). Available at: Consulted 15 jun 2023.

16. Falkenbach, D., Freitas D’avila, H., & Daniel De Mello, E. (2018). Knowledge, Attitudes and Practices of Primary School Teachers on Nutrition and Food. Journal of Nutrology,11, 21–29.

17. Rosário, R., Oliveira, B., Araújo, A., Lopes, O., Padrão, P., Moreira, A., Teixeira, V., Barros, R., Pereira, B., & Moreira, P. (2012). The impact of an intervention taught by trained teachers on childhood overweight. International journal of environmental research and public health, 9(4):1355-67. doi: 10.3390/ijerph9041355.

18. Albuquerque, A.G., Pontes, C.M., & Osório, M.M. (2013). Knowledge of educators and dieticians on food and nutrition education in the school environment. Revista de Nutrição, 26(03):291–300.

19. Parlak, M.E., & Ener, D. (2023). Nutritional knowledge levels and food preferences of teachers. Medicine Science, 12(1):1-8.

20. Bezerra, K.F.; Capuchinho, L.C.F.M.; & Pinho, L. (2015). Conhecimento e abordagem sobre alimentação saudável por professores do ensino fundamental. Demetra, 10(1); 119-131.

21. World Health Organization. Regional Office for Europe. (2006). Food and nutrition policy for schools : a tool for the development of school nutrition programmes in the European Region. Copenhagen : WHO Regional Office for Europe.

22. Shimabukuro, E.E., Oliveira, M., & Taddei, J. A. (2008). Conhecimentos de educadores de creches sobre alimentação infantil. Revista Paulista De Pediatria, 26(3), 231–237.

23. Liu, H.; Xu, X.; Liu, D.; Rao, Y.; Reis, C.; Sharma, M.; Yuan, J.; Chen, Y.; & Zhao, Y. (2018). Nutrition-Related Knowledge, Attitudes, and Practices (KAP) among Kindergarten Teachers in Chongqing, China: A Cross-Sectional Survey.International journal of environmental research and public health,  15,615.

24. Habib, M.A., Alam, M.R., Rahman, T., Chowdhury, A.I., & Shill, L.C. (2023). Knowledge, attitudes, and practices (KAP) of nutrition among school teachers in Bangladesh: A cross-sectional study. PLoS One,18(3): e0283530.

25. Fernandez, P.M., & Silva, D.O. (2008). A description of the conceptual notions about food groups by 1st to 4th grade teachers: the necessity to review the concepts.Ciência & Educação (Bauru), 14(03):4451–4466.