Association between nutritional literacy and cancer anorexia among gastrointestinal cancer patients: a moderated mediation analysis on the roles of self-efficacy and family support.

OBJECTIVES

To test the relationship between nutritional literacy, self-efficacy, family support and cancer anorexic behavior among patients with gastrointestinal cancer undergoing chemotherapy. And examine the moderating role of family support on the relationship between nutritional literacy and self-efficacy.

METHODS

Using convenience sampling, 248 patients with gastrointestinal cancer undergoing chemotherapy were recruited from the Oncology Center of a Grade A Level 3 general hospital in Henan Province, China, between June and November 2025. Data analysis was performed by SPSS 27.0, while PROCESS macro v5.0 was used to test the moderated mediation model.

RESULTS

Nutritional literacy mediated by self-efficacy was positively associated with anorexic behavior score (β = 0.334, t = 6.156, P<0.001). Family support played a positive moderating role in the relationship between nutritional literacy and self-efficacy (β = 0.051, t = 4.704, P<0.001). When family support was high, nutritional literacy had a stronger association with self-efficacy.

CONCLUSIONS

This study found that nutritional literacy among patients with gastrointestinal cancer is directly associated with cancer anorexic behavior and indirectly associated with it through self-efficacy. Furthermore, family support moderates the relationship between nutritional literacy and self-efficacy. Moving forward, interventions should be implemented on three fronts-improving patients' nutritional literacy, strengthening their sense of self-efficacy, and enhancing family support systems-to alleviate cancer-related anorexia, improve nutritional status, and enhance quality of life.