To investigate the impact of nutritional health knowledge levels on dietary patterns among childbearing-age women, to analyze the mediating role of eating out and breakfast consumption frequency, and to provide evidence-based references for formulating nutritional intervention strategies.

A total of 1 340 reproductive-age women aged 18-49 years from 10 districts/counties in Hunan Province were selected as research subjects from the 2022-2023 National Survey on Residents’ Nutritional and Health Knowledge Awareness. Data on basic information, nutritional and health knowledge, and dietary consumption were collected. Factor analysis was used to extract dietary patterns, Logistic regression to examine the association between knowledge levels and dietary patterns, and structural equation modeling with Bootstrap method to test mediating effects.

Among women of childbearing age in Hunan Province, the nutrition and health knowledge awareness rate was 25.9%, 29.8% eating out ≥1 day/week, and 26.6% having breakfast <7 days/week. Four dietary patterns were identified: high-energy, fruit-dairy-seafood, poultry-egg-bean, and whole grain-vegetable. Logistic regression showed that the level of nutrition and health knowledge was negatively correlated with high-energy dietary pattern (OR=0.428, 95% CI:0.319-0.575) and positively correlated with whole grain-vegetable dietary pattern (OR=1.513, 95% CI:1.142-2.005). Mediator effect analysis showed the total effect of knowledge on high-energy pattern was -0.493(-0.616--0.370), direct effect was -0.278(-0.382--0.174), mediating effects of eating out and breakfast consumption frequency were -0.180(-0.250--0.117) and -0.035(-0.057--0.016), accounting for 43.6% of total effect; total effect on whole grain-vegetable pattern was 0.132(0.007-0.256), direct effect was 0.108(-0.017-0.232), mediating effect of breakfast frequency was 0.024(0.008-0.047), accounting for 18.2% of total effect.

Eating out and breakfast consumption frequency mediate the relationship between childbearing-age women’s nutritional health knowledge level and high-energy dietary patterns, and whole-grain vegetable dietary patterns.