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INTRODUCTION
The Internet has become the largest and fastest-growing source of health information, with millions of individuals conducting daily searches (1-3). Unlike traditional media such as newspapers, radio, or television, the Internet and social media platforms enable active participation in the communication process, fostering connection and engagement among users (3,4). These platforms wield significant social influence, empowering users to express opinions on critical issues and shaping attitudes and perceptions on a broad range of topics (5).
Platforms such as X (formerly Twitter), TikTok, Instagram, and YouTube have emerged as powerful tools for sharing information, engaging in political discourse, discussing healthcare practices, promoting health behaviors, and connecting with diverse audiences, including patients, caregivers, students, and healthcare professionals (6). Their ability to rapidly disseminate information and mobilize large groups enhances progress toward public health objectives, positioning social media as an essential medium for health education (5,6). Among these platforms, microblogging networks like Twitter are especially noteworthy for their real-time updates, brief format, and unique capacity to support social interaction (7). These platforms serve as a critical source of big data for public health researchers, facilitating the analysis of crowd behaviors, monitoring health trends, and even predicting disease outbreaks (8,9).
Understanding the distinction between social media and social networks is fundamental. Social media encompasses a broad range of digital tools, platforms, and strategies that enable interaction and content sharing, including blogs, forums, and video platforms. In contrast, social networks are specific online platforms, such as Facebook, Instagram, and LinkedIn, designed to foster connections and content exchange among users with shared interests (10). Microblogging platforms, like Twitter, offer a dynamic environment for the rapid exchange of concise updates and are a particularly valuable resource for public health research due to their accessibility and real-time content.
The widespread use of social media has also amplified discussions around food and diet, reflecting growing public concerns about long-term health risks associated with nutrition. Studies reveal that 60 % of individuals are increasingly worried about these risks (11). This heightened awareness, combined with the pervasive use of social media, has fueled a significant rise in food-related searches across platforms (12-14). However, the quality and reliability of health information shared on these platforms remain critical challenges. The interactive nature of social media exacerbates the spread of misinformation—false information shared by individuals who believe it to be true—and disinformation—intentionally false information shared to mislead others (6,15,16).
Instagram, for instance, pioneered the integration of visual content into digital marketing strategies, enabling users to discover and interact with images more effectively. Similarly, YouTube, the second most visited website globally as of 2017, provides a user-friendly platform for sharing videos (1). TikTok, as the preferred social network to millions of young users to create, share, and comment on videos worldwide (17,18). Despite these advantages, the potential for misinformation dissemination underscores the need for vigilance and quality control on these platforms.
This review synthesizes findings from over 182 studies on diet and misinformation across Twitter, Instagram, YouTube, and TikTok, encompassing more than 2 million Instagram posts, 1,000 YouTube videos, and 46,000 tweets. The primary objective is to characterize existing research and develop a taxonomy to i) identify the social networks most frequently associated with spreading misinformation, and ii) evaluate the predominant themes used in disseminating this information.
METHODS
We conducted a systematic review of the literature, in which the preferred reporting items for systematics reviews and meta-analyses (PRISMA) (19).
The aim was to review the available international literature on the use of social media and the potential impact on diet and nutrition disinformation. In addition, this work highlights possible risks found, identify signs of dangerous use, and provide recommendations based on these findings.
SEARCH METHODOLOGY
To identify relevant studies, a literature search was conducted covering a wide range of published health-related research from the following databases: Medline, Web of Science and Scopus. The time frame studied included articles published from 1st of January 2017 to 30th June 2024.
The search terms used in the different databases were focused on obtaining the appropriate result to answer the objectives set out in this study, these are as follows: terms used for nutrition included “nutrition” OR “nutrition facts” OR “diet” OR “diets”, On the other hand, search terms related to social networks included: “social networks” OR “Twitter” OR “X” OR “TikTok” OR “X” OR “Instagram” OR “YouTube” OR “Facebook”.
INCLUSION AND EXCLUSION CRITERIA
Studies eligible for inclusion in the review were retrieved according to predefined criteria. It is important to highlight that articles that did not meet all these criteria were excluded (Table I).
SELECTION OF ARTICLES
After retrieving the studies from the databases, duplicate reports were removed, and the titles and abstracts of the remaining articles were screened to exclude studies that did not meet the eligibility criteria. To avoid error and bias, three independent researchers conducted the review process to identify articles that met the inclusion criteria (SSF, BJG and PJJH), using the Zotero bibliographic reference manager, which allows for the detection and elimination of duplicate articles (20). Titles and abstracts were then analyzed to exclude irrelevant articles. Finally, the full texts were evaluated using PRISMA criteria, to determine whether the articles met the eligibility criteria. During this selection phase, any disagreements among the investigators were resolved by discussion and consultation with a reviewer who was not actively involved in the study selection (IHP).
ARTICLE CLASSIFICATION
After selecting relevant articles, these were analyzed following 4 criteria: i) manuscript's focus, ii) pathology/disease addressed in the manuscript, iii) use of social network, iv) health information.
Due to the heterogeneity of the studies included in this paper, a narrative synthesis was conducted according to these criteria: a content analysis was performed with the aim of obtaining information about the focus of the manuscripts, the social networks included, and the disease/pathology or situation associated with health and nutrition describe in the manuscripts. Finally, about the “health information” criteria, an analysis of the manuscripts was performed to explore how the health disinformation or information that is not based on scientific evidence, were analyzed.
Finally, we grouped the articles into two categories: i) articles focused on miracle diets and ii) articles focused on health disinformation or non-verified health information.
RESULTS
SELECTION OF SOURCES OF EVIDENCE
Our search initially identified 673 articles within the 3 databases. After removing duplicates, a total of 548 articles were screened to determine if they met the eligibility criteria, finally 487 articles were removed for not meeting these inclusion criteria, leaving 61 articles to be analyzed by reading the full text (Fig. 1).
The selected articles were divided into two main categories: on the one hand, papers dealing with miracle diets and associated misinformation (Table II). On the other hand, the documents that analyzed the misinformation disseminated through social networks about food without being associated with miracle diets (Table III).
A total of 18 articles (62.06 %) were found that were categorized as studies that addressed the relationship between nutrition, the emergence of miracle diets and the misinformation generated among users who consume information about miracle diets through social networks.
GENERAL DESCRIPTION OF RESULTS
The most frequently mentioned social media were Instagram (50 %), YouTube (39.28 %), and Twitter (10.72 %). On the other hand, the least mentioned social media were Facebook (18.75 %) and TikTok (5.13 %).
It is striking that the most widely used social network in the world, Facebook, is in this case one of the least used for sharing information related to nutrition. On the other hand, the most relevant are Instagram or YouTube, social media focused on sharing videos or audiovisual material. Therefore, this feature becomes relevant when getting information across to the public (21).
Regarding the misinformation that exists on the platforms analyzed in the different articles, we observed that 100 % confirm the existence of misinformation on diets and health. The approach to this misinformation in the different articles is quite similar, as they all deal with the increasing amount of content shared by channels or users not related to the health field, without following any scientific method or contrasting the information posted (22-33).
Nevertheless, there are also articles which analyze this context of misinformation in greater depth. One of these articles' links misinformation to the promotion of some brands by Youtubers (22). The case of these content generators is analyzed in another article, revealing that up to 87.3 % of the accounts analyzed on Instagram provide unhealthy nutritional information (23). We see the importance of these new profiles dedicated to sharing information on social media, and how they do not always seek veracity in the shared content, but to achieve relevance. One of the articles goes so far as to associate the utilization of some content to attract women with low self-esteem (22).
This can be seen in the article by Bradley P., which analyzes publications that have low veracity, but still, they get more views and likes (23). This may explain why in the results of this review we find 100 % of the articles that talk about misinformation.
In these 29 articles we found different pathologies, highlighting two of them above the rest: COVID-19 (14.28 %) and orthorexia (14.28 %). Other pathologies that appeared were acne, gout, osteoporosis, renal disease, diabetes, irritable bowel syndrome and celiac disease. (Tables II and III).
Diet is a key and very important element for people's health (24). It is important to distinguish attempts to distort the information, to deceive the population with diets claiming to cure different conditions in a short period of time, without providing any scientific evidence. These types of diets, colloquially called ‘miracle diets'—although they are also referred to using many euphemisms such as “superfoods” or “healthy diets”—are present in 18 of the 29 studies analyzed.
MIRACLE DIETS AND MISINFORMATION
These studies address miracle diets in different ways, such as claiming that they can help you boost your immune system, along with the advertisement for a brand of supplements, (25) or how to protect yourself from COVID-19 by taking vitamins or cooking meat in a particular way (26) (Table II).
In all, 64.70 % of the studies advocating for these miracle diets are linked to the social network Instagram, 41.17 to YouTube, 29.41 % to Twitter and 21.12 % to Facebook (Table II).
It is observed that social networks that use videos and images as the primary means of communication are the most common. Likewise, it is noteworthy that the most used social media to share this kind of information are those platforms designed to share information along with images and sound.
When it comes to miracle diets, there is no pattern with respect to the various pathologies mentioned above, and they are present in infectious diseases as well as in chronic diseases. The articles in which these diets are discussed cover diseases as diverse as acne, COVID, gout or diabetes.
However, it is noteworthy that in 100 % of the articles in which orthorexia is mentioned, miracle diets are also present (27-30). There seems to be a link between this disorder, which is characterized by an unhealthy obsession with food quality, and the promotion of diets that are not always scientifically based, taking advantage of people suffering from this condition (27) (Table II).
MISINFORMATION ABOUT NUTRITION ON SOCIAL NETWORKS
These studies address misinformation in nutrition observed from different pathologies and social networks such as how information about kidney disease (34,35), celiac disease (36,37), or irritable bowel syndrome (38) are treated with nutrition (Table III).
In all, 54.54 % of the studies are linked to the social network YouTube, the same as Twitter. Furthermore, 27.27 % of the studies are related to Instagram while Facebook only has 11.75 % of the articles (Table III).
Likewise, we can observe that social networks that use videos and images as the primary means of communication are the most common. Also, 18.18 % of the articles focus on the role of influencers in diet, although in one article we can see how social networks are misused to encourage consumers to consume dietary supplements to achieve quick and easy results in fitness (22), while in another one the Instagram community relates the term “healthy food” with a healthy lifestyle, fitness, and diet (39). One of the studies analyzed the accounts of different celebrities, who recommended less healthy food and beverages based on nutrition scores in 87.3 % of the cases (23) (Table III).
There is no pattern with respect to pathologies and misinformation, which is present in infectious diseases as well as in chronic diseases. There is also no pattern regarding the social networks in which the most misinformation is shared (Table III).
Through the analysis of the eating patterns, we observed how are changing in recent years. On the one hand, we have the hoaxes that we see on different social networks and how they can affect people's diet (39) and even make their health condition worse as they are not quality information (34). We can also see how sometimes this information if verified, can raise awareness among the lifestyle population and make them improve it (40). Finally, we can even observe how the Mediterranean diet has been generating less interest over the last few years (40) (Table III).
DISCUSSION
PRINCIPAL FINDINGS
This study aimed to review the current literature on the dissemination of nutrition-related misinformation on social networks. The objectives were: i) to identify the social networks most frequently used for spreading this misinformation, and ii) to evaluate the main topics, including diseases and dietary claims, utilized in these messages.
In addressing the first objective, the findings indicate a predominant use of audiovisual social networks such as Instagram, YouTube, and TikTok for spreading nutrition-related misinformation. These platforms, which emphasize visual and interactive content, appear to attract younger audiences, particularly those under 30 years old, who engage more actively with these mediums. This shift from text-based to audiovisual platforms has been previously noted in the literature, reflecting changing user preferences and the platforms' suitability for conveying engaging yet unverified content (1,18,21). The ease of access, coupled with minimal content regulation, amplifies the spread of misinformation, particularly on topics such as diets and nutrition (50,51).
Regarding the second objective, the study highlights two major themes within the misinformation disseminated on social networks: miracle diets and general dietary misinformation related to specific pathologies. Miracle diets were frequently associated with claims of rapid health improvements, such as immune system enhancement or COVID-19 prevention, without scientific backing (25,26). Particularly concerning is the strong link between miracle diets and orthorexia, with 100 % of studies mentioning orthorexia also referencing miracle diets. This underscores the exploitation of vulnerable populations by promoting unrealistic dietary ideals under the guise of health benefits (27,30).
The results also reveal the proliferation of misinformation during public health crises, such as the COVID-19 pandemic. For example, during the pandemic, a surge in misinformation about diets aimed at preventing or curing COVID-19 was observed on platforms like Instagram and Twitter (26,33). This highlights the dual role of social networks as both sources of valuable information and breeding grounds for unverified claims. Importantly, nutrition-related content from credible sources, such as dietitians and healthcare organizations, was found to be more accurate, emphasizing the need for increased visibility of these voices (33,34).
IMPLICATIONS FOR PUBLIC HEALTH
The widespread dissemination of misinformation on social networks poses a significant public health challenge. Users often lack the necessary tools to critically evaluate the credibility of the information they encounter. As a result, low-quality content, such as posts advocating miracle diets or unverified health claims, garners significant engagement, potentially influencing user behaviors and perceptions negatively (22,23).
Public health institutions and healthcare professionals play a crucial role in combating misinformation. These entities should prioritize creating and promoting accessible, evidence-based content on social media to counteract false narratives. Additionally, targeted interventions, such as digital literacy programs, can empower users to discern credible information from misinformation.
LIMITATIONS AND STRENGTHS
This study's limitations include its focus on English-language articles and the selected social media platforms, which may exclude broader trends. Additionally, the heterogeneity of methodologies and data collection processes among the reviewed studies posed challenges in synthesizing the findings. Future research should explore the underlying motivations for disseminating misinformation and evaluate the effectiveness of interventions aimed at mitigating its impact.
Despite these limitations, the study's strengths lie in its comprehensive analysis of multiple social networks and pathologies, offering a nuanced understanding of the issue. By including studies from various platforms and focusing on diverse diseases, this review provides a robust foundation for addressing the challenges posed by nutrition-related misinformation on social networks.
CONCLUSIONS
Social networks have revolutionized global communication, offering unprecedented access to information. However, the absence of rigorous content oversight has made misinformation a pervasive issue, particularly in topics as critical as health and nutrition. This phenomenon has been compounded by the public's growing reliance on these platforms as primary sources of health information.
Our analysis underscores that nutrition is integral to human health and a subject widely discussed across platforms like Twitter, Instagram, TikTok, and YouTube. Consequently, these discussions are often influenced by misinformation, as evidenced by the prevalence of miracle diets in more than half of the studies reviewed. These diets, which promise quick results with minimal effort, pose significant public health risks, including the exacerbation of conditions like orthorexia and the spread of unverified claims about disease prevention, such as COVID-19.
This study brings to light a critical public health challenge: the widespread acceptance and influence of misinformative content on social networks. Public health institutions must take proactive measures to address this issue, including developing accessible tools to help users evaluate the credibility of the information they consume. These efforts should be complemented by targeted campaigns to promote digital literacy and critical thinking skills among the public.
Healthcare professionals also have a pivotal role to play on control of disinformation, in example establishing a strong presence on social media, they can disseminate accurate, evidence-based information and counteract the spread of false narratives. Embracing these platforms as allies rather than adversaries will enable professionals to reach broader audiences and foster informed, health-conscious communities.
Wherefore, tackling misinformation on social networks requires a concerted effort from public health authorities, healthcare professionals, and the platforms themselves. Only through collaborative action can we ensure that social networks serve as a source of reliable information and a tool for promoting public health.
