Sociodemographic differences in dietary habits described by food frequency questions — results from Denmark

Addressing nutritional issues and eating behaviours among university students: a narrative review

University life is a critical period for establishing healthy eating habits and attitudes. However, university students are at risk of developing poor eating habits due to various factors, including economic conditions, academic stress and lack of information about nutritional concepts. Poor diet quality leads to malnutrition or overnutrition, increasing the risk of preventable diseases. Food environments on university campuses also play a significant role in shaping the dietary habits of students, with the availability of and accessibility to healthy food options being important factors influencing food choices and overall diet quality. Disordered eating habits and body dissatisfaction are prevalent among university students and can lead to eating disorders. Income and living arrangements also influence dietary habits, with low household income and living alone being associated with unhealthy eating habits. This study is a narrative review that aimed to address nutritional issues and eating behaviours, specifically among university students. We investigated the eating behaviours of university students, including their dietary patterns, food choices and food environments. The objective of this review was to provide insights into the nutritional issues and eating behaviours of university students, with the aim of identifying target areas for intervention to improve the overall health and wellbeing among college students. University food environments need to be restructured to promote healthy eating, including the availability, accessibility, affordability and labelling of healthy foods, and policies to limit the availability of unhealthy foods and drinks on campus.

Application of EFSA EU menu database and R computing language to calculate the green chlorophyll intake in the European population

The growing evidence of the health benefits of chlorophyll pigments and the claims that could arise from industry and academia require data on their common dietary intakes. This study presents data on the chronic intake of green chlorophyll in 23 European countries using standardised methodologies to manage food consumption data within the EU Menu methodology. A mean intake of 207.12 mg of green chlorophylls/(d × person) for the adult population was calculated, considering significant covariates. The hierarchical cluster and partial least squares discriminant analysis (PLS-DA) techniques were applied to analyse intake disparities by region and age groups, identifying common food sources of green chlorophylls, such as olive oil, kale, and spinach. This paper presents a modern mathematical approach for obtaining novel information from existing databases of food composition data. Future challenges include building a comprehensive chlorophyll composition database for foods and extending the estimation to non-green chlorophyll pigments and metallo-chlorophyll food colourants.

Socioeconomic determinants of nutritional behaviors of households in Fars Province, Iran, 2018

Introduction

Households' dietary habits are affected by their environment and socioeconomic status (SES). This study aims to investigate eating behaviors and determine the factors affecting nutritional status in households in Fars Province in 2018.

Method

In this cross-sectional study, urban and rural households were selected using the multistage sampling method. A questionnaire was employed to interview the mother or householder to record the demographic, SES, and dietary habits of the family for major food items commonly used. A logistic regression model was used to analyze the data. The p-value less than 0.05 was considered significant.

Results

In total, 6,429 households participated in the study. The majority of households use traditional flatbread, low-fat milk, and liquid/cooking oil. Frying was the most prevalent method of cooking. Parents' level of education and SES were associated with type of consumed bread, milk and dairy, methods of food preparation, adding salt at the table, eating out, and fast-food usage. Parents' higher level of education was significantly associated with salt storage in optimal conditions and not using salt before tasting the meal.

Conclusion

Most of the households had healthy practices, especially in consumption of certain oils and methods of preparing their food as well as keeping salt in an optimal condition and using iodized salt. The most important unhealthy nutritional behavior was high consumption of fast food and outdoor food, especially in urban regions. Unhealthy dietary habits were more prevalent in households with low household and regional SES. Both households and regions with higher SES had better dietary habits.

Does the neighbourhood food environment contribute to ethnic differences in diet quality? Results from the HELIUS study in Amsterdam, the Netherlands

OBJECTIVE

The aim of the current study was to establish whether the neighbourhood food environment, characterised by the healthiness of food outlets, the diversity of food outlets and fast-food outlet density within a 500 m or 1000 m street network buffer around the home address, contributed to ethnic differences in diet quality.

DESIGN

Cross-sectional cohort study.

SETTING

Amsterdam, the Netherlands.

PARTICIPANTS

Data on adult participants of Dutch, South-Asian Surinamese, African Surinamese, Turkish and Moroccan descent (n total 4728) in the HELIUS study were analysed.

RESULTS

The neighbourhood food environment of ethnic minority groups living in Amsterdam is less supportive of a healthy diet and of less diversity than that of participants of Dutch origin. For example, participants of Turkish, Moroccan and South-Asian Surinamese descent reside in a neighbourhood with a significantly higher fast-food outlet density (≤1000 m) than participants of Dutch descent. However, we found no evidence that neighbourhood food environment characteristics directly contributed to ethnic differences in diet quality.

CONCLUSION

Although ethnic minority groups lived in less healthy food environments than participants of ethnic Dutch origin, this did not contribute to ethnic differences in diet quality. Future research should investigate other direct or indirect consequences of residing in less supportive food environments and gain a better understanding of how different ethnic groups make use of their neighbourhood food environment.

A Traditional Costa Rican Adolescents' Diet Score Is a Valid Tool to Capture Diet Quality and Identify Sociodemographic Groups With Suboptimal Diet

Traditional diet indices may capture diet quality according to local food culture. Higher adherence to traditional diet scores may help prevent disease, yet evidence in adolescents is limited. This cross-sectional study aimed to develop and validate a Traditional Costa Rica Adolescents Diet Score (TCRAD) and determine its association with sociodemographic characteristics, under the hypothesis that girls, adolescents from rural areas, and with low socioeconomic status, have a more traditional healthy diet. A total of 804 urban and rural adolescents (13-18 years old) participated in the study. The TCRAD showed adequate internal validity as shown by significant associations with intake of 14 traditional foods and nutrients (legumes, vegetables, fruits, oils, dairy, and corn tortilla scored as healthy; and white rice, red/processed meat, solid fats, desserts/pastries, sugar-sweetened beverages, snacks, fast food, and bread and cookies scored as unhealthy). A high TCRAD score, indicative of a healthier and more traditional diet, was observed among adolescents in the low socioeconomic group vs. medium or high socioeconomic categories (42.9, 41.2, and 38.2%, respectively, p < 0.05), adolescents living in rural areas vs. urban (47.6 vs. 34.2%, p < 0.05), and among boys vs. girls (46.9 vs. 37.5%, p < 0.05). The TCRAD score is a valid tool to capture diet quality of adolescents in Costa Rica and could be used to measure association of diet with disease outcomes in this and similar populations. Public health nutrition programs in Costa Rica should focus on improving intake of foods and nutrients, and prioritize girls, adolescents in urban areas, and adolescents with high socioeconomic status.

Does Health Information Technology Promote Healthy Behaviors? The Mediating Role of Self-Regulation

Health information technology (health IT) has the potential to facilitate the self-regulation of fruit and vegetable intake (FVI) and physical activity (PA). This study explores whether using health IT for self-regulation mediates the relationship between sociodemographic factors and health behaviors including FVI and PA among U.S. adults. Bayesian mediation analysis was used to analyze a nationally representative sample of the U.S. adults (N = 3285) from Cycle 1 of the 2017 Health Information National Trends Survey (HINTS). The 95% credibility intervals (CI) were calculated for each sociodemographic factor and the mediator using health IT for self-regulation in relation to FVI and PA. About 58% of the participants used at least one type of health IT for self-regulation. Age was negatively associated with using health IT for self-regulation, whereas being a female and having a higher income and education were positively associated with it. Using health IT for self-regulation partially mediated the positive relationships between income, education, and FVI, but it is unrelated to PA. The findings support the efficacy of using health IT to regulate healthier eating. Nevertheless, the digital divide is a critical issue to consider when applying health IT to promote behavior change.

Association between socioeconomic status and diet quality in Mexican men and women: A cross-sectional study

Examining the potential differences in diet quality among socioeconomic status (SES) subgroups in Mexican adults may help to explain SES disparities in the burden of non-communicable diseases. We determined the association between SES, gender and diet quality among Mexican adults. We analyzed data from adults participating in the subsample with dietary information from the Mexican National Health and Nutrition Survey 2012 (n = 2,400), and developed the Mexican Diet Quality Index based on the Mexican Dietary Guidelines. We tested the interaction between sex and SES indicators using multivariable linear regression models. Sex was not a modifier; therefore, the analyses were carried out in the overall sample of men and women. The mean age was 42 (SE = 0.4) years, the total diet quality score was 38 (SE = 0.4), and a high percentage of men and women were classified with reading/writing skills or 3-9 years of school. A higher percentage of adults were classified with high versus medium or low assets index. In the multivariable model further adjusted for the assets index, for adults with education in the reading and/or 3-9 years of schooling and those with ≥10 years of school, there was a 3.7 and 5.8 points lower total diet quality score than with adults with no reading/writing skills (p < 0.05). Likewise, in multivariable model further adjusted for educational level, the total diet quality score was 2.5 points and 3.3 points lower in adults classified with medium and high assets index, respectively, versus low assets index (p < 0.05). The difference between individuals with medium and high assets index was not statistically significant. Although there is currently better diet quality among adults with low SES, this needs to continue to be monitored as Mexico progress through the nutrition transition.

Association between hours worked in paid employment and diet quality, frequency of eating out and consuming takeaways in the UK

OBJECTIVE

To examine associations between hours worked and diet quality, frequency of eating out and consuming takeaways.

DESIGN

Data were taken from the National Diet and Nutrition Survey (2008-2014). Associations between hours worked in paid employment and diet quality, assessed using the Diet Quality Index (DQI) and selected foods and nutrients, were tested using linear regression models. Associations between hours worked and frequency of eating out and consuming takeaways were tested using ordinal logistic regression models. All models were adjusted for sex, age, equivalised household income, household composition and household food role.

SETTING

UK.

PARTICIPANTS

Adults (n 2154) aged 19-64 years in employment.

RESULTS

Mean (95 % CI) hours worked per week was 36·1 (35·6, 36·6) and mean DQI score was 41·9 (41·2, 42·5) %. Hours worked was not associated with DQI score, frequency of eating out or consuming takeaways. Hours worked was positively associated with consuming red meat, processed meat and alcohol intake. Adults working more hours had lower intake of fibre but higher total fat and saturated fat intakes if they lived in households with children.

CONCLUSIONS

Working hours may not be the main factor driving poor-quality diets among this sample of UK adults in employment. Focusing on consumption of foods prepared outside the household may not be the most efficient way to improve diet quality as effort is needed at all levels. Although it is unclear what is driving the differences in nutrient intakes according to household composition, they are important to consider when developing interventions to improve healthy eating.

Educational level and living arrangements are associated with dietary intake of red meat and fruit/vegetables: A Danish cross-sectional study

Aims: To evaluate the association between education and living arrangements and the intake of fish, red meat and fruit and vegetables.Methods: The study design was cross-sectional and conducted in Denmark in 2013. Participants filled in questionnaires about their educational level and living arrangements (living alone or with others) and dietary intake including fish, red meat, fruit and vegetables. Regression analyses were performed to assess the associations within 85,456 randomly sampled healthy men and women who were at least 25 years old.Results: Length of education was statistically significant and positively associated with the intake of fruit and vegetables and negatively associated with the intake of red meat for both men and women. Men with a high level of education had a 187g/week (95% confidence interval: 199-175g/week) lower intake of red meat and a 109g/day (95% confidence interval: 102-117g/day) higher intake of fruit and vegetables than men with a low level of education. Women with a high level of education had a 175g/week (95% confidence interval: 186-164g/week) lower intake of red meat and a 106g/day (95% confidence interval: 97-114g/day) higher intake of fruit and vegetables than women with a low level of education. Living with others was statistically significant and positively associated with the intake of red meat, and fruit and vegetables. There were no clear associations between education, living arrangements and intake of fish.Conclusions: Men and women with a high educational level ate more fruit and vegetables but less red meat than men and women with a low educational level. Men and women living with others ate more red meat, fruit and vegetables than men and women living alone.

Review of a priori dietary quality indices in relation to their construction criteria

A multitude of indices measure the healthiness of dietary patterns. Because validation results with respect to health outcomes do not sufficiently facilitate the choice of a specific dietary quality index, the decision of which index to use for a particular research objective should be based on other criteria. This review aims to provide guidance on which criteria to focus upon when choosing a dietary index for a specific research question. A review of 57 existing specifications of dietary quality indices was conducted, taking explicitly into account relevant construction criteria explicated in the Organisation for Economic Co-operation and Development handbook on constructing composite indicators. Index construction choices regarding the following criteria were extracted: theoretical framework, indicator selection, normalization and valuation functions, and aggregation methods. Preferable features of dietary indices are discussed, and a summarizing toolbox is provided to help identify indices with the most appropriate construction features for the respective study aim and target region and with regard to the available database. Directions for future efforts in the specification of new diet quality indices are given.

Nutrition in primary and secondary prevention of cardiovascular risk in the continental and Mediterranean regions of Croatia

BACKGROUND

The aim of this observational study was to evaluate the effect of Mediterranean and continental nutrition on cardiovascular risk in patients with acute and chronic coronary heart disease in Croatia.

METHODS

The study included 1284 patients who were hospitalized in a 28-month period due to acute or chronic ischaemic heart disease in hospitals across Croatia. An individual questionnaire was prepared which enabled recording of various cardiovascular risk factors.

RESULTS

Patients with chronic coronary artery disease have a better index of healthy diet than patients with acute coronary disease. Women have a better index of diet than men in both Croatian regions. When the prevalence of risk factors (impaired glucose tolerance, diabetes mellitus types I and II, hypercholesterolaemia, hypertriglyceridaemia and hypertension) in patients with Mediterranean and continental nutrition is compared, a trend is seen for patients who have risk factors to consume healthier food.

CONCLUSION

The Mediterranean diet is associated with reduced risk of developing cardiovascular disease. This effect is more evident in patients with known cardiovascular disease.

Food consumption, nutrient intake, and dietary patterns in Ghanaian migrants in Europe and their compatriots in Ghana

Background: West African immigrants in Europe are disproportionally affected by metabolic conditions compared to European host populations. Nutrition transition through urbanisation and migration may contribute to this observations, but remains to be characterised. Objective: We aimed to describe the dietary behaviour and its socio-demographic factors among Ghanaian migrants in Europe and their compatriots living different Ghanaian settings. Methods: The multi-centre, cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study was conducted among Ghanaian adults in rural and urban Ghana, and Europe. Dietary patterns were identified by principal component analysis. Results: Contributions of macronutrient to the daily energy intake was different across the three study sites. Three dietary patterns were identified. Adherence to the 'mixed' pattern was associated with female sex, higher education, and European residency. The 'rice, pasta, meat, and fish' pattern was associated with male sex, younger age, higher education, and urban Ghanaian environment. Adherence to the 'roots, tubers, and plantain' pattern was mainly related to rural Ghanaian residency. Conclusion: We observed differences in food preferences across study sites: in rural Ghana, diet concentrated on starchy foods; in urban Ghana, nutrition was dominated by animal-based products; and in Europe, diet appeared to be highly diverse.

The impact of educational intervention on physical activity, nutrition and laboratory parameters in type II diabetic patients

Background

Diabetes is one of the most common chronic diseases that is now widely spread around the world, and day by day the number of patients is increasing. The purpose of this study was to determine the impact of educational intervention on physical activity, nutrition and laboratory parameters in type 2 diabetic patients.

Methods

This semi-experimental study was performed from March to October 2015 on 100 patients with type 2 diabetes who referred to the Niknejad health center. The type of sampling was simple random. Data were collected using a questionnaire including demographic questions, assessment of nutritional status and physical activity, history of diabetes, physical measurements and laboratory parameters of patients. Data were analyzed using SPSS 16, and descriptive and analytical tests (paired-samples t-test) and the results were significant at the level of (p<0.05).

Results

In present study, body measurements, the mean number of units of fruit and vegetable intake per day, type of oil consumption, the mean number of days of fish intake per week or the mean number of days with intense physical activity per week, had no significant difference before and after the intervention, while the variables of FBS level (p<0.003), rate of HbA_1c (p<0.027), the mean number of days of fruit intake (p<0.001) and vegetable intake (p<0.037) per week and the mean number of days with moderate physical activity (p<0.03) of patients, had significant difference before and after the intervention.

Conclusion

According to the findings of this study, to improve BMI, fish intake, type of oil consumption and also increased daily fruit and vegetable intake in these patients, a variety of educational-supportive interventions are recommended.

Dietary Patterns Characterized by High Meat Consumption Are Associated with Other Unhealthy Life Styles and Depression Symptoms

OBJECTIVE

We aimed to identify dietary patterns (DPs) of Portuguese adults, to assess their socioeconomic, demographic, lifestyle determinants, and to identify their impact on health.

DESIGN

EpiDoC 2 study included 10,153 Portuguese adults from the EpiDoC Cohort, a population-based study. In this study, trained research assistants using computer-assisted telephone interview collected socioeconomic, demographic, dietary, lifestyles, and health information from March 2013 to July 2015. Cluster analysis was performed, based on questions regarding the number of meals, weekly frequency of soup consumption, vegetables, fruit, meat, fish, dairy products, and daily water intake. Factors associated with DP were identified through logistic regression models.

RESULTS

Two DPs were identified: the "meat dietary pattern" and the "fruit & vegetables dietary pattern." After multivariable adjustment, women (OR = 0.52; p < 0.001), older adults (OR = 0.97; p < 0.001), and individuals with more years of education (OR = 0.96; p = 0.025) were less likely to adopt the "meat dietary pattern," while individuals in a situation of job insecurity/unemployment (OR = 1.49; p = 0.013), Azores island residents (OR = 1.40; p = 0.026), current smoking (OR = 1.58; p = 0.001), daily alcohol intake (OR = 1.46; p = 0.023), and physically inactive (OR = 1.86; p < 0.001) were positively and significantly associated with "meat dietary pattern." Moreover, individuals with depression symptoms (OR = 1.50; p = 0.018) and the ones who did lower number of medical appointments in the previous year (OR = 0.98; p = 0.025) were less likely to report this DP.

CONCLUSION

Our results suggest that unhealthy DPs (meat DP) are part of a lifestyle behavior that includes physical inactivity, smoking habits, and alcohol consumption. Moreover, depression symptoms are also associated with unhealthy DPs.

Sociodemographic Determinants of Low Fruit and Vegetable Consumption Among Bangladeshi Adults: Results From WHO-STEPS Survey 2010

This study aimed to investigate factors affecting fruit and vegetables (FAVs) intake among Bangladeshi adults. Dietary data of 9275 adults from the Bangladesh Noncommunicable Disease Risk Factor Survey 2010 were analyzed. The mean age of the respondents was 42.4 (±13.5) years. Multistage cluster sampling was applied to identify samples. Demographics, personal habits, physical activity, diet, and anthropometric data were collected using the WHO-STEPs questionnaire. Average daily intake of <5 servings of FAVs combined was considered to be low FAV consumption, and its prevalence was 82.8%. A mixed-effect logistic regression model was fitted to assess association of factors with low FAV intake. Higher educational attainment, greater wealth, female sex, low physical activity, body mass index >25 kg/m², and smokeless tobacco consumption were significantly associated with higher FAV consumption. Frequency of low FAV intake increased with increasing age and decreased with increasing educational attainment. Programs targeting people at risk of low FAV consumption are needed to promote consumption.

Factors associated with consumption of fruits and vegetables among Community Kitchens customers in Lima, Peru

Community Kitchens (CKs) are one of the main food providers to low-income families in Peru and may encourage healthier diets. We aimed to determine the prevalence of fruit and vegetable consumption and associated sociodemographic and behavioral factors among CKs customers. A cross-sectional study enrolling customers of 48 CKs in two areas of Lima, Peru, was performed. The self-reported amount of fruits and vegetables consumed (< 5 vs. ≥ 5 servings/day) was the outcome. The exposures were grouped in sociodemographic variables (i.e. age, gender, education level, etc.), and self-reported intention to change eating- and exercise-related habits in the last four weeks just prior to the interview. Prevalence ratios (PR) were estimated using Poisson regression. Data from 422 subjects were analyzed, 328 females (77.9%), mean age 43.7 (± 14.5) years. Only 36 (8.5%; 95% CI 5.9%–11.2%) customers reported consuming ≥ 5 servings of fruits and vegetables daily. This pattern was 4-fold more likely among those with higher levels of education (≥ 12 vs. < 7 years), and 64% less common for migrants relative to non-migrants. In terms of intentions to change habits, those who reported having tried to reduce sugar consumption or to eat more fruits were up to 90% more likely to meet the ≥ 5 servings/day target. A substantial gap in the consumption of ≥ 5 servings of fruits and vegetables/day was found among CKs customers that does not appear to be dependent on familial income. The profiles reported in this study can inform appropriate strategies to increase healthier eating in this population.

•

Only 10% of CKs clients consumed recommended amount of fruits and vegetables.

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The gap in fruits and vegetables consumption is not dependent of familial income.

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Better educated participants were more likely to report healthy eating habits.

•

Strategies to increase fruits/vegetables consumption in this population are needed.

Mississippi Communities for Healthy Living

BACKGROUND

Improving the diet of communities experiencing health inequities can be challenging given that multiple dietary components are low in quality. Mississippi Communities for Healthy Living was designed to test the comparative effectiveness of nutrition education using a single- versus multiple-message approach to improve the diet of adult residents in the Lower Mississippi Delta.

METHOD

The single-message approach targeted discretionary calories while the multiple-message approach also targeted vegetables, fruits, whole grains, and lean protein. Delta food frequency questionnaires were used to measure participants' diet, while the Healthy Eating Index-2005 (HEI-2005) was used to generate diet quality scores. Generalized linear mixed model regression was used to test for significant time, treatment, and time × treatment interaction effects in HEI-2005 component and total score changes.

RESULTS

The majority of participants in the single- and multiple-message arms ( n = 114 and 127, respectively) were female (88% and 96%, respectively), African American (90% and 98%, respectively), overweight or obese (92% and 87%, respectively), and 41 to 60 years of age (57% and 43%, respectively). Significant time effects were present for HEI-2005 total and component scores, with three exceptions-whole fruit, total grains, and saturated fat. Significant treatment effects were present for two components-total and whole fruit; scores were higher in the multiple-message approach arm as compared to the single-message approach arm across time points. No interaction effects were significant for any of the HEI-2005 scores.

CONCLUSION

Focusing nutrition education on the discretionary calories component of the diet may be as effective as focusing on multiple components for improving diet quality.

Relationship between social network, social support and health behaviour in people with type 1 and type 2 diabetes: cross-sectional studies

BACKGROUND

Psychosocial and behavioural aspects of diabetes may differ according to diabetes type. This study compared people with type 1 and type 2 diabetes with respect to social relations (cohabitation status, contact with the social network and social support) and health behaviours (diet and physical activity). Furthermore, we examined whether potential differences in health behaviour between people with type 1 and type 2 diabetes were influenced by education level and social relations.

METHODS

We conducted two cross-sectional surveys consisting of people with type 2 diabetes (N = 1081) and type 1 diabetes (N = 2419) from a specialist diabetes clinic. Gender-stratified stepwise multiple regression models assessed differences by diabetes type and other variables of interest.

RESULTS

Significant associations were found between diabetes type and social network, social support and health behaviour. No differences were observed regarding cohabitation status. People with type 2 diabetes were less physically active, less likely to follow recommended diet (men), had fewer contacts with family and friends and were less certain of counting on help in case of severe illness than people with type 1 diabetes. No impact of education level, social network and social support were observed concerning differences in health behaviours by diabetes type; however, in women, the association between physical activity and diabetes type was not significant after adjustment for social relations and education level.

CONCLUSIONS

People with type 2 diabetes had less contact with the social network, less certainty about support in case of severe illness and fewer healthy behaviours than people with type 1 diabetes. It may be important to draw attention to differences in health behaviours and social relations between people with type 1 and type 2 diabetes in diabetes care, patient education and support initiatives.

Food Security Status and Barriers to Fruit and Vegetable Consumption in Two Economically Deprived Communities of Oakland, California, 2013-2014

Introduction

Food security status may moderate how people perceive barriers to fruit and vegetable consumption. This study aimed to 1) describe the association between fruit and vegetable consumption and microbarriers and mezzobarriers to consumption, and 2) test whether these associations differ by food security status.

Methods

We surveyed adults (n = 531) living in 2 economically deprived communities in Oakland, California, in 2013 and 2014. Multivariate linear regression assessed associations between microbarriers (taste, cost, busyness) and mezzobarriers (produce selection, quality, and purchase ease) and fruit and vegetable consumption, derived from a 26-item dietary screener. Interactions were tested by food security status.

Results

Respondents consumed a mean 2.4 (standard deviation, 1.5) servings of fruits and vegetables daily; 39% of the sample was food insecure. Being too busy to prepare healthy foods was associated with reduced fruit and vegetable consumption (β_busyness = −0.40; 95% confidence interval [CI], −0.52 to −0.28) among all respondents. Food security moderated the relationship between fruit and vegetable consumption and taste, cost, and perceived ease of purchase of healthy foods. Among the food secure, disliking healthy food taste (β_taste = −0.38; 95% CI, −0.60 to −0.15) and cost (β_cost = −0.29; 95% CI, −0.44 to −0.15) concerns were associated with lower consumptions of fruits and vegetables. Mezzobarriers were not significantly associated with consumption in either group.

Conclusion

Perceived time constraints influenced fruit and vegetable consumption. Taste and cost influenced fruit and vegetable consumption among the food secure and may need to be considered when interpreting analyses that describe dietary intake and designing diet-related interventions.

Dietary Patterns and Socioeconomic Status in the Very Old: The Newcastle 85+ Study

Background

Dietary patterns (DP) are associated with health outcomes in younger adults but there is a lack of evidence in the very old (aged 85+) on DP and their association with sociodemographic factors, lifestyle, health and functioning measures. Higher socioeconomic status (SES) has been linked with healthier DP but it is not known whether these associations are sustained in the very old.

Objective

We aimed to (a) characterise DP in the very old and (b) assess the relationships between three SES indicators (education, occupational class and area-deprivation index [IMD]) and DP.

Methods

Complete dietary data at baseline (2006/07) for 793 participants in the Newcastle 85+ Study were established through 24-hr multiple pass recall. We used Two-Step clustering and 30 food groups to derive DP, and multinomial logistic regression models to assess the association with SES.

Results

We identified three distinct DP (characterised as ‘High Red Meat’, ‘Low Meat’, and ‘High Butter’) that varied with key sociodemographic, health and functioning measures. ‘Low Meat’ participants were more advantaged (i.e. higher education and occupational class, and lived in more affluent areas in owned homes), were least disabled, cognitively impaired, and depressed, and were more physically active than those in the other DP. After adjusting for other lifestyle factors, cognitive status and BMI, lower educational attainment remained a significant predictor of ‘High Red Meat’ and ‘High Butter’ membership compared with ‘Low Meat’ (‘High Red Meat’: OR [95% CI] for 0–9 and 10–11 years of education vs. ≥12 years: 5.28 [2.85–9.79], p<0.001 and 3.27 [1.65–6.51], p = 0.001, respectively; ‘High Butter’: 3.32 [1.89–5.82], p<0.001 and 2.83 [1.52–5.28], p = 0.001).

Conclusions

In this cohort of very old adults, we detected a favourable DP (‘Low Meat’), which was associated with better health and functioning and higher SES.

The association between socio-economic position and diet quality in Australian adults

OBJECTIVE

We aimed to investigate the association between multiple measures of socio-economic position (SEP) and diet quality, using a diet quality index representing current national dietary guidelines, in the Australian adult population.

DESIGN

Cross-sectional study. Linear regression analyses were used to estimate the association between indicators of SEP (educational attainment, level of income and area-level disadvantage) and diet quality (measured using the Dietary Guideline Index (DGI)) in the total sample and stratified by sex and age (≤55 years and >55 years).

SETTING

A large randomly selected sample of the Australian adult population.

SUBJECTS

Australian adults (n 9296; aged ≥25 years) from the Australian Diabetes, Obesity and Lifestyle Study.

RESULTS

A higher level of educational attainment and income and a lower level of area-level disadvantage were significantly associated with a higher DGI score, across the gradient of SEP. The association between indicators of SEP and DGI score was consistently stronger among those aged ≤55 years compared with their older counterparts. The most disadvantaged group had a DGI score between 2 and 5 units lower (depending on the marker of SEP) compared with the group with the least disadvantage.

CONCLUSIONS

A higher level of SEP was consistently associated with a higher level of diet quality for all indicators of SEP examined. In order to reduce socio-economic inequalities in diet quality, healthy eating initiatives need to act across the gradient of socio-economic disadvantage with a proportionate focus on those with greater socio-economic disadvantage.

Patterns of dietary behaviours identified by latent class analysis are associated with chronic uninvestigated dyspepsia

To our knowledge, no study has assessed the relationships between patterns of dietary behaviours, identified by latent class analysis (LCA), and chronic uninvestigated dyspepsia (CUD). The present study was conducted to determine the association between the patterns of dietary behaviours, identified by LCA, and CUD in a large sample of adults. In a cross-sectional study conducted on 4763 Iranian adults, we assessed the patterns of dietary behaviours in four domains, including 'meal patterns', 'eating rate', 'intra-meal fluid intake' and 'meal-to-sleep interval', as identified by LCA, using a pre-tested comprehensive questionnaire. Patients with CUD were identified using the Rome III diagnostic criteria. CUD was prevalent in 15·2 % (95 % CI 14·4, 16·2 %; n 723) of patients. Early satiation occurred in 6·3 % (n 302) of patients, bothersome postprandial fullness in 8·0 % (n 384) of patients and epigastric pain in 7·8 % (n 371) of patients. We defined two distinct classes of meal patterns: 'regular' and 'irregular'. For eating rates, three classes were defined: 'moderate', 'moderate-to-slow' and 'moderate-to-fast'. Participants were identified as ingesting fluid with meals in two major classes: 'moderate intra-meal drinking' and 'high intra-meal drinking'. In terms of the interval between meals and sleeping, two distinct classes were identified: 'short meal-to-sleep interval' and 'long meal-to-sleep interval'. After controlling for potential confounders, the 'irregular meal pattern' was significantly associated with a greater odds of CUD (OR 1·42, 95 % CI 1·12, 1·78) compared with a 'regular meal pattern'. Individuals with a 'moderate-to-fast eating rate' were more likely to have CUD compared with those who had a 'moderate eating rate' (OR 1·42, 95 % CI 1·15, 1·75). Patterns of the 'meal-to-sleep interval' and 'intra-meal fluid intake' were not significantly associated with CUD. In conclusion, the 'irregular meal pattern' and the 'moderate-to-fast eating rate' were significantly associated with a greater odds of CUD. Further prospective investigations are warranted to confirm this association.

Vegan-vegetarian diets in pregnancy: danger or panacea? A systematic narrative review

BACKGROUND

Although vegan-vegetarian diets are increasingly popular, no recent systematic reviews on vegan-vegetarian diets in pregnancy exist.

OBJECTIVES

To review the literature on vegan-vegetarian diets and pregnancy outcomes.

SEARCH STRATEGY

PubMed, Embase, and the Cochrane library were searched from inception to September 2013 for pregnancy and vegan or vegetarian Medical Subject Headings (MeSH) and free-text terms.

SELECTION CRITERIA

Vegan or vegetarian diets in healthy pregnant women. We excluded case reports and papers analysing vegan-vegetarian diets in poverty and malnutrition. Searching, paper selection, and data extraction were performed in duplicate.

DATA COLLECTION AND ANALYSIS

The high heterogeneity of the studies led to a narrative review.

MAIN RESULTS

We obtained 262 full texts from 2329 references; 22 selected papers reporting maternal-fetal outcomes (13) and dietary deficiencies (nine) met the inclusion criteria. None of the studies reported an increase in severe adverse outcomes or in major malformations, except one report of increased hypospadias in infants of vegetarian mothers. Five studies reported vegetarian mothers had lower birthweight babies, yet two studies reported higher birthweights. The duration of pregnancy was available in six studies and was similar between vegan-vegetarians and omnivores. The nine heterogeneous studies on microelements and vitamins suggest vegan-vegetarian women may be at risk of vitamin B12 and iron deficiencies.

AUTHOR'S CONCLUSIONS

The evidence on vegan-vegetarian diets in pregnancy is heterogeneous and scant. The lack of randomised studies prevents us from distinguishing the effects of diet from confounding factors. Within these limits, vegan-vegetarian diets may be considered safe in pregnancy, provided that attention is paid to vitamin and trace element requirements.

Gender differences in autoimmune disease

Autoimmune diseases are a range of diseases in which the immune response to self-antigens results in damage or dysfunction of tissues. Autoimmune diseases can be systemic or can affect specific organs or body systems. For most autoimmune diseases there is a clear sex difference in prevalence, whereby females are generally more frequently affected than males. In this review, we consider gender differences in systemic and organ-specific autoimmune diseases, and we summarize human data that outlines the prevalence of common autoimmune diseases specific to adult males and females in countries commonly surveyed. We discuss possible mechanisms for sex specific differences including gender differences in immune response and organ vulnerability, reproductive capacity including pregnancy, sex hormones, genetic predisposition, parental inheritance, and epigenetics. Evidence demonstrates that gender has a significant influence on the development of autoimmune disease. Thus, considerations of gender should be at the forefront of all studies that attempt to define mechanisms that underpin autoimmune disease.

Who uses herbs and spices?

Purpose

– This paper aims to examine the usage patterns of herbs and spices among Australians and to identify how herbs and spices were consumed by respondents from different social backgrounds.

Design/methodology/approach

– In all, 1,023 adult Australians completed an online survey and ranked the frequencies of use of 21 herbs and spices and provided details of their demographics, cooking intentions and household types.

Findings

– Latent class analysis was applied and three types of usage patterns were identified, including high use, moderate use and low use of herbs and spices. The usage patterns were associated differentially with several covariates. For example, the chance of being in the high-usage group was positively associated with age, number of adults living in the household and cooking evening meals from scratch, but negatively related to levels of education and possession of cooking or culinary qualifications. Moreover, respondents who cooked their evening meals from scratch and who were not interested in receiving information or advice about making inexpensive but tasty meals were more likely to be in the moderate- rather than the low-usage group.

Originality/value

– The identification of groups of users of herbs and spices would enable health communications to be tailored to enhance the use of herbs and spices and reduce the use of other flavouring agent including fat, sugar and salt.

[Socioeconomic pattern in unhealthy diet in children and adolescents in Spain]

Objetivo

Investigar la posible asociación de patrones alimentarios relacionados con la obesidad y la posición socioeconómica en la población infantil y adolescente española.

Diseño

Estudio descriptivo transversal.

Participantes

Los datos proceden de la Encuesta Nacional de Salud de 2007, realizada a una muestra representativa española de 0 a 15 años. En este estudio se han analizado 6.143 sujetos de 5 a 15 años.

Mediciones principales

Se ha estimado la prevalencia de omisión de desayuno, la prevalencia de bajo consumo de fruta y verdura y la prevalencia de alto consumo de comida rápida, snacks y bebidas azucaradas. Los indicadores de posición socioeconómica han sido el nivel de estudios y la clase social de la persona que aportaba más ingresos económicos al hogar. En cada consumo de alimentos se han estimado las diferencias socioeconómicas mediante la razón de prevalencia, tomando como referencia la categoría socioeconómica más alta.

Resultados

Tanto en la infancia como en la adolescencia la magnitud de la razón de prevalencia muestra un gradiente socioeconómico inverso en todos los consumos de alimentos investigados: la menor y la mayor razón de prevalencia se observa en los sujetos de familias de posición socioeconómica más alta y más baja, respectivamente.

Conclusión

En la población infantil y adolescente española la alimentación no saludable relacionada con la obesidad muestra un patrón socioeconómico claro.

Fruit and vegetables: intake and sociodemographic determinants among Portuguese mothers

BACKGROUND

Fruit and vegetable intake is crucial in health promotion and disease prevention. Inadequate intake is found among adult populations worldwide.

AIMS

To assess fruit and vegetable intake among Portuguese mothers and to examine its association with sociodemographic determinants.

METHODS

A national cross-sectional survey was performed in Portugal as part of the Pro Children study. Data from self-administrated precoded 24-hour recall and food frequency questionnaires answered by 1,853 mothers of 11- to 13-year-old children were analyzed. Descriptive analysis of the data was followed by logistic regression to assess associations between daily fruit and vegetable intake and sociodemographic determinants.

RESULTS

The mean fruit and vegetable intake was 221.2 and 170.0 g/day, respectively. Only 46% of the mothers met the WHO recommendations (≥400 g fruit and vegetables/day). Daily fruit intake was significantly higher among mothers who live with a spouse/partner, and who belong to a higher social class. For vegetables, daily intake was significantly higher among mothers with a higher education and social class.

CONCLUSIONS

This study shows that the mean intake of fruit and vegetables among Portuguese mothers is far below international recommendations. Effective strategies to promote fruit and vegetable intake are needed, especially for mothers belonging to lower social classes and educational levels.

Dietary patterns of Pakistani adults and their associations with sociodemographic, anthropometric and life-style factors

Dietary pattern analysis is an epidemiological method designed to consider the complexity of food preferences and diet patterns of populations. Few studies from South Asia have used this methodology to describe population food intake. Our objective was to identify dietary patterns and understand their associations with sociodemographic, anthropometric and life-style factors among low-income Pakistani urban adults. Dietary information was collected by a thirty-three-item FFQ and dietary patterns were derived by principal component analyses in 5491 subjects enrolled in the Control of Blood Pressure and Risk Attenuation (COBRA) study. Three dietary patterns were identified: a fat and sweet pattern characterised by fried snacks/foods, desserts, organ meats, bakery products, Pakistani bread and food purchased from outside the home; a fruit and vegetable pattern including fruits, juices, raw and cooked vegetables, lean meat and low-fat milk; and a seafood and yogurt pattern identified by prawns, fish, potatoes and yogurt. The fat and sweet pattern scores were low among older subjects, those with high BMI and waist circumference but high among females and physically active participants. The fruit and vegetable pattern was associated with younger age, high BMI, education and non-tobacco use. The seafood and yogurt pattern was associated with high BMI, increased physical activity and non-tobacco use. In conclusion, distinct dietary patterns exist for the Pakistani population that may be related to some of the population characteristics and thus may have importance in suggesting dietary and life-style interventions in the prevention of chronic diseases.

Snack frequency: associations with healthy and unhealthy food choices

Objective

We examined associations between snack frequency, sociodemographic characteristics, BMI, dietary and eating behaviour. In order to identify whether various subgroups of high-frequency snack consumers exist, we investigated underlying food patterns and lifestyle factors.

Design

The data were based on the Swiss Food Panel Questionnaire of 2010, which included an FFQ, questions relating to sociodemographics and lifestyle factors. Data were examined using ANOVA, regression analysis and hierarchical cluster analysis. Gender differences were also investigated in the analysis of the data.

Setting

A sample of 6189 adults participating in the Swiss Food Panel filled in a questionnaire (response rate 30 %).

Subjects

The sample consisted of both men and women, with a mean age of 54·4 (sd 13·5) years.

Results

There was no association between snack frequency and BMI. Consumption frequency of sweets and savouries as well as fruit intake increased with increasing snack frequency. Additionally, three different subgroups of high-frequency snack consumers could be revealed: healthy, moderate and unhealthy dietary-pattern groups. The latter included respondents who were less health-conscious and was characterized by high alcohol consumption frequency, daily breakfast skipping and watching television during the main meal.

Conclusions

High snack frequency occurred in the context of healthy as well as unhealthy dietary behaviour and lifestyle patterns. Women made healthier dietary food choices and were more likely to consume fruits as snacks, while men chose unhealthy foods, such as sweets and savouries, more often.

Is there an association between socioeconomic status and body mass index among adolescents in Mauritius?

There are no documented studies on socioeconomic status (SES) and body mass index (BMI) among Mauritian adolescents. This study aimed to determine the relationships between SES and BMI among adolescents with focus on diet quality and physical activity (PA) as mediating factors. Mauritian school adolescents (n = 200; 96 males, 104 females) were recruited using multistage sampling. Participants completed a self-reported questionnaire. Height and weight were measured and used to calculate BMI (categorised into underweight, healthy-weight, overweight, obese). Chi-square test, Pearson correlation, and Independent samples t-test were used for statistical analysis. A negative association was found between SES and BMI (χ(2) = 8.15%, P < 0.05). Diet quality, time spent in PA at school (P = 0.000), but not total PA (P = 0.562), were significantly associated with high SES. Poor diet quality and less time spent in PA at school could explain BMI discrepancies between SES groups.

Population compliance with national dietary recommendations and its determinants: findings from the ORISCAV-LUX study

The objective of the present study was to determine the proportion of adults meeting national recommendations for food and nutrient intake and to identify the demographic, socio-economic and behavioural factors that may contribute to weaken dietary compliance. ORISCAV-LUX is a cross-sectional study that took place in Luxembourg (2007-8). A representative stratified random sample of 1352 adults aged 18-69 years participated in the nationwide cardiovascular health survey. A FFQ was used to estimate food intake. Radar charts were built to compare graphically the compliance of the participants with different key dietary guidelines on the same set of axes. The thirteen food- and nutrient-based recommendations were scored and summed to create a recommendation compliance index (range -0·5 to 14). Ordinal logistic regression analyses were performed to determine the factors contributing to poor dietary compliance. Several food- and nutrient-based guidelines were insufficiently respected compared with others. The greatest gaps occurred in the adherence to grain and dairy product consumption guidelines, as well as to total fat and notably to SFA recommendations. Age, country of birth, economic status, smoking status and subject's awareness of the importance of balanced meals emerged as independently associated with weak dietary compliance. Obese subjects conformed more to dietary recommendations compared with normal-weight subjects. The findings underscore the need for specific nutrition education messages along with targeted interventions. Efforts should be continued to increase population awareness of the importance of a healthy lifestyle and a balanced diet.

Does a population-based multi-factorial lifestyle intervention increase social inequality in dietary habits? The Inter99 study

OBJECTIVE

To investigate whether the effect of an individualised multi-factorial lifestyle intervention on dietary habits differs across socioeconomic groups.

METHODS

The study was an individualised multi-factorial lifestyle intervention study with a control group, Inter99 (1999-2006), Copenhagen, Denmark. Participants in the intervention group (n=6 091) received lifestyle intervention during a five-year period. The control group (n=3 324) was followed by questionnaires. Multilevel regression analyses were used, including interaction term between intervention effect and socioeconomic position (SEP) and analysed separately for men and women. SEP was measured as length of education and employment status and dietary habits were measured by a validated food frequency questionnaire.

RESULTS

Men with a short education improved their dietary habits more (net-change [95% confidence interval]) (0.25 points [-0.01;0.52]) than men with longer education (0.02 points [-0.09;0.14]), (interaction: p=0.02). Furthermore, unemployed women improved their dietary intake more (0.33 points [0.05;0.61]) than employed women (0.01 points [-0.10;0.11]), (interaction: p=0.03). Similar results were found for fruit intake, whereas no significant interactions were found for fish, fat and vegetable intake.

CONCLUSIONS

Individualised dietary interventions do not increase and may even decrease or hinder further widening of the social inequalities in health due to unhealthy dietary habits among socially disadvantaged individuals.

Does diet cost mediate the relation between socioeconomic position and diet quality?

BACKGROUND/OBJECTIVES

Socioeconomic disparities in diet quality are well established. This study tested the hypothesis that such disparities are mediated, in part, by diet cost.

SUBJECTS/METHODS

The Seattle Obesity Study (S.O.S) was a cross-sectional study based on a representative sample of 1266 adults of King County, WA, conducted in 2008-09. Demographic and socioeconomic variables were obtained through telephone survey. Income and education were used as indicators of socioeconomic position. Dietary intake data were obtained using a food frequency questionnaire (FFQ). Diet cost was calculated based on retail prices for FFQ component foods. Energy density (KJ/g) and mean adequacy ratio (MAR) were used as two indices of overall diet quality.

RESULTS

Higher income and education were each associated with lower energy density and higher MAR scores, adjusting for covariates. Higher income and education were also associated with higher energy adjusted diet cost. Higher quality diets were in turn associated with higher diet costs. All these associations were significant (P<0.0001). In formal mediation analyses, diet cost significantly mediated the pathway between income and diet quality measures, adjusting for covariates (P<0.05 each). Further, income-diet cost-diet quality pathway was found to be moderated by education level.

CONCLUSIONS

The social gradient in diet quality may be explained by diet cost. Strategies to improve diet quality among lower socioeconomic strata may need to take food prices and diet cost along with nutrition education into account.

Changes in socio-economic differences in food habits over time

Objective

To examine absolute socio-economic differences in food habits and their changes over time.

Design

A longitudinal study using the cohort baseline mail surveys conducted in 2000–2002 (n 8960, response rate 67 %) and the follow-up in 2007 (n 7332, response rate 83 %), including data on seven food habits recommended in the national dietary guidelines, as well as socio-economic and sociodemographic variables.

Setting

Data from the Helsinki Health Study survey, followed up for 5–7 years.

Subjects

Municipal employees of the City of Helsinki, Finland.

Results

Apart from fish and vegetable-based margarine on bread, the proportions of the recommended food items were higher for women than for men. The consumption of the recommended food items either increased or remained stable over the follow-up period. On the basis of the slope index of inequality (SII) it was observed that socio-economic differences widened with regard to the consumption of fresh vegetables and fish and use of vegetable-based margarine or oil in cooking, with the upper classes consuming these foods more often. The largest differences were observed in the consumption of fresh vegetables, for which the SII value among women was 2·38 (95 % CI 1·93, 2·95) at baseline and 2·47 (95 % CI 2·01, 3·03) at follow-up, and 3·36 (95 % CI 1·80, 6·28) and 3·47 (95 % CI 1·95, 6·19) for men, respectively. Socio-economic differences were non-existent for milk, and the reverse was observed for dark bread and vegetable-based margarine on bread.

Conclusions

Consumption of the recommended food items increased in the examined cohort over time. This increase was mostly similar throughout the socio-economic groups and thus the socio-economic differences remained stable. The upper classes followed the guidelines better with regard to the consumption of vegetables and fish and in the use of vegetable-based margarine or oil in cooking.

Patterns and predictors of fast food consumption after acute myocardial infarction

Although fast food is affordable and convenient, it is also high in calories, saturated fat, and sodium. The frequency of fast food intake at the time of and after acute myocardial infarction (AMI) is modifiable. However, patterns of fast food intake and characteristics associated with its consumption in patients with AMI are unknown. The aim of this study was to study fast food consumption at the time of AMI and 6 months later in 2,481 patients from the prospective, 24-center Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) study of patients with AMI. Fast food intake was categorized as frequent (weekly or more often) or infrequent (less than weekly). Multivariate log-binomial regression was used to identify patient characteristics associated with frequent fast food intake 6 months after AMI. At baseline, 884 patients (36%) reported frequent fast food intake, which decreased to 503 (20%) 6 months after discharge (p <0.001). Male gender, white race, lack of college education, current employment, and dyslipidemia were independently associated with frequent fast food intake 6 months after AMI. In contrast, older patients and those who underwent coronary bypass surgery were less likely to eat fast food frequently. Documentation of discharge dietary counseling was not associated with 6-month fast food intake. In conclusion, fast food consumption by patients with AMI decreased 6 months after the index hospitalization, but certain populations, including younger patients, men, those currently working, and less educated patients were more likely to consume fast food, at least weekly, during follow-up. Novel interventions that go beyond traditional dietary counseling may be needed to address continued fast food consumption after AMI in these patients.

Socio-economic circumstances and food habits in Eastern, Central and Western European populations

OBJECTIVE

To assess the relationship between several socio-economic indicators and frequency of consumption of seven predefined healthy foods (consumption of fruit, vegetables, wholegrain bread, vegetable-fat spread, vegetable cooking fat, low-fat milk and low-fat cheese) in populations from Eastern, Central and Western Europe.

DESIGN

Analysis of baseline data collected in two cross-sectional cohort studies between 2000 and 2005: the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study and the Finnish Helsinki Health Study (HHS).

SETTING

Urban populations in the Czech Republic, Russia, Poland and Finland.

SUBJECTS

In the HAPIEE study, random samples of men and women aged 45-69 years were drawn from population registers and electoral lists of selected cities. In the HHS, men and women aged 40-60 years employed by the City of Helsinki were recruited. Data on 21,326 working subjects from both cohorts were analysed.

RESULTS

Healthy food habits were, in general, positively associated with higher education, occupational position and fewer economic difficulties, but there were differences in the strength of the gradient by food and country. Fruit consumption showed the most consistent gradients, especially in relation to socio-economic status among men (country-specific relative index of inequality (RII)=2.02-5.17) and women (RII=2.09-3.57).

CONCLUSIONS

The associations between socio-economic indicators and healthy food habits showed heterogeneity between countries. Future studies of dietary behaviours should consider multiple measures of socio-economic position.

Diet cost, diet quality and socio-economic position: how are they related and what contributes to differences in diet costs?

OBJECTIVE

To examine diet costs in relation to dietary quality and socio-economic position, and to investigate underlying reasons for differences in diet costs.

DESIGN

Dietary intake was assessed by a 4 d food diary and evaluated using the 2005 Healthy Eating Index (HEI). National consumer food prices collected by Statistics Sweden and from two online stores/supermarkets were used to estimate diet costs.

SETTING

Sweden.

SUBJECTS

A nationally representative sample of 2160 children aged 4, 8 or 11 years.

RESULTS

Higher scores on the HEI resulted in higher diet costs and, conversely, higher diet costs were linked to increased total HEI scores. Children who consumed the most healthy and/or expensive diets ate a more energy-dilute and varied diet compared with those who ate the least healthy and/or least expensive diets. They also consumed more fish, ready meals and fruit. Regression analysis also linked increased food costs to these food groups. There was a positive, but weak, relationship between HEI score and diet cost, parental education and parental occupation respectively.

CONCLUSIONS

Healthy eating is associated with higher diet cost in Swedish children, in part because of price differences between healthy and less-healthy foods. The cheapest and most unhealthy diets were found among those children whose parents were the least educated and had manual, low-skill occupations. Our results pose several challenges for public health policy makers, as well as for nutrition professionals, when forming dietary strategies and providing advice for macro- and microlevels in society.

Influences on the quality of young children's diets: the importance of maternal food choices

It is recognised that eating habits established in early childhood may track into adult life. Developing effective interventions to promote healthier patterns of eating throughout the life course requires a greater understanding of the diets of young children and the factors that influence early dietary patterns. In a longitudinal UK cohort study, we assessed the diets of 1640 children at age 3 years using an interviewer-administered FFQ and examined the influence of maternal and family factors on the quality of the children's diets. To describe dietary quality, we used a principal components analysis-defined pattern of foods that is consistent with healthy eating recommendations. This was termed a 'prudent' diet pattern and was characterised by high intakes of fruit, vegetables and wholemeal bread, but by low intakes of white bread, confectionery, chips and roast potatoes. The key influence on the quality of the children's diets was the quality of their mother's diets; alone it accounted for almost a third of the variance in child's dietary quality. Mothers who had better-quality diets, which complied with dietary recommendations, were more likely to have children with comparable diets. This relationship remained strong even after adjustment for all other factors considered, including maternal educational attainment, BMI and smoking, and the child's birth order and the time spent watching television. Our data provide strong evidence of shared family patterns of diet and suggest that interventions to improve the quality of young women's diets could be effective in improving the quality of their children's diets.

Compliance with French nutrition and health program recommendations is strongly associated with socioeconomic characteristics in the general adult population

BACKGROUND

In many countries, nutrition policies such as the Programme National Nutrition Santé (PNNS), implemented in France since 2001, have been developed to prevent and reduce the risk of chronic disease. However, the way in which such programs might benefit persons having different socioeconomic characteristics is unknown. The French nutrition and health survey (Etude Nationale Nutrition Santé [ENNS]) represented an opportunity to address this issue.

OBJECTIVE

To describe compliance with PNNS recommendations in the general population and to investigate the relationship between social, economic, and educational characteristics and poor compliance with French nutrition recommendations.

DESIGN

A national cross-sectional multistage sampling survey. Food intake was estimated through three 24-hour recalls. Adherence to French nutrition recommendations was estimated using the PNNS guideline score (15 possible points).

PARTICIPANTS

Two thousand five hundred seventy-seven adults aged 18 to 74 years living in France in 2006-2007 were included in these analyses.

STATISTICAL ANALYSIS

All analyses were carried out in men and women separately. Sex-specific quartiles of score were estimated. Multiple logistic models were used to identify socioeconomic characteristics (ie, age, marital status, occupational status, education level, and holiday trip in the past 12 months) associated with poor compliance with recommendations (first PNNS guideline score quartile vs three other quartiles), estimating odds ratios (ORs), and their 95% confidence intervals (CIs).

RESULTS

The mean PNNS guideline score was 7.67+/-0.17 in men and 8.55+/-0.12 in women. In both sex groups, a difference of approximately four attained recommendations (out of 13 maximum) was observed between the lowest and highest quartiles. In multivariate models, being in the first PNNS guideline score quartile was significantly associated with lower age and lower occupational status for both sexes. Moreover, women living without a partner were at higher risk of poor compliance with recommendations (adjusted OR 1.43; 95% CI 1.01 to 2.04, vs women living with a partner), as were men not having taken a holiday trip during the past 12 months (adjusted OR 1.78, 95% CI 1.05 to 3.02, vs at least one holiday trip).

CONCLUSIONS

Compliance with nutrition recommendations can be improved despite several years of public health interventions carried out by the PNNS. Identification of characteristics associated with poor compliance should help to target future public health measures.

A systematic review of studies on socioeconomic inequalities in dietary intakes associated with weight gain and overweight/obesity conducted among European adults

This Review examined socioeconomic inequalities in intakes of dietary factors associated with weight gain, overweight/obesity among adults in Europe. Literature searches of studies published between 1990 and 2007 examining socioeconomic position (SEP) and the consumption of energy, fat, fibre, fruit, vegetables, energy-rich drinks and meal patterns were conducted. Forty-seven articles met the inclusion criteria. The direction of associations between SEP and energy intakes were inconsistent. Approximately half the associations examined between SEP and fat intakes showed higher total fat intakes among socioeconomically disadvantaged groups. There was some evidence that these groups consume a diet lower in fibre. The most consistent evidence of dietary inequalities was for fruit and vegetable consumption; lower socioeconomic groups were less likely to consume fruit and vegetables. Differences in energy, fat and fibre intakes (when found) were small-to-moderate in magnitude; however, differences were moderate-to-large for fruit and vegetable intakes. Socioeconomic inequalities in the consumption of energy-rich drinks and meal patterns were relatively under-studied compared with other dietary factors. There were no regional or gender differences in the direction and magnitude of the inequalities in the dietary factors examined. The findings suggest that dietary behaviours may contribute to socioeconomic inequalities in overweight/obesity in Europe. However, there is only consistent evidence that fruit and vegetables may make an important contribution to inequalities in weight status across European regions.

Work-family conflicts and health behaviors among British, Finnish, and Japanese employees

BACKGROUND

Work-family conflicts are associated with poor health. However, work-family conflicts and health behaviors have been little studied.

PURPOSE

This study examined the associations of conflicts between paid work and family life with unhealthy behaviors among British, Finnish, and Japanese employees.

METHOD

Data were derived from postal questionnaire surveys among 40 to 60 years old employees from three cohorts, the British Whitehall II Study (n = 3,397), the Finnish Helsinki Health Study (n = 4,958), and the Japanese Civil Servants Study (n = 2,901). Outcomes were current smoking, heavy drinking, physical inactivity, and unhealthy food habits. Work-family conflicts were measured with eight items. Age, marital status, and occupational class were adjusted for in logistic regression analyses.

RESULTS

Work-family conflicts had few and inconsistent associations with unhealthy behaviors in all three cohorts. In the Finnish cohort, strong work-family conflicts were associated with current smoking among men. Women with strong conflicts had more often unhealthy food habits and were more often heavy drinkers than women with weaker conflicts. Likewise, British women with strong work-family conflicts were more often heavy drinkers.

CONCLUSION

Although work-family conflicts were fairly prevalent in the examined cohorts, these conflicts had but few associations with the studied key health behaviors.