Dietary intakes of adults in the Netherlands by childhood and adulthood socioeconomic position

Diet quality as assessed by Healthy Eating Index-2015 among Hungarian Roma living in settlements of Northeast Hungary

Inequalities in diet quality are increasingly reported, but such studies among Roma are scarce and challenging. Here we attempt to examine diet quality and adherence to food based dietary guidelines among Hungarian Roma (HR) ethnic minority living in segregated settlements while comparing a sample of Hungarian adults from the general population (HG). Data were obtained from a complex comparative health survey conducted in Northeast Hungary in 2018, including sociodemographic and physical examination data. Dietary data were collected using two non-consecutive 24-h dietary recalls. We assessed diet quality based on using a 13-component Healthy Eating Index-2015 (HEI-2015, range 0-100). Differences in median intakes of food and nutrients and HEI-2015 scores were evaluated by Mann-Whitney test or Kruskal-Wallis test. Quantile regression was used to adjust HEI-2015 scores for socioeconomic factors including age, sex, educational status, and perceived financial status. This analysis included 393 and 415 subjects, aged between 18 to 70 years, of HR and HG populations, respectively. Results showed overall low median HEI-2015 scores for both HR and HG, with significantly lower total score among HR participants (41.6, interquartile range (IQR): 39.5-42.8) compared to HG (47.2, IQR: 45.7-51.1). Scores for individual components, such as intake of fruits, greens and beans, whole grains, seafood, and plant proteins were particularly suboptimal among both groups, but significantly lower among the HR population. Scores for refined grains, sodium, saturated fats and added sugar reflected high intakes of these components but did not differ between study groups. Our findings revealed an unfavorable diet quality among the HR compared to HG and a potentially increased risk for diet-related NCDs. Future health intervention programs are warranted to address dietary disparities of segregated minorities in Hungary while considering ethnic and cultural differences.

The Associations Between Maternal Socioeconomic Factors and Adequacy of Energy and Macronutrient Intakes in Pregnant Women From Yucatan, Mexico

BACKGROUND

Socioeconomic factors influence diet quality during pregnancy. However, dearth of evidence about the influence on energy and macronutrients adequacy calls for research.

OBJECTIVE

To analyze the association between socioeconomic factors and adequacy rates of energy and macronutrients intakes in pregnant women from Merida, Yucatan, Mexico.

METHODS

During September to December 2019, we applied a socioeconomic questionnaire and three 24-hour dietary recalls to 83 pregnant females resident in Merida, Yucatan. Energy and macronutrient intakes were compared with the estimated trimester-specific energy and macronutrient requirements to calculate adequacies (%). Outcome variables were average adequacy of energy, carbohydrates, total fat, and protein intakes and the main predictors were maternal education, monthly family income, working status, and marital status. Descriptive statistics of adequacy were calculated for each category of predictors. The association between socioeconomic factors and outcome variables was analyzed through simple and multiple linear regression models.

RESULTS

Adequacy rates of energy and macronutrients decreased as education and familial income levels increased, as well as among unemployed women. Consistently with these results, simple linear regressions showed that years of education, family income, and working status (i.e., women working to earn money), were negatively associated with adequacy rates of energy and macronutrients intakes. When all predictors and covariates were included in a multiple linear regression model, only having a job was significantly associated with adequacy rates. Marital status was not associated with outcomes.

CONCLUSIONS

Women in disadvantaged socioeconomic conditions (unemployed and low levels of education and familial income) show greater energy and macronutrient intakes.

'Known to be unhealthy': Exploring how social epidemiological research constructs the category of low socioeconomic status

We examine how the category of low socioeconomic status (LSES) was constructed in European social epidemiological research and policy advice from 1977 to 2019. We analysed 22 empirical social epidemiological research publications on LSES and health, as well as six scientific advisory reports that offered government officials an overview of scientific evidence on health inequalities. We show the construction and reification of LSES as a problematic group in dominant thought, which consists of the following components: 1) the proliferation of SES concepts, indicators and groups labelled LSES; 2) generalisation through which LSES is constructed as a single population; 3) problematisation through which LSES is constructed as an inherently unhealthy population; and 4) individualisation by which a LSES personality is presented as an explanation of health differences. We also show how this knowledge is extrapolated into the policy domain in the form of scientific advisory reports. These findings provide evidence of the construction of LSES as an inherently unhealthy population through hyperproliferation and references to the objectivity of scientific research. With respect to the LSES category, the dynamics of research and policy resemble those regarding categories of ethnicity and gender. We conclude that if the construction of LSES remains unquestioned, social epidemiology might continue to (re)produce what it examines: LSES populations 'known to be unhealthy'.

Influence of individual life course and neighbourhood socioeconomic position on dietary intake in African Americans: the Jackson Heart Study

OBJECTIVE

African Americans, especially those in the Southeastern USA, have different dietary behaviours from the general US population, and have the highest prevalence, incidence and mortality of diet-related disease outcomes, such as cardiovascular disease. However, there are scant data regarding factors such as socioeconomic position (SEP) across the life course that influence dietary behaviours in this high-risk population. Our aim was to examine the impact of life course and neighbourhood SEPs on dietary intake among African Americans.

PARTICIPANTS AND SETTING

Data for this cross-sectional analysis came from the community-based Jackson Heart Study (JHS). We analysed a total of 3948 JHS participants (mean age: 55.4±12.5; 63.9% women), who had complete dietary intake and covariate information.

METHODS

We examined the associations of childhood SEP (CSEP), adulthood SEP (ASEP) and neighbourhood SEP (NSEP) with 10 selected dietary intake measures, using multilevel log-gamma generalised linear regression models.

OUTCOME MEASURES

Dietary intake measures include daily saturated fat, sodium, protein, fibre, fruits and vegetables, whole grains, sugar-sweetened beverage, nuts, fish and processed meat.

RESULTS

In age, sex and total energy intake adjusted models, most dietary intakes were associated with these three SEP measures. After additional adjustment for other SEP measures, most of the significant associations with CSEP and NSEP were attenuated, except for the associations of fibre with CSEP (relative rate [RR] [95% CI] 1.05 [1.00-1.10]) and whole grains with NSEP (RR [95% CI] 1.28 [1.02-1.61]). The associations (shown as RR [95% CI]) between ASEP and sugar-sweetened beverage: 0.70 (0.59-0.83), processed meat: 0.75 (0.63-0.90), sodium: 0.99 (0.94-1.00), fibre: 1.10 (1.03-1.16), protein: 1.05 (1.01-1.09), fruits and vegetables: 1.21 (1.11-1.32), nuts: 2.13 (1.59-2.87), and fish: 1.57 (1.27-1.95) generally persisted after additional adjustment for both CSEP and NSEP. However, the association between ASEP and whole grains was attenuated.

CONCLUSIONS

High ASEP may have a more beneficial influence on dietary practices in African Americans than CSEP or NSEP.

Prospective associations between diet quality and body mass index in disadvantaged women: the Resilience for Eating and Activity Despite Inequality (READI) study

Background

Dietary patterns that align with recommended guidelines appear to minimize long-term weight gain in the general population. However, prospective associations between diet quality and weight change in disadvantaged adults have not been examined. This study examined associations between concurrent change in diet quality and body mass index (BMI) over 5 years among women living in socioeconomically disadvantaged neighbourhoods.

Methods

Dietary intake and BMI were self-reported among 1242 women living in disadvantaged neighbourhoods in Victoria, Australia, at three time points from 2007/08 to 2012/13. Diet quality was evaluated using the Australian Dietary Guideline Index (DGI). Associations between concurrent change in diet quality and BMI were assessed over the three time points using fixed effects and mixed models. Models were adjusted for age, smoking, menopausal status, education, marital status, number of births, urban/rural location and physical activity.

Results

Average BMI increased by 0.14 kg/m2 per year increase in age in the fixed effects model, and by 0.13 kg/m2 in the mixed model (P < 0.0001). BMI decreased by 0.014 kg/m2 for a woman of average age with each unit increase in DGI score in the fixed effects model (p < 0.0001), and by 0.012 kg/m2 in the mixed model (P = 0.001). The rate of change in BMI with age was greater for those with a lower DGI score than for those with a higher score (P < 0.10).

Conclusions

Positive change in diet quality was associated with reduced BMI gain among disadvantaged women. Supporting disadvantaged women to adhere to population-level dietary recommendations may assist them with long-term weight management.

Association between childhood socioeconomic status and fruit and vegetable intake among older Japanese: The JAGES 2010 study

Fruit and vegetable intake (FVI) contributes to the prevention of non-communicable diseases. Although food preference is considered to be determined early in life, few studies have investigated the association between childhood socioeconomic status (SES) and FVI in older age. Because a school lunch program was initiated in Japan after World War II, we were able in this study to examine this association in an older Japanese population. We used data from a population of physically and cognitively independent adults aged 65years or older who were living independently in the community and were recruited from 27 municipalities in the Japan Gerontological Evaluation Study 2010 project (August 2010-January 2012). Three categories of childhood SES (low, middle, and high) and current FVI were evaluated via a self-reported questionnaire. Poisson regression was used to investigate the association between childhood SES and FVI in 19,920 individuals. After adjustment for age and sex, older people with low childhood SES were 1.36 times more likely (95% CI 1.23-1.52) to have poor FVI than those with high childhood SES. In the fully adjusted model, the significant association disappeared. Further age-stratified analysis revealed a positive association between childhood SES and FVI among people aged 70-76years who were partially exposed to the school lunch program, but not among people aged 65-69years old who were fully exposed to the program. In conclusion, social policy such as school lunches targeting children with low SES could help improve FVI in old age.

Gender, childhood and adult socioeconomic inequalities in functional disability among Chinese older adults

BACKGROUND

Gender difference and life-course socioeconomic inequalities in functional disability may exist among older adults. However, the association is less well understood among Chinese older population. The objective is to provide empirical evidences on this issue by exploring the association between gender, childhood and adult socioeconomic inequalities in functional disability.

METHODS

Data from the 2013 wave of the China Health and Retirement Longitudinal Study (CHARLS) was utilized. Functional disability was assessed by the activities of daily living (ADL) and instrumental activities of daily living (IADL). Childhood socioeconomic status (SES) was measured by birthplace, father's education and occupation. Adult SES was measured in terms of education and household income. Multivariate logistic regressions were conducted to assess the association between gender, childhood and adult SES and functional disability.

RESULTS

Based on a sample of 18,448 older adults aged 45 years old and above, our results showed that the prevalence of ADL and IADL disability was higher among women than men, but gender difference disappeared after adult SES and adult health were controlled. Harsh conditions during childhood were associated with functional disability but in multivariate analyses only father's education was associated with IADL disability (OR for no education = 1.198; 95% CI = 1.062-1.353). Current SES such as higher education and good economic situation are protective factors of functional disability.

CONCLUSIONS

Childhood and adult SES were both related to functional disability among older adults. Our findings highlight the need for policies and programs aimed at decreasing social inequalities during childhood and early adulthood, which could reduce socioeconomic inequalities in functional disability in later life.

Evaluation of dietary cholesterol intake in elderly Chinese: a longitudinal study from the China Health and Nutrition Survey

OBJECTIVE

This study aimed to evaluate daily cholesterol intake across demographic factors and its food sources in elderly Chinese.

DESIGN

A longitudinal study was conducted using demographic and dietary data for elders aged 60 and above from eight waves (1991-2011) of the China Health and Nutrition Survey.

SETTING

The data were derived from urban and rural communities of nine provinces (autonomous regions) in China.

PARTICIPANTS

There were 16 274 participants (7657 male and 8617 female) in this study.

OUTCOMES

The primary outcome was daily cholesterol intake, which was calculated by using the Chinese Food Composition Table, based on dietary data.

RESULTS

Daily consumption of cholesterol in the elderly significantly increased by 34% from 1991 to 2011 (p<0.0001) and reached 253.9 mg on average in 2011. Secular trends in the proportion of subjects with an intake of >300 mg/day increased significantly during 1991-2011 (p<0.0001). The major food sources of cholesterol by ranked order were eggs, pork, and fish and shellfish in 1991 and 2011, while organ meats which ranked fourth in the contribution to total intake in 1991 was replaced by poultry in 2011. Moreover, younger elders, male elders and elders from a high-income family or a highly urbanised community had higher cholesterol intakes and larger proportions of subjects with excessive cholesterol consumption in each survey year.

CONCLUSIONS

The large growth in daily cholesterol intake may pose major challenges for the health of elders in China. Reduced exposure to food enriched in cholesterol is required for elderly Chinese.

Neighbourhood socioeconomic disadvantage and fruit and vegetable consumption: a seven countries comparison

BACKGROUND

Low fruit and vegetable consumption is a risk factor for poor health. Studies have shown consumption varies across neighbourhoods, with lower intakes in disadvantaged neighbourhoods. However, findings are inconsistent, suggesting that socio-spatial inequities in diet could be context-specific, highlighting a need for international comparisons across contexts. This study examined variations in fruit and vegetable consumption among adults from neighbourhoods of varying socioeconomic status (SES) across seven countries (Australia, Canada, Netherlands, New Zealand, Portugal, Scotland, US).

METHODS

Data from seven existing studies, identified through literature searches and knowledge of co-authors, which collected measures of both neighbourhood-level SES and fruit and vegetable consumption were used. Logistic regression was used to examine associations between neighbourhood-level SES and binary fruit and vegetable consumption separately, adjusting for neighbourhood clustering and age, gender and education. As much as possible, variables were treated in a consistent manner in the analysis for each study to allow the identification of patterns of association within study and to examine differences in the associations across studies.

RESULTS

Adjusted analyses showed evidence of an association between neighbourhood-level SES and fruit consumption in Canada, New Zealand and Scotland, with increased odds of greater fruit intake in higher SES neighbourhoods. In Australia, Canada, New Zealand and Portugal, those residing in higher SES neighbourhoods had increased odds of greater vegetable intake. The other studies showed no evidence of a difference by neighbourhood-level SES.

CONCLUSIONS

Acknowledging discrepancies across studies in terms of sampling, measures, and definitions of neighbourhoods, this opportunistic study, which treated data in a consistent manner, suggests that associations between diet and neighbourhood-level socioeconomic status vary across countries. Neighbourhood socioeconomic disadvantage may differentially impact on access to resources in which produce is available in different countries. Neighbourhood environments have the potential to influence behaviour and further research is required to examine the context in which these associations arise.

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.

Diet quality in older age: the influence of childhood and adult socio-economic circumstances

Socio-economic gradients in diet quality are well established. However, the influence of material socio-economic conditions particularly in childhood, and the use of multiple disaggregated socio-economic measures on diet quality have been little studied in the elderly. In the present study, we examined childhood and adult socio-economic measures, and social relationships, as determinants of diet quality cross-sectionally in 4252 older British men (aged 60-79 years). A FFQ provided data on daily fruit and vegetable consumption and the Elderly Dietary Index (EDI), with higher scores indicating better diet quality. Adult and childhood socio-economic measures included occupation/father's occupation, education and household amenities, which combined to create composite scores. Social relationships included social contact, living arrangements and marital status. Both childhood and adult socio-economic factors were independently associated with diet quality. Compared with non-manual social class, men of childhood manual social class were less likely to consume fruit and vegetables daily (OR 0.80, 95% CI 0.66, 0.97), as were men of adult manual social class (OR 0.65, 95% CI 0.54, 0.79), and less likely to be in the top EDI quartile (OR 0.73, 95% CI 0.61, 0.88), similar to men of adult manual social class (OR 0.66, 95 % CI 0.55, 0.79). Diet quality decreased with increasing adverse adult socio-economic scores; however, the association with adverse childhood socio-economic scores diminished with adult social class adjustment. A combined adverse childhood and adulthood socio-economic score was associated with poor diet quality. Diet quality was most favourable in married men and those not living alone, but was not associated with social contact. Diet quality in older men is influenced by childhood and adulthood socio-economic factors, marital status and living arrangements.

Factors affecting food choices of older adults from high and low socioeconomic groups: a discrete choice experiment

BACKGROUND

Healthiness, price, and convenience are typically indicated as important motives for food choices; however, it is largely unknown to what extent older adults from high and low socioeconomic groups differ in these underlying motives. A discrete choice experiment (DCE) is an innovative way to elicit implicit motives for food choices.

OBJECTIVE

The aim was to investigate differences in food motives between socioeconomic groups by means of a DCE.

DESIGN

A DCE was carried out during a face-to-face interview among older adults as part of the Health and Living Conditions in Eindhoven and surrounding cities (GLOBE) cohort study, The Netherlands. Participants (n = 399; mean age: 63.3 y) were offered a series of choice sets about a usual dinner at home and were asked to choose in each choice set between 2 meals and an opt-out choice, with different combinations of attribute levels. We included 5 meal attributes (taste, healthiness, preparation time, travel time to shops, and price) and 3 or 4 levels for each attribute. Data were analyzed by multinomial logit models.

RESULTS

Healthiness, taste, price, and travel time to the grocery store proved to significantly influence older adults' meal decisions; preparation time was not significant. Healthiness was the most important attribute for all of the participants. More highly educated participants rated a healthy and less expensive meal to be more important than did less educated participants. Those with a high income rated a meal that was healthy and very tasteful to be more important than did those with a lower income.

CONCLUSIONS

Healthiness, taste, price, and travel time to grocery shops influenced older adults' meal decisions. Higher socioeconomic groups valued health more than did lower socioeconomic groups. DCEs represent a promising method to gain insight into the relative importance of motives for food choices. This trial was registered at www.isrctn.com as ISRCTN60293770.

Dietary intake and nutrition-related knowledge in a sample of Lebanese adolescents of contrasting socioeconomic status

BACKGROUND

Socioeconomic status (SES) is postulated to be a major predictor of dietary intake and nutrition-related knowledge in adults. To date, very few studies have addressed this effect among adolescents.

OBJECTIVE

To explore differences in nutrient intake and nutrition-related knowledge among adolescents of contrasting SES in Lebanon.

METHODS

In a cross-sectional survey, 209 males and females, aged 17 to 19 years, were recruited from a private university with high tuition and a free public university in Beirut. The participants completed a multicomponent, self-administered questionnaire that inquired about demographic characteristics and nutrition-related knowledge. Three nonconsecutive 24-hour dietary recalls were obtained through interviews. Energy-adjusted means of dietary intake and age-adjusted nutrition-related knowledge were compared between groups using a general linear model.

RESULTS

Adolescents in the high-SES group consumed more vegetables, meats, and fats and oils (p < .05). Energy and nutrient intake analysis showed that adolescents in the high-SES group consumed significantly higher amounts of calories, protein, fat, vitamin A, vitamin C, and iron (p < .001) and significantly lower amounts of carbohydrates (p < .05). Nutritional knowledge, although high among all participants, was higher in the high-SES group (p < .05).

CONCLUSIONS

Although both groups showed good nutrition-related knowledge, SES significantly affected dietary intake in a sample of Lebanese adolescents. This warrants consideration of other factors, such as cost and environment, that may modulate eating behavior among adolescents from different socioeconomic strata.

Maternal work hours in early to middle childhood link to later adolescent diet quality

Objective

Previous studies on maternal work hours and child diet quality have reported conflicting findings possibly due to differences in study design, lack of a comprehensive measure of diet quality and differing ages of the children under investigation. The present study aimed to prospectively examine the impact of parental work hours from age 1 year to age 14 years on adolescent diet quality.

Design

Multivariate linear regression models were used to examine independent associations between parents’ work hours at each follow-up and across 14 years and adolescent diet quality at age 14 years. A diet quality index was based on the international literature and Australian recommendations, consisting of six food groups and nine nutrients.

Setting

Perth, Western Australia.

Subjects

Children (n 1629) participating in the Western Australian Pregnancy Cohort (Raine) Study.

Results

Compared with children of mothers in full-time employment, children of mothers who were not employed in early childhood up to age 5 years had a higher average diet quality score at age 14 years, independent of maternal and family socio-economic status. Across 14 years the number of years the mother worked full time and increasing average weekly hours were associated with lower diet quality. Father's work hours had little association with adolescent diet quality.

Conclusions

Having a mother stay at home in early to middle childhood is associated with better diet quality in adolescence. Support may be beneficial for families where the mother returns to full-time employment before the child reaches 8 years of age.

A systematic review of environmental factors and obesogenic dietary intakes among adults: are we getting closer to understanding obesogenic environments?

This study examined whether physical, social, cultural and economical environmental factors are associated with obesogenic dietary behaviours and overweight/obesity among adults. Literature searches of databases (i.e. PubMed, CSA Illumina, Web of Science, PsychInfo) identified studies examining environmental factors and the consumption of energy, fat, fibre, fruit, vegetables, sugar-sweetened drinks, meal patterns and weight status. Twenty-eight studies were in-scope, the majority (n= 16) were conducted in the USA. Weight status was consistently associated with the food environment; greater accessibility to supermarkets or less access to takeaway outlets were associated with a lower BMI or prevalence of overweight/obesity. However, obesogenic dietary behaviours did not mirror these associations; mixed associations were found between the environment and obesogenic dietary behaviours. Living in a socioeconomically-deprived area was the only environmental factor consistently associated with a number of obesogenic dietary behaviours. Associations between the environment and weight status are more consistent than that seen between the environment and dietary behaviours. The environment may play an important role in the development of overweight/obesity, however the dietary mechanisms that contribute to this remain unclear and the physical activity environment may also play an important role in weight gain, overweight and obesity.

Lifelong socioeconomic position and physical performance in midlife: results from the British 1946 birth cohort

Socioeconomic position (SEP) across life is found to be related to adult physical performance, but the underlying pathways are not well characterized. Using a British birth cohort (N = 2956), the associations of SEP from childhood into midlife with objective physical performance measures in midlife were examined, adjusting for possible confounders or mediators, including indicators of muscle development and central nervous system function. Childhood and adulthood SEP were positively related to standing balance and chair rise performance, but not to grip strength after basic adjustments. When both father’s occupation and mother’s education were included in the same model, having a mother with low education was associated with 0.6 standard deviations (SD) (95% confidence interval (CI: 0.3, 0.8)) poorer standing balance time compared with having a mother with the highest educational level, and having a father in the lowest occupational group was associated with a 0.3 SD (95% CI: 0.1, 0.6) lower chair rise score compared with having a father in the highest occupational group. These associations were maintained, albeit attenuated, after adjustment. In contrast, the associations of own education and adult occupation with physical performance were generally not maintained after adjustment. SEP across life impacts on midlife physical performance, and thereby the ageing process.

Maternal mental health and childrearing context in the development of children at 6, 18 and 36 months: a Taiwan birth cohort pilot study

BACKGROUND

This study investigated a possible pathway of the childrearing context and maternal mental health at 6 months, and how these factors influence children's development at 6, 18 and 36 months.

METHODS

Using random sampling, 2048 children and mothers were selected. The mother's health status was evaluated using the Taiwanese version of the 36-Item Short Form Health Survey (SF-36), and infant development was assessed using the high reliable Taiwan birth cohort study instrument. All data were collected using parental self-report, and were analysed using multiple linear regression analysis and further pathway using structural equation modelling.

RESULTS

This study showed that 12 factors effected children's development at 6 months, and some dissipated with growth. Of these, maternal education had an enduring effect on different domains of child development, and this effect intensified as the child grew older. Children who grew up in a family with more siblings would show a delay in language development at 6 months; they have a delay in motor and social development at 18 and 36 months. Additionally, maternal mental health effected the children's fine motor development at 6 months. However, this effect disappeared at 18 months, and influenced children's social development at 36 months.

CONCLUSIONS

This study demonstrated that the development of children at as young as 6 months is affected by various factors. These factors may dissipate, continue to influence child development up to 3 years of age, turn from being disadvantageous to beneficial, or affect different domains of child development. Also, parental self-report instrument might be has its limitation and could be contributed by several confounding factors. Thus, continuous longitudinal follow-up on changes in maternal conditions, family factors, and environmental factors is vital to understand how these early infantile factors affect each other and influence the developmental trajectories of children into early childhood.

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.

Energy density, energy costs and income - how are they related?

OBJECTIVE

To examine the association between energy density and energy costs in single food items and composed diets, and to explore differences in energy density and energy cost between income levels.

DESIGN

A cross-sectional study using data from two Dutch cohort studies and recent national food prices. Food prices were retrieved from two market leader supermarkets. Data on dietary intake were measured using a computerized face-to-face interview (cohort 1) and 24 h recalls (cohort 2).

SETTING

The Netherlands.

SUBJECTS

A sample of 373 young adults from the Amsterdam Growth and Health Longitudinal Study (AGHLS, measured in 2000) and a sample of 200 community-dwelling elderly from the Longitudinal Ageing Study Amsterdam (LASA, measured in 2007).

RESULTS

We found significant inverse associations between energy density and energy costs in single food items (r = -0.436, P < 0.01) and composed diets (AGHLS men r = -0.505, women r = -0.413, P < 0.001; LASA men r = -0.559, women r = -0.562, P < 0.001). Furthermore, we found that people stratified into higher energy density quartiles consumed significantly more energy per day, less fruits and vegetables, and had significantly lower diet costs. Explorative analyses on income did not reveal significant differences regarding energy density, costs, or fruit and vegetable intake.

CONCLUSIONS

In the Netherlands also, energy density was inversely related with energy costs, implying that healthier diets cost more. However, we could not find differences in energy density or costs between income levels. Future research, using precise food expenditures, is of main importance in studying the economics of obesity and in the aim of making the healthier choice easier.

How to find information on national food and nutrient consumption surveys across Europe: systematic literature review and questionnaires to selected country experts are both good strategies

The present research was conducted within the framework of the EURopean micronutrient RECommendations Aligned project. In order to identify the best practice in assessing nutrient intakes, a search strategy for collecting data from national food consumption surveys/studies in Europe was developed. Systematic literature searches were carried out on twenty-eight European and the four European Free Trade Association countries. A questionnaire was also sent to two to five experts in each country. Systematic reviews using PubMed yielded 12 703 abstracts that were reduced to 200 studies using inclusion and exclusion criteria. Similarly, a search of ministry web sites yielded 3033 hits, and subsequently reduced to nine surveys. Belgium, France, Germany, Ireland, Sweden, Spain and the United Kingdom were the countries with most data and Slovenia and Liechtenstein were those with the least. Seventy-eight expert questionnaires were obtained from all countries except for Liechtenstein, Luxembourg and Slovakia. Detailed results and references are given. A systematic search and questionnaires are equally good at identifying national surveys across countries. Literature searching provides globally accessible and objective information albeit limited, whereas the questionnaire provides information that, depending upon responders, can be more complete. A combination of both strategies is recommended.

Influence of life course socioeconomic position on older women's health behaviors: findings from the British Women's Heart and Health Study

OBJECTIVES

We examined the association between health behaviors and socioeconomic status (SES) in childhood and adult life.

METHODS

Self-reported diet, smoking, and physical activity were determined among 3523 women aged 60 to 79 years recruited from general practices in 23 British towns from 1999 through 2001.

RESULTS

The most affluent women reported eating more fruit, vegetables, chicken, and fish and less red or processed meat than did less affluent women. Affluent women were less likely to smoke and more likely to exercise. Life course SES did not influence the types of fat, bread, and milk consumed. Adult SES predicted consumption of all foods considered and predicted smoking and physical activity habits independently of childhood SES. Childhood SES predicted fruit and vegetable consumption independently of adult SES and, to a lesser extent, predicted physical activity. Downward social mobility over the life course was associated with poorer diets and reduced physical activity.

CONCLUSIONS

Among older women, healthful eating and physical activity were associated with both current and childhood SES. Interventions designed to improve social inequalities in health behaviors should be applied during both childhood and adult life.

The impact of education on risk factors and the occurrence of multimorbidity in the EPIC-Heidelberg cohort

Background

In aging populations, the prevalence of multimorbidity is high, and the role of socioeconomic status and its correlates is not well described. Thus, we investigated the association between educational attainment and multimorbidity in a prospective cohort study, taking also into account intermediate factors that could explain such associations.

Methods

We included 13,781 participants of the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC), who were 50–75 years at the end of follow-up. Information on diet and lifestyle was collected at recruitment (1994–1998). During a median follow-up of 8.7 years, information on chronic conditions and death were collected.

Results

Overall, the prevalence of multimorbidity (>= 2 concurrent chronic diseases) was 67.3%. Compared to the highest educational category, the lowest was statistically significantly associated with increased odds of multimorbidity in men (OR = 1.43; 95% CI 1.28–1.61) and women (OR = 1.33; 95% CI 1.18–1.57). After adjustment, the positive associations were attenuated (men: OR = 1.28; 95% CI 1.12–1.46; women: OR = 1.16; 95% CI 0.99–1.36). Increasing BMI was more strongly than smoking status an intermediate factor in the association between education and multimorbidity.

Conclusion

In this German population, the prevalence of multimorbidity is high and is significantly associated with educational level. Increasing BMI is the most important predictor of this association. However, even the fully adjusted model, i.e. considering also other known risk factors for chronic diseases, could not entirely explain socio-economic inequalities in multimorbidity. Educational level should be considered in the development and implementation of prevention strategies of multimorbidity.

Does social class predict diet quality?

A large body of epidemiologic data show that diet quality follows a socioeconomic gradient. Whereas higher-quality diets are associated with greater affluence, energy-dense diets that are nutrient-poor are preferentially consumed by persons of lower socioeconomic status (SES) and of more limited economic means. As this review demonstrates, whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher SES. In contrast, the consumption of refined grains and added fats has been associated with lower SES. Although micronutrient intake and, hence, diet quality are affected by SES, little evidence indicates that SES affects either total energy intakes or the macronutrient composition of the diet. The observed associations between SES variables and diet-quality measures can be explained by a variety of potentially causal mechanisms. The disparity in energy costs ($/MJ) between energy-dense and nutrient-dense foods is one such mechanism; easy physical access to low-cost energy-dense foods is another. If higher SES is a causal determinant of diet quality, then the reported associations between diet quality and better health, found in so many epidemiologic studies, may have been confounded by unobserved indexes of social class. Conversely, if limited economic resources are causally linked to low-quality diets, some current strategies for health promotion, based on recommending high-cost foods to low-income people, may prove to be wholly ineffective. Exploring the possible causal relations between SES and diet quality is the purpose of this review.

How do socio-economic status, perceived economic barriers and nutritional benefits affect quality of dietary intake among US adults?

BACKGROUND

Socio-economic factors may affect diet quality, perhaps differentially across gender and ethnicity. The mechanism of this association is still largely unknown.

OBJECTIVES

We examined the independent effects of socio-economic status (SES), perceived barrier of food price (PBFP) and perceived benefit of diet quality (PBDQ) on diet quality indicators and indices (DQI(j,k)), across gender and ethnicity. Additionally, we estimated the mediation proportion of the effect of SES on DQI(j,k) through PBFP and PBDQ.

METHODS

Data from two cross-sectional surveys, the Continuing Survey of Food Intakes by Individuals (CSFII) and Diet and Health Knowledge Survey (DHKS) 1994-96 were used. Our sample consisted of 4356 US adults aged 20-65 years. With principal components analysis, SES (an index) was measured using household income per capita and education, and PBDQ was measured using an 11-item scale. PBFP was defined as the ratio of importance of food price score relative to nutrition. DQI(j,k) were assessed by a set of indicators and two indices including the Healthy Eating Index.

RESULTS

The associations between SES, PBFP, PBDQ and DQI(j,k) varied significantly across gender and ethnic groups. PBFP acted as a mediator in the association between SES and selected DQI(j) indicators, namely energy, fat intake, sodium and simple sugar consumption (mediation proportion >10%), but not PBDQ.

CONCLUSIONS

SES, PBFP and PBDQ all affect dietary intake, and vary by ethnicity and gender. Positive effect of SES on DQI(j,k) may be mediated by PBFP but not PBDQ which is an independent protective factor. Nutrition education is important to promote healthy eating.

Multiple socio-economic circumstances and healthy food habits

OBJECTIVE

To examine associations between seven indicators of socio-economic circumstances and healthy food habits, while taking into account assumed temporal order between these socio-economic indicators.

DESIGN AND SETTING

Data were derived from cross-sectional postal questionnaires in 2000-2002. Socio-economic circumstances were assessed by parental education, childhood economic difficulties, own education, occupational class, household income, home ownership and current economic difficulties. Healthy food habits were measured by an index consisting of consumption of fresh vegetables, fruit or berries, rye bread, fish and choosing vegetable fats on bread and oil in cooking. Sequential logistic regression models were used, adjusting for age and marital status.

PARTICIPANTS

Employees of the City of Helsinki, Finland (n=8960, aged 40-60 years).

RESULTS

Healthy food habits were reported by 28% of women and by 17% of men. Own education, occupational class, household income, home ownership and current economic difficulties were associated with healthy food habits. These associations were attenuated but mainly remained after mutual adjustments for the socio-economic indicators. Among women, a pathway was found suggesting that part of the effects of education on food habits were mediated through occupational class.

CONCLUSIONS

Employees in higher and lower socio-economic positions differ in their food habits, and those in lower positions and economically disadvantaged are less likely to report healthy food habits. Health promotion programmes and food policies should encourage healthier food choices among those in lower socio-economic positions and among those with economic difficulties in particular.

Childhood socioeconomic status predicts physical functioning a half century later

BACKGROUND

Socioeconomic status (SES) affects health outcomes at all stages of life. Relating childhood socioeconomic environment to midlife functional status provides a life course perspective on childhood factors associated with poor and good health status later in life.

METHODS

The British 1946 birth cohort was prospectively evaluated with periodic examinations from birth through age 53 years, when physical performance tests assessing strength, balance, and rising from a chair were administered. Early childhood socioeconomic factors were examined as predictors of low, middle, or high function at midlife. We tested the hypothesis that adulthood behavioral risk factors would explain the childhood SES-midlife physical function associations.

RESULTS

Multiple measures of childhood deprivation were associated with midlife function but in multivariate analyses only father's occupation was associated with low function (relative risk [RR] for manual occupation = 1.6; 95% confidence interval [CI], 1.1-2.3), and only mother's education was associated with high function (RR for lower mother's education = 0.49; 95% CI, 0.34-0.72). Early adulthood behavioral risk factors and middle-age SES and disease status only modestly attenuated the relationship between father's occupation and low function and had no impact on the relationship of mother's education with high function.

CONCLUSIONS

The social environment in which a child grows up has a strong association with midlife, objectively measured functional status, which is a reflection of the aging process and chronic diseases accumulated over the life course. Of particular interest is the role of higher maternal education in promoting high midlife functioning.