Socio-economic status, dietary intake and 10 y trends: the Dutch National Food Consumption Survey

Time trends in social differences in nutrition habits of a Lithuanian population: 1994-2010

Background

During the post-communist transition period, political, economic, and social changes affected the lifestyles of the Lithuanian population, including their nutritional habits. However, people of lower socio-economic position were more vulnerable to these changes. The aim of the present study was to evaluate the trends in selected food habits of the Lithuanian adult population by their level of education and place of residence from 1994 to 2010.

Methods

The data were obtained from nine biannual cross-sectional postal surveys of Lithuanian health behaviours, beginning in 1994. Each survey used a randomly selected nationally representative sample of 3000 inhabitants aged 20-64 drawn from the population register. In total, 7358 men and 9796 women participated in these surveys. Questions about food consumption were included within all health behaviour questionnaires.

Results

During the transition period, use of vegetable oil in cooking and the frequency of consumption of fresh vegetables increased, use of butter on bread decreased, and the proportion of women drinking high-fat milk declined. Lithuanians with higher education reported more frequent use of vegetable oil in cooking as well as daily consumption of fresh vegetables than those with a lower level of education. Consumption of high-fat milk was inversely associated with educational background. In addition, the proportion of persons spreading butter on bread increased with higher education level. The greatest urban-rural difference was observed in high-fat milk consumption. The increase in the use of vegetable oil in cooking, and the reduction of spreading butter on bread was more evident among less educated and rural inhabitants. Meanwhile, a greater proportion of the rural population, compared to urban, reduced their use of butter on bread. Daily consumption of fresh vegetables increased most among highly educated Lithuanians.

Conclusions

The data from our study indicate beneficial dietary changes among the Lithuanian adult population. In general, those with a higher level of education had healthier food habits than those with low education. The educational gradient in analyzed food habits, except the use of vegetable oil, enlarged. A higher proportion of the rural population, compared to urban, reduced their usage of butter on bread. However, consumption of high-fat milk was greatest in the rural population. Our data highlight the need for future food and nutrition policies, as well as health promotion programmes, targeting the whole population, particularly those with lower education and living in rural areas.

Who consumed 5 or more portions of fruit and vegetables per day in 1986-1987 and in 2000-2001?

OBJECTIVE

The aim of the study was to describe who ate 5 or more portions of fruit and vegetables per day ('compliers') in 1986-1987 and in 2000-2001.

DESIGN

We used data from the Dietary and Nutritional Surveys of British Adults. Each is a nationally representative dietary survey using 7 d weighed food records for men and women, aged 16-64 years, living in private households in Great Britain in 1986-1987 and in 2000-2001.

SETTING

Great Britain.

SUBJECTS

Data were analysed for 2197 adults in 1986-1987 and 1724 adults in 2000-2001.

RESULTS

In 1986-1987 12·7 % were classified as 'compliers' compared with 16·5 % in 2000-2001. Manual social classes, younger participants and people on benefits or outside paid employment were less likely to be 'compliers'. Being divorced, widowed or separated was negatively related to being a 'complier', as was being in a household with dependant children or a lone parent with dependant children. Between 1986-1987 and 2000-2001 improvements were seen across social class groups and differences between men and women and between regions were reduced.

CONCLUSIONS

Only 12·7 % participants in the Dietary and Nutritional Surveys of British Adults were classified as 'compliers' in 1986-1987 compared with 16·5 % in 2000-2001. There have been some important changes in the distribution of 'compliers', but the low levels overall support the need for a reinvigorated policy drive to improve compliance with fruit and vegetable goals.

Intake estimation of total and individual flavan-3-ols, proanthocyanidins and theaflavins, their food sources and determinants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Epidemiological studies suggest health-protective effects of flavan-3-ols and their derived compounds on chronic diseases. The present study aimed to estimate dietary flavan-3-ol, proanthocyanidin (PA) and theaflavin intakes, their food sources and potential determinants in the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration cohort. Dietary data were collected using a standardised 24 h dietary recall software administered to 36 037 subjects aged 35-74 years. Dietary data were linked with a flavanoid food composition database compiled from the latest US Department of Agriculture and Phenol-Explorer databases and expanded to include recipes, estimations and retention factors. Total flavan-3-ol intake was the highest in UK Health-conscious men (453·6 mg/d) and women of UK General population (377·6 mg/d), while the intake was the lowest in Greece (men: 160·5 mg/d; women: 124·8 mg/d). Monomer intake was the highest in UK General population (men: 213·5 mg/d; women: 178·6 mg/d) and the lowest in Greece (men: 26·6 mg/d in men; women: 20·7 mg/d). Theaflavin intake was the highest in UK General population (men: 29·3 mg/d; women: 25·3 mg/d) and close to zero in Greece and Spain. PA intake was the highest in Asturias (men: 455·2 mg/d) and San Sebastian (women: 253 mg/d), while being the lowest in Greece (men: 134·6 mg/d; women: 101·0 mg/d). Except for the UK, non-citrus fruits (apples/pears) were the highest contributors to the total flavan-3-ol intake. Tea was the main contributor of total flavan-3-ols in the UK. Flavan-3-ol, PA and theaflavin intakes were significantly different among all assessed groups. This study showed heterogeneity in flavan-3-ol, PA and theaflavin intake throughout the EPIC countries.

Contribution of take-out food consumption to socioeconomic differences in fruit and vegetable intake: a mediation analysis

Lower fruit and vegetable (F/V) intake among socioeconomically disadvantaged groups has been well documented, and may be a consequence of a higher consumption of take-out foods. This study examined whether, and to what extent, take-out food consumption mediated (explained) the association between socioeconomic position and F/V intake. A cross-sectional postal survey was conducted among 1,500 randomly selected adults aged 25 to 64 years in Brisbane, Australia, during 2009 (response rate 63.7%, N=903). A food frequency questionnaire assessed usual daily servings of F/V (0 to 6), overall take-out consumption (times per week), and the consumption of 22 specific take-out items (never to once per day or more). These specific take-out items were grouped into "less healthy" and "healthy" choices and indexes were created for each type of choice (0 to 100). Socioeconomic position was ascertained by education. The analyses were performed using linear regression, and a bootstrap resampling approach estimated the statistical significance of the mediated effects. Mean daily servings of F/V were 1.89±1.05 and 2.47±1.12, respectively. The least educated group members were more likely to consume fewer servings of fruit (β= -.39, P<0.001) and vegetables (β= -.43, P<0.001) compared with members of the highest educated group. The consumption of "less healthy" take-out food partly explained (mediated) education differences in F/V intake; however, no mediating effects were observed for overall and "healthy" take-out consumption. Regular consumption of "less healthy" take-out items may contribute to socioeconomic differences in F/V intake, possibly by displacing these foods.

Dietary patterns are associated with weight gain in newlyweds: findings from a cross-sectional study in Shanghai, China

OBJECTIVE

The present study aimed to characterize the dietary patterns of newlyweds married within one year and to examine the factors associated with weight changes.

DESIGN

A cross-sectional study was carried out in 2009.

SETTING

Baoshan District, Shanghai, China.

SUBJECTS

A total of 342 pairs of newlyweds were recruited at their first visit. Weight and height were measured and food intake was measured based on an FFQ with forty-nine items. Dietary patterns were identified through factor analysis, and the factors associated with weight changes were determined by multiple regression models.

RESULTS

Average weight gain of the participants during marital transition was 1.9 kg (2.2 kg for men and 1.6 kg for women). Four major dietary patterns were identified: vegetable pattern, sweets and fats pattern, legume pattern and poultry, beef and mutton pattern. In multivariate analyses, the highest quintile of factor 2 (sweets and fats pattern) was significantly associated with weight gain after marriage in a comparison with the lowest quintile (β = 2.94; 95 % CI 0.75, 5.15; P = 0.01) in men. The highest quintile of factor 4 (poultry, beef and mutton pattern) was inversely associated with weight gain after marriage in a comparison with the lowest quintile (β = -1.21; 95 % CI -2.32, -0.11; P = 0.03).

CONCLUSIONS

Our results suggest that a pattern rich in sugar, oil and condiments may lead to greater marital weight gain in men; another pattern rich in poultry, beef and mutton may lead to less marital weight gain in both men and women.

Stressors and resources mediate the association of socioeconomic position with health behaviours

BACKGROUND

Variability in health behaviours is an important cause of socioeconomic health disparities. Socioeconomic differences in health behaviours are poorly understood. Previous studies have examined whether (single) stressors or psychosocial resources mediate the relationship between socioeconomic position and health or mortality. This study examined: 1) whether the presence of stressors and the absence of resources can be represented by a single underlying factor, and co-occur among those with lower education, 2) whether stressors and resources mediated the relation between education and health behaviours, and 3) addressed the question whether an aggregate measure of stressors and resources has an added effect over the use of individual measures.

METHODS

Questionnaire data on sociodemographic variables, stressors, resources, and health behaviours were collected cross-sectionally among inhabitants (n = 3050) of a medium-sized Dutch city (Utrecht). Descriptive statistics and bootstrap analyses for multiple-mediator effects were used to examine the role of stressors and resources in mediating educational associations with health behaviours.

RESULTS

Higher levels of stressors and lower levels of resources could be represented by a single underlying factor, and co-occurred among those with lower educational levels. Stressors and resources partially mediated the relationship between education and four health- behaviours (exercise, breakfast frequency, vegetable consumption and smoking). Financial stress and poor perceived health status were mediating stressors, and social support a strong mediating resource. An aggregate measure of the stressors and resources showed similar associations with health behaviours compared to the summed individual measures.

CONCLUSIONS

Lower educated groups are simultaneously affected by the presence of various stressors and absence of multiple resources, which partially explain socioeconomic differences in health behaviours. Compared to the direct associations of stressors and resources with health behaviours, the association with socioeconomic status was modest. Therefore, besides addressing structural inequalities, interventions promoting financial management, coping with chronic disease, and social skills training have the potential to benefit large parts of the population, most notably the lower educated. Further research is needed to clarify how stressors and resources impact health behaviours, why this differs between behaviours and how these disparities could be alleviated.

Dietary sources of animal and plant protein intake among Flemish preschool children and the association with socio-economic and lifestyle-related factors

Background

The aims of this study were to assess the intake of animal, plant and food group-specific protein, and to investigate their associations with socio-economic and lifestyle-related factors in Flemish preschoolers.

Methods

Three-day estimated dietary records were collected from 661 preschoolers aged 2.5-6.5 y (338 boys and 323 girls). Multiple linear regression analysis was used to investigate the association between animal, plant, and food group-specific protein intake and socio-economic and lifestyle factors.

Results

Animal proteins (mean 38 g/d) were the main source of total protein (mean 56 g/d), while mean plant protein intake amounted to 18 g/d. The group of meat, poultry, fish and eggs was the main contributor (51%) to animal protein intake, followed by milk and milk products (35%). Bread and cereals (41%) contributed most to the plant protein intake, followed by low-nutritious, energy-dense foods (21%). With higher educated fathers and mothers as reference, respectively, preschoolers with lower secondary and secondary paternal education had lower animal, dairy-, and meat-derived protein intakes, and those with lower secondary and secondary maternal education consumed less plant, and bread and cereal-derived proteins. Compared to children with high physical activity levels, preschoolers with low and moderate physical activity had lower animal and plant protein intakes. Significantly higher potatoes and grains-, and fish- derived proteins were reported for children of smoking mothers and fathers, respectively, compared to those of non-smoking mothers and fathers.

Conclusions

The total protein intake of Flemish preschoolers was sufficient according to the recommendations of the Belgian Superior Health Council. Parental level of education and smoking status might play a role in the sources of children's dietary proteins.

An economic analysis of community-level fast food prices and individual-level fast food intake: a longitudinal study

BACKGROUND

While dietary intake is shaped by cost, there is minimal research on the association between community-level food prices and dietary intake.

METHODS

We used nationally representative, longitudinal data to examine how community-level food price variation was associated with individual-level fast food intake by race/ethnicity and income across waves II (1996) and III (2001-2002) of the National Longitudinal Study of Adolescent Health (n=11,088) from 158 baseline and 363 follow-up US counties.

RESULTS

Negative binomial regression models predicting the number of fast food meals per week show strong relationships between fast food consumption and prices of fast food and soda that varied by gender and race/ethnicity. We found relatively stronger association between food prices and fast food intake for males and relatively greater price sensitivity for soda versus burgers. In the group with strongest associations (black males), a 20% increase in the price of soda was associated with a decrease of 0.25 visits to a fast food restaurant per week.

CONCLUSIONS

Economic incentives may be an effective mechanism to address fast food intake in an age group at high risk for obesity.

The intake of grain fibers modulates cytokine levels in blood

Dietary fiber may modulate the environment of the intestinal lumen, alter the intestinal microflora populations, and influence the immune response and disease risk. Epidemiological investigations have suggested that higher fiber intake is associated with lower overall mortality, in particular from cardiovascular and digestive tract diseases. Here a panel of 17 cytokines and chemokines were measured in plasma of 88 cancer-free subjects sampled within the Italian EPIC-Italy cohort. A statistically significant inverse association (p-trend = 0.01) was observed for cereal fiber and cytokines included in the main factor in factor analysis (IL-1β, IL-4, IL-5, IL-6, IL-13, and TNF-α), which alone explained 35.5% of variance. Our study suggests that fiber intake, especially cereal fiber, may be associated with a decreased level of pro-inflammatory cytokines.

National Diet and Nutrition Survey: fat and fatty acid intake from the first year of the rolling programme and comparison with previous surveys

High saturated fat intake is an established risk factor for several chronic diseases. The objective of the present study is to report dietary intakes and main food sources of fat and fatty acids (FA) from the first year of the National Diet and Nutrition Survey (NDNS) rolling programme in the UK. Dietary data were collected using 4 d estimated food diaries (n 896) and compared with dietary reference values (DRV) and previous NDNS results. Total fat provided 34-36 % food energy (FE) across all age groups, which was similar to previous surveys for adults. Men (19-64 years) and older girls (11-18 years) had mean intakes just above the DRV, while all other groups had mean total fat intakes of < 35 % FE. SFA intakes were lower compared with previous surveys, ranging from 13 to 15 % FE, but still above the DRV. Mean MUFA intakes were 12·5 % FE for adults and children aged 4-18 years and all were below the DRV. Mean n-3 PUFA intake represented 0·7-1·1 % FE. Compared with previous survey data, the direction of change for n-3 PUFA was upwards for all age groups, although the differences in absolute terms were very small. Trans-FA intakes were lower than in previous NDNS and were less than 2 g/d for all age groups, representing 0·8 % FE and lower than the DRV in all age groups. In conclusion, dietary intake of fat and FA is moving towards recommended levels for the UK population. However, there remains room for considerable further improvement.

Consumer food choices: the role of price and pricing strategies

Objective

To study differences in the role of price and value in food choice between low-income and higher-income consumers and to study the perception of consumers about pricing strategies that are of relevance during grocery shopping.

Design

A cross-sectional study was conducted using structured, written questionnaires. Food choice motives as well as price perceptions and opinion on pricing strategies were measured.

Setting

The study was carried out in point-of-purchase settings, i.e. supermarkets, fast-food restaurants and sports canteens.

Subjects

Adults (n 159) visiting a point-of-purchase setting were included.

Results

Price is an important factor in food choice, especially for low-income consumers. Low-income consumers were significantly more conscious of value and price than higher-income consumers. The most attractive strategies, according to the consumers, were discounting healthy food more often and applying a lower VAT (Value Added Tax) rate on healthy food. Low-income consumers differ in their preferences for pricing strategies.

Conclusions

Since price is more important for low-income consumers we recommend mainly focusing on their preferences and needs.

Food sources of nutrients among 13-year-old Portuguese adolescents

Objective

To identify food sources of nutrients in adolescents’ diets and to identify differences in food sources according to individual characteristics.

Design

A cross-sectional evaluation was carried out in the 2003/2004 school year. Self-administered questionnaires were used and a physical examination was performed. Diet was evaluated using an FFQ.

Setting

Public and private schools in Porto, Portugal.

Subjects

Adolescents aged 13 years (n 1522) enrolled at school.

Results

The main sources of energy were starchy foods (26·5 %), dairy (12·5 %) and meat (12·0 %). The major contributors to carbohydrate intake were starchy foods (38·2 %) and fruit (13·8 %) and to protein intake were meat (28·0 %), dairy products (20·3 %), starchy foods (15·3 %) and seafood (13·6 %). The main sources of total fat were meat (22·0 %), starchy foods (13·4 %) and dairy products (12·7 %). Sweets and pastries presented important contributions to energy (11·1 %), carbohydrate (12·4 %), total fat (13·3 %) and saturated fat (16·6 %) intakes. Parental education was inversely associated with the contribution of sweets and pastries to energy, carbohydrate and fat intakes and it was positively associated with the seafood contribution to protein intake.

Conclusions

The major sources of carbohydrates were starchy foods, which also accounted for a quarter of energy intake. Dairy products plus meat accounted for another quarter of energy. Meat was a major source of protein and fats. Sweets and pastries contributed more than 10 % to energy, carbohydrates, total and saturated fat. Parental education was the strongest determinant of food sources and was positively associated with a healthier contribution of food groups.

A prospective cohort study of dietary patterns of non-western migrants in the Netherlands in relation to risk factors for cardiovascular diseases: HELIUS-Dietary Patterns

Background

In Western countries the prevalence of cardiovascular disease (CVD) is often higher in non-Western migrants as compared to the host population. Diet is an important modifiable determinant of CVD. Increasingly, dietary patterns rather than single nutrients are the focus of research in an attempt to account for the complexity of nutrient interactions in foods. Research on dietary patterns in non-Western migrants is limited and may be hampered by a lack of validated instruments that can be used to assess the habitual diet of non-western migrants in large scale epidemiological studies. The ultimate aims of this study are to (1) understand whether differences in dietary patterns explain differences in CVD risk between ethnic groups, by developing and validating ethnic-specific Food Frequency Questionnaires (FFQs), and (2) to investigate the determinants of these dietary patterns. This paper outlines the design and methods used in the HELIUS-Dietary Patterns study and describes a systematic approach to overcome difficulties in the assessment and analysis of dietary intake data in ethnically diverse populations.

Methods/Design

The HELIUS-Dietary Patterns study is embedded in the HELIUS study, a Dutch multi-ethnic cohort study. After developing ethnic-specific FFQs, we will gather data on the habitual intake of 5000 participants (18-70 years old) of ethnic Dutch, Surinamese of African and of South Asian origin, Turkish or Moroccan origin. Dietary patterns will be derived using factor analysis, but we will also evaluate diet quality using hypothesis-driven approaches. The relation between dietary patterns and CVD risk factors will be analysed using multiple linear regression analysis. Potential underlying determinants of dietary patterns like migration history, acculturation, socio-economic factors and lifestyle, will be considered.

Discussion

This study will allow us to investigate the contribution of the dietary patterns on CVD risk factors in a multi-ethnic population. Inclusion of five ethnic groups residing in one setting makes this study highly innovative as confounding by local environment characteristics is limited. Heterogeneity in the study population will provide variance in dietary patterns which is a great advantage when studying the link between diet and disease.

The obesity epidemic: from the environment to epigenetics - not simply a response to dietary manipulation in a thermoneutral environment

The prevalence of obesity continues to increase particularly in developed countries. To establish the primary mechanisms involved, relevant animal models which track the developmental pathway to obesity are required. This need is emphasized by the substantial rise in the number of overweight and obese children, of which a majority will remain obese through adulthood. The past half century has been accompanied with unprecedented transitions in our lifestyle. Each of these changes substantially contributes to enhancing our capacity to store energy into adipose tissues. The complex etiology of adiposity is critical as a majority of models investigating obesity utilize a simplistic high-fat/low-carbohydrate diet, fed over a short time period to comparatively young inbred animals maintained in fixed environment. The natural history of obesity is much more complex involving many other mechanisms and this type of challenge may not be the optimal experimental intervention. Such processes include changes in adipose tissue composition with time and the transition from brown to white adipose tissue. Brown adipose tissue, due its unique ability to rapidly produce large amounts of heat could have a pivotal role in energy balance and is under epigenetic regulation mediated by the histone H3k9-specific demethylase Jhdma2a. Furthermore, day length has a potential role in determining endocrine and metabolic responses in brown fat. The potential to utilize novel models and interventions across a range of animal species in adipose tissue development may finally start to yield sustainable strategies by which excess fat mass can, at last, be avoided in humans.

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.

Dietary iron intake during early pregnancy and birth outcomes in a cohort of British women

BACKGROUND Iron deficiency during pregnancy is associated with adverse birth outcomes, particularly, if present during early gestation. Iron supplements are widely recommended during pregnancy, but evidence of their benefit in relation to infant outcomes is not established. This study was performed in the UK, where iron supplements are not routinely recommended during pregnancy, to investigate the association between iron intake in pregnancy and size at birth. METHODS From a prospective cohort of 1274 pregnant women aged 18-45 years, dietary intake was reported in a 24-h recall administered by a research midwife at 12-week gestation. Dietary supplement intake was ascertained using dietary recall and three questionnaires in the first, second and third trimesters. RESULTS Of the cohort of pregnant women, 80% reported dietary iron intake below the UK Reference Nutrient Intake of 14.8 mg/day. Those reported taking iron-containing supplements in the first, second and third trimesters were 24, 15 and 8%, respectively. Women with dietary iron intake >14.8 mg/day were more likely to be older, have a higher socioeconomic profile and take supplements during the first trimester. Vegetarians were less likely to have low dietary iron intake [odds ratio = 0.5, 95% confidence interval (CI): 0.4, 0.8] and more likely to take supplements during the first and second trimesters. Total iron intake, but not iron intake from food only, was associated with birthweight centile (adjusted change = 2.5 centiles/10 mg increase in iron, 95% CI: 0.4, 4.6). This association was stronger in the high vitamin C intake group, but effect modification was not significant. CONCLUSION There was a positive relationship between total iron intake, from food and supplements, in early pregnancy and birthweight. Iron intake, both from diet and supplements, during the first trimester of pregnancy was higher in vegetarians and women with a better socioeconomic profile.

Fibre intake among the Belgian population by sex–age and sex–education groups and its association with BMI and waist circumference

The objectives of the present study were to assess total dietary fibre intake and the main contributors to fibre intake in the Belgian population by sex–age and sex–education groups and to investigate its relationship with BMI and waist circumference (WC). The participants of the Belgian food consumption survey (2004) were randomly selected. Information about food intake was collected using two repeated, non-consecutive 24 h recall interviews. A total of 3083 individuals ( ≥ 15 years; 1546 men and 1537 women) completed both interviews. The main contributors to total fibre intake (17·8 g/d) were cereals and cereal products (34 %; 5·9 g/d), potatoes and other tubers (18·6 %; 3·3 g/d), fruits (14·7 %; 2·8 g/d) and vegetables (14·4 %; 2·6 g/d). Legume fibre intake was extremely low (0·672 %; 0·139 g/d). In all sex–age and sex–education groups, total fibre intake was below the recommendations of the Belgian Superior Health Council. Men (21 g/d) consumed significantly more fibre than women (17·3 g/d) (P < 0·001). Lower educated men and higher educated women reported the highest fibre intake. A significant inverse association was found between total fibre intake and WC (β = − 0·118, P < 0·001). Fruit-derived fibre was positively associated with WC (β = 0·731, P = 0·001). In summary, total fibre intake was inversely associated with WC, whereas fruit-derived fibre intake was positively associated with WC in the Belgian population.

Dietary sources of fiber intake and its association with socio-economic factors among Flemish preschool children

The objectives were to assess total dietary fiber intake, identify the major sources of dietary fiber, and examine its association with socio-economic factors among Flemish preschoolers. Three-day estimated dietary records were collected from a representative sample of preschoolers 2.5-6.5 years old (n = 661; 338 boys, 323 girls). The mean dietary fiber intake (13.4 g/d) was lower than the intake level recommended by the Belgian Superior Health Council (70% boys and 81% girls below the guidelines). The most important contributor was the group of bread and cereals (29.5%), followed by fruits (17.8%), potatoes and grains (16.0%), energy-dense, low-nutritious foods (12.4%), and vegetables (11.8%). Multiple linear regression analyses showed that total fiber intake was associated with maternal education and parents' employment. Overall, fiber intakes from high-nutritious foods (vegetables and fruits) were higher in preschoolers of higher educated mothers and those with one or both parents being employed. In conclusion, the majority of the preschoolers had dietary fiber intakes below the recommended level. Hence, dietary fiber should be promoted among parents of preschoolers and low socio-economic status families should be addressed in particular.

Self-reported socio-economic status, social, physical and leisure activities and risk for malnutrition in late life: a cross-sectional population-based study

OBJECTIVES

Our goal was to evaluate the proportion of community-dwelling elderly people at risk for malnutrition and the effect of different socioeconomic status (SES) indicators as well as social, physical and leisure activities in late life on the risk for malnutrition.

DESIGN

A cross-sectional population-based study.

SETTING

A sub-urban area in Northern Italy.

PARTICIPANTS

698 community-dwelling older persons.

MEASUREMENTS

The nutritional status of participants was assessed through the Mini Nutritional Assessment-Short Form (MNA-SF). SES was defined by means of early-life education, longest occupation, and late-life financial conditions. The following indicators were also evaluated: social contacts, and performing mental, physical and leisure activities during late-life. Chronic diseases, functional, cognitive and affective status were considered as potential confounders when examining the risk for malnutrition by logistic regression models.

RESULTS

8% of the participants (average age 75.6 years, 408 women) were at risk for malnutrition (MNA-SF ≤ 11). Low education, poor financial condition, and lack of physical and leisure activities showed a crude association with risk for malnutrition. Multi-adjusted logistic regression models showed that only low education (OR=2.9; 95% CI=1.2-6.8) and lack of physical activity (OR=4.4;95%CI=2.0-9.7) were independently associated with the risk for malnutrition.

CONCLUSIONS

Low education and lack of physical activity in late-life may affect the risk for malnutrition in the elderly. Further studies are needed to clarify the cause-effect relationship between lack of physical activity and malnutrition.

Plant and animal protein intake and its association with overweight and obesity among the Belgian population

The objective of the present study was to assess animal and plant protein intakes in the Belgian population and to examine their relationship with overweight and obesity (OB). The subjects participated in the Belgian National Food Consumption Survey conducted in 2004. Food consumption was assessed by using two non-consecutive 24 h dietary recalls. About 3083 participants ( ≥ 15 years of age; 1546 males, 1537 females) provided completed dietary information. Animal protein intake (47 g/d) contributed more to total protein intakes of 72 g/d than plant protein intake, which accounted for 25 g/d. Meat and meat products were the main contributors to total animal protein intakes (53 %), whereas cereals and cereal products contributed most to plant protein intake (54 %). Males had higher animal and plant protein intakes than females (P < 0·001). Legume and soya protein intakes were low in the whole population (0·101 and 0·174 g/d, respectively). In males, animal protein intake was positively associated with BMI (β = 0·013; P = 0·001) and waist circumference (WC; β = 0·041; P = 0·002). Both in males and females, plant protein intake was inversely associated with BMI (males: β = − 0·036; P < 0·001; females: β = − 0·046; P = 0·001) and WC (male: β = − 0·137; P < 0·001; female: β = − 0·096; P = 0·024). In conclusion, plant protein intakes were lower than animal protein intakes among a representative sample of the Belgian population and decreased with age. Associations with anthropometric data indicated that plant proteins could offer a protective effect in the prevention of overweight and OB in the Belgian population.

Discussing patient's lifestyle choices in the consulting room: analysis of GP-patient consultations between 1975 and 2008

BACKGROUND

The increasing prevalence of chronic diseases and the growing understanding that lifestyle behaviour plays an essential role in improving overall health suggest a need for increased attention to lifestyle choices in the consulting room.This study aims to examine whether or not healthy and unhealthy lifestyle choices of patients are currently being discussed more often in primary care consultations than in former decades. Furthermore, we are interested in GPs' approach to lifestyle behaviour during consultations. Lastly, we examine whether lifestyle behaviour is discussed more with certain patients during consultations, depending on gender, age and educational background.

METHOD

We analysed video-recordings of medical consultations, collected between 1975 and 2008 in Dutch GP practices. Data were analysed using logistic regression.

RESULTS

This study shows that discussion of smoking behaviour and physical activity has increased somewhat over time. A change in discussion of nutrition and alcohol is, however, less clear. Overall, alcohol use is the least discussed and physical activity the most discussed during consultations. GPs mainly refer to lifestyle when it is relevant to the patient's complaints (symptom approach). GPs' approach to lifestyle behaviour did not change over time. In general, lifestyle behaviour is discussed more with older, male patients (except for nutrition). GPs talk about lifestyle behaviour with patients from different educational backgrounds equally (except for physical activity).

CONCLUSION

In recent years there is greater awareness of a healthy lifestyle, which is reflected to a limited extent in this study. Still, lifestyle behaviour is discussed in only a minority of consultations. GPs do not refer to lifestyle behaviour as a routine procedure, i.e. do not include it in primary prevention. This highlights the importance of the introduction of prevention consultations, where GPs can discuss lifestyle issues with patients who do not (yet) have risk symptoms.

A 50% higher prevalence of life-shortening chronic conditions among cancer patients with low socioeconomic status

Background:

Comorbidity and socioeconomic status (SES) may be related among cancer patients.

Method:

Population-based cancer registry study among 72 153 patients diagnosed during 1997–2006.

Results:

Low SES patients had 50% higher risk of serious comorbidity than those with high SES. Prevalence was increased for each cancer site. Low SES cancer patients had significantly higher risk of also having cardiovascular disease, chronic obstructive pulmonary diseases, diabetes mellitus, cerebrovascular disease, tuberculosis, dementia, and gastrointestinal disease. One-year survival was significantly worse in lowest vs highest SES, partly explained by comorbidity.

Conclusion:

This illustrates the enormous heterogeneity of cancer patients and stresses the need for optimal treatment of cancer patients with a variety of concomitant chronic conditions.

Socio-economic and demographic variations in school lunch participation of French children aged 3-17 years

OBJECTIVE

To assess school canteen attendance in a French nationally representative sample of children and to analyse its association with the socio-economic and demographic characteristics of the children and their families.

DESIGN

Data from the second French national cross-sectional food consumption survey (INCA2), performed in 2006-2007, were used. Information on usual weekly school canteen attendance was collected through a self-reported questionnaire, and demographic and socio-economic variables through a face-to-face questionnaire. The associations between school canteen attendance and the socio-economic and demographic variables were investigated by multivariate logistic regression analyses.

SETTING

The INCA2 sample was representative of the children aged 3-17 years in France.

SUBJECT

Analysis was performed on 1413 schoolchildren who completed the school canteen attendance questions.

RESULTS

Some 65·6 % of schoolchildren aged 3-17 years had school lunch at least once weekly. This rate of attendance was positively correlated with age. Whatever the school level, school canteen attendance was positively associated with the educational level of the caregiver/parent. In pre- and elementary-school children, enrolment at the school canteen was also higher when the caregiver/parent worked, or in single-parent families. In secondary-school children, school lunch participation decreased with children living in more densely populated areas and increased with the level of the household's living standards.

CONCLUSIONS

School canteen attendance was positively associated with children's socio-economic background. This could reduce the effectiveness of the forthcoming school meal composition regulations designed to improve the diet of children from deprived backgrounds, who are more likely to have unhealthy food habits.

Nighttime light level co-distributes with breast cancer incidence worldwide

Breast cancer incidence varies widely among countries of the world for largely unknown reasons. We investigated whether country-level light at night (LAN) is associated with incidence. We compared incidence rates of five common cancers in women (breast, lung, colorectal, larynx, and liver), observed in 164 countries of the world from the GLOBOCAN database, with population-weighted country-level LAN, and with several developmental and environmental indicators, including fertility rate, per capita income, percent of urban population, and electricity consumption. Two types of regression models were used in the analysis: Ordinary Least Squares and Spatial Errors. We found a significant positive association between population LAN level and incidence rates of breast cancer. There was no such an association between LAN level and colorectal, larynx, liver, and lung cancers. A sensitivity test, holding other variables at their average values, yielded a 30-50% higher risk of breast cancer in the highest LAN exposed countries compared to the lowest LAN exposed countries. The possibility that under-reporting from the registries in the low-resource, and also low-LAN, countries created a spurious association was evaluated in several ways and shown not to account for the results. These findings provide coherence of the previously reported case-control and cohort studies with the co-distribution of LAN and breast cancer in entire populations.

Reduction of salt: will iodine intake remain adequate in The Netherlands?

Salt is the main vehicle for iodine fortification in The Netherlands. A reduction in salt intake may reduce the supply of iodine. Our aim was to quantify the effect of salt reduction on the habitual iodine intake of the Dutch population and the risk of inadequate iodine intake. We used data of the Dutch National Food Consumption Survey (1997–8) and an update of the food composition database to estimate habitual salt and iodine intake. To take into account uncertainty about the use of iodised salt (industrial and discretionary) and food supplements, a simulation model was used. Habitual iodine and salt intakes were simulated for scenarios of salt reduction and compared with no salt reduction. With 12, 25 and 50 % salt reduction in industrially processed foods, the iodine intake remained adequate for a large part of the Dutch population. For the extreme scenario of a 50 % reduction in both industrially and discretionary added salt, iodine intake might become inadequate for part of the Dutch population (up to 10 %). An increment of the proportion of industrially processed foods using iodised salt or a small increase in iodine salt content will solve this. Nevertheless, 8–35 % of 1- to 3-year-old children might have iodine intakes below the corresponding estimated average requirement (EAR), depending on the salt intake scenario. This points out the need to review the EAR value for this age group or to suggest the addition of iodine to industrially manufactured complementary foods.

Nutritional status of Flemish vegetarians compared with non-vegetarians: a matched samples study

The present study compares the nutritional status of vegetarian (V) with non-vegetarian (NV) subjects. A three-day food record and a health questionnaire were completed by 106 V and 106 NV matched for following characteristics: sex, age, BMI, physical activity, tobacco use and alcohol consumption. Total energy intake was not significantly different (men: V: 2,346 ± 685 kcal/d; NV: 2,628 ± 632 kcal/d; p = 0.078; women: V: 1,991 ± 539 kcal/d; NV: 1,973 ± 592 kcal/d; p = 0.849). Macronutrients intake differed significantly between the V and NV subjects for protein (men: V:12.7 ± 2.3 E%; NV:15.3 ± 4.5 E%; p = 0.003; women: V: 13.2 ± 2.3 E%; NV:16.0 ± 4.0 E%; p < 0.001), fat (men: V: 29.3 ± 8.4 E%; NV: 33.8 ± 5.3 E%; p = 0.010; women: V: 29.7 ± 6.9 E%; NV: 34.7 ± 9.0 E%; p < 0.001), and carbohydrate (men: V: 55.3 ± 10.1 E%; NV: 47.4 ± 6.9 E%; p < 0.001; women: V: 55.1 ± 7.6 E%; NV: 47.2 ± 8.2 E%; p < 0.001). The intake of most minerals was significantly different between the V and the NV subjects. V had a lower sodium intake, higher calcium, zinc, and iron intake compared to the NV subjects. Our results clearly indicate that a vegetarian diet can be adequate to sustain the nutritional demands to at least the same degree as that of omnivores. The intakes of the V subjects were closer to the recommendations for a healthy diet when compared to a group of well matched NV subjects.

Trends in dietary carbohydrate quality during puberty from 1988 to 2007: a cause for concern?

The extent to which the quality of dietary carbohydrates (CHO) changes throughout puberty is not known. We analysed trends in the quantity and quality of CHO intake among German adolescents by separately examining trends during puberty (pubertal trends) and trends in CHO intake from 1988 to 2007 (secular trends). Linear mixed-effects regression analyses were performed in 216 participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study who had provided weighed 3 d dietary records at the onset of the pubertal growth spurt (defined by age at take-off) and over the subsequent 4 years. Over the course of puberty, CHO quality changed little: added sugar intake from beverages increased in girls (0·25 (se 0·12) % energy (% E)/year, P = 0·04) and added sugar intake from sweets decreased in both sexes (boys: - 0·22 (se 0·11) % E/year, P = 0·049; girls: - 0·20 (se 0·10) % E/year, P = 0·04). For both sexes, significant upward secular trends were observed for CHO (% E), glycaemic load (g/MJ) and added sugar intakes from sources other than sweets and soft drinks (% E), while absolute fibre intake (g/d) decreased (P ≤ 0·04). Concomitant increases in total added sugar intake (% E) and decreases in fibre and whole-grain densities (g/MJ) (P = 0·001-0·02) were confined to boys only. The quality of dietary CHO consumed by healthy German adolescents shows notable secular declines, but does not change markedly during puberty. Public health initiatives should be tailored to improve the overall quality of CHO nutrition.

Frequent use of staff canteens is associated with unhealthy dietary habits and obesity in a Norwegian adult population

OBJECTIVE

To explore socio-economic differences in use of staff canteens and whether frequent use of staff canteens is associated with different food patterns and obesity.

DESIGN

Cross-sectional study using three self-administered questionnaires, two of them including food frequency questions. Factor analysis was used to explore food patterns.

SETTING

Oslo, Norway, 2000-2001.

SUBJECTS

In total 8943 adult, working Oslo citizens.

RESULTS

Frequent (≥3 times/week) use of staff canteens was most likely among men, younger workers and those in the highest education and income groups. However, after adjustment for demographic, socio-economic and lifestyle factors, those with highest education were least likely to use staff canteens frequently. Frequent eating in staff canteens was positively associated with a Western food pattern (based on fat-rich food, fast food and red meat) and inversely associated with a traditional food pattern (based on boiled potatoes and gravy, and less rice, pasta and oil) in multivariate analyses. Unadjusted, frequent eating in staff canteens was also inversely associated with a prudent food pattern (based on fruit, vegetables, fish, legumes and oil). The likelihood of being obese (BMI ≥ 30 kg/m2) increased significantly with frequent eating in staff canteens, also when adjusted for demographic and socio-economic variables. Adjustment for the food patterns attenuated this relationship, but it was still significant.

CONCLUSIONS

Frequent eating in staff canteens was negatively related to socio-economic position and positively associated with unhealthy dietary habits. This partly explained higher odds for obesity among frequent users of staff canteens. Future research should assess the availability and food options of staff canteens.

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.

Educational differences in the diet of Finnish adults and the associations between education and the determinants and facilitators of dietary fat quality

Objective

The aim of the study is to elucidate differences in adults’ diet by education, and to analyse the associations between dietary facilitators, education and dietary fat quality.

Design

In all, one-third of subjects from the national FINRISK health survey were invited to participate in the FINDIET 2007 Survey. A 48 h dietary interview was used for dietary data and personal background data were collected by the health survey questionnaire.

Setting

Representative sample from five regions in Finland in spring 2007.

Subjects

A total of 1576 adults, participation rate 60 %.

Results

Oil used in cooking differed by education. Instead perception of cardiovascular risk, or the following of a cholesterol-lowering diet, were equal across all educational categories. The diet of men with low education contained less protein and carbohydrates, more fat and more SFA and MUFA than that of highly educated men. The diet of women with low education contained less PUFA, vitamin C and vitamin E than in the highly educated category. High education remained a significant determinant for the lower intake of SFA in men, and for the higher intake of PUFA in women, after adjusting for the determinants and facilitators of dietary behaviour and age. The lower intake of SFA was also associated with following a cholesterol-lowering diet in both genders. In addition to education, the intake of unsaturated fatty acids was determined by the oil used in cooking by women, and by frequent lunches served by caterers for men.

Conclusions

In dietary behaviour, awareness and reporting of cholesterol-lowering diet seem to indicate a tendency to control the intake of saturated fat. Health messages are likely to enhance tools for increasing the intake of PUFA, in addition to reducing the intake of SFA.

Nutrition inequities in Canada

In Canada, increased morbidity and shorter life expectancy have been found among those with lower incomes and lower levels of education, but there has been little examination of socioeconomic variation in food and nutrient intake. Using data from the 2004 Canadian Community Health Survey, we examined the relationship between household income and education level and adults’ and children’s intakes of energy, fibre, micronutrients, and number of servings consumed of food groups from Canada’s Food Guide. To explore the public health significance of observed associations, we estimated the prevalence of inadequacy for selected nutrients for adults, stratifying by household income, education level, and sex. We found that a higher household income adequacy and (or) higher levels of education were associated with increased consumption of milk and alternatives, and vegetables and fruit, and significantly higher vitamin, mineral, and fibre intakes among both adults and children. The prevalence of inadequate nutrient intakes among adults was higher among adults with the lowest level of income adequacy or educational attainment, compared with others. Our results suggest that the nutritional quality of Canadians’ food intakes is, in part, a function of their social position. The impact of policy and program interventions needs to be examined across socioeconomic strata to ensure that actions reduce rather than exacerbate nutrition inequities.

Socio-economic status, place of residence and dietary habits among the elderly: the Mediterranean islands study

OBJECTIVE

To investigate whether the socio-economic status (SES) of elderly eastern Mediterranean islanders is associated with their dietary habits, particularly with adherence to the traditional Mediterranean diet.

DESIGN

Cross-sectional.

SETTING

Adherence to the Mediterranean diet was measured by the MedDietScore (range: 0-55), whereas SES was estimated using education and financial status.

SUBJECTS

During 2005-2007, 300 men and women from Cyprus, 100 from Samothraki, 142 from Mitilini, 114 from Kefalonia, 131 from Crete, 150 from Lemnos, 150 from Corfu and 103 from Zakynthos (aged 65-100 years), free of known chronic diseases, participated in the survey.

RESULTS

Multiple linear regression analysis revealed that belonging to the highest SES was associated with a higher MedDietScore (P < 0.01), after adjusting for potential sociodemographic, lifestyle, dietary and clinical confounders. A significant positive association was also found between MedDietScore and years of school (P = 0.004), as well as financial status (P = 0.001).

CONCLUSIONS

Older Greek people of higher SES seem to follow a relatively healthier diet. Both education and income seem to play a role in this issue. Thus, public health policy makers should focus on people with low SES in order to improve their quality of diet and, consequently, their health status.

Breakfast trends in children and adolescents: frequency and quality

Objective

Although breakfast is important for obesity prevention and dietary quality, breakfast skipping is a common behaviour. Knowledge of changes in breakfast habits may provide potential behaviour targets for intervention programmes. The present study describes the actual data on trends in breakfast habits and composition.

Design

A total of 7800 3 d dietary records of 1081 participants aged 2–18 years collected between 1986 and 2007 in the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) Study were analysed using mixed linear models.

Results

Breakfast was eaten at 78 % of all record days; regular breakfast (breakfast was eaten on all three recorded weekdays) was eaten in 75 % of records. During the study period, the number of records with regular breakfast decreased significantly in 6–12- and 13–18-year-olds (P= 0·0084 and 0·0350, respectively). Of all breakfast meals, 62 % were bread meals and 21 % were ready-to-eat cereal (RTEC) meals. RTEC meals nearly doubled from the youngest to the oldest age group (P< 0·0001). During the study period, the percentage of bread meals decreased, whereas the percentage of RTEC meals increased (P< 0·0001). A higher percentage of RTEC meals than the bread meals was in accordance with the food-based guidelines (36 %v. 20 %,P< 0·0001), i.e. a breakfast including grain, dairy and fruit/vegetables.

Conclusions

In the DONALD Study sample, a negative age and time trend in breakfast consumption was verified. Interventions regarding breakfast habits should be aimed at adolescents and should focus on fruit/vegetables.

Trends and correlates in meat consumption patterns in the US adult population

OBJECTIVE

Few studies have examined recent shifts in meat consumption (MC), differences among US population groups, and the influence of psychosocial-behavioural factors.

DESIGN

Nationally representative data collected for US adults aged >or=18 years in the 1988-1994 and 1999-2004 National Health and Nutrition Examination Survey (NHANES) and the 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII) and Diet and Health Knowledge Survey (DHKS) were used.

RESULTS

We found a U-shaped trend in MC, a decrease between 1988-1994 and 1994-1996, and an increase from 1994-1996 to 1999-2004. NHANES 1988-1994 and 1999-2004 indicate that MC did not change significantly, particularly for all meat, red meat, poultry and seafood. Between 1994-1996 and 1999-2004, average MC, including red meat, poultry, seafood and other meat products, increased in men. Women's total MC decreased, mainly due to decreased red meat and other meat products, except for increased seafood. Noticeable differences existed in the changes across population groups. Black men had the largest increase in consumption of total meat, poultry and seafood; Mexican American men had the smallest increase in poultry, seafood and other meat products. In 1999-2004, ethnic differences in MC became greater in women than among women in 1994-1996. Associations between MC and energy intake changed over time. Perceived benefit of dietary quality and food label use were associated with reduced red MC.

CONCLUSIONS

Noticeable differences exist in the shifts in MC across population groups and surveys. MC increased in men but decreased in women in recent years.

Dietary behaviours during pregnancy: findings from first-time mothers in southwest Sydney, Australia

BACKGROUND

Limited prevalence data are available for nutrition related health behaviours during pregnancy. This study aimed to assess dietary behaviours during pregnancy among first-time mothers, and to investigate the relationships between these behaviours and demographic characteristics, so that appropriate dietary intervention strategies for pregnant women can be developed.

METHOD

An analysis of cross-sectional survey was conducted using data from 409 first-time mothers at 26-36 weeks of pregnancy, who participated in the Healthy Beginnings Trial conducted in southwestern Sydney, Australia. Dietary behaviours, including consumption of vegetables, fruit, water, milk, soft drinks, processed meat products, fast foods/take away and chips, were assessed using the New South Wales Health Survey questionnaire through face-to-face interviews. Factors associated with dietary behaviours were determined by logistic regression modeling. Log-binomial regression was used to calculate adjusted risk ratios (ARR).

RESULTS

Only 7% of mothers reported meeting the recommended vegetable consumption and 13% reported meeting the recommended fruit consumption. Mean and median intakes per day were 2.3 (SD 1.3) and 2 serves of vegetables, and 2.1 (SD 1.4) and 2 serves of fruit respectively. About one fifth of mothers (21%) reported drinking 2 cups (500 ml) or more of soft drink per day and 12% reported consuming more than 2 meals or snacks from fast-food or takeaway outlets per week. A small percentage of mothers (5%) had experienced food insecurity over the past 12 months. There were significant inverse associations between water and soft drink consumption (Spearman's rho -0.20, P < 0.001), and between fruit and fast food/takeaway consumption (Spearman's rho -0.16, P = 0.001). The dietary behaviours were associated with a variety of socio-demographic characteristics, but no single factor was associated with all the dietary behaviours.

CONCLUSIONS

There were low reported levels of vegetable and fruit consumption and high reported levels of soft drink and takeaway/fast food consumption among pregnant women. Dietary interventions to prevent adverse health consequences need to be tailored to meet the needs of pregnant women of low socio-economic status in order to improve their own healthy eating behaviors. Increasing water and fruit consumption could lead to reduced consumption of soft drink and takeaway/fast food among pregnant women.

TRIAL REGISTRATION

HBT is registered with the Australian Clinical Trial Registry (ACTRNO12607000168459).

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.

Trends in food and nutritional intakes of French adults from 1999 to 2007: results from the INCA surveys

Two independent cross-sectional dietary surveys (the Individual and National Food Consumption Surveys, INCA), performed in 1998–99 (INCA1) and in 2006–07 (INCA2) on nationally representative samples of French people, were used to analyse trends in the dietary habits and nutritional intake of French adults. Food consumption was recorded through 7-d dietary records, and nutritional intakes were assessed using the French food composition database. After exclusion of under-reporters, analyses were performed on 3267 adults, aged 18–79 years: 1345 from INCA1 and 1922 from INCA2. The trends highlighted over the 8-year period showed a decrease in consumption of dairy products, meat, bread, potatoes, pastries/croissant-like pastries/cakes/biscuits and sugar/confectionery. In contrast, the consumption of fruits and vegetables, rice, ice cream and chocolate increased. Other food groups, like fish and snacking foods, remained stable. Food choices were mostly age specific. These age differences remained consistent over the years and underlined two opposite dietary trends: a ‘traditional’ one mainly followed by the elderly, and a ‘snacking and convenience’ one mainly adopted by young adults. The overall trends in food consumption did not influence the mean energy intake, but did slightly modify the contribution of each macronutrient to energy intake. These repeated surveys highlighted the fact that trends in French food habits have moved towards an average European diet at the crossroads between Mediterranean and Northern diets, and that food consumption changes impacted, to a lesser extent, nutritional intake.

Individual-level socioeconomic status is associated with worse asthma morbidity in patients with asthma

BACKGROUND

Low socioeconomic status (SES) has been linked to higher morbidity in patients with chronic diseases, but may be particularly relevant to asthma, as asthmatics of lower SES may have higher exposures to indoor (e.g., cockroaches, tobacco smoke) and outdoor (e.g., urban pollution) allergens, thus increasing risk for exacerbations.

METHODS

This study assessed associations between adult SES (measured according to educational level) and asthma morbidity, including asthma control; asthma-related emergency health service use; asthma self-efficacy, and asthma-related quality of life, in a Canadian cohort of 781 adult asthmatics. All patients underwent a sociodemographic and medical history interview and pulmonary function testing on the day of their asthma clinic visit, and completed a battery of questionnaires (Asthma Control Questionnaire, Asthma Quality of Life Questionnaire, and Asthma Self-Efficacy Scale). General Linear Models assessed associations between SES and each morbidity measure.

RESULTS

Lower SES was associated with worse asthma control (F = 11.63, p < .001), greater emergency health service use (F = 5.09, p = .024), and worse asthma self-efficacy (F = 12.04, p < .01), independent of covariates. Logistic regression analyses revealed that patients with <12 years of education were 55% more likely to report an asthma-related emergency health service visit in the last year (OR = 1.55, 95%CI = 1.05-2.27). Lower SES was not related to worse asthma-related quality of life.

CONCLUSIONS

Results suggest that lower SES (measured according to education level), is associated with several indices of worse asthma morbidity, particularly worse asthma control, in adult asthmatics independent of disease severity. Results are consistent with previous studies linking lower SES to worse asthma in children, and add asthma to the list of chronic diseases affected by individual-level SES.

Trends in nutritional inequality by educational level: a case of South Korea

OBJECTIVE

There is much evidence of a cross-sectional relation between socioeconomic position and dietary intakes but the trend of this relation is little studied. This study aimed to examine the extent and trend of nutritional inequality by educational level based on the prevalence of inadequate nutrient intakes.

METHODS

Three cross-sectional nationwide surveys (1998, 2001, 2005) of the Korean National Health and Nutrition Examination Survey were used. A total of 20 777 participants > or = 20 y old were included. The socioeconomic position indicator was educational level. Dietary nutrient intakes were assessed by a 24-h recall and inadequacy of intake for nutrients was assessed on the basis of the percentage of attainment of the dietary reference intakes for Koreans. To assess nutritional inequality by educational level, the prevalence ratio, relative index of inequality, and slope index of inequality were used.

RESULTS

Poorer dietary intakes and higher estimated prevalence of nutrient inadequacy were more apparent in the lower education group than the higher education group for both genders and each survey year. Graded patterns of inequalities in nutrient intakes by educational level were generally clear at each survey year. The trend of the relative nutritional inequalities in Korean men and women remained unchanged from 1998 to 2005, with some exceptions.

CONCLUSION

The inequality in nutrient intakes by educational level was persistently apparent for both genders in the Korean adult population, although the relative inequalities did not increase over time.