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

Trends in food intake in French children from 1999 to 2007: results from the INCA (étude Individuelle Nationale des Consommations Alimentaires) dietary surveys

The objectives of the present study were to assess the intake of different food groups in French children aged 3–17 years (n 1455), and to analyse trends since a dietary survey undertaken 8 years ago. Dietary intake was evaluated using data from the 2006–7 cross-sectional INCA2 national dietary survey (étude Individuelle Nationale sur les Consommations Alimentaires), based on a 7 d food record. Dietary intake (percentage of subjects consuming the food group and amount eaten) was assessed for thirty-nine food categories. We observed variations in food consumption by age, sex, North–South regional gradient, seasonal period and educational level of the responding parent. Trends in dietary intake between 1999 and 2007 were determined by comparing the INCA1 (n 1126) and the INCA2 surveys. Both surveys had been carried out using the same methodology. The findings showed a decrease in energy intake in children aged 3–14 years, due to a reduction in the consumption of foods of animal origin and sweetened products. In adolescents aged 15–17 years, energy intake remained rather stable; during this 8-year period, the consumption of meat decreased, whereas the consumption of savoury snacks such as sandwiches and hamburgers significantly increased. These trends occurred during a time of growing concern about overweight and the associated co-morbidities in France. A number of public health measures were implemented over this period to improve dietary habits and physical activity patterns in children and adults. The periodic monitoring of dietary patterns through the INCA surveys is an essential part of the surveillance network in France.

Dietary fiber and associations with adiposity and fasting insulin among college students with plausible dietary reports

OBJECTIVE

We examined dietary fiber intake, food sources of dietary fiber, and relation of dietary fiber to body composition and metabolic parameters in college students with plausible dietary reports.

METHODS

Students (18-24 y of age) provided data on anthropometry, fasting blood chemistries, and body composition (bioelectric impedance). Diet and physical activity were assessed with the Diet History Questionnaire and the International Physical Activity Questionnaire. Plausible dietary reporters were identified (+/-1 SD cutoffs for reported energy intake as a percentage of predicted energy requirement). Multiple regression analyses were conducted with the total (n = 298) and plausible (n = 123) samples, adjusting for age, race, sex, smoking status, physical activity, energy intake, and fat-free mass (where applicable).

RESULTS

Food sources of dietary fiber were similar in men and women. In the plausible sample compared with the total sample, dietary fiber was more strongly associated with fat mass (beta = -0.24, P < 0.001), percentage of body fat (beta = -0.23, P < 0.001), body mass index (beta = -0.11, P < 0.01), waist circumference (beta = -0.67, P < 0.05), and fasting insulin (beta = -0.15, P < 0.001). When the effect of sex was investigated, dietary fiber was inversely related to fasting insulin and fat mass in men and women and inversely related to percentage of body fat, body mass index, and waist circumference in men only (P < 0.05).

CONCLUSION

Inclusion of implausible dietary reports may result in spurious or weakened diet-health associations. Dietary fiber is negatively associated with fasting insulin levels in men and women and consistently associated with adiposity measurements in men.

Over-indebtedness as a marker of socioeconomic status and its association with obesity: a cross-sectional study

Background

The recent credit crunch will have implications for private households. Low socioeconomic status is associated to various diseases. While income, education and occupational status is frequently used in definitions of socioeconomic status, over-indebtedness of private households is usually not considered. Over-indebtedness is currently increasing in high-income countries. However, its association with health – particularly with obesity – remains unknown. Therefore, the aim of this study was to assess an association between over-indebtedness and overweight or obesity.

Methods

A cross-sectional study on over-indebtedness and health including 949 over-indebted subjects from 2006 and 2007 in Rhineland-Palatinate and Mecklenburg-Western Pomerania (Germany) and the telephonic health survey 2003 of the Robert Koch-Institute including 8318 subjects, who are representative for the German population, were analysed with adjusted logistic regression considering overweight (BMI ≥25.0 kg/m²) and obesity (BMI ≥30 kg/m²) as response variable.

Results

After adjusting for socio-economic (age, sex, education, income) and health factors (depression, smoking habits) an independent effect of the over-indebt situation on the probability of overweight (aOR 1.97 95%-CI 1.65–2.35) and obesity (aOR 2.56 95%-CI 2.07–3.16) could be identified.

Conclusion

Over-indebtedness was associated with an increased prevalence of overweight and obesity that was not explained by traditional definitions of socioeconomic status. Over-indebtedness should be additionally considered when assessing health effects of socioeconomic status.

Dietary assessment methods used for low-income populations in food consumption surveys: a literature review

In order to assess nutritional adequacy, reliable estimates of nutrient intake are required. Specifically, the EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence needs clear guidelines on methods suitable for assessing micronutrient intakes among vulnerable population groups. The objective of this project was to collect, evaluate data and review the suitability of methods used to assess dietary intake of low-income groups across Europe. A comprehensive literature review methodology was employed, which involved structured search MEDLINE, from 1990 to 2008, on (nutrient intake methods) and (validity terms) and (human studies) and finally (low-income terms). In addition, manual searches were conducted for published books and national studies. Seven studies satisfied the selection criteria for inclusion in the review in which four dietary intake methods had been described and validated. Three other studies found in the grey literature used similar methods. Only one study tested a variety of methods to assess reliability and the method preferred by those having low incomes. Preferred methods were 24 h recalls and a FFQ which, compared with the weighed inventory, also yielded higher estimates of energy and nutrient intakes. Many of the methods used in low-income populations have not been subjected to evaluation and consequently may not demonstrate sensitivity and/or specificity when used in this population. Based on one study only, four multiple-pass 24 h recalls are recommended as the most appropriate method for the evaluation of nutritional adequacy in low-income households.

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.

Simulation model accurately estimates total dietary iodine intake

One problem with estimating iodine intake is the lack of detailed data about the discretionary use of iodized kitchen salt and iodization of industrially processed foods. To be able to take into account these uncertainties in estimating iodine intake, a simulation model combining deterministic and probabilistic techniques was developed. Data from the Dutch National Food Consumption Survey (1997-1998) and an update of the Food Composition database were used to simulate 3 different scenarios: Dutch iodine legislation until July 2008, Dutch iodine legislation after July 2008, and a potential future situation. Results from studies measuring iodine excretion during the former legislation are comparable with the iodine intakes estimated with our model. For both former and current legislation, iodine intake was adequate for a large part of the Dutch population, but some young children (<5%) were at risk of intakes that were too low. In the scenario of a potential future situation using lower salt iodine levels, the percentage of the Dutch population with intakes that were too low increased (almost 10% of young children). To keep iodine intakes adequate, salt iodine levels should not be decreased, unless many more foods will contain iodized salt. Our model should be useful in predicting the effects of food reformulation or fortification on habitual nutrient intakes.

Correlates of soft drink and fruit juice consumption among Swedish adolescents

The aim of the study was to investigate how soft drink and fruit juice consumption in teenagers is associated with life-style, other food choices, eating behaviour and maternal characteristics. A cross-sectional study of 16-year-old girls (n 275) and boys (n 199) and their mothers was undertaken. Questionnaires were used to assess habitual dietary intake, eating behaviour, physical activity, smoking and educational level. Weight and height were measured. It was found that eating breakfast less than five times per week was independently associated with a high soft drink consumption in both girls and boys. A low intake of cooked meals and milk and a high intake of salty snacks were associated with soft drinks in boys only, and a low intake of fruits in girls only. A high maternal juice intake, low milk and high fruit consumption were independent correlates of fruit juice intake in both girls and boys. In girls, being a smoker, having a smoking mother, a high soft drink intake, scoring low on emotional eating and high on cognitive restraint were also associated with fruit juice intake. A low intake of soft drinks and cooked meals was associated with fruit juice intake in boys only. Neither soft drinks nor fruit juice was associated with BMI. In conclusion, a high intake of both fruit juice and soft drinks were associated with a lower intake of foods such as milk and cooked meals. It might be possible to influence fruit juice intake among teenagers by aiming at their mothers, whereas the adolescents themselves should be targeted when the aim is to reduce soft drink consumption.

Global co-distribution of light at night (LAN) and cancers of prostate, colon, and lung in men

The incidence rates of cancers in men differ by countries of the world. We compared the incidence rates of three of the most common cancers (prostate, lung, and colon) in men residing in 164 different countries with the population-weighted light at night (LAN) exposure and with several developmental and environmental indicators, including per capita income, percent urban population, and electricity consumption. The estimate of per capita LAN exposure was a novel aspect of this study. Both ordinary least squares (OLS) and spatial error (SE) regression models were used in the analysis. We found a significant positive association between population exposure to LAN and incidence rates of prostate cancer, but no such association with lung cancer or colon cancer. The prostate cancer result is consistent with a biological theory and a limited number of previous studies of circadian disruption and risk. The LAN-prostate cancer connection is postulated to be due to suppression of melatonin and/or disruption of clock gene function. An analysis holding other variables at average values across the 164 countries yielded a risk of prostate cancer in the highest LAN-exposed countries 110% higher than in the lowest LAN exposed countries. This observed association is a necessary condition for a potentially large effect of LAN on risk of prostate cancer. However, it is not sufficient due to potential confounding by factors that increase the risk of prostate cancer and are also associated with LAN among the studied countries.

Green tea catechin plus caffeine supplementation to a high-protein diet has no additional effect on body weight maintenance after weight loss

BACKGROUND

Green tea (epigallocatechin gallate + caffeine) and protein each were shown to improve body weight maintenance after weight loss.

OBJECTIVE

We investigated the effect of a green tea-caffeine mixture added to a high-protein (HP) diet on weight maintenance (WM) after body weight loss in moderately obese subjects.

DESIGN

A randomized, placebo-controlled, double-blind parallel trial was conducted in 80 overweight and moderately obese subjects [age (mean +/- SD): 44 +/- 2 y; body mass index (BMI; in kg/m(2)): 29.6 +/- 2.0] matched for sex, age, BMI, height, body mass, and with a habitually low caffeine intake. A very-low-energy diet intervention during 4 wk was followed by 3 mo of WM; during the WM period, the subjects received a green tea-caffeine mixture (270 mg epigallocatechin gallate + 150 mg caffeine/d) or placebo, both in addition to an adequate protein (AP) diet (50-60 g protein/d) or an HP diet (100-120 g protein/d).

RESULTS

Subjects lost 7.0 +/- 1.6 kg, or 8.2 +/- 2.0%, body weight (P < 0.001). During the WM phase, WM, resting energy expenditure, and fat-free mass (FFM) increased relatively in both the HP groups and in the AP + green tea-caffeine mixture group (P < 0.05), whereas respiratory quotient and body fat mass decreased, all compared with the AP + placebo group. Satiety increased only in both HP groups (P < 0.05). The green tea-caffeine mixture was only effective with the AP diet.

CONCLUSION

The green tea-caffeine mixture, as well as the HP diet, improved WM independently through thermogenesis, fat oxidation, sparing FFM, and, for the HP diet, satiety; a possible synergistic effect failed to appear.

Cross-cultural differences in the macronutrient intakes of women with anorexia nervosa in Australia and Singapore

AIM

To compare the macronutrient intakes of women with and without anorexia nervosa (AN) across cultures.

METHOD

Participants were women with AN (n = 39) and without AN (n = 89) of North European and East Asian backgrounds recruited in Australia and Singapore. Energy and the percentage energy contributed by protein (%protein), fat (%fat) and carbohydrate (%CHO) were assessed from participant's diet histories and analysed in terms of cultural group, acculturation, socio-economic status (SES) and education level.

RESULTS

AN status was associated with lower energy and higher %CHO. Greater %protein was associated with greater acculturation to Western culture and lower SES, but not AN. Greater %fat was associated with lower SES and lower acculturation in women with AN, but with higher acculturation in controls. Greater %CHO was also associated with higher SES.

CONCLUSION

The findings may represent Western diets' higher protein and fat contents, 'Western' knowledge of weight-loss diets, and affordability of low fat foods.

Are eating occasions and their energy content related to child overweight and socioeconomic status?

The objectives of this study were: (i) to assess the relationships between childhood overweight (OW) and four eating behaviors: daily eating frequency, and the relative contribution of breakfast, main meals (lunch and dinner), and snacks to total daily energy intake (EI); (ii) to explore whether these eating behaviors are involved in the negative association between socioeconomic status (SES) and OW. A representative sample of French children aged 3-11 years (n = 748) was taken from the 1998-1999 cross-sectional French INCA1 (Enquête Individuelle et Nationale sur les Consommations Alimentaires) food consumption survey. Food intake was reported in a 7-day food record, and SES, physical activity, sedentary behavior (SED), weight, and height were reported by answering face-to-face questionnaires. After adjusting for EI, physical activity, and SED, OW was positively associated with the contribution of the main meals to EI (P = 0.03), not significantly associated with the contribution of breakfast to EI, and inversely correlated to the number of eating episodes (P = 0.009) and to the contribution of snacking episodes to EI (P = 0.007). Our data suggest that a combination of more frequent intake occasions and lower contribution of the main meals to total daily EI is associated with a smaller risk of OW in children. However, eating frequency was the only eating behavior that played a slight mediation role (contributing approximately 8%) in the inverse relationship between SES and OW.

Socio-demographic influences on trends of fish consumption during later adult life in the Whitehall II study

Our aim was to investigate how socio-demographic factors influence trends and age-related trajectories of fish consumption. We examined consumption of total, fried and recommended fish (white and oily fish, and shellfish) in the Whitehall II study over 11 years in participants aged 39–59 years at phase 3. The cohort included 8358 British civil servants who completed a FFQ at phase 3 (1991–3), phase 5 (1997–9, n 5430) and phase 7 (2002–4, n 5692). Occupational grade, ethnicity, marital and retirement status were collected at each phase. To analyse changes in age-related trends of fish intake over time according to socio-demographic characteristics, we applied a random mixed-effect model. Over the follow-up a significant increase in consumption of ‘recommended’ (mean: 1·85 to 2·22 portions/week) and total fish (mean: 2·32 to 2·65 portions/week) and a decreasing trend in fried-fish intake (mean: 0·47 to 0·43 portions/week) was observed. Recommended, fried and total fish consumption differed by occupational status, ethnicity, marital status and sex. The trend of age-related fish intake diverged significantly by ethnicity. In South Asian participants (n 432), slope of recommended-fish consumption was significantly higher compared with white participants (0·077 v. 0·025 portions/week per year). For black participants (n 275) slope of fried-fish intake was significantly higher compared with white participants (0·0052 v. − 0·0025 portions/week per year). In terms of public health, our descriptive and analytical work allows detailed understanding of the impact of socio-demographic factors on fish intake and its age-related trends. Such information is valuable for food policies that seek to promote health equity.

Effects of tailored feedback on multiple health behaviors

BACKGROUND

The effects of tailored intervention on multiple behaviors and possible moderators of tailoring effects have not yet been sufficiently demonstrated.

PURPOSE

The purpose of this study was to examine the effectiveness of a computer-tailored intervention on smoking; physical activity; and fruit, vegetable, and fat intake; and to test potential moderators of the effectiveness (BMI, age, SES, gender, motivation, and the number of behaviors for which respondents met the recommendations from national guidelines).

METHODS

Respondents were randomly assigned to a tailored intervention group, receiving one tailored letter on all of these behaviors, or a control intervention group, receiving one general information letter on all behaviors.

RESULTS

Three months after the baseline assessment, the tailored intervention group showed significantly better effects than the control group for all behaviors studied, except for smoking. Notably, the intervention did not enhance the health behaviors, but rather reduced a decline in these behaviors during the 3-month study interval. Effect sizes were small. No moderating factors were found, except for the number of behaviors for which recommendations were met in the tailoring intervention group on fruit consumption. The largest effects of the tailored intervention were found for fruit in respondents who did not meet the recommendations for any behavior (Cohen's d = 0.3).

CONCLUSIONS

A tailored intervention on multiple behaviors had significant, but limited effects when compared to generic information. The number of bad habits influenced the effects of the tailored intervention on fruit consumption.

Dietary habits mediate the relationship between socio-economic status and CVD factors among healthy adults: the ATTICA study

BACKGROUND

The aims of the present work were to investigate whether dietary habits are associated with socio-economic status (SES), and if they modify the relationship between SES and CVD risk factors, in a sample of men and women free from known CVD.

METHODS

This population-based study was carried out in the province of Attica, where Athens is a major metropolis. During 2001-2002, information from 1,528 men (18-87 years old) and 1,514 women (18-89 years old) was collected (75 % participation rate). Among several sociodemographic, clinical and biological factors, adherence to the Mediterranean diet was assessed by a special diet score (Mediterranean Diet Score, MDS) that incorporated the inherent characteristics of this traditional diet. CVD risk factors were examined across the participants' educational level and annual income that defined their SES.

RESULTS

Low SES groups exhibited higher prevalence of CVD risk factors, such as obesity, hypertension, diabetes mellitus and hypercholesterolaemia (all P < 0.001). Low SES groups also showed less adherence to the Mediterranean diet than high SES groups (MDS: 23.6 (sd 8.1) v. 25.6 (sd 5.6), P < 0.001). Higher SES index was associated with lower likelihood of having hypercholesterolaemia (OR = 0.91; 95 % CI 0.83, 1.00) and diabetes (OR = 0.83; 95 % CI 0.72, 0.95), after adjusting for various potential confounders. However, the previously mentioned inverse relationship observed between SES and prevalence of CVD risk factors was mainly explained by the dietary habits of the participants.

CONCLUSIONS

Low SES groups showed less adherence to the Mediterranean diet compared with high SES groups. This finding may, in part, explain the higher CVD risk factors profile observed among low SES participants.

Social determinants, suboptimal health behavior, and morbidity in urban slum population: an Indian perspective

Improving the health of urban residents, particularly those living in slum areas, requires an integrated approach. Appropriate interventions must be based on a well-grounded understanding of health determinants. Social factors are as important as physical factors in determining health status and suggest alternative interventions. Employment, stress, social exclusion, social support, substance use, nutrition, transport, and conditions during childhood are among the most important social determinants of health status identified by the International Center for Health and Society. This paper uses social determinants of health approach to understand morbidity outcomes for people residing in the slums of Surat City, India. To quantify suboptimal health behavior and identify the determinants of health status for this population survey data on household characteristics, health-seeking behavior, socioeconomic status, food and personal habits, social life, and physical activity has been used. After controlling for socioeconomic and demographic factors, logistic regression analysis reveals that social exclusion, stress, and lack of social support are significantly associated with morbidity. Thus, understanding of social determinants of health by policy makers is important as the health sector has a crucial role in addressing disparities in social determinants.

Understanding eating behaviours in Spanish women enrolled in a weight-loss treatment

AIM

To identify the beliefs and attitudes of a sample of obese and overweight Spanish women undertaking a weight-loss treatment.

BACKGROUND

Obesity is a global epidemic. Weight-loss treatments focus on changing eating behaviours; however, many patients fail to adhere to the diet. This suggests that more effective behaviour-change interventions are required to help people change their eating behaviours. According to the theory of planned behaviour (TPB) human behaviour is influenced by beliefs. Identification of people's beliefs is an essential step in the design of behaviour-change interventions.

DESIGN

A qualitative approach was employed using semi-structured interviews to interview participants. Seventeen obese and overweight Spanish women enrolled in a weight-loss treatment were recruited using a criterion sample strategy.

FINDINGS

Participants' reported beliefs referring to the benefits of losing weight and the emotions related to dieting. The more positive these beliefs were the more positive their attitude towards the diet seemed to be. Findings highlight the importance of follow-ups in creating a subjective norm to maintain a diet. Perceived behavioural control to diet seemed to be related to beliefs about social support; whereas beliefs about lack of willpower to overcome temptations seemed to decrease perceived control over eating behaviours.

CONCLUSIONS

Participants reported several beliefs and attitudes that offer plausible explanations of their eating behaviours. Data from this study seemed to fit the propositions of the TPB and could be used in further research to develop effective eating behaviour-change interventions.

RELEVANCE TO CLINICAL PRACTICE

Nurses could use the TPB to assess individuals' attitudes, beliefs and expectations when following a diet. That assessment would provide insight into what aspects are relevant for individual patients when dieting, which could lead to more effective diet behaviour-change interventions being designed.

Impact of socio-economic factors on stroke prevalence among urban and rural residents in Mainland China

Background

An inverse relationship between better socioeconomic status (total household income, education or occupation) and stroke has been established in developed communities, but family size has generally not been considered in the use of socioeconomic status indices. We explored the utility of Family Average Income (FAI) as a single index of socioeconomic status to examine the association with stroke prevalence in a region of China, and we also compared its performance as a single index of socioeconomic status with that of education and occupation.

Methods

A population-based cross-sectional study was conducted in Nanjing municipality of China during the period between October 2000 and March 2001. A total of 45 administrative villages were randomly selected using a multi-stage sampling approach and all regular local residents aged 35 years or above were included. Descriptive statistics and logistic regression models were used in analysis.

Results

The overall prevalence of diagnosed stroke was 1.54% in all 29,340 eligible participants. An elevated prevalence of stroke was associated with increasing levels of FAI. After adjustment for basic demographic variables (age, urban/rural area and gender) and a group of defined conventional risk factors, this gradient still remained significant, with participants in the highest (OR = 1.94, 95% CI = 1.40, 2.70) and middle (OR = 1.43, 95% CI = 1.01, 2.02) categories of FAI having higher risks compared with the lowest category. A significantly elevated OR of stroke prevalence was found in white collar workers compared to blue collar workers, while no significant relationship was observed with education.

Conclusion

Our study consistently revealed that the prevalence of stroke was associated with increasing levels of all SES indices, including FAI, education, and occupation. However, a significant gradient was only observed with FAI after controlling for important confounding factors. The findings suggested that, compared with occupation and education, FAI could be used as a more sensitive index of socio-economic status for public health studies in China.

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.

Do nutrition knowledge and beliefs modify the association of socio-economic factors and diet quality among US adults?

OBJECTIVES

We examined effects of socio-economic status (SES) factors on diet quality and fruits and vegetables intake among US adults and effect modification by nutrition knowledge and beliefs.

METHODS

We used national cross-sectional data (Continuing Survey of Food Intake by Individuals) on 4356 US adults, aged 20-65 years, collected in 1994-1996. Socio-economic factors considered were education and poverty income ratio. Nutrition knowledge and belief score was measured by principal components analysis of 11 question responses. We considered three binary and two continuous outcomes related to United States Department of Agriculture recommended intake of fruits and vegetables and overall diet quality through Healthy Eating Index and alternate Mediterranean Diet Score.

RESULTS

Multivariate analyses indicated that better SES independently improved likelihood of adequate fruits and vegetables intake and overall diet quality. In several cases, nutrition knowledge and beliefs acted as an effect modifier. In particular, education showed no association with diet quality among subjects in the lowest nutrition knowledge and belief tertile, while the association was consistently stronger in the highest tertile (Education x Nutrition knowledge and beliefs interaction term P<0.10 for Healthy Eating Index and both fruits and vegetables guidelines). A similar interaction was noted for poverty income ratio.

CONCLUSION

For improvement in overall diet quality, socio-economic interventions must be coupled with health education programs targeting all segments of the US population.

Associations between self-reported fruit and vegetable consumption and home availability of fruit and vegetables among Greek primary-school children

OBJECTIVE

To examine whether the self-reported fruit and vegetable consumption of Greek primary-school children is associated with the home availability of fruit and vegetables.

DESIGN

Cross-sectional study.

SETTING

Five primary schools in the city of Pyrgos in south-west Greece.

SUBJECTS

One hundred and sixty-seven students in fifth and sixth grades.

METHODS

Fruit and vegetable consumption was assessed using an FFQ. Home availability of fruit and vegetables was assessed using a modified version of a US home availability questionnaire. Participant BMI was assessed and parental education obtained by self-report. Hierarchical regression models that took account of the clustering of participants in schools were used to examine the relationship between consumption and availability after controlling for parental education and BMI.

RESULTS

Regression analyses showed that home availability of fruit was a significant predictor of consumption (beta=0.524, Z=9.77, P<0.001) in a model that explained 46 % of the overall variance. Home availability of vegetables was a significant predictor of vegetable intake (beta=0.378, Z=6.23, P<0.001) in a model that explained 29 % of the overall variance.

CONCLUSION

Home availability of fruit and vegetables was associated with consumption among Greek primary-school children. The association between home availability of fruit and intake was higher than the associations that have been reported in other samples. Results support focusing on the home availability of fruit and vegetables as a potential mediator of consumption that could be manipulated as a means of increasing fruit and vegetable intake among children.

Does participation in a population-based dietary intervention scheme have a lasting impact on fruit intake in young children?

BACKGROUND

The National Schools Fruit Scheme (NSFS) is intended to improve fruit intake in young children by providing free daily fruit at school.

METHODS

We used a parentally completed questionnaire for three consecutive years to study fruit intake in young children before, during and after participation in the NSFS compared with a control region.

RESULTS

In 2003, 2004 and 2005, a total of 224, 220 and 179 schools, respectively, were studied with responses from 5,606, 5,111 and 3,382 children for each survey. Between 2003 and 2004, individual fruit consumption in the intervention region increased by more (from a median of 7.5 to 14.0 pieces/week) than in the control region (from a median of 9.2-11.0 pieces/week), resulting in a difference (P < 0.001) between the two regions in 2004. However, after ceasing to be eligible for the NSFS, fruit intake in children in the intervention region fell to a median of 12 pieces per week, lower than that in the control region (median value of 14 pieces per week, P = 0.02).

CONCLUSIONS

School-based fruit distribution schemes providing free fruit at school appear to be an effective means of increasing dietary fruit intake in young children, including those who live in relatively socio-economically deprived areas. However, this approach does not influence fruit intake after the provision of free fruit ends, so schemes may need to be sustained to provide the maximum benefit to young children.

Associations between deprivation, attitudes towards eating breakfast and breakfast eating behaviours in 9–11-year-olds

Objectives

To examine school-level relationships between deprivation and breakfast eating behaviours (breakfast skipping and the healthfulness of foods consumed) in 9–11-year-old schoolchildren and to examine whether attitudes towards eating breakfast mediated these relationships.

Design

Cross-sectional survey.

Setting

One hundred and eleven primary schools in Wales.

Subjects

Year 5 and 6 pupils within the 111 primary schools. Measures were completed by 4314 children. Analysis was conducted at the group (school) level, with each school representing one group.

Results

Deprivation was positively associated with breakfast skipping and consumption of ‘unhealthy’ items (i.e. sweet snacks, crisps) for breakfast. A significant negative association was found between deprivation and consumption of ‘healthy’ items (i.e. fruit, bread, cereal, milk). Deprivation was significantly inversely associated with attitudes towards eating breakfast. The relationships between deprivation and (1) breakfast skipping and (2) consumption of ‘healthy’ items for breakfast were mediated by attitudes towards eating breakfast. The hypothesis that attitudes mediated the relationship between deprivation and consumption of ‘unhealthy’ breakfast items was unsupported.

Conclusions

Deprivation is associated with adverse breakfast eating behaviours amongst children aged 9–11 years, in terms of breakfast skipping and the quality of breakfasts consumed. Socio-economic differences in attitudes towards eating breakfast are apparent amongst this age group, and appear to relate to social gradients in breakfast eating behaviours. Research is needed to examine the causal nature of these trends and to elucidate factors underlying the development of socio-economic differences in eating-related cognitions.

Trends of socioeconomic differences in daily vegetable consumption, 1979-2002

BACKGROUND

Studies from different time periods have shown that consumption of vegetables is more common in higher socioeconomic groups and among women. However, there are only few studies of changes of socioeconomic differences in vegetable consumption over time. Our aim was to determine whether socioeconomic differences, measured by educational level and household income, in daily vegetable consumption have increased, decreased or been stable over the last two decades among Finnish men and women.

METHODS

Data on daily consumption of fresh vegetables were derived from repeated annual cross-sectional surveys performed among representative samples of Finnish working aged (15-64 years) population. Data from the years 1979-2002 were linked with data on education and household income from Statistics Finland. Those under 25 years and all students were excluded, giving a total of 69 383 respondents. The main analyses were conducted with logistic regression.

RESULTS

Daily consumption of fresh vegetables became overall more prevalent during the study period. Daily consumption of fresh vegetables was more common among those with higher education and higher income during the whole study period. Both educational level and household income differences in daily vegetable consumption slightly narrowed since 1979 among men and women.

CONCLUSIONS

Women with high socioeconomic position have been initial trend setters, but the prevalence of daily consumers of vegetables in these groups has not increased since the early 1990s. The prevalence of daily consumption of fresh vegetables has increased more in lower educational and income groups during the 1980s and 1990s along with narrowing socioeconomic differences.

Safe addition of vitamins and minerals to foods: setting maximum levels for fortification in the Netherlands

Background

In 2004, the European Court of Justice decided that the prohibition of fortification with vitamin A, vitamin D, folic acid, selenium, copper, and zinc in the Netherlands conflicts with the principle of free movement of goods in the European Union. This decision led to a change in the Dutch policy, resulting in a more flexible handling of requests for exemption from this prohibition to fortify. Therefore, an investigation was proposed in which it would be determined whether a general exemption could be granted for food fortification with a certain maximum safe amount per micronutrient.

Aim of the study

To develop a risk assessment model to estimate maximum safe fortification levels (MSFLs) of vitamins and minerals to foods on the Dutch market, and to evaluate these levels to derive allowed fortification levels (AFLs), which can be used for a general exemption.

Methods

We developed a risk assessment model to estimate MSFLs of vitamins and minerals to foods on the basis of existing models. We used European tolerable upper intake levels in combination with national food consumption data to estimate MSFLs for fortification of foods for several age groups. Upon extensive stakeholder dialogue, the risk manager considered these estimated MSFLs and the final AFLs for a general exemption were set.

Results

For folic acid, vitamin A, and vitamin D, the MSFLs were calculated in the risk-assessment model. Children up to 6-years old were the group most sensitive to folic acid fortification, and they had an MSFL of 0 µg/100 kcal, but following a risk management evaluation, this was upgraded to an AFL of 100 µg/100 kcal. The MSFL for vitamin D was 3.0 µg/100 kcal (children 4–10 years old), and the risk manager increased this to an AFL of 4.5 µg/100 kcal. Children up to 10 years old, men, and postmenopausal women were the groups most sensitive to vitamin A fortification (MSFL = 0 µg/100 kcal). Because these groups represent a large part of the population and because of the seriously harmful effects of excessive vitamin A, the risk manager did not allow a general exemption.

Conclusions

The combination of a risk assessment model and risk manager evaluation led to the setting of AFLs for general exemption of fortification with folic acid and vitamin D. This model is also applicable for other micronutrients, for which an UL is derived, and in other countries.

Educational variations in the consumption of foods containing fat in Finland and the Baltic countries

Objective

To examine educational differences among people who consume foods containing fat in Finland and the Baltic countries.

Design

Data were collected from cross-sectional postal Finbalt Health Monitor surveys that were carried out in 1998, 2000 and 2002.

Setting

Estonia, Finland, Latvia and Lithuania.

Subjects

For each survey, nationally representative random samples of adults aged 20–64 years were drawn from population registers (Estonia,n = 3656; Finland,n = 9354, Latvia,n = 6015; Lithuania,n = 5944).

Results

Differences were revealed between the countries in the consumption of foods that contain fat. Finnish people consumed butter on bread, high-fat milk, meat and meat products, and vegetable oil for cooking less frequently than people in the Baltic countries. Cheese was most popular in Finland. Educational differences in fat-related food habits were examined by applying logistic regression analysis. A positive association was found between level of education and consumption of vegetable oil used in food preparation. Drinking high-fat milk was associated with low education in all countries. People with higher education tended to consume cheese more often. Educational patterns in the consumption of butter on bread and in the consumption of meat and meat products differed between countries.

Conclusions

The consumption of foods containing fat was related to educational levels in all four countries. The diet of better-educated people was closer to recommendations for the consumption of saturated and unsaturated fats than the diet of people with lower level of education. The educational gradient was more consistent in Finland than in the Baltic countries. These existing educational differences in sources of fat consumed should be taken into account in the development of national cardiovascular disease prevention programmes.

An exploration of socioeconomic variation in lifestyle factors and adiposity in the Ontario Food Survey through structural equation modeling

Title

An exploration of socioeconomic variation in lifestyle factors and adiposity in the Ontario Food Survey through structural equation models.

Background

Socioeconomic indicators have been inversely associated with overweight and obesity, with stronger associations observed among women. The objective of the present secondary analysis was to examine the relationships among socioeconomic measures and adiposity for men and women participating in the Ontario Food Survey (OFS), and to explore lifestyle factors as potential mediators of these associations.

Methods

The cross-sectional 1997/98 OFS collected anthropometric measurements, a food frequency questionnaire, data on socio-demographics (age, sex, income, and education) and physical activity from 620 women and 467 men, ages 18 to 75. Based on the 2003 Health Canada guidelines, waist circumference and BMI values were used to derive least risk, increased risk, and high risk adiposity groups. Structural equation modeling was conducted to examine increased risk and high risk adiposity in relation to education and income, with leisure time physical activity, fruit and vegetable intake, and smoking status included as potential mediators of these associations.

Results

The probability of high risk adiposity was directly associated with education (β-0.19, p < 0.05) and income (β-0.22, p < 0.05) for women, but not for men. Fruit and vegetable intake was a marginally significant mediator of the relationship between education and high risk adiposity for women. Increased risk adiposity was not associated with income or education for men or women.

Conclusion

The socioeconomic context of adiposity continues to differ greatly between men and women. For women only in the OFS, fruit and vegetable intake contributed to the inverse association between education and high risk adiposity; however, additional explanatory factors are yet to be determined.

Secular trends in the association of socio-economic position with self-reported dietary attributes and biomarkers in the US population: National Health and Nutrition Examination Survey (NHANES) 1971-1975 to NHANES 1999-2002

OBJECTIVE

Recent reports suggest persistence of health disparities related to socio-economic position (SEP). To understand if diet may be a contributor to these trends, we examined secular trends in the association of diet and indicators of SEP from 1971-1975 to 1999-2002.

DESIGN

We used data from the National Health and Nutrition Examination Surveys (NHANES) I (1971-1975), II (1976-1980), III (1988-1994) and 1999-2002 to examine the independent associations of poverty income ratio (PIR) and education with diet and biomarkers of diet and disease in 25-74-year-olds (n = 36,600). We used logistic and linear regression methods to adjust for multiple covariates and survey design to examine these associations.

RESULTS

A large PIR differential in the likelihood of reporting a fruit or all five food groups and vitamin C intake, and an education differential in likelihood of obesity and carbohydrate intake, was noted in 1971-1975 but narrowed in 1999-2002 (P < 0.007). The positive association of education with intake of a fruit, vegetable or all five food groups, vitamins A and C, calcium and potassium intake remained unchanged across surveys (P < 0.001). Similarly, the positive association of PIR with the amount of foods and intakes of energy and potassium remained unchanged over three decades (P < 0.001). The education and the PIR differential in energy density, and the PIR differential in the likelihood of obesity, persisted over the period of the four surveys (P < 0.001).

CONCLUSIONS

Persistence of unfavourable dietary and biomarker profiles in Americans with low income and education suggests continued need for improvement in the quality of diets of these high-risk groups.

Trends in energy and macronutrient intakes, body weight and physical activity in female university students (1988–2003), and effects of excluding under-reporters

The present study investigated trends in reported energy intake, macronutrient intake, physical activity level (PAL) and body weight and effects of excluding under-reporters (UR). Dietary intake and time spent in sixteen activity categories were recorded by 887 female university students (median age 29 years) from 1988 to 2003. Energy expenditure (EE) and PAL were measured using a factorial method. All data collected were self-reported. Individuals with reported EI:EE<0·76 were classified as UR. The remainder were classified as non-under-reporters (NUR). Trends were determined from simple linear regression of median data for each year for the entire cohort (ALL) and for NUR and UR separately, and from multiple regression analysis with the subgroups (NUR and UR) as an additional predictor (BOTH). Prevalence of under-reporting and overweight increased between 1988 and 2003. In ALL and BOTH there were trends to increased body mass, protein intake (g/d and % energy) and carbohydrate intake (% energy only) and decreased fat and alcohol intakes (g/d and % energy). In BOTH there were also increases in reported EI and carbohydrate intake (g/d). None of the trends in NUR was significantly different from those in UR, but some trends in ALL and/or BOTH were not significant when UR were excluded. Trends remaining significant in NUR were increased reported energy intake, protein (g/d) and carbohydrate (g/d) intakes, and decreased fat (% energy only) intake. There were no significant trends in PAL. We conclude that some, but not all, dietary trends were affected by exclusion of UR.

Traditional v. modified dietary patterns and their influence on adolescents' nutritional profile

Korea has experienced exceptionally rapid economic developments. Even though the country has managed to maintain aspects of its traditional diet, dietary habits are changing, especially among adolescents. This study was carried out to identify prevailing dietary patterns among Korean adolescents and to compare the nutrient intakes and dietary behaviours between the patterns. A 3 d diet record, collected from 671 Korean adolescents aged 12–14 years in Seoul, Korea, was assessed. By cluster analysis, subjects were classified into a modified (69·9 %) and a traditional (30·1 %) dietary pattern group. The modified group consumed more bread, noodles, cookies and pizza/hamburgers compared with the traditional group, which consumed mainly rice and kimchi (fermented cabbage). The modified group had significantly higher intakes of all nutrients. It had a higher total daily energy intake (7719 kJ), a higher daily energy intake from fat (29·8 %) and a higher cholesterol intake (326 mg/d), compared with the traditional group (6686 kJ, 24·8 % and 244 mg/d, respectively). The modified group was more likely to consume fast foods, fried foods and carbonated beverages even though they consumed more fresh fruits and milk, while the traditional group was more likely to have a rice-based diet and not to skip breakfast. These results suggest that monitoring dietary behaviours of adolescents, especially in a society experiencing a nutrition transition, is necessary in order to identify both negative and positive changes in respect of risk factors for nutrition-related chronic diseases as well as for undernutrition.

Does food group consumption vary by differences in socioeconomic, demographic, and lifestyle factors in young adults? The Bogalusa Heart Study

OBJECTIVE

To examine if food group consumption varies by differences in socioeconomic, demographic, and lifestyle factors in young adults from a semirural setting in Louisiana.

DESIGN

Cross-sectional.

SUBJECTS

Young adults (n=1,266, 74% European American, 26% African American; 39% men, 61% women) aged 20 to 38 years, enrolled in the Bogalusa Heart Study.

MEASURES

Food group consumption was assessed by a food frequency questionnaire. Socioeconomic (eg, income and education), demographic (eg, age, sex, and ethnicity), and lifestyle (eg, marital status and physical activity) information was obtained by a self-administered questionnaire and the subjects were stratified according to these groups.

STATISTICAL ANALYSES

Analysis of covariance (adjusted for covariates) was used to detect differences in the mean servings of food groups consumed per day between the various socioeconomic, demographic, and lifestyle groups.

RESULTS

Compared to income<or=$15,000, those with an income>$45,000 had lower consumption of burgers/sandwiches (P<0.05) and those with income levels from $30,001 to $45,000 had lower consumption of mixed dishes (P<0.05). Intake of cereals/breads (P<0.05), dairy products (P<0.01), fruits/100% fruit juices (P<0.001), and vegetables (P<0.001) was higher in subjects with >12 years of education. European-American men consumed more servings of dairy products (P<0.05) and sweetened beverages (P<0.05) than African-American men. European-American women consumed more servings of dairy products (P<0.05), vegetables (P<0.05), and fats (P<0.05) than African-American women. African Americans (men and women) consumed more servings of fruits/100% fruit juices (P<0.0001) than European Americans (men and women), respectively. Married individuals consumed more servings of snacks/desserts (P<0.05), but fewer servings of alcoholic beverages (P<0.0001) than those who were unmarried. Active individuals consumed more servings of fruits/100% fruit juices (P<0.05) and fewer servings of burgers/sandwiches (P<0.05) than inactive individuals.

CONCLUSIONS

These findings suggest that food group consumption varies by socioeconomic, demographic, and lifestyle factors in young adults from a semirural setting. Food and nutrition professionals who encounter diverse populations need to consider the influence of income, education, sex, ethnicity, marital status, and physical activity on food consumption patterns when planning diets, nutrition education programs, and interventions for young adults.

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.

The effect of socioeconomic status on dietary intake, physical activity and Body Mass Index in Austrian pregnant women

OBJECTIVES

To examine the associations of socioeconomic status (SES) with dietary intake and health related factors in pregnant women.

SUBJECTS

A total of 261 pregnant women attending maternity clinics in Austria.

METHODS

Descriptive cross-sectional survey using a self-administered questionnaire in combination with an interview to assess dietary intake (24-hour-recall).

RESULTS

In the linear regression models, women with a higher level of education showed a higher intake of dietary fibre (P = 0.015), folate (P = 0.048), beta-carotene (P = 0.008), and calcium (P = 0.003), whereas the intake of total fat (P = 0.039) was lower. The mean reported prepregnancy Body Mass Index (BMI) of lower educated women (23.6 kg m(-2)) was significantly higher (p for trend = 0.018) than that of women with medium or high levels of education (21.7 and 21.6 kg m(-2), respectively). The manual occupation group was more than four times less likely to engage in structured physical activity compared with the nonmanual occupation group (adjusted odds ratio for manual group = 0.23, 95% CI: 0.08; 0.87).

CONCLUSIONS

Education is a strong and independent predictor of nutrient intake and BMI in pregnant women. The use of occupation and household income in addition to education improves the description of socioeconomic inequalities in diet and health related factors.

Ethnic differences in lifestyle and overweight in the Netherlands

OBJECTIVE

To study the effects of lifestyle variables and socioeconomic status on overweight among native Dutch and immigrants in The Netherlands.

RESEARCH METHODS AND PROCEDURES

Data were used from a survey sample (N = 2551) of native Dutch and immigrant respondents (Surinamese/Antilleans, Turks, and Moroccans). BMI was calculated using self-reported weight and height. Lifestyle variables such as modern food habits (take-out food and eating out) and participating in sports were included, as well as socioeconomic and demographic background variables. Bivariate and ordinary least squares analyses were performed to study BMI and the determinants of overweight among the different groups.

RESULTS

All immigrant groups had a higher prevalence of overweight than the Dutch, except Moroccans. Men were overweight more frequently than women. Take-out food, eating out, and fresh vegetables were related to a decrease in BMI, whereas convenience foods were related to an increase in BMI. For ready-to-eat meals, the results were mixed. In all groups, age was associated with a higher BMI, and a higher level of education was associated with a lower BMI. Immigrants participated in sports less frequently than native Dutch people.

DISCUSSION

One percent to 5% of the total public health costs can be attributed to costs for overweight-related diseases. Public health policies should aim at stimulating healthy lifestyles and discouraging bad food habits through higher taxes on high-calorie foods. In particular, Dutch immigrants should be encouraged to lose weight, because they have a higher risk for overweight-related diseases.

Acculturation and education level in relation to quality of the diet: a study of Surinamese South Asian and Afro-Caribbean residents of the Netherlands

BACKGROUND

To consider the changes in overall diet quality following migration we examined the associations of acculturation variables and education level with diet in Surinamese South Asian and Surinamese Afro-Caribbean origin on the one hand, and ethnic Dutch residents of the Netherlands on the other. Surinam is a former Dutch colony in South America.

METHODS

We randomly selected men and women aged 35-60 years: ethnic Dutch, n = 552; South Asian, n = 306; Afro-Caribbean, n = 660. Intakes of fruit, vegetables, red meat, fish, vegetable oils, breakfast and salt were measured using a short questionnaire that formed the basis for a 'diet quality indicator' score. Highest education was measured and acculturation of the Surinamese groups was assessed by age at migration, number of resident years and a scale measure of social contacts with ethnic Dutch.

RESULTS

Compared with ethnic Dutch, both Surinamese groups scored higher on overall diet quality (P < or = 0.001) but some aspects of diet (breakfast and salt use) were less prudent. Education was positively associated with diet quality in ethnic Dutch (P < or = 0.01), but not consistently so in Surinamese. Associations with social contact with ethnic Dutch varied for different quality aspects of the diet. Residence duration (mean = 22 years) and age at migration (mean = 21 years) were not associated with diet.

CONCLUSIONS

A greater degree of acculturation does not necessarily lead to a less healthful diet in migrants. In addition, the association of education level with diet may differ for migrant groups. The diet of migrants differ from host populations, suggesting that migrant groups should be considered in the development of nutrition health promotion activities.

Impact of a programme of mass mammography screening for breast cancer on socio-economic variation in survival: a population-based study

Background

After a systematic mass mammography breast cancer screening programme was implemented between 1991 and 1996 (attendance 80%), we evaluated its impact on survival according to socioeconomic status (SES).

Methods

We studied survival rates up to 1-1-2005 for all consecutive breast cancer patients aged 50–69 and diagnosed in the period 1983–2002 in the area of the Eindhoven Cancer Registry (n = 4939). Multivariate analyses were performed using Cox regression analysis.

Results

The proportion of breast cancer patients with a low SES decreased from 22% in 1983–1990 to 14% in 1997–2002 when attendance was 85%. The proportion of newly diagnosed patients with stage III or IV disease in 1997–2002 was only 10% compared to 14% in 1991–1996 and 26% in 1983–1989 (P < 0.0001). Stage distribution improved for all socio-economic groups (P = 0.01). Survival was similar for all socio-economic groups in 1983–1990, but after the introduction of the screening programme women with low SES had lower age- and stage-adjusted survival rates (HR 2.0, 95%CI: 1.3–3.0). Survival was better for patients diagnosed in 1997–2002 compared to 1983–1990 for all socioeconomic strata; it was substantially better for the high SES group (HR 0.36, 0.2–0.5) compared to the lowest SES (HR 0.77, 0.6–1.1).

Conclusion

Although survival improved for women from each of the socio-economic strata, related to the high participation rate of the screening programme, women from lower socio-economic strata clearly benefited less from the breast cancer screening programme. That is also related to the higher prevalence of comorbidity and possibly suboptimal treatment.

Past food habit change is related to obesity, lifestyle and socio-economic factors in the Malmo Diet and Cancer Cohort

Objectives

To examine if obesity status and socio-economic and lifestyle factors are associated with self-reported past food habit change, and also whether the level of obesity depends on the reason for change.

Design

Cross-sectional analysis within the Malmo Diet and Cancer (MDC) study using data from the baseline examination and the extensive socio-economic and lifestyle questionnaire including questions of past food habit change. The risk of having changed food habits in the past was examined using logistic regression. Mean differences in obesity status across categories of reasons for past food habit change were examined using analysis of variance.

Setting

Malmö, the third largest city in Sweden.

Subjects

A sub-sample (15 282 women and 9867 men) from the MDC cohort recruited from 1992 to 1996.

Results

Individuals with body mass index (BMI) >30 kg m−2 had an increased risk of having reported past food habit change compared with individuals with BMI <25 kg m−2 (odds ratio (OR) = 1.63, 95% confidence interval (CI) = 1.48–1.83 for women; OR = 1.53, 95% CI = 1.32–1.76 for men). The highest level of obesity was observed among individuals who had changed their diet due to reasons related to the metabolic syndrome. Changers were more likely to be highly educated and to live alone, be retired, ex-smokers and non-drinkers at baseline.

Conclusions

Because past food habit change is related to obesity and other lifestyle and socio-economic factors, a complex confounding situation may exist that could seriously influence observed relationships between diet and disease. Studies need to collect information on past food habit change and take this information into account in the analysis and when interpreting study outcomes.

Having lunch at a staff canteen is associated with recommended food habits

Objective:

To describe the characteristics of employees having lunch at staff canteens and to examine the association between workplace lunch and recommended food habits.

Design:

A mailed questionnaire including data on lunch pattern, food habits, sociodemographic background, work-related factors and body weight. Logistic regression models including food habits as dependent variables and lunch pattern, sociodemographic factors, work-related factors and body mass index as independent variables.

Setting:

Helsinki Health Study survey data, collected in spring 2001.

Subjects:

Employees from the City of Helsinki reaching 40, 45, 50, 55 and 60 years. The data included 2474 women and 591 men; the response rate was 68%.

Results:

About half of those with a staff canteen at work had lunch there. Those with higher educational level were more likely to have lunch at the staff canteen, as also were women with pre-school children and normal-weight men. Those having lunch at staff canteens were more likely to follow recommended food habits, compared with other subjects. Having lunch at the staff canteen seemed to increase the consumption frequency of vegetables and fish.

Conclusions:

Having lunch at staff canteens is associated with the quality of the diet. To serve a cooked meal including vegetables during working time may be an efficient way to improve diet among adult employees. More emphasis should be put on increasing the possibility for employees to have lunch at staff canteens.

Breakfast eating and overweight in a pre-school population: is there a link?

Objectives

To analyse the socio-economic factors related to breakfast eating, the association between breakfast eating and overweight, and to gain a more thorough understanding of the relationship between these two elements in a population-based cohort of 4.5-year-old children. We hypothesised that a relationship could be observed between breakfast skipping and overweight independently of socio-economic factors such as ethnicity, maternal education, single parenting and family income.

Design

A population-based study whereby standardised nutritional interviews were conducted with each child's parent. The children's height and weight were taken by a trained nutritionist and parents were asked about their child's breakfast eating.

Setting

The analyses were performed using data from the Québec Longitudinal Study of Child Development (1998–2002), conducted by Santé Québec (Canada).

Subjects

Subjects were 1549 children between the ages of 44 and 56 months, with a mean age of 49 months.

Results

Almost a tenth (9.8%) of the children did not eat breakfast every day. A greater proportion of children with immigrant mothers (19.4% vs. 8.3% from non-immigrant mothers), with mothers with no high school diploma (17.5% vs. <10% for higher educated mothers) and from low-income families (15% for income of $39 999 or less vs. 5–10% for better income) did not eat breakfast every day. Not eating breakfast every day nearly doubled the odds (odds ratio = 1.9, 95% confidence interval 1.2–3.2) of being overweight at 4.5 years when mother's immigrant status, household income and number of overweight/obese parents were part of the analysis.

Conclusion

Although our results require replication before public policy changes can be advocated, encouraging breakfast consumption among pre-school children is probably warranted and targeting families of low socio-economic status could potentially help in the prevention of childhood obesity.

An examination of income-related disparities in the nutritional quality of food selections among Canadian households from 1986–2001

Socio-economic disparities in nutrition have been documented in numerous countries, and have been linked to health inequalities. Social and economic policy changes occurring over the last several years have resulted in growing levels of income inequality in many countries. However, the extent to which these temporal changes have affected nutrition disparities is largely unknown. Our research examined income-related disparities in the nutritional quality of food selections among Canadian households from 1986 to 2001. Data from the 1986, 1992, 1996 and 2001 Family Food Expenditure surveys were pooled together (n=35048). The relationships between household income and the nutritional quality of food purchases (considering nutrients both as absolute amounts and adjusted for energy, and total energy density) were estimated using general linear models, including tests of significance for differences across the survey years. Results revealed significant positive relationships between income and most nutrients, which persisted over time, and for some nutrients grew stronger. One exception was folate, where the positive relationship between income and folate (independent of energy) was no longer apparent in 2001; this could be attributed to the mandatory fortification of some cereal grain products with folic acid, which came into effect in 1998, resulting in greater availability of folate from grain products. There was also a significant negative relationship between income and total energy density (ratio of food energy to food weight), which persisted across the survey years. At a time of growing income inequality and worsening problems of poverty, food policy makers need to pay attention to the potential for policy interventions to exacerbate or improve nutrition disparities.

Impact of parental education and income inequality on children's food intake

Objective

To analyse the association between socio-economic indicators and diet among 2-year-old children, by assessing the independent contribution of parental education and equivalent income to food intake.

Design

The analysis was based on data from a prospective birth cohort study. Information on diet was obtained using a semi-quantitative food-frequency questionnaire. Low and high intake of food was defined according to the lowest and the highest quintile of food consumption frequency, respectively.

Setting

Four German cities (Munich, Leipzig, Wesel, Bad Honnef), 1999–2001.

Subjects

Subjects were 2637 children at the age of 2 years, whose parents completed questionnaires gathering information on lifestyle factors, including parental socio-economic status, household consumption frequencies and children's diet.

Results

Both low parental education and low equivalent income were associated with a low intake of fresh fruit, cooked vegetables and olive oil, and a high intake of canned vegetables or fruit, margarine, mayonnaise and processed salad dressing in children. Children with a low intake of milk and cream, and a high intake of hardened vegetable fat, more likely had parents with lower education. Low butter intake was associated with low equivalent income only.

Conclusions

These findings may be helpful for future intervention programmes with more targeted policies aiming at an improvement of children's diets.

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.

Design of the Dutch Obesity Intervention in Teenagers (NRG-DOiT): systematic development, implementation and evaluation of a school-based intervention aimed at the prevention of excessive weight gain in adolescents

Background

Only limited data are available on the development, implementation, and evaluation processes of weight gain prevention programs in adolescents. To be able to learn from successes and failures of such interventions, integral written and published reports are needed.

Methods

Applying the Intervention Mapping (IM) protocol, this paper describes the development, implementation, and evaluation of the Dutch Obesity Intervention in Teenagers (DOiT), a school-based intervention program aimed at the prevention of excessive weight gain.

The intervention focussed on the following health behaviours: (1) reduction of the consumption of sugar-sweetened beverages, (2) reduction of energy intake derived from snacks, (3) decrease of levels of sedentary behaviour, and (4) increase of levels of physical activity (i.e. active transport behaviour and sports participation).

The intervention program consisted of an individual classroom-based component (i.e. an educational program, covering 11 lessons of both biology and physical education classes), and an environmental component (i.e. encouraging and supporting changes at the school canteens, as well as offering additional physical education classes).

We evaluated the effectiveness of the intervention program using a randomised controlled trial design. We assessed the effects of the intervention on body composition (primary outcome measure), as well as on behaviour, behavioural determinants, and aerobic fitness (secondary outcome measures). Furthermore, we conducted a process evaluation.

Discussion

The development of the DOiT-intervention resulted in a comprehensive school-based weight gain prevention program, tailored to the needs of Dutch adolescents from low socio-economic background.

School region socio-economic status and geographic locale is associated with food behaviour of Ontario and Alberta adolescents

BACKGROUND

In an attempt to elucidate broader determinants of adolescent dietary intake and habits, food intakes and selected food behaviours of grades 9 and 10 students from Ontario and Alberta were examined according to school region socio-economic status and urban/rural locale.

METHODS

Using a stratified random sample framework, 53 high schools from 28 school boards were recruited (45 public and 8 private; 33 urban and 20 rural). Median family income for Canada Post's forward sortation area of the school was used to define school region SES. Public and private schools were compared as a proxy measure of SES. A web-based survey of food intake and behaviours, including a 24-hour diet recall and food frequency questionnaire, was completed by 2,621 students in grades 9 and 10. Comparison of intakes and behaviours by school designation as urban/rural, public/private or regional SES (generalized linear model procedure) controlled for student gender and grade distribution and number of participants within schools.

RESULTS

School region SES ranged from dollars 40,959 to dollars 85,922/year. Vegetable and fruit consumption (p < 0.001), fibre intake (p < 0.001) and frequency of breakfast consumption (p < 0.01) increased with increasing income, while added sugar intake decreased (p < 0.01). Private versus public school students had lower intakes of sweetened drinks (p < 0.01) and higher intakes of fibre (p=0.02). Rural students reported higher mean intakes of calcium (1106 vs. 995 mg/day, respectively, p = 0.03) and milk products (2.7 vs. 2.3 servings/day, p < 0.01) than urban students.

CONCLUSION

Selected food behaviours of youth from Ontario and Alberta improve with increasing school SES and vary with rural/urban school locale. Identifying regional demographics may be useful in tailoring healthy eating programs to the specific school.