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Dolcini J, Ponzio E, D'Errico MM, Barbadoro P. Socioeconomic differences in dietary habits in Italy before and during COVID-19 pandemic: secondary analysis of a nationwide cross-sectional study. BMC Public Health 2024; 24:153. [PMID: 38200456 PMCID: PMC10782767 DOI: 10.1186/s12889-023-17530-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Several socioeconomic conditions may influence subjects' adherence to healthy eating habits. Food consumption may be influenced by external stress during crisis periods; however, the effects of these events on food habits are difficult to predict. Also, a pandemic crisis like the recent COVID-19 pandemic may have influenced dietary habits and food consumption. The objective of this study was to compare the dietary habits of Italian people before the COVID-19 pandemic with those belonging to the year 2020 in a nationwide population sample. MATERIALS AND METHODS Information on dietary habits has been obtained from the multi-purpose survey on families' "Aspects of daily life", carried out in Italy by the Italian National Statistics Institute (ISTAT). We analyzed data coming from 2016 and 2020 editions of the survey (43,000 subjects each year). We used population attributable fraction (PAF) adjusted for age, defined as the proportional reduction in unhealthy diet that would occur if all participants had had a higher education, assuming higher educated individuals as more socially advantaged. Prevalence association for each dietary exposition has been calculated through logistic regression. RESULTS Looking at aggregated data from 2016 and 2020 both men and women showed a high prevalence of unhealthy dietary habits. Regarding men, excessive consumption of eggs, pork meat, and bovine meat was characterized by a PAF attributable to socioeconomic conditions to an extent greater than 30%. Women showed the same trend. Focusing on different years of investigation, in 2020, during the COVID-19 pandemic, men and women increased their consumption of eggs, cooked fats, snacks, and sweets, and reduced consumption of fruits and vegetables. Additionally, women increased the assumption of dietary products and meat. Both sexes registered an increase in overweight and obese subjects in 2020. CONCLUSIONS To our knowledge, this study was the first in our country to use a yearly, nationwide sample to analyze dietary habits by examining specific types of various foods on a nationwide scale and establishing a correlation between these habits and the COVID-19 pandemic. Our results showed unbalanced dietary habits of the Italian population with an excess of consumption of several foods like eggs, cooked fats snacks, and sweets with low consumption of fruits and vegetables. Socioeconomic differences influence food choices but in a complex way since they seemed to affect some wrong dietary habits but not others, especially regarding fruits and vegetables assumption where differences were less evident among social classes. Outside stressors like a crisis period such as the COVID-19 pandemic seem to have an important role in both men and women regarding the assumption of so-called "junk food".
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Affiliation(s)
- Jacopo Dolcini
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, Ancona, Italy.
| | - Elisa Ponzio
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, Ancona, Italy
| | - Marcello Mario D'Errico
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, Ancona, Italy
| | - Pamela Barbadoro
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, Ancona, Italy
- Centre of Obesity, Marche Polytechnic University, Via Tronto 10a, Ancona, 60126, Italy
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2
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Rodriguez Roca B, Tully MA, Sansano-Nadal O, Caserotti P, Coll-Planas L, Roqué M, Brønd J, Blackburn NE, Wilson JJ, Rothenbacher D, McIntosh E, Deidda M, Andrade-Gómez E, Giné-Garriga M. Is education level, as a proxy for socio-economic position, related to device-measured and self-reported sedentary behavior in European older adults? A cross-sectional study from the SITLESS project. Front Public Health 2023; 11:1296821. [PMID: 38169596 PMCID: PMC10758416 DOI: 10.3389/fpubh.2023.1296821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
Background Sedentary behavior (SB) is a determinant of health in older adult people. Educational level is a primary driver of health disparities and is demonstrated to be a reliable measure of socioeconomic position. We aimed to examine the associations between educational level and self-reported along with device-measured SB in older adults living in Europe and the association of mentally active and passive SB domains with the educational level and gender in these associations. Methods The design is cross-sectional. One thousand three hundred and sixty participants aged 65 and over (75.3±6.3 years old, 61.8% women) participated. Inclusion criteria were scored with the Short Physical Performance Battery. Variables that describe the sample were assessed with an interview, and device-measured SB was assessed with an accelerometer. SB was assessed with the Sedentary Behavior Questionnaire and an accelerometer. Multiple linear regression models were used to study the association between the level of education and SB. Results Participants self-reported an average of 7.82 (SD: 3.02) daily waking hours of SB during weekend days, and the average of device-measured SB was 11.39 (1.23) h. Total mentally active SB (weekdays and weekends) was associated with the education level (p < 0.000). Participants were more sedentary during the week than during weekends, regardless of level of education (p < 0.000). Education level was significantly associated with self-reported mean hours per day in 46SB (p = 0.000; R=0.026; 95%CI). Conclusion Low education level in older adults is associated with self-reported SB but not with objective SB measures.
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Affiliation(s)
- Beatriz Rodriguez Roca
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Mark A. Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, United Kingdom
| | - Oriol Sansano-Nadal
- Department of Physical Activity and Sport Sciences, Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, Barcelona, Spain
- School of Health and Sport Sciences (EUSES), Rovira i Virgili University, Amposta, Spain
| | - Paolo Caserotti
- Department of Sports Science and Clinical Biomechanics, Center for Active and Healthy Ageing (CAHA), Syddansk Universitet, Odense, Denmark
| | - Laura Coll-Planas
- Fundació Salut I Envelliment (Foundation on Health and Ageing) – UAB, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Roqué
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jan Brønd
- Department of Sports Science and Clinical Biomechanics, Center for Active and Healthy Ageing (CAHA), Syddansk Universitet, Odense, Denmark
| | - Nicole E. Blackburn
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, United Kingdom
| | - Jason J. Wilson
- Sport and Exercise Sciences Research Institute, School of Sport, Ulster University, Newtownabbey, United Kingdom
| | | | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Glasgow, United Kingdom
| | - Manuela Deidda
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Glasgow, United Kingdom
| | - Elena Andrade-Gómez
- Department of Nursing, Faculty of Health Sciences, University of La Rioja, Logroño, Spain
| | - Maria Giné-Garriga
- Department of Physical Activity and Sport Sciences, Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, Barcelona, Spain
- Department of Physical Therapy, Faculty of Health Sciences (FCS) Blanquerna, Ramon Llull University, Barcelona, Spain
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3
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Abstract
Social determinants of health (SDoH) are reflected in how people live (access to health care, economic stability, built environment, food security, climate), learn (the educational environment), work (occupational environment), and play/socialize (social context and digital domain). All of these day-to-day conditions play a vital role in a patient's overall health, and a primary care provider should be prepared to understand their role to screen, assess, and address SDoH in clinical practice.
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Affiliation(s)
- Vincent Morelli
- Department of Family & Community Medicine, Meharry Medical College, 3rd Floor, Old Hospital Building, 1005 Dr. D. B. Todd, Jr., Boulevard, Nashville, TN 37208-3599, USA.
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4
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Graça J, Campos L, Guedes D, Roque L, Brazão V, Truninger M, Godinho C. How to enable healthier and more sustainable food practices in collective meal contexts: A scoping review. Appetite 2023; 187:106597. [PMID: 37178929 DOI: 10.1016/j.appet.2023.106597] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
Collective meal contexts such as restaurants, cafeterias and canteens can help accelerate transitions to healthier and more sustainable diets. However, evidence from intervention studies on these contexts lacks integration. This scoping review aimed to map determinants of dietary change in collective meal contexts across multiple settings, interventions, target groups, and target behaviors. The review provided two main outcomes: (i) identifying intervention components to promote dietary change in collective meal contexts, based on the existing body of evidence; and (ii) classifying and integrating these intervention components into an overarching framework of behavior change (i.e., COM-B system). The review encompassed twenty-eight databases via two indexing services and extracted information from 232 primary sources (27,458 records selected for title and abstract screening, 574 articles selected for full-text screening). We identified a total of 653 intervention activities, which were classified into intervention components and grouped under three broad themes, namely contextual and environmental changes, social influence, and knowledge and behavioral regulation. Multi-component interventions tended to report overall positive outcomes. The review proposes several directions for future research, including: (i) moving toward more theory-based interventions in collective meal contexts; (ii) providing more detailed information about intervention settings, implementation, target groups, activities, and materials; and (iii) improving the use of open science practices in the field. Furthermore, the review offers a free, original, open-access list and synthesis of 277 intervention studies in collective meal contexts, which can help intervention planners and evaluators optimize their efforts to promote healthier and more sustainable food practices in these contexts.
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Affiliation(s)
- João Graça
- University of Groningen, Groningen, the Netherlands; Instituto de Ciências Sociais da Universidade de Lisboa (ICS-ULisboa), Lisboa, Portugal.
| | - Lúcia Campos
- Instituto de Ciências Sociais da Universidade de Lisboa (ICS-ULisboa), Lisboa, Portugal; Iscte - Instituto Universitário de Lisboa, CIS_Iscte, Portugal
| | - David Guedes
- Instituto de Ciências Sociais da Universidade de Lisboa (ICS-ULisboa), Lisboa, Portugal; Iscte - Instituto Universitário de Lisboa, CIS_Iscte, Portugal
| | - Lisa Roque
- Iscte - Instituto Universitário de Lisboa, CIS_Iscte, Portugal
| | | | - Monica Truninger
- Instituto de Ciências Sociais da Universidade de Lisboa (ICS-ULisboa), Lisboa, Portugal
| | - Cristina Godinho
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
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5
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Burke DT, Bennett AE, Hynds P, Priyadarshini A. Identifying Novel Data-Driven Dietary Patterns via Dimensionality Reduction and Associations with Socioeconomic Profile and Health Outcomes in Ireland. Nutrients 2023; 15:3256. [PMID: 37513674 PMCID: PMC10385811 DOI: 10.3390/nu15143256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Dietary patterns and body mass index (BMI) play a significant role in the development of noncommunicable diseases (NCDs), which are the leading cause of mortality worldwide, including Ireland. A cross-sectional survey was conducted across Ireland to collate respondents' socioeconomic profiles, health status, and dietary patterns with a representative sample size of 957 adult respondents. Principal component analysis (PCA) and statistical analyses were subsequently employed. To the author's knowledge, this is the first study to use recent (2021) nationally representative data to characterise dietary patterns in Ireland via dimensionality reduction. Five distinct dietary patterns ("meat-focused", "dairy/ovo-focused", "vegetable-focused", "seafood-focused", and "potato-focused") were identified and statistically characterised. The "potato-focused" group exhibited the highest mean BMI (26.88 kg/m2), while the "vegetable-focused" group had the lowest (24.68 kg/m2). "Vegetable-focused" respondents were more likely to be associated with a categorically healthy BMI (OR = 1.90) and urban residency (OR = 2.03). Conversely, "meat-focused" respondents were more likely to have obesity (OR = 1.46) and rural residency (OR = 1.72) along with the "potato-focused" group (OR = 2.15). Results show that data-derived dietary patterns may better predict health outcomes than self-reported dietary patterns, and transitioning to diets focusing on vegetables, seafood, and lower meat consumption may improve health.
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Affiliation(s)
- Daniel T Burke
- Environmental Sustainability & Health Institute, Technological University Dublin, D07 EWV4 Dublin, Ireland
| | | | - Paul Hynds
- Environmental Sustainability & Health Institute, Technological University Dublin, D07 EWV4 Dublin, Ireland
| | - Anushree Priyadarshini
- Environmental Sustainability & Health Institute, Technological University Dublin, D07 EWV4 Dublin, Ireland
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6
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Baltacı P, Tanrıöver Ö, Yavuzer H, Erdinçler DS, Eyupoglu OE. Evaluation of diet quality and associated factors in geriatric outpatients: A cross-sectional study. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2023. [DOI: 10.3233/mnm-220112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND: In this study, our aim was to investigate the quality of dietary intake of elderly individuals and to identify the factors that may be associated with their diet quality. METHODS: This cross-sectional study was conducted with 198 elderly participants. Mini Nutritional Assessment (MNA) was used to evaluate nutritional status. The frequency of dietary intake was assessed using the Elderly Diet Index (EDI) score. RESULTS: The median age of study population was 76.0 years. The median EDI score was 27.0, moreover, only 27.3%of the study population had moderate or high diet quality. The results of the univariate analysis revealed that having an average or a poor appetite reduced the diet quality in the elderly which was statistically significantly (p = 0.010 and p = 0.019, respectively), and each point increase in the MNA score statistically significantly increased the chance of moderate/good diet quality by 1.16 times. CONCLUSIONS: The poor diet quality of the elderly was associated with their education, appetite, nutritional, and smoking status.
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Affiliation(s)
- Pelin Baltacı
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Kültür University, Istanbul, Turkey
| | - Özlem Tanrıöver
- Department of Family Medicine and Medical Education, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Hakan Yavuzer
- Division of Geriatrics, Department of Internal Medicine, Faculty of Cerrahpasa Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Deniz Suna Erdinçler
- Division of Geriatrics, Department of Internal Medicine, Faculty of Cerrahpasa Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozan Emre Eyupoglu
- Department of Biochemistry, School of Pharmacy, Istanbul Medipol University, Istanbul, Turkey
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7
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Romero I, Díez J, Del Cura I, Franco M, Gullón P. Diet Quality Changes by Educational Level among Adults in Spain from 2017 to 2021. Nutrients 2023; 15:nu15040858. [PMID: 36839216 PMCID: PMC9961002 DOI: 10.3390/nu15040858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Despite increasing attention on addressing socioeconomic disparities in diet quality, longitudinal studies are scarce. Furthermore, the effects of the COVID-19 pandemic on diet-related outcomes are yet to be fully understood. We examined changes in diet quality by educational level among adults in Madrid, Spain. We used data from recruitment (in 2017) and from 2021. At baseline, our sample included 1358 adults aged 40-75 years who were free of cardiovascular disease and completed a validated diet quality screener. Of them, 931 answered the survey in the follow-up visit in 2021. We used participants' diet quality index scores (range: 18-54; higher scores indicate better diet quality) as the dependent variable. As our independent variable, we assessed participants' educational levels (low, medium, and high). We fitted a multinomial regression using the categories of educational level as the main predictor, adjusting for age, sex, country of origin, and household composition. During the study period, 78.0% of participants sustained their diet quality, 11.6% improved it, and 10.4% moved away from a healthier dietary pattern. In descriptive analyses, we observed an increase in diet quality among less-educated females. Unadjusted multinomial models showed that a lower educational level predicted both increases and decreases in diet quality over the period. Even though the median diet quality scores did not change significantly, we observed heterogeneous changes over the four years. Variability within diet, with some improving and some worsening, seems to have increased among participants with lower educational levels. Future studies should look at the determinants of change in these population subgroups.
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Affiliation(s)
- Isabel Romero
- Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Aragón, Spain
| | - Julia Díez
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain
- Correspondence:
| | - Isabel Del Cura
- Primary Care Research Unit, Madrid Health Service, 28035 Madrid, Spain
- Department of Preventive Medicine and Public Health, Universidad Rey Juan Carlos, 28933 Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC) & Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Institute of Health Carlos III, 28029 Madrid, Spain
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, 17165 Stockholm, Sweden
| | - Manuel Franco
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Pedro Gullón
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain
- Center for Urban Research, RMIT University, Melbourne 3004, Australia
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8
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Salmela J, Kouvonen A, Mauramo E, Rahkonen O, Roos E, Lallukka T. Associations of childhood and adult socioeconomic circumstances with recommended food habits among young and midlife Finnish employees. BMC Nutr 2022; 8:65. [PMID: 35836295 PMCID: PMC9281257 DOI: 10.1186/s40795-022-00557-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/06/2022] [Indexed: 11/22/2022] Open
Abstract
Background Disadvantaged socioeconomic circumstances are associated with certain unhealthy food habits such as inadequate consumption of fruit and vegetables. This study examined whether multiple socioeconomic measures are consistently associated with a variety of food habits. Methods We examined associations of 2 childhood and 6 adult socioeconomic measures with 8 recommended food habits among 19–39-year-old employees of the City of Helsinki, Finland. The data were collected in 2017 via online and mailed surveys. Our sample consisted of 4621 employees (80% women). The analyses included adjusted binary logistic regression models. Results More advantaged socioeconomic circumstances were positively associated with the recommended consumption of vegetables, fruit or berries, dark bread, skimmed milk products, fish, and cooking oil, but not consistently with red or processed meat and fat spread. All socioeconomic measures were positively associated with having several (6–8) recommended food habits after gender and age adjustments. The strongest associations were found for participant’s education, occupational class, and current financial difficulties. These associations remained after adjustments of childhood and adult socioeconomic measures, although especially participant’s education attenuated the associations for occupational class. Conclusions The consistent associations between multiple childhood and adult socioeconomic measures and food habits found among employees highlight the need for improving food habits among people with disadvantaged socioeconomic circumstances in particular. Financial barriers together with social aspects of adhering to healthy diets should be considered in future dietary interventions and policy actions. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00557-0.
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Affiliation(s)
- Jatta Salmela
- Department of Public Health, University of Helsinki, PO Box 20 (Tukholmankatu 8 B), 00014, Helsinki, Finland.
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Elina Mauramo
- Department of Public Health, University of Helsinki, PO Box 20 (Tukholmankatu 8 B), 00014, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, PO Box 20 (Tukholmankatu 8 B), 00014, Helsinki, Finland
| | - Eva Roos
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.,Folkhälsan Research Center, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, PO Box 20 (Tukholmankatu 8 B), 00014, Helsinki, Finland
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9
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Tatoli R, Lampignano L, Donghia R, Castellana F, Zupo R, Bortone I, De Nucci S, Campanile G, Lofù D, Vimercati L, Lozupone M, De Pergola G, Panza F, Giannelli G, Di Noia T, Boeing H, Sardone R. Dietary Customs and Social Deprivation in an Aging Population From Southern Italy: A Machine Learning Approach. Front Nutr 2022; 9:811076. [PMID: 35340551 PMCID: PMC8942783 DOI: 10.3389/fnut.2022.811076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/10/2022] [Indexed: 12/20/2022] Open
Abstract
Background Diet and social determinants influence the state of human health. In older adults, the presence of social, physical and psychological barriers increases the probability of deprivation. This study investigated the relationship between social deprivation and eating habits in non-institutionalized older adults from Southern Italy, and identified foods and dietary habits associated with social deprivation. Methods We recruited 1,002 subjects, mean age 74 years, from the large population based Salus in Apulia Study. In this cross-sectional study, eating habits and the level of deprivation were assessed with FFQ and DiPCare-Q, respectively. Results Deprived subjects (n = 441) included slightly more females, who were slightly older and with a lower level of education. They consumed less fish (23 vs. 26 g), fruiting vegetables (87 vs. 102 g), nuts (6 vs. 9 g) and less “ready to eat” dishes (29 vs. 33 g). A Random Forest (RF) model was used to identify a dietary pattern associated with social deprivation. This pattern included an increased consumption of low-fat dairy products and white meat, and a decreased consumption of wine, leafy vegetables, seafood/shellfish, processed meat, red meat, dairy products, and eggs. Conclusion The present study showed that social factors also define diet and eating habits. Subjects with higher levels of deprivation consume cheaper and more readily available food.
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Affiliation(s)
- Rossella Tatoli
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Luisa Lampignano
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Rossella Donghia
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Fabio Castellana
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Roberta Zupo
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Ilaria Bortone
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Sara De Nucci
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Giuseppe Campanile
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Domenico Lofù
- Department of Electrical and Information Engineering, Polytechnic of Bari, Bari, Italy
| | - Luigi Vimercati
- Interdisciplinary Department of Medicine, Section of Occupational Medicine B. Ramazzini, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Madia Lozupone
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giovanni De Pergola
- Unit of Internal Medicine and Geriatrics, National Institute of Gastroenterology "S. de Bellis" Research Hospital, Castellana Grotte, Italy.,Department of Biomedical Science and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Panza
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Gianluigi Giannelli
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
| | - Tommaso Di Noia
- Department of Electrical and Information Engineering, Polytechnic of Bari, Bari, Italy
| | - Heiner Boeing
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy.,Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Rodolfo Sardone
- Unit of Digital Health and Health Technology Assessment for "Salus in Apulia Study," National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy
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10
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Mendonça N, Gregório MJ, Salvador C, Henriques AR, Canhão H, Rodrigues AM. Low Adherence to the Mediterranean Diet Is Associated with Poor Socioeconomic Status and Younger Age: A Cross-Sectional Analysis of the EpiDoC Cohort. Nutrients 2022; 14:nu14061239. [PMID: 35334895 PMCID: PMC8954252 DOI: 10.3390/nu14061239] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 01/10/2023] Open
Abstract
The Mediterranean diet (MD) is recognized as one of the healthiest dietary patterns as it has been consistently associated with several beneficial health outcomes. Adherence to the MD pattern has been decreasing in southern European countries for the last decades, especially among low socioeconomic groups. The aim of this study was to assess the adherence to the MD in Portugal, to evaluate regional differences, and explore associated factors (sociodemographic, economic, and lifestyles behaviors). This study used the third data collection wave of the Epidemiology of Chronic Diseases Cohort Study (EpiDoC 3). MD adherence was assessed using the Portuguese-validated MD adherence score (MEDAS) questionnaire. Non-adjusted and adjusted logistic regression models were used to assess the risk factors for low MD adherence and individual MEDAS items. In this cross-sectional evaluation of the EpiDoC 3 cohort study (n = 5647), 28.8% of the Portuguese population had low adherence to a MD. Azores and Madeira had lower adherence to the MD than the rest of the country. Younger individuals in lower income categories (e.g., ORfinding it very difficult = 1.48; 95% CI 1.16-1.91) and with a lower educational level (e.g., OR0-4 years = 2.63; 95% CI 2.09-3.32) had higher odds of having a lower adherence to the MD. Portuguese adults have a high prevalence of low adherence to the MD, especially among those who are younger and have lower socioeconomic status. Public health policies to promote adherence to the MD should pay special attention to these groups.
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Affiliation(s)
- Nuno Mendonça
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1099-085 Lisboa, Portugal; (N.M.); (M.J.G.); (C.S.); (A.R.H.); (H.C.)
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1150-082 Lisboa, Portugal
| | - Maria João Gregório
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1099-085 Lisboa, Portugal; (N.M.); (M.J.G.); (C.S.); (A.R.H.); (H.C.)
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1150-082 Lisboa, Portugal
- EpiSaúde Sociedade Científica, 7005-837 Évora, Portugal
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, 4200-465 Porto, Portugal
- Programa Nacional para a Promoção da Alimentação Saudável, Direção-Geral da Saúde, 1049-005 Lisboa, Portugal
| | - Clara Salvador
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1099-085 Lisboa, Portugal; (N.M.); (M.J.G.); (C.S.); (A.R.H.); (H.C.)
- Programa Nacional para a Promoção da Alimentação Saudável, Direção-Geral da Saúde, 1049-005 Lisboa, Portugal
| | - Ana Rita Henriques
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1099-085 Lisboa, Portugal; (N.M.); (M.J.G.); (C.S.); (A.R.H.); (H.C.)
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1150-082 Lisboa, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1099-085 Lisboa, Portugal; (N.M.); (M.J.G.); (C.S.); (A.R.H.); (H.C.)
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1150-082 Lisboa, Portugal
- EpiSaúde Sociedade Científica, 7005-837 Évora, Portugal
| | - Ana M. Rodrigues
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1099-085 Lisboa, Portugal; (N.M.); (M.J.G.); (C.S.); (A.R.H.); (H.C.)
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1150-082 Lisboa, Portugal
- EpiSaúde Sociedade Científica, 7005-837 Évora, Portugal
- Rheumatology Unit, Hospital dos Lusíadas, 1500-458 Lisboa, Portugal
- Correspondence: ; Tel.: +351-218803000
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Hohneck A, Custodis F, Rosenkaimer S, Hofheinz R, Maier S, Akin I, Borggrefe M, Gerhards S. Gender aspects in cardiooncology. Eur J Public Health 2021; 31:1170-1176. [PMID: 34516614 DOI: 10.1093/eurpub/ckab146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cardiooncology is a relatively new subspeciality, investigating the side effects of cytoreductive therapies on the cardiovascular (CV) system. Gender differences are well known in oncological and CV diseases, but are less elucidated in cardiooncological collectives. METHODS Five hundred and fifty-one patients (278 male, 273 female) with diagnosed cancer who underwent regular cardiological surveillance were enrolled in the 'MAnnheim Registry for CardioOncology' and followed over a median of 41 (95% confidence interval: 40-43) months. RESULTS Female patients were younger at the time of first cancer diagnosis [median 60 (range 50-70) vs. 66 (55-75), P = 0.0004], while the most common tumour was breast cancer (49.8%). Hyperlipidaemia was more often present in female patients (37% vs. 25%, P = 0.001). Male patients had a higher cancer susceptibility than female patients. They suffered more often from hypertension (51% vs. 67%, P = 0.0002) or diabetes (14% vs. 21%, P = 0.02) and revealed more often vitamin D deficiency [(U/l) median 26.0 (range 17-38) vs. 16 (9-25), P = 0.002] and anaemia [(g/dl) median 11.8 (range 10.4-12.9) vs. 11.7 (9.6-13.6), P = 0.51]. During follow-up, 140 patients died (male 77, female 63; P = 0.21). An increased mortality rate was observed in male patients (11.4% vs. 14%, P = 0.89), with even higher mortality rates of up to 18.9% vs. 7.7% (P = 0.02) considering tumours that can affect both sexes compared. CONCLUSIONS Although female patients were younger at the time of first cancer diagnosis, male patients had both higher cancer susceptibility and an increased mortality risk. Concomitant CV diseases were more common in male patients.
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Affiliation(s)
- Anna Hohneck
- First Department of Medicine (Cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Florian Custodis
- Second Department of Medicine, Klinikum Saarbruecken, Saarbruecken, Germany
| | - Stephanie Rosenkaimer
- First Department of Medicine (Cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), Mannheim, Germany
| | - Ralf Hofheinz
- Third Department of Medicine (Oncology), Day Treatment Center (TTZ), Interdisciplinary Tumor Center Mannheim (ITM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sandra Maier
- First Department of Medicine (Cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine (Cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine (Cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Stefan Gerhards
- First Department of Medicine (Cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), Mannheim, Germany
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Lo Siou G, Akawung AK, Solbak NM, McDonald KL, Al Rajabi A, Whelan HK, Kirkpatrick SI. The effect of different methods to identify, and scenarios used to address energy intake misestimation on dietary patterns derived by cluster analysis. Nutr J 2021; 20:42. [PMID: 33964947 PMCID: PMC8106845 DOI: 10.1186/s12937-021-00696-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background All self-reported dietary intake data are characterized by measurement error, and validation studies indicate that the estimation of energy intake (EI) is particularly affected. Methods Using self-reported food frequency and physical activity data from Alberta’s Tomorrow Project participants (n = 9847 men 16,241 women), we compared the revised-Goldberg and the predicted total energy expenditure methods in their ability to identify misreporters of EI. We also compared dietary patterns derived by k-means clustering under different scenarios where misreporters are included in the cluster analysis (Inclusion); excluded prior to completing the cluster analysis (ExBefore); excluded after completing the cluster analysis (ExAfter); and finally, excluded before the cluster analysis but added to the ExBefore cluster solution using the nearest neighbor method (InclusionNN). Results The predicted total energy expenditure method identified a significantly higher proportion of participants as EI misreporters compared to the revised-Goldberg method (50% vs. 47%, p < 0.0001). k-means cluster analysis identified 3 dietary patterns: Healthy, Meats/Pizza and Sweets/Dairy. Among both men and women, participants assigned to dietary patterns changed substantially between ExBefore and ExAfter and also between the Inclusion and InclusionNN scenarios (Hubert and Arabie’s adjusted Rand Index, Kappa and Cramer’s V statistics < 0.8). Conclusions Different scenarios used to account for EI misreporters influenced cluster analysis and hence the composition of the dietary patterns. Continued efforts are needed to explore and validate methods and their ability to identify and mitigate the impact of EI misestimation in nutritional epidemiology. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-021-00696-3.
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Affiliation(s)
- Geraldine Lo Siou
- Cancer Research & Analytics, Alberta Health Services, Richmond Road Diagnostic & Treatment Centre, 1820 Richmond Rd SW, Calgary, Alberta, T2T 5C7, Canada
| | - Alianu K Akawung
- Cancer Research & Analytics, Alberta Health Services, Richmond Road Diagnostic & Treatment Centre, 1820 Richmond Rd SW, Calgary, Alberta, T2T 5C7, Canada
| | - Nathan M Solbak
- Cancer Research & Analytics, Alberta Health Services, Richmond Road Diagnostic & Treatment Centre, 1820 Richmond Rd SW, Calgary, Alberta, T2T 5C7, Canada
| | - Kathryn L McDonald
- Cancer Research & Analytics, Alberta Health Services, Richmond Road Diagnostic & Treatment Centre, 1820 Richmond Rd SW, Calgary, Alberta, T2T 5C7, Canada.
| | - Ala Al Rajabi
- Cancer Research & Analytics, Alberta Health Services, Richmond Road Diagnostic & Treatment Centre, 1820 Richmond Rd SW, Calgary, Alberta, T2T 5C7, Canada.,Health Sciences Department, College of Natural and Health Sciences, Zayed University, Abu Dhabi, UAE
| | - Heather K Whelan
- Department of Health and Physical Education, Faculty of Health, Community and Education, Mount Royal University, Calgary, AB, Canada
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Velhinho A, Perelman J. Socioeconomic Inequalities in Food Consumption: A Cross-Sectional Study in Portuguese Adults. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2021. [DOI: 10.1159/000515937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Food is a major determinant of chronic noncommunicable diseases. Because of this, social inequalities in food consumption will likely produce social inequalities in disease and life expectancy. <b><i>Objectives:</i></b> This study analyses the social inequalities in food consumption in Portugal and whether they differ between men and women and between younger and older people. <b><i>Methods:</i></b> Following a cross-sectional observational study, we analyzed data from 11,085 individuals aged 25–64 years who participated in the 2014 National Health Interview Survey (NHIS). Logistic regression models were used to measure the association between socioeconomic conditions, i.e., education and income, and food consumption. The analysis was then stratified by sex and age. <b><i>Results:</i></b> A positive gradient for income and education was observed in the consumption of fish, cakes, natural juices, and dairy products. The consumption of legumes and soft drinks was inversely related to income and education. A socioeconomic gradient for fruits and vegetables was observed only among women and older people. Worse-off people consumed less soup, and underprivileged women consumed fewer fast-food products. <b><i>Conclusion:</i></b> The food consumption patterns of Portuguese adults are related to their socioeconomic condition, with few variations across demographic categories.
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Diet Quality Indices in the SUN Cohort: Observed Changes and Predictors of Changes in Scores Over a 10-Year Period. J Acad Nutr Diet 2021; 121:1948-1960.e7. [PMID: 33906824 DOI: 10.1016/j.jand.2021.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dietary quality indices (DQI) are widely used in nutritional epidemiology. However, how they might change over time in a Mediterranean population is not well understood. OBJECTIVE To evaluate within-participant longitudinal changes in scores for nine a priori-defined DQIs: Fat Quality Index (FQI), Carbohydrate Quality Index (CQI), Pro-vegetarian Dietary Pattern (PVG), Mediterranean Diet Adherence Screener (MEDAS), Mediterranean Diet Score (MDS), Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND), Prime Diet Quality Score (PDQS) and Alternate Healthy Eating Index (AHEI-2010) in the "Seguimiento Universidad de Navarra" (SUN) cohort, a well-known Mediterranean cohort of university graduates, and to identify baseline predictors of improvement in MEDAS and AHEI-2010 after 10 years of follow-up. DESIGN In this longitudinal cohort study, DQI scores were calculated based on responses from a validated semiquantitative food-frequency questionnaire (FFQ). PARTICIPANTS/SETTING Spanish university graduates enrolled in the SUN cohort before March 2008, who completed the 10-year FFQ and reported total dietary intake at baseline and after 10 years of follow-up, included 2,244 men and 3,271 women, whose mean age at baseline was 36.3 years (standard deviation [SD], 10.7). MAIN OUTCOME MEASURES Main outcome measures were within-participant longitudinal changes for FQI, CQI, PVG, MEDAS, MDS, DASH, MIND, PDQS, and AHEI-2010. STATISTICAL ANALYSES PERFORMED Adjusted logistic regression models were used to evaluate within-participant longitudinal changes and to identify baseline predictors of improvements ≥10% in MEDAS and AHEI-2010 scores after 10 years of follow-up. RESULTS The comparison of the nine scores of DQI calculated at baseline and after 10 years of follow-up showed an improvement in all DQI scores except for PDQS. The greatest changes in DQIs were found for MEDAS (from 6.2 to 7.2, +22.9%) and MDS (from 4.3 to 4.4, +15.4%). The strongest predictors at baseline for ≥10% improvements in MEDAS or AHEI-2010 scores varied across indices. Being female, ≥35 years old, and more physically active at baseline were associated with improvement, whereas snacking between meals was associated with <10% improvements in both indices. CONCLUSIONS In this cohort, the changes in nine a priori-defined DQI scores suggested modest improvements in diet quality, in which MEDAS and MDS scores showed the largest improvements. Additional longitudinal studies, especially intervention trials with long follow-up, are warranted to establish the most appropriate DQIs to assess long-term changes in diet quality in adult populations.
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Power M, Pybus KJ, Pickett KE, Doherty B. "The reality is that on Universal Credit I cannot provide the recommended amount of fresh fruit and vegetables per day for my children": Moving from a behavioural to a systemic understanding of food practices [version 1; peer review: 2 approved]. EMERALD OPEN RESEARCH 2021; 3:3. [PMID: 36034185 PMCID: PMC7613434 DOI: 10.35241/emeraldopenres.14062.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Evidence suggests that people living in poverty often experience inadequate nutrition with short and long-term health consequences. Whilst the diets of low-income households have been subject to scrutiny, there is limited evidence in the UK on the diet quality and food practices of households reporting food insecurity and food bank use. We explore lived experiences of food insecurity and underlying drivers of diet quality among low-income families, drawing upon two years of participatory research with families of primary school age children. METHODS We report on a mixed-methods study of the relationship between low income, food bank use, food practices and consumption from a survey of 612 participants, including 136 free text responses and four focus groups with 22 participants. The research followed a parallel mixed-methods design: qualitative and quantitative data were collected separately, although both were informed by participatory work. Quantitative data were analysed using binary and multinomial logistic regression modelling; qualitative data were analysed thematically. RESULTS Lower income households and those living with food insecurity struggle to afford a level of fruit and vegetable consumption that approaches public health guidance for maintaining a healthy diet, despite high awareness of the constituents of a healthy diet. Participants used multiple strategies to ensure as much fruit, vegetable and protein consumption as possible within financial constraints. The quantitative data suggested a relationship between higher processed food consumption and having used a food bank, independent of income and food security status. CONCLUSIONS The findings suggest that individualised, behavioural accounts of food practices on a low-income misrepresent the reality for people living with poverty. Behavioural or educational interventions are therefore likely to be less effective in tackling food insecurity and poor nutrition among people on a low income; policies focusing on structural drivers, including poverty and geographical access to food, are needed.
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Affiliation(s)
- Maddy Power
- Health Sciences, University of York, York, UK
| | | | | | - Bob Doherty
- The York Management School, University of York, York, UK
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16
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Berger E, Maitre N, Romana Mancini F, Baglietto L, Perduca V, Colineaux H, Sieri S, Panico S, Sacerdote C, Tumino R, Vineis P, Boutron-Ruault MC, Severi G, Castagné R, Delpierre C. The impact of lifecourse socio-economic position and individual social mobility on breast cancer risk. BMC Cancer 2020; 20:1138. [PMID: 33228587 PMCID: PMC7684912 DOI: 10.1186/s12885-020-07648-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/17/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Women with an advantaged socioeconomic position (SEP) have a higher risk of developing breast cancer (BC). The reasons for this association do not seem to be limited to reproductive factors and remain to be understood. We aimed to investigate the impact of lifecourse SEP from childhood and social mobility on the risk of BC considering a broad set of potential mediators. METHODS We used a discovery-replication strategy in two European prospective cohorts, E3N (N = 83,436) and EPIC-Italy (N = 20,530). In E3N, 7877 women were diagnosed with BC during a median 24.4 years of follow-up, while in EPIC-Italy, 893 BC cases were diagnosed within 15.1 years. Hazard ratios (HR) were estimated using Cox proportional hazard models on imputed data. RESULTS In E3N, women with higher education had a higher risk of BC (HR [95%CI] = 1.21 [1.12, 1.30]). This association was attenuated by adjusting for reproductive factors, in particular age at first childbirth (HR[95%CI] = 1.13 [1.04, 1.22]). Health behaviours, anthropometric variables, and BC screening had a weaker effect on the association. Women who remained in a stable advantaged SEP had a higher risk of BC (HR [95%CI] = 1.24 [1.07; 1.43]) attenuated after adjustment for potential mediators (HR [95%CI] = 1.13 [0.98; 1.31]). These results were replicated in EPIC-Italy. CONCLUSIONS These results confirm the important role of reproductive factors in the social gradient in BC risk, which does not appear to be fully explained by the large set of potential mediators, including cancer screening, suggesting that further research is needed to identify additional mechanisms.
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Affiliation(s)
- Eloïse Berger
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France.
| | - Noële Maitre
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Francesca Romana Mancini
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Laura Baglietto
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Vittorio Perduca
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
- Université de Paris, CNRS, MAP5 UMR 8145, F-75006, Paris, France
| | - Hélène Colineaux
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
- Epidemiology Department, Toulouse Teaching Hospital, Toulouse, France
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provicial Health Authority (ASP) Ragusa, Ragusa, Italy
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, Imperial College London, MRC-PHE Centre for Environment and Health, School of Public Health, London, UK
- Italian Institute for Genomic Medicine, Torino, Italy
| | - Marie-Christine Boutron-Ruault
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Gianluca Severi
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
- Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Florence, Italy
| | - Raphaële Castagné
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Cyrille Delpierre
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
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Plagg B, Zerbe S. How does the environment affect human ageing? An interdisciplinary review. JOURNAL OF GERONTOLOGY AND GERIATRICS 2020. [DOI: 10.36150/2499-6564-420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Romeiro ACT, Curioni CC, Bezerra FF, Faerstein E. Sociodemographic determinants of food consumption pattern: Pró-Saúde Study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200090. [PMID: 32725090 DOI: 10.1590/1980-549720200090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/25/2019] [Indexed: 02/07/2023] Open
Abstract
AIMS To identify dietary patterns (DP) and to investigate their association with sociodemographic aspects. METHODOLOGY A cross-sectional data analysis of a sub-sample from Phase 4 of the Pró-Saúde Longitudinal Study (2012-2013), constituting a total of 520 participants. DP were obtained by principal component analysis from a food frequency questionnaire. Association between DP and sociodemographic aspects was analyzed by adjusted logistic regression. RESULTS Four DP were identified: processed and ultraprocessed products; fresh food; meats and alcoholic beverages; and traditional Brazilian foods. There was a greater adherence chance to "processed and ultraprocessed products" pattern among adults ≥ 55 years and lower chance among men. The probability of adherence to "fresh food" pattern was directly associated to men, subjects with a high educational level and inversely associated to adults aged ≥ 60 years. There was a lower chance of "meats and alcoholic beverages" pattern among men and increased chance of adherence to "traditional Brazilian foods" pattern among whites, subjects with ≥ 60 years and low schooling. CONCLUSION Sociodemographic factors were important determinants of DP, especially gender, schooling and age. Presence of a DP composed of processed and ultraprocessed products indicates the need for awareness strategies and supply limitation in this population, since it affects their health.
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Affiliation(s)
- Ariane Cristina Thoaldo Romeiro
- Programa de Pós-Graduação em Alimentação, Nutrição e Saúde, Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Cintia Chaves Curioni
- Programa de Pós-Graduação em Alimentação, Nutrição e Saúde, Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Flávia Fiorucci Bezerra
- Programa de Pós-Graduação em Alimentação, Nutrição e Saúde, Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Eduardo Faerstein
- Programa de Pós-Graduação em Saúde Coletiva, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Baumhofer NK, Panapasa SV, Francis Cook E, Roberto CA, Williams DR. Sociodemographic factors influencing island foods consumption in the Pacific Islander Health Study. ETHNICITY & HEALTH 2020; 25:305-321. [PMID: 29284279 DOI: 10.1080/13557858.2017.1418300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/06/2017] [Indexed: 06/07/2023]
Abstract
Objectives: Pacific Islander Americans are a small, but quickly growing population that experiences alarming disparities in obesity and obesity-related chronic illnesses influenced by dietary patterns. This population also has a unique culinary heritage including traditional foods and more contemporary imports such as tinned meats and refined carbohydrates. This analysis is a novel attempt to understand the sociodemographic factors influencing island foods consumption.Design: A sample of 240 Samoan and Tongan adults in California from the Pacific Islander Health Study was used. Following univariate and bivariate analyses, a series of four multivariable regression models were created to predict past week frequency of island foods consumption after sequential adjustment for demographic, socioeconomic, and cultural covariates.Results: Participants reported consuming island foods an average of 2.93 times in the previous week, with the largest proportion of participants (20.42%) reporting eating island foods 6 or more times. Age and Samoan ethnicity were initially significant, positive predictors of island foods consumption, but their effect was attenuated after addition of cultural covariates. With the third model that adjusted for birthplace, financial insecurity and Tongan birthplace were positive predictors. Both lost significance in the fourth and final model upon addition of cultural affinity, which was positively associated with island foods.Conclusion: Understanding how sociodemographic factors are associated with island foods consumption is a first step in understanding the broad way in which an ethnically specific dietary pattern may be associated with obesity-related chronic illness risk among Pacific Islander Americans.
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Affiliation(s)
- N Kau'i Baumhofer
- Department of Native Hawaiian Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI, USA
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sela V Panapasa
- Institute for Social Research, University of Michigan, 5068 Institute for Social Research, Ann Arbor, MI, USA
| | - E Francis Cook
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David R Williams
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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20
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Strategies to Address Misestimation of Energy Intake Based on Self-Report Dietary Consumption in Examining Associations Between Dietary Patterns and Cancer Risk. Nutrients 2019; 11:nu11112614. [PMID: 31683814 PMCID: PMC6893710 DOI: 10.3390/nu11112614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to determine the influence of strategies of handling misestimation of energy intake (EI) on observed associations between dietary patterns and cancer risk. Data from Alberta's Tomorrow Project participants (n = 9,847 men and 16,241 women) were linked to the Alberta Cancer Registry. The revised-Goldberg method was used to characterize EI misestimation. Four strategies assessed the influence of EI misestimation: Retaining individuals with EI misestimation in the cluster analysis (Inclusion), excluding before (ExBefore) or after cluster analysis (ExAfter), or reassigning into ExBefore clusters using the nearest neighbor method (InclusionNN). Misestimation of EI affected approximately 50% of participants. Cluster analysis identified three patterns: Healthy, Meats/Pizza and Sweets/Dairy. Cox proportional hazard regression models assessed associations between the risk of cancer and dietary patterns. Among men, no significant associations (based on an often-used threshold of p < 0.05) between dietary patterns and cancer risk were observed. In women, significant associations were observed between the Sweets/Dairy and Meats/Pizza patterns and all cancer risk in the ExBefore (HR (95% CI): 1.28 (1.04-1.58)) and InclusionNN (HR (95% CI): 1.14 (1.00-1.30)), respectively. Thus, strategies to address misestimation of EI can influence associations between dietary patterns and disease outcomes. Identifying optimal approaches for addressing EI misestimation, for example, by leveraging biomarker-based studies could improve our ability to characterize diet-disease associations.
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21
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The Association of Unhealthy Diet with Socioeconomic Inequality in Children: A Study in Kurdistan, West of Iran. HEALTH SCOPE 2019. [DOI: 10.5812/jhealthscope.58336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Fu R, Noguchi H, Kaneko S, Kawamura A, Kang C, Takahashi H, Tamiya N. How do cardiovascular diseases harm labor force participation? Evidence of nationally representative survey data from Japan, a super-aged society. PLoS One 2019; 14:e0219149. [PMID: 31276516 PMCID: PMC6611572 DOI: 10.1371/journal.pone.0219149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/17/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate how cardiovascular diseases harm labor force participation (LFP) among the Japanese population and verify the validity of plasma biomarkers as instrumental variables of cardiovascular diseases after adjusting for a broad set of confounders including dietary intake. DESIGN Using nationally representative repeated cross-sectional surveys in Japan, the Comprehensive Survey of Living Conditions and National Health and Nutrition Survey, with plasma biomarkers as instrumental variables for quasi-randomization. SETTING Onset of cardiovascular diseases in those receiving regular treatment for hypertension, intracerebral hemorrhage, intracerebral infarction, angina pectoris, myocardial infarction, or other types of cardiovascular diseases. PARTICIPANTS A total of 65,615 persons aged ≥ 20 years (35,037 women and 30,578 men) who completed a survey conducted every three years from 1995 through 2013. MAIN OUTCOME MEASURES Respondent employment and weekly working hours during each survey year. RESULTS Cardiovascular diseases significantly and remarkably reduced the probability of working by 15.4% (95% CI: -30.6% to -0.2%). The reduction in working probability was detected for women only. Respondents aged ≥ 40 years were less likely to work once diagnosed and the reduction was enlarged for those aged ≥ 65 years, while those aged < 40 years appeared to be unaffected. Probability of engaging in manual labor significantly decreased once diagnosed; however, no impact was found for cognitive occupations. Among employed respondents, the adverse effects of cardiovascular diseases decreased working hours by five hours per week. Validity of the biomarker instrumental variables was generally verified. CONCLUSIONS A vicious circle is suggested between LFP and unfavorable health. However, the effects vary across age, sex, and occupation type, even after adjusting for causal effects, which could cause a downward bias in LFP impact. ATTRIBUTES cardiovascular disease, labor force participation, instrumental variable method as quasi-randomization, plasma biomarker, Comprehensive Survey of Living Conditions, National Health and Nutrition Survey.
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Affiliation(s)
- Rong Fu
- Waseda University, Faculty of Political Science and Economics, Tokyo, Japan
| | - Haruko Noguchi
- Waseda University, Faculty of Political Science and Economics, Tokyo, Japan
| | - Shuhei Kaneko
- Waseda University, Faculty of Political Science and Economics, Tokyo, Japan
| | - Akira Kawamura
- Waseda University, Faculty of Political Science and Economics, Tokyo, Japan
| | - Cheolmin Kang
- Waseda University, Faculty of Political Science and Economics, Tokyo, Japan
| | | | - Nanako Tamiya
- Health Services Research & Development Center, University of Tsukuba, Tsukuba, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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23
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Mouodi S, Hosseini SR, Graham Cumming R, Bijani A, Esmaeili H, Ghadimi R. Physiological risk factors for cardiovascular disease in middle-aged (40-60 year) adults and their association with dietary intake, Northern Iran. CASPIAN JOURNAL OF INTERNAL MEDICINE 2019; 10:55-64. [PMID: 30858942 PMCID: PMC6386329 DOI: 10.22088/cjim.10.1.55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Considering the importance of healthy diet in the protection of cardiovascular diseases (CVD), this research aimed to assess the physiological risk factors for CVD in middle-aged adults and their association with dietary intake in the north of Iran. Methods In this cross-sectional study conducted in the years 2016-2017 among the adults aged 40-60 years living in Amirkola, Babol, the participants´ physical activity, dietary intake, body mass index, fat mass, blood pressure, fasting blood glucose and serum lipid profile were reported. The International Physical Activity Questionnaire was used to assess physical activity and a structured 24-hour food-recall questionnaire was used to assess the participants´ dietary intake. Consumed foods and beverages on two separate days were analyzed and transcribed in 10 food groups (gram). Results Two hundred and ninety-one persons (96.7%) had complete participation, 96.2% with at least one CVD risk factor and 75.9% had overweight or obesity; 33% with hypertension; 6.2% had high fasting blood glucose; 64.6% with hypercholesterolemia, 47.8% had hypertriglyceridemia, and 8.9% with low HDL. Mean daily intake values of carbohydrate, protein and fat were all higher than dietary reference intakes for adults. Physical activity less than 1500 MET-minutes per week was significantly associated with having three or more physiological risk factors for CVD [adjusted odds ratio: 2.04 (1.08-3.85)] (P=0.029). Conclusion Most of the middle-aged adults in this region had at least one of the physiological risk factors for CVD and daily intakes of carbohydrate and protein were higher than dietary reference intakes (DRIs) for adults.
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Affiliation(s)
- Simin Mouodi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Seyed Reza Hosseini
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Ali Bijani
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Haleh Esmaeili
- Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Reza Ghadimi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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24
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Multi-cohort study identifies social determinants of systemic inflammation over the life course. Nat Commun 2019; 10:773. [PMID: 30770820 PMCID: PMC6377676 DOI: 10.1038/s41467-019-08732-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 01/28/2019] [Indexed: 12/17/2022] Open
Abstract
Chronic inflammation has been proposed as having a prominent role in the construction of social inequalities in health. Disentangling the effects of early life and adulthood social disadvantage on inflammation is key in elucidating biological mechanisms underlying socioeconomic disparities. Here we explore the relationship between socioeconomic position (SEP) across the life course and inflammation (as measured by CRP levels) in up to 23,008 participants from six European cohort studies from three countries conducted between 1958 and 2013. We find a consistent inverse association between SEP and CRP across cohorts, where participants with a less advantaged SEP have higher levels of inflammation. Educational attainment is most strongly related to inflammation, after adjusting for health behaviours, body mass index and later-in-life SEP. These findings suggest socioeconomic disadvantage in young adulthood is independently associated with later life inflammation calling for further studies of the pathways operating through educational processes. Here, the authors explore the relationship between socioeconomic position (SEP) across the life course and inflammation in a multi-cohort study and show that educational attainment is most strongly related to inflammation, suggesting that socioeconomic disadvantage in young adulthood is independently associated with later life inflammation.
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25
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Wang Q, Shen JJ, Frakes K. Limited contribution of health behaviours to expanding income-related chronic disease disparities based on a nationwide cross-sectional study in China. Sci Rep 2018; 8:12485. [PMID: 30131504 PMCID: PMC6104030 DOI: 10.1038/s41598-018-30256-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/26/2018] [Indexed: 11/08/2022] Open
Abstract
This study estimated the association of income and prevalence of cardiovascular diseases (CVD) and hypertension, and then quantified the contribution of health behaviors to the association in China. Using the 2013 survey of the China Health and Retirement Longitudinal Study (CHARLS), a logit model was applied to examine income-related health disparities in relation to CVD and hypertension. A four-step regression method was then constructed to measure the role of health behaviors in income-related health disparities. Using indirect effects, mediation by health behaviors was examined. Income-related health disparities in chronic diseases were found to exist in China. Specifically, individuals in the high-income group had a 14% (OR = 0.86; 95% CI 0.73-1.02) and 14% (OR = 0.86; 95% CI 0.76-0.97) lower odds of suffering from CVD and hypertension than those in the low-income group. However, limited evidence shows this association was mediated by health behaviors. The Heaviness of Smoking Index (HSI), heavy drinking, irregular eating, and nap time did not significantly mediate the association of income and prevalence of CVD and hypertension. To curb the rising prevalence of CVD and hypertension in China, policies should focus on the low-income subpopulation. However, healthy behaviors interventions targeting smoking, heavy drinking, unhealthy napping and irregular eating habits among low-income people may be ineffective in reduction of income-related disparities in prevalence of CVD and hypertension.
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Affiliation(s)
- Qing Wang
- School of business, Dalian University of Technology, Panjin, 124221, Liaoning, China.
- School of public health, Shandong University, Jinan, 250100, shandong, China.
| | - Jay J Shen
- Department of Health Care Administration and Policy, School of Community Health Sciences, University of Nevada Las Vegas, 4505 Maryland Parkway, Las Vegas, NV, 89154-3023, USA
| | - Kaitlyn Frakes
- Department of Health Care Administration and Policy, School of Community Health Sciences, University of Nevada Las Vegas, 4505 Maryland Parkway, Las Vegas, NV, 89154-3023, USA
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26
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Biesbroek S, Kneepkens MC, van den Berg SW, Fransen HP, Beulens JW, Peeters PHM, Boer JMA. Dietary patterns within educational groups and their association with CHD and stroke in the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort. Br J Nutr 2018; 119:949-956. [PMID: 29644959 PMCID: PMC6088537 DOI: 10.1017/s0007114518000569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 02/08/2018] [Accepted: 02/15/2018] [Indexed: 11/07/2022]
Abstract
Higher-educated people often have healthier diets, but it is unclear whether specific dietary patterns exist within educational groups. We therefore aimed to derive dietary patterns in the total population and by educational level and to investigate whether these patterns differed in their composition and associations with the incidence of fatal and non-fatal CHD and stroke. Patterns were derived using principal components analysis in 36 418 participants of the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort. Self-reported educational level was used to create three educational groups. Dietary intake was estimated using a validated semi-quantitative FFQ. Hazard ratios were estimated using Cox Proportional Hazard analysis after a mean follow-up of 16 years. In the three educational groups, similar 'Western', 'prudent' and 'traditional' patterns were derived as in the total population. However, with higher educational level a lower population-derived score for the 'Western' and 'traditional' patterns and a higher score on the 'prudent' pattern were observed. These differences in distribution of the factor scores illustrate the association between education and food consumption. After adjustments, no differences in associations between population-derived dietary patterns and the incidence of CHD or stroke were found between the educational groups (P interaction between 0·21 and 0·98). In conclusion, although in general population and educational groups-derived dietary patterns did not differ, small differences between educational groups existed in the consumption of food groups in participants considered adherent to the population-derived patterns (Q4). This did not result in different associations with incident CHD or stroke between educational groups.
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Affiliation(s)
- Sander Biesbroek
- National Institute for Public Health and the Environment,
Antonie van Leeuwenhoeklaan 9, 3721 MA
Bilthoven, The Netherlands
| | - Mirjam C. Kneepkens
- National Institute for Public Health and the Environment,
Antonie van Leeuwenhoeklaan 9, 3721 MA
Bilthoven, The Netherlands
| | - Saskia W. van den Berg
- National Institute for Public Health and the Environment,
Antonie van Leeuwenhoeklaan 9, 3721 MA
Bilthoven, The Netherlands
| | - Heidi P. Fransen
- Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Universiteitsweg
100, 3584 CG Utrecht, The
Netherlands
| | - Joline W. Beulens
- Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Universiteitsweg
100, 3584 CG Utrecht, The
Netherlands
- Department of Epidemiology & Biostatistics, EMGO+
Institute for Health and Care Research, VU University Medical
Center, De Boelelaan 1105, 1081 HV
Amsterdam, The Netherlands
| | - Petra H. M. Peeters
- Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Universiteitsweg
100, 3584 CG Utrecht, The
Netherlands
- School of Public Health, Imperial College
London, South Kensington Campus, London
SW7 2AZ, UK
| | - Jolanda M. A. Boer
- National Institute for Public Health and the Environment,
Antonie van Leeuwenhoeklaan 9, 3721 MA
Bilthoven, The Netherlands
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27
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Determinants of organophosphate pesticide exposure in pregnant women: A population-based cohort study in the Netherlands. Int J Hyg Environ Health 2018; 221:489-501. [PMID: 29499913 PMCID: PMC6046212 DOI: 10.1016/j.ijheh.2018.01.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/19/2018] [Accepted: 01/27/2018] [Indexed: 01/06/2023]
Abstract
Background In the Netherlands organophosphate (OP) pesticides are frequently used for pest control in agricultural settings. Despite concerns about the potential health impacts of low-level OP pesticides exposure, particularly in vulnerable populations, the primary sources of exposure remain unclear. The present study was designed to investigate the levels of DAP metabolites concentrations across pregnancy and to examine various determinants of DAP metabolite concentrations among an urban population of women in the Netherlands. Method Urinary concentrations of six dialkyl phosphate (DAP) metabolites, the main urinary metabolites of OP pesticides, were determined at < 18, 18–25, and > 25 weeks of pregnancy in 784 pregnant women participating in the Generation R Study (between 2004 and 2006), a large population-based birth cohort in Rotterdam, the Netherlands. Questionnaires administered prenatally assessed demographic and lifestyle characteristics and maternal diet. Linear mixed models, with adjustment for relevant covariates, were used to estimate associations between the potential exposure determinants and DAP metabolite concentrations expressed as molar concentrations divided by creatinine levels. Results The median DAP metabolite concentration was 311 nmol/g creatinine for the first trimester, 317 nmol/g creatinine for the second trimester, and 310 nmol/g creatinine for the third trimester. Higher maternal age, married/living with a partner, underweight or normal weight (BMI of < 18.5 and 18.5– < 25), high education, high income, and non-smoking were associated with higher DAP metabolite concentrations, and DAP metabolite concentrations tended to be higher during the summer. Furthermore, fruit intake was associated with increased DAP metabolite concentrations. Each 100 g/d difference in fruit consumption was associated with a 7% higher total DAP metabolite concentration across pregnancy. Other food groups were not associated with higher DAP metabolite concentrations. Conclusions The DAP metabolite concentrations measured in the urine of pregnant women in the Netherlands were higher than those in most other studies previously conducted. Fruit intake was the main dietary source of exposure to OP pesticides in young urban women in the Netherlands. The extent to which DAP metabolite concentrations reflect exposure to the active parent pesticide rather than to less toxic metabolites remains unclear. Further research will be undertaken to investigate the possible effects of this relatively high level OP pesticides exposure on offspring health.
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28
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Schoufour JD, de Jonge EA, Kiefte-de Jong JC, van Lenthe FJ, Hofman A, Nunn SP, Franco OH. Socio-economic indicators and diet quality in an older population. Maturitas 2018; 107:71-77. [DOI: 10.1016/j.maturitas.2017.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/02/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
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29
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Borges CA, Rinaldi AE, Conde WL, Mainardi GM, Behar D, Slater B. Dietary patterns: a literature review of the methodological characteristics of the main step of the multivariate analyzes. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 18:837-57. [PMID: 26982299 DOI: 10.1590/1980-5497201500040013] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/14/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To describe the solutions adopted in the multiple steps of the use of multivariate techniques to obtain a dietary pattern (DP) concerning: the objective of the studies, the selection of the method for measuring food intake, the criteria for grouping the foods, the number of food groups used, the number of DP obtained, and the nomenclature criteria. METHODS The articles were selected from MEDLINE and Lilacs scientific databases using the following keywords: "dietary patterns" versus "factor analysis"; "principal components analysis"; "cluster analysis" and "reduced regression rank." The initial search resulted in 1,752 articles. After inclusion and exclusion criteria, 189 publications were selected. RESULTS The following aspects were relevant among the studies: the prevalence of the principal component analysis (PCA); the prevalence of the use of 4 to 5 DPs in the studies of association with health outcomes; the use of 30 or more food groups from the food frequency questionnaire (FFQ); the prevalence of studies that associated DPs with health outcomes and socioeconomic factors; and the heterogeneity of criteria used throughout the analytical stages of the multivariate techniques. CONCLUSION The heterogeneity between the publications concentrates on the criteria for food grouping, the nomenclature, and the number of dietary patterns calculated, which varied depending on the number of food groups present in these analyses. To understand, apply, and explore in full, the multivariate techniques has become necessary in order to improve the reliability of the results and, consequently, to improve the relationships with health outcomes and socioeconomic factors.
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Affiliation(s)
| | - Ana Elisa Rinaldi
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wolney Lisboa Conde
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Dora Behar
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Betzabeth Slater
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
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30
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Boakye J, Mensah D, Sakhuja S, Jolly PE, Akinyemiju T. Socioeconomic Disparities in the Prevalence of Cardiometabolic Risk Factors in Ghanaian Women. Ann Glob Health 2017; 83:423-431. [PMID: 29221515 DOI: 10.1016/j.aogh.2017.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent trends toward urbanization in developing countries like Ghana, coupled with nutritional transition and aging populations, have led to a rapid increase in the prevalence of noncommunicable diseases such as obesity, diabetes, and hypertension. The purpose of this study was to evaluate the association between socioeconomic status and cardiometabolic risk factors among women in Ghana. METHODS Data for this analysis were obtained from Wave 1 of the Ghana Study of Global Aging and Health, conducted in 2007, and included women 18 years and older. Survey weighted descriptive and multivariable linear regression models were used to examine the association between socioeconomic status and cardiometabolic risk factors. RESULTS Among a total of 1988 women, 48% ages 40-64 years, almost half were overweight or obese (47%) and 21% had current hypertension, whereas only 4.3% and 2% of women self-reported a history of hypertension and diabetes, respectively. Multivariable adjusted analysis indicated that women with a high school education had 2-fold increased odds of being overweight or obese compared with those with no formal education (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.20-3.42). Women employed in the public sector had almost a 5 times higher odds of being overweight or obese (OR: 4.94, 95% CI: 1.42-17.15), whereas those employed in the private sector or self-employed had reduced odds of diabetes (OR: 0.27, 95% CI: 0.10-0.70) and hypertension (OR: 0.43, 95% CI: 0.21-0.86). CONCLUSION The prevalence of cardiometabolic risk factors varies by socioeconomic status among Ghanaian women. Targeted intervention programs to reduce overweight and obesity may begin among Ghanaian women employed in the public sector, and improved access to health care will be critical for timely diagnosis and management of other disease risk factors.
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Affiliation(s)
- Jeffrey Boakye
- Department of Biology, Philander Smith College, Little Rock, AR; Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; Minority Health International Research Training Program, University of Alabama at Birmingham, Birmingham, AL
| | - Danielle Mensah
- Minority Health International Research Training Program, University of Alabama at Birmingham, Birmingham, AL; Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Swati Sakhuja
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Pauline E Jolly
- Minority Health International Research Training Program, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Tomi Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL.
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31
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Krebs NM, Allen SI, Veldheer S, Martinez DJ, Horn K, Livelsberger C, Modesto J, Kuprewicz R, Wilhelm A, Hrabovsky S, Kazi A, Fazzi A, Liao J, Zhu J, Wasserman E, Reilly SM, Reinhart L, Trushin N, Moyer RE, Bascom R, Foulds J, Richie JP, Muscat JE. Reduced nicotine content cigarettes in smokers of low socioeconomic status: study protocol for a randomized control trial. Trials 2017; 18:300. [PMID: 28673312 PMCID: PMC5496140 DOI: 10.1186/s13063-017-2038-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/01/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The Family Smoking Prevention and Tobacco Control Act gave the Food and Drug Administration jurisdiction over the regulation of all tobacco products, including their nicotine content. Under this act, a major strategy to reduce harm from cigarette tobacco is lowering the nicotine content without causing unintended adverse consequences. Initial research on reduced nicotine content (RNC) cigarettes has shown that smokers of these cigarettes gradually decrease their smoking frequency and biomarkers of exposure. The effectiveness of this strategy needs to be demonstrated in different populations whose response to RNC cigarettes might be substantially mediated by personal or environmental factors, such as low socioeconomic status (SES) populations. This study aims to evaluate the response to a reduced nicotine intervention in low SES smokers, as defined here as those with less than 16 years of education, by switching smokers from high nicotine commercial cigarettes to RNC cigarettes. METHODS/DESIGN Adults (N = 280) who have smoked five cigarettes or more per day for the past year, have not made a quit attempt in the prior month, are not planning to quit, and have less than 16 years of education are recruited into a two-arm, double-blinded randomized controlled trial. First, participants smoke their usual brand of cigarettes for 1 week and SPECTRUM research cigarettes containing a usual amount of nicotine for 2 weeks. During the experimental phase, participants are randomized to continue smoking SPECTRUM research cigarettes that contain either (1) usual nicotine content (UNC) (11.6 mg/cigarette) or (2) RNC (11.6 to 0.2 mg/cigarette) over 18 weeks. During the final phase of the study, all participants are offered the choice to quit smoking with nicotine replacement therapy, continue smoking the research cigarettes, or return to their usual brand of cigarettes. The primary outcomes of the study include retention rates and compliance with using only research cigarettes and no use of other nicotine-containing products. Secondary outcomes are tobacco smoke biomarkers, nicotine dependence measures, smoking topography, stress levels, and adverse health consequences. DISCUSSION Results from this study will provide information on whether low SES smokers can maintain a course of progressive nicotine reduction without increases in incidence of adverse effects. TRIAL REGISTRATION ClinicalTrials.gov, NCT01928719 . Registered on 21 August 2013.
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Affiliation(s)
- Nicolle M. Krebs
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Sophia I. Allen
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Susan Veldheer
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Diane J. Martinez
- The Milken School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, D.C, 20052 USA
| | - Kimberly Horn
- The Milken School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, D.C, 20052 USA
| | - Craig Livelsberger
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Jennifer Modesto
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Robin Kuprewicz
- The Milken School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, D.C, 20052 USA
| | - Ashley Wilhelm
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Shari Hrabovsky
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Abid Kazi
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Alyse Fazzi
- Investigational Drug Service, Department of Pharmacy, Pennsylvania State University, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Jason Liao
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Samantha M. Reilly
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Lisa Reinhart
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Neil Trushin
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Robinn E. Moyer
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Rebecca Bascom
- Department of Medicine, Pennsylvania State University, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - John P. Richie
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Joshua E. Muscat
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
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O’Brien OA, Lindsay KL, McCarthy M, McGloin AF, Kennelly M, Scully HA, McAuliffe FM. Influences on the food choices and physical activity behaviours of overweight and obese pregnant women: A qualitative study. Midwifery 2017; 47:28-35. [DOI: 10.1016/j.midw.2017.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 11/16/2022]
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Psaltopoulou T, Hatzis G, Papageorgiou N, Androulakis E, Briasoulis A, Tousoulis D. Socioeconomic status and risk factors for cardiovascular disease: Impact of dietary mediators. Hellenic J Cardiol 2017; 58:32-42. [DOI: 10.1016/j.hjc.2017.01.022] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 09/29/2016] [Indexed: 11/17/2022] Open
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Fan R, Xu M, Wang J, Zhang Z, Chen Q, Li Y, Gu J, Cai X, Guo Q, Bao L, Li Y. Sustaining Effect of Intensive Nutritional Intervention Combined with Health Education on Dietary Behavior and Plasma Glucose in Type 2 Diabetes Mellitus Patients. Nutrients 2016; 8:nu8090560. [PMID: 27649232 PMCID: PMC5037545 DOI: 10.3390/nu8090560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/23/2016] [Accepted: 09/07/2016] [Indexed: 01/19/2023] Open
Abstract
Diabetes mellitus is very common in elderly Chinese individuals. Although nutritional intervention can provide a balanced diet, the sustaining effect on at-home dietary behavior and long-term plasma glucose control is not clear. Consequently, we conducted a long-term survey following one month of experiential nutritional intervention combined with health education. Based on the Dietary Guidelines for a Chinese Resident, we found that the food items met the recommended values, the percentages of energy provided from fat, protein, and carbohydrate were more reasonable after one year. The newly formed dietary patterns were “Healthy”, “Monotonous”, “Vegetarian”, “Japanese”, “Low energy”, and “Traditional” diets. The 2h-PG of female participants as well as those favoring the “Japanese diet” decreased above 12 mmol/L. Participants who selected “Japanese” and “Healthy” diets showed an obvious reduction in FPG while the FPG of participants from Group A declined slightly. “Japanese” and “Healthy” diets also obtained the highest DDP scores, and thus can be considered suitable for T2DM treatment in China. The results of the newly formed dietary patterns, “Japanese” and “Healthy” diets, confirmed the profound efficacy of nutritional intervention combined with health education for improving dietary behavior and glycemic control although health education played a more important role. The present study is encouraging with regard to further exploration of comprehensive diabetes care.
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Affiliation(s)
- Rui Fan
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Meihong Xu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Junbo Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Zhaofeng Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Qihe Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Ye Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Jiaojiao Gu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Xiaxia Cai
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Qianying Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Lei Bao
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
| | - Yong Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
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Gutiérrez-Pliego LE, Camarillo-Romero EDS, Montenegro-Morales LP, Garduño-García JDJ. Dietary patterns associated with body mass index (BMI) and lifestyle in Mexican adolescents. BMC Public Health 2016; 16:850. [PMID: 27549220 PMCID: PMC4994211 DOI: 10.1186/s12889-016-3527-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/20/2016] [Indexed: 01/29/2023] Open
Abstract
Background The objetive in this study is to determine the relationship between dietary patterns, BMI, type 2 diabetes mellitus family history (T2DMFH) and some lifestyle variables such as smoking and skipping breakfast in a Mexican adolescent population. Methods Cross-sectional, observational, analytical study.Subjetcts: 14-16 years old male and female adolescents (n 373). A previously validated food frequency questionnaire (FFQ) was used and dietary patterns were derived using principal component analysis (PCA). Scores for dietary patterns were categorized by tertiles. Results Three major dietary patterns that explained 47 % of variance were found: westernized, high in protein/fat and prudent pattern. Subjects at the highest tertile of prudent pattern had lower BMI. And was also associated with less T2DMFH and less smoking habit when compared with the lowest tertile. We found a positive correlation between BMI and high scores for westernized and high in protein/fat pattern Conclusions Dietary patterns of adolescents are a public health concern because there is a direct association between inadequate diet at this early age and obesity
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Affiliation(s)
- Laura Elisa Gutiérrez-Pliego
- Facultad de Medicina Universidad Autónoma del Estado de México, Av. Paseo Tollocan 248 Universidad, Toluca Estado de México, CP50130, Mexico.,Centro de Investigación en Ciencias Médicas UAEMex, Cuerpo académico salud del Universitario Av. Jesús Carranza 205, Universidad, Toluca Estado de México, CP 50130, Mexico
| | - Eneida Del Socorro Camarillo-Romero
- Centro de Investigación en Ciencias Médicas UAEMex, Cuerpo académico salud del Universitario Av. Jesús Carranza 205, Universidad, Toluca Estado de México, CP 50130, Mexico
| | - Laura Patricia Montenegro-Morales
- Centro de Investigación en Ciencias Médicas UAEMex, Cuerpo académico salud del Universitario Av. Jesús Carranza 205, Universidad, Toluca Estado de México, CP 50130, Mexico
| | - José de Jesus Garduño-García
- Centro de Investigación en Ciencias Médicas UAEMex, Cuerpo académico salud del Universitario Av. Jesús Carranza 205, Universidad, Toluca Estado de México, CP 50130, Mexico. .,Instituto Mexicano del Seguro Social HGR251, Metepec Estado de, Mexico.
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The effect of under-reporting of energy intake on dietary patterns and on the associations between dietary patterns and self-reported chronic disease in women aged 50–69 years. Br J Nutr 2016; 116:547-58. [DOI: 10.1017/s000711451600218x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe aim of this cross-sectional study was to investigate whether under-reporting of energy intake affects derived dietary patterns and the association between dietary patterns and self-reported chronic disease. Diets of 6204 women aged 50–69 years participating in the Norwegian Breast Cancer Screening Program were assessed using a 253-item FFQ. We identified dietary patterns using principal component analysis. According to the revised Goldberg cut-off method, women with a ratio of reported energy intake:estimated BMR<1·10 were classified as low energy reporters (n 1133, 18 %). We examined the associations between dietary patterns and self-reported chronic diseases by log-binomial regression, and the results are presented as prevalence ratios (PR) and CI. ‘Prudent’, ‘Western’ and ‘Continental’ dietary patterns were identified among all reporters and plausible reporters. The PR expressing the associations between the ‘Western’ and ‘Prudent’ dietary pattern scores and self-reported chronic diseases were consistently highest among plausible reporters except for joint/muscle/skeletal disorders. The largest difference in PR among plausible v. all reporters was found for the association between the ‘Prudent’ pattern and diabetes (PR for highest v. lowest tertile: PRall reporters 2·16; 95 % CI 1·50, 3·13; Ptrend<0·001; PRplausible reporters 2·86; 95 % CI 1·81, 4·51; Ptrend<0·001). In conclusion, our results suggest that under-reporting can result in systematic error that can affect the association between dietary pattern and disease. In studies of dietary patterns, investigators ought to consider reporting effect estimates both for all individuals and for plausible reporters.
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Socio-economic inequalities in diet and body weight: evidence, causes and intervention options. Public Health Nutr 2015; 18:759-63. [PMID: 25710706 DOI: 10.1017/s1368980015000233] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Vasiljevic M, Ng YL, Griffin SJ, Sutton S, Marteau TM. Is the intention-behaviour gap greater amongst the more deprived? A meta-analysis of five studies on physical activity, diet, and medication adherence in smoking cessation. Br J Health Psychol 2015; 21:11-30. [PMID: 26264673 PMCID: PMC5014219 DOI: 10.1111/bjhp.12152] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/03/2015] [Indexed: 11/29/2022]
Abstract
Objectives Unhealthy behaviour is more common amongst the deprived, thereby contributing to health inequalities. The evidence that the gap between intention and behaviour is greater amongst the more deprived is limited and inconsistent. We tested this hypothesis using objective and self‐report measures of three behaviours, both individual‐ and area‐level indices of socio‐economic status, and pooling data from five studies. Design Secondary data analysis. Methods Multiple linear regressions and meta‐analyses of data on physical activity, diet, and medication adherence in smoking cessation from 2,511 participants. Results Across five studies, we found no evidence for an interaction between deprivation and intention in predicting objective or self‐report measures of behaviour. Using objectively measured behaviour and area‐level deprivation, meta‐analyses suggested that the gap between self‐efficacy and behaviour was greater amongst the more deprived (B = .17 [95% CI = 0.02, 0.31]). Conclusions We find no compelling evidence to support the hypothesis that the intention–behaviour gap is greater amongst the more deprived. Statement of contribution What is already known on this subject? Unhealthy behaviour is more common in those who are more deprived. This may reflect a larger gap between intentions and behaviour amongst the more deprived. The limited evidence to date testing this hypothesis is mixed.
What does this study add? In the most robust study to date, combining results from five trials, we found no evidence for this explanation. The gap between intentions and behaviour did not vary with deprivation for the following: diet, physical activity, or medication adherence in smoking cessation. We did, however, find a larger gap between perceived control over behaviour (self‐efficacy) and behaviour in those more deprived. These findings add to existing evidence to suggest that higher rates of unhealthier behaviour in more deprived groups may be reduced by the following:
Strengthening behavioural control mechanisms (such as executive function and non‐conscious processes) or Behaviour change interventions that bypass behavioural control mechanisms.
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Affiliation(s)
| | - Yin-Lam Ng
- Behaviour and Health Research Unit, University of Cambridge, UK
| | - Simon J Griffin
- Behaviour and Health Research Unit, University of Cambridge, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Stephen Sutton
- Behaviour and Health Research Unit, University of Cambridge, UK.,Behavioural Science Group, University of Cambridge, UK
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Kamphuis CBM, Jansen T, Mackenbach JP, van Lenthe FJ. Bourdieu's Cultural Capital in Relation to Food Choices: A Systematic Review of Cultural Capital Indicators and an Empirical Proof of Concept. PLoS One 2015; 10:e0130695. [PMID: 26244763 PMCID: PMC4526463 DOI: 10.1371/journal.pone.0130695] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 05/24/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Unhealthy food choices follow a socioeconomic gradient that may partly be explained by one's 'cultural capital', as defined by Bourdieu. We aim 1) to carry out a systematic review to identify existing quantitative measures of cultural capital, 2) to develop a questionnaire to measure cultural capital for food choices, and 3) to empirically test associations of socioeconomic position with cultural capital and food choices, and of cultural capital with food choices. DESIGN We systematically searched large databases for the key-word 'cultural capital' in title or abstract. Indicators of objectivised cultural capital and family institutionalised cultural capital, as identified by the review, were translated to food choice relevant indicators. For incorporated cultural capital, we used existing questionnaires that measured the concepts underlying the variety of indicators as identified by the review, i.e. participation, skills, knowledge, values. The questionnaire was empirically tested in a postal survey completed by 2,953 adults participating in the GLOBE cohort study, The Netherlands, in 2011. RESULTS The review yielded 113 studies that fulfilled our inclusion criteria. Several indicators of family institutionalised (e.g. parents' education completed) and objectivised cultural capital (e.g. possession of books, art) were consistently used. Incorporated cultural capital was measured with a large variety of indicators (e.g. cultural participation, skills). Based on this, we developed a questionnaire to measure cultural capital in relation to food choices. An empirical test of the questionnaire showed acceptable overall internal consistency (Cronbach's alpha of .654; 56 items), and positive associations between socioeconomic position and cultural capital, and between cultural capital and healthy food choices. CONCLUSIONS Cultural capital may be a promising determinant for (socioeconomic inequalities in) food choices.
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Affiliation(s)
- Carlijn B. M. Kamphuis
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Tessa Jansen
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Johan P. Mackenbach
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Frank J. van Lenthe
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Dekker LH, Nicolaou M, van Dam RM, de Vries JHM, de Boer EJ, Brants HAM, Beukers MH, Snijder MB, Stronks K. Socio-economic status and ethnicity are independently associated with dietary patterns: the HELIUS-Dietary Patterns study. Food Nutr Res 2015; 59:26317. [PMID: 26041009 PMCID: PMC4454783 DOI: 10.3402/fnr.v59.26317] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 04/16/2015] [Accepted: 04/22/2015] [Indexed: 01/10/2023] Open
Abstract
Background Differences in dietary patterns between ethnic groups have often been observed. These differences may partially be a reflection of differences in socio-economic status (SES) or may be the result of differences in the direction and strength of the association between SES and diet. Objective We aimed to examine ethnic differences in dietary patterns and the role of socio-economic indicators on dietary patterns within a multi-ethnic population. Design Cross-sectional multi-ethnic population-based study. Setting Amsterdam, the Netherlands. Subjects Principal component analysis was used to identify dietary patterns among Dutch (n=1,254), South Asian Surinamese (n=425), and African Surinamese (n=784) participants. Levels of education and occupation were used to indicate SES. Linear regression analysis was used to examine the association between ethnicity and dietary pattern scores first and then between socio-economic indicators and dietary patterns within and between ethnic groups. Results ‘Noodle/rice dishes and white meat’, ‘red meat, snacks, and sweets’ and ‘vegetables, fruit and nuts’ patterns were identified. Compared to the Dutch origin participants, Surinamese more closely adhered to the ‘noodle/rice dishes and white meat’ pattern which was characterized by foods consumed in a ‘traditional Surinamese diet’. Closer adherence to the other two patterns was observed among Dutch compared to Surinamese origin participants. Ethnic differences in dietary patterns persisted within strata of education and occupation. Surinamese showed greater adherence to a ‘traditional’ pattern independent of SES. Among Dutch participants, a clear socio-economic gradient in all dietary patterns was observed. Such a gradient was only present among Surinamese dietary oatterns to the ‘vegetables, fruit and nuts’ pattern. Conclusions We found a selective change in the adherence to dietary patterns among Surinamese origin participants, presumably a move towards more vegetables and fruits with higher SES but continued fidelity to the traditional diet.
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Affiliation(s)
- Louise H Dekker
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands;
| | - Mary Nicolaou
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob M van Dam
- Saw Swee Hock School of Public Health and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Jeanne H M de Vries
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Evelien J de Boer
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Henny A M Brants
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Marja H Beukers
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Marieke B Snijder
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Funtikova AN, Gomez SF, Fitó M, Elosua R, Benítez-Arciniega AA, Schröder H. Effect of energy under-reporting on secular trends of dietary patterns in a mediterranean population. PLoS One 2015; 10:e0127647. [PMID: 26023775 PMCID: PMC4449204 DOI: 10.1371/journal.pone.0127647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 04/17/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Diet is an important factor in the prevention of chronic diseases. Analysis of secular trends of dietary patterns can be biased by energy under-reporting. Therefore, the objective of the present study was to analyse the impact of energy under-reporting on dietary patterns and secular trends in dietary patterns defined by cluster analysis. DESIGN AND METHODS Two cross-sectional population-based surveys were conducted in Spain, in 2000 and 2005, with 3058 and 6352 participants, respectively, aged 25 to 74 years. Validated questionnaire was used to collect dietary data. Cluster analysis was run separately for all participants, plausible energy reporters (PER), and energy under-reporters (EUR) to define dietary patterns. RESULTS Three clusters, "healthy", "mixed" and "western", were identified for both surveys. The "mixed" cluster was the predominant cluster in both surveys. Excluding EUR reduced the proportion of the "mixed" cluster up to 6.40% in the 2000 survey; this caused secular trend increase in the prevalence of the "mixed" pattern. Cross-classification analysis of all participants and PER' data showed substantial agreement in cluster assignments: 68.7% in 2000 and 84.4% in 2005. Excluding EUR did not cause meaningful (≥ 15%) changes in the "healthy" pattern. It provoked changes in consumption of some food groups in the "mixed" and "western" patterns: mainly decreases of unhealthy foods within the 2000 and increases of unhealthy foods within the 2005 surveys. Secular trend effects of EUR were similar to those within the 2005 survey. Excluding EUR reversed the direction of secular trends in consumption of several food groups in PER in the "mixed" and "western" patterns. CONCLUSIONS EUR affected distribution of participants between dietary patterns within and between surveys, secular trends in food group consumption and amount of food consumed in all, but not in the "healthy" pattern. Our findings emphasize threats from energy under-reporting in dietary data analysis.
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Affiliation(s)
- Anna N. Funtikova
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- PhD program “Foods and Nutrition”, University of Barcelona, Barcelona, Spain
| | - Santiago F. Gomez
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Fundación THAO, Barcelona, Spain
| | - Montserrat Fitó
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics (EGEC-ULEC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Helmut Schröder
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- * E-mail:
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Atkins JL, Ramsay SE, Whincup PH, Morris RW, Lennon LT, Wannamethee SG. Diet quality in older age: the influence of childhood and adult socio-economic circumstances. Br J Nutr 2015; 113:1441-52. [PMID: 25827289 PMCID: PMC4462157 DOI: 10.1017/s0007114515000604] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 01/07/2015] [Accepted: 02/04/2015] [Indexed: 01/24/2023]
Abstract
Socio-economic gradients in diet quality are well established. However, the influence of material socio-economic conditions particularly in childhood, and the use of multiple disaggregated socio-economic measures on diet quality have been little studied in the elderly. In the present study, we examined childhood and adult socio-economic measures, and social relationships, as determinants of diet quality cross-sectionally in 4252 older British men (aged 60-79 years). A FFQ provided data on daily fruit and vegetable consumption and the Elderly Dietary Index (EDI), with higher scores indicating better diet quality. Adult and childhood socio-economic measures included occupation/father's occupation, education and household amenities, which combined to create composite scores. Social relationships included social contact, living arrangements and marital status. Both childhood and adult socio-economic factors were independently associated with diet quality. Compared with non-manual social class, men of childhood manual social class were less likely to consume fruit and vegetables daily (OR 0.80, 95% CI 0.66, 0.97), as were men of adult manual social class (OR 0.65, 95% CI 0.54, 0.79), and less likely to be in the top EDI quartile (OR 0.73, 95% CI 0.61, 0.88), similar to men of adult manual social class (OR 0.66, 95 % CI 0.55, 0.79). Diet quality decreased with increasing adverse adult socio-economic scores; however, the association with adverse childhood socio-economic scores diminished with adult social class adjustment. A combined adverse childhood and adulthood socio-economic score was associated with poor diet quality. Diet quality was most favourable in married men and those not living alone, but was not associated with social contact. Diet quality in older men is influenced by childhood and adulthood socio-economic factors, marital status and living arrangements.
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Affiliation(s)
- Janice L. Atkins
- Department of Primary Care and Population Health,
University College London Medical School, Royal Free
Campus, LondonNW3 2PF, UK
| | - Sheena E. Ramsay
- Department of Primary Care and Population Health,
University College London Medical School, Royal Free
Campus, LondonNW3 2PF, UK
| | - Peter H. Whincup
- Division of Population Health Sciences and Education, Population Health
Research Centre, St George's University of London, LondonSW17 0RE, UK
| | - Richard W. Morris
- Department of Primary Care and Population Health,
University College London Medical School, Royal Free
Campus, LondonNW3 2PF, UK
| | - Lucy T. Lennon
- Department of Primary Care and Population Health,
University College London Medical School, Royal Free
Campus, LondonNW3 2PF, UK
| | - S. Goya Wannamethee
- Department of Primary Care and Population Health,
University College London Medical School, Royal Free
Campus, LondonNW3 2PF, UK
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The impact of conventional dietary intake data coding methods on foods typically consumed by low-income African-American and White urban populations. Public Health Nutr 2014; 18:1922-31. [PMID: 25435191 DOI: 10.1017/s1368980014002687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Analysing dietary data to capture how individuals typically consume foods is dependent on the coding variables used. Individual foods consumed simultaneously, like coffee with milk, are given codes to identify these combinations. Our literature review revealed a lack of discussion about using combination codes in analysis. The present study identified foods consumed at mealtimes and by race when combination codes were or were not utilized. DESIGN Duplicate analysis methods were performed on separate data sets. The original data set consisted of all foods reported; each food was coded as if it was consumed individually. The revised data set was derived from the original data set by first isolating coded foods consumed as individual items from those foods consumed simultaneously and assigning a code to designate a combination. Foods assigned a combination code, like pancakes with syrup, were aggregated and associated with a food group, defined by the major food component (i.e. pancakes), and then appended to the isolated coded foods. SETTING Healthy Aging in Neighborhoods of Diversity across the Life Span study. SUBJECTS African-American and White adults with two dietary recalls (n 2177). RESULTS Differences existed in lists of foods most frequently consumed by mealtime and race when comparing results based on original and revised data sets. African Americans reported consumption of sausage/luncheon meat and poultry, while ready-to-eat cereals and cakes/doughnuts/pastries were reported by Whites on recalls. CONCLUSIONS Use of combination codes provided more accurate representation of how foods were consumed by populations. This information is beneficial when creating interventions and exploring diet-health relationships.
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Walthouwer MJL, Oenema A, Soetens K, Lechner L, de Vries H. Are clusters of dietary patterns and cluster membership stable over time? Results of a longitudinal cluster analysis study. Appetite 2014; 82:154-9. [DOI: 10.1016/j.appet.2014.07.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/30/2014] [Accepted: 07/21/2014] [Indexed: 12/20/2022]
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Lee KW, Cho MS. The traditional Korean dietary pattern is associated with decreased risk of metabolic syndrome: findings from the Korean National Health and Nutrition Examination Survey, 1998-2009. J Med Food 2014; 17:43-56. [PMID: 24456354 DOI: 10.1089/jmf.2013.3049] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The traditional Korean diet has several healthy components, including abundant vegetables, fermented foods, a variety of foodstuffs, and a balance of animal and vegetable food intake. Although the traditional Korean diet has many healthy components, few studies have been conducted on the health advantages of the Korean dietary pattern. This study is intended to clarify the relationship between Korean dietary patterns and chronic diseases using the Integrated Korean Dietary Pattern Score (I-KDPS). I-KDPS is an index for measuring Korean dietary patterns based on traditional Korean meals and reflects the complex and multifaceted characteristics of Korean food culture. I-KDPS is composed of seven items to measure the level of balance and adequacy of Korean food consumption, with a maximum score of 60. When I-KDPS was applied to the Korean National Health and Nutrition Examination Survey (1998-2009), a nationwide survey, I-KDPS was closely related to the risk of metabolic syndrome. Even though there were a few differences among the years surveyed, the risk of metabolic syndrome, obesity, hypertension, and hypertriglyceridemia significantly decreased as I-KDPS increased. These results indicate that risk of diseases, including metabolic syndrome, decreases in individuals adhering to traditional Korean dietary patterns in adequate levels and those who eat a balanced diet. The result of this study shows that the traditional Korean table setting, which comprises side dishes, including seasoned vegetables, grilled dishes, and fermented products with cooked rice (bap), soup (guk), and kimchi, contains traits that help prevent metabolic syndrome. I-KDPS coupled with the basic study of the healthfulness of the Korean dietary lifestyle is expected to help establish a foundation for continuous development of health promoting Korean foods and dietary culture.
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Affiliation(s)
- Kyung Won Lee
- Department of Nutritional Science and Food Management, Ewha Womans University , Seoul, Korea
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Giesinger I, Goldblatt P, Howden-Chapman P, Marmot M, Kuh D, Brunner E. Association of socioeconomic position with smoking and mortality: the contribution of early life circumstances in the 1946 birth cohort. J Epidemiol Community Health 2014; 68:275-9. [PMID: 24249001 PMCID: PMC4157998 DOI: 10.1136/jech-2013-203159] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/14/2013] [Accepted: 10/17/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND A large part of the socioeconomic mortality gradient can be statistically accounted for by social patterning of adult health behaviours. However, this statistical explanation does not consider the early life origins of unhealthy behaviours and increased mortality risk. METHODS Analysis is based on 2132 members of the MRC National Survey of Health and Development with mortality follow-up and complete data. Smoking behaviour was summarised by pack-years of exposure. Socioeconomic circumstances were measured in childhood (father's social class (age 4), maternal education (age 6)) and age 26 (education attainment, home ownership, head of household social class). We estimated the direct effect of early circumstances, the indirect effect through smoking and the independent direct effect of smoking on inequality in all-cause mortality from age 26 to 66. RESULTS Mortality risk was higher in those with lower socioeconomic position at age 26, with a sex-adjusted HR (relative index of inequality) of 1.97 (95% CI 1.18 to 3.28). Smoking and early life socioeconomic indicators together explained 74% of the socioeconomic gradient in mortality (the gradient). Early life circumstances explained 47% of the gradient, 23.5% directly and 23.0% indirectly through smoking. The explanatory power of smoking behaviour for the gradient was reduced from 50.8% to 28% when early life circumstances were added to the model. CONCLUSIONS Early life socioeconomic circumstances contributed importantly to social inequality in adult mortality. Our life-course model focusing on smoking provides evidence that social inequalities in health will persist unless prevention strategies tackle the intergenerational transmission of disadvantage and risk.
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Affiliation(s)
- Ingrid Giesinger
- Institute of Epidemiology and Health Care, University College London,London, UK
| | - Peter Goldblatt
- Institute of Epidemiology and Health Care, University College London,London, UK
| | | | - Michael Marmot
- Institute of Epidemiology and Health Care, University College London,London, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing, London, UK
| | - Eric Brunner
- Institute of Epidemiology and Health Care, University College London,London, UK
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Brimblecombe J, Ferguson M, Liberato SC, O'Dea K, Riley M. Optimisation modelling to assess cost of dietary improvement in remote Aboriginal Australia. PLoS One 2013; 8:e83587. [PMID: 24391790 PMCID: PMC3877064 DOI: 10.1371/journal.pone.0083587] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 11/05/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The cost and dietary choices required to fulfil nutrient recommendations defined nationally, need investigation, particularly for disadvantaged populations. OBJECTIVE We used optimisation modelling to examine the dietary change required to achieve nutrient requirements at minimum cost for an Aboriginal population in remote Australia, using where possible minimally-processed whole foods. DESIGN A twelve month cross-section of population-level purchased food, food price and nutrient content data was used as the baseline. Relative amounts from 34 food group categories were varied to achieve specific energy and nutrient density goals at minimum cost while meeting model constraints intended to minimise deviation from the purchased diet. RESULTS Simultaneous achievement of all nutrient goals was not feasible. The two most successful models (A & B) met all nutrient targets except sodium (146.2% and 148.9% of the respective target) and saturated fat (12.0% and 11.7% of energy). Model A was achieved with 3.2% lower cost than the baseline diet (which cost approximately AUD$13.01/person/day) and Model B at 7.8% lower cost but with a reduction in energy of 4.4%. Both models required very large reductions in sugar sweetened beverages (-90%) and refined cereals (-90%) and an approximate four-fold increase in vegetables, fruit, dairy foods, eggs, fish and seafood, and wholegrain cereals. CONCLUSION This modelling approach suggested population level dietary recommendations at minimal cost based on the baseline purchased diet. Large shifts in diet in remote Aboriginal Australian populations are needed to achieve national nutrient targets. The modeling approach used was not able to meet all nutrient targets at less than current food expenditure.
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Affiliation(s)
- Julie Brimblecombe
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Megan Ferguson
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Selma C. Liberato
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kerin O'Dea
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Division of Health Sciences (School of Population Health), University of South Australia, Adelaide, South Australia, Australia
| | - Malcolm Riley
- Commonwealth Scientific Industrial Research Organisation (Animal, Food and Health Sciences), Parkville, Victoria, Australia
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Dodge HH, Zhu J, Lee CW, Chang CCH, Ganguli M. Cohort effects in age-associated cognitive trajectories. J Gerontol A Biol Sci Med Sci 2013; 69:687-94. [PMID: 24270062 DOI: 10.1093/gerona/glt181] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The age-specific prevalence and incidence of dementia and cognitive impairment in the United States have either remained stable or even slightly declined during the 1980s-1990s. A suggested but untested reason for this improvement in cognitive function over time is higher educational attainment among more recent cohorts. METHODS We used data from two large prospective population-based epidemiological dementia studies conducted in two adjacent regions during the period 1987-2012. We examined whether (i) cohort effects could be observed in age-associated trajectories of cognitive functions and (ii) the observed cohort effects could be explained by educational attainment. Trajectories of neuropsychological tests tapping three domains (psychomotor speed, executive function, and language) were compared among cohorts born between 1902 and 1911, 1912 and 1921, 1922 and 1931, and 1932 and 1943. We examined Age × Cohort interactions in mixed-effects models with/without controlling for education effects. RESULTS Cohort effects in age-associated trajectories were observed in all three domains, with consistent differences between the earliest born cohort and the most recent cohort. Executive functions showed the strongest and persistent differences between the most recent and other three cohorts. Education did not attenuate any of these associations. CONCLUSIONS Cohort effects were observed in all examined cognitive domains and, surprisingly, remained significant after controlling for educational effects. Factors other than education are likely responsible for the cohort effects in cognitive decline.
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Affiliation(s)
- Hiroko H Dodge
- Department of Neurology, Oregon Health & Science University, Portland. Department of Neurology and
| | - Jian Zhu
- Department of Biostatistics, University of Michigan, Ann Arbor
| | | | | | - Mary Ganguli
- Department of Epidemiology, University of Pittsburgh, Pennsylvania. Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania
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Finger JD, Tylleskär T, Lampert T, Mensink GBM. Dietary behaviour and socioeconomic position: the role of physical activity patterns. PLoS One 2013; 8:e78390. [PMID: 24223150 PMCID: PMC3819390 DOI: 10.1371/journal.pone.0078390] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/11/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The positive association between education level and health outcomes can be partly explained by dietary behaviour. We investigated the associations between education and several indices of food intake and potential influencing factors, placing special emphasis on physical-activity patterns, using a representative sample of the German adult population. METHODS The German National Health Interview and Examination Survey 1998 (GNHIES98) involved 7,124 participants aged between 18 and 79. Complete information on the exposure (education) and outcome (nutrition) variables was available for 6,767 persons. The associations between 'education' and indices of 'sugar-rich food', 'fat-rich food', 'fruit-and-vegetable' and 'alcohol' intake were analysed separately for men and women using multivariate logistic regression analysis. Odds ratios (OR) of education level on nutrition outcomes were calculated and adjusted for age, region (former East/West Germany), occupation, income and other influencing factors such as physical activity indicators. RESULTS Men and women with only a primary education had a more frequent intake of sugar-rich and fat-rich foods and a less frequent intake of fruit and vegetables and alcohol than people with a tertiary education. 'Physical work activity' partly explained the associations between education and sugar-rich food intake. The interference with physical work activity was stronger among men than women. No significant associations between education and energy-dense food intake were observed in the retirement-age group of persons aged 65+ and among persons with low energy expenditure. CONCLUSIONS In Germany, adults with a low level of education report that they consume energy-dense foods more frequently - and fruit and vegetables and alcohol less frequently - than adults with a high education level. High levels of physical work activity among adults with a low education level may partly explain why they consume more energy-dense foods.
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Affiliation(s)
- Jonas D. Finger
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- * E-mail:
| | | | - Thomas Lampert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Gert B. M. Mensink
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Lee A, Mhurchu CN, Sacks G, Swinburn B, Snowdon W, Vandevijvere S, Hawkes C, L'abbé M, Rayner M, Sanders D, Barquera S, Friel S, Kelly B, Kumanyika S, Lobstein T, Ma J, Macmullan J, Mohan S, Monteiro C, Neal B, Walker C. Monitoring the price and affordability of foods and diets globally. Obes Rev 2013; 14 Suppl 1:82-95. [PMID: 24074213 DOI: 10.1111/obr.12078] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Food prices and food affordability are important determinants of food choices, obesity and non-communicable diseases. As governments around the world consider policies to promote the consumption of healthier foods, data on the relative price and affordability of foods, with a particular focus on the difference between 'less healthy' and 'healthy' foods and diets, are urgently needed. This paper briefly reviews past and current approaches to monitoring food prices, and identifies key issues affecting the development of practical tools and methods for food price data collection, analysis and reporting. A step-wise monitoring framework, including measurement indicators, is proposed. 'Minimal' data collection will assess the differential price of 'healthy' and 'less healthy' foods; 'expanded' monitoring will assess the differential price of 'healthy' and 'less healthy' diets; and the 'optimal' approach will also monitor food affordability, by taking into account household income. The monitoring of the price and affordability of 'healthy' and 'less healthy' foods and diets globally will provide robust data and benchmarks to inform economic and fiscal policy responses. Given the range of methodological, cultural and logistical challenges in this area, it is imperative that all aspects of the proposed monitoring framework are tested rigorously before implementation.
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Affiliation(s)
- A Lee
- School of Public Health and Social Work and School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
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