The role of socio-economic factors in food consumption of Portuguese children and adolescents: results from the National Food, Nutrition and Physical Activity Survey 2015-2016

Each Indicator of Socioeconomic Status (Education, Occupation, Income, and Household Size) Is Differently Associated with Children's Diets: Results from a Cross-Sectional CroCOSI Study

Background: There has yet to be an agreement on which specific socioeconomic status (SES) indicator most effectively reflects disparities in children's diets. However, children from lower SES backgrounds are particularly vulnerable, as research in other countries indicates that their diets contain fewer fruits and vegetables and more sweetened beverages. This paper aims to evaluate the associations between dietary habits and various SES indicators (education, occupation, income, and household size) among a representative sample of children in Croatia aged 7-10. Methods: Parents of children were asked to complete a questionnaire that contained indicators of their children's dietary habits and socioeconomic status (n = 5608). Associations between SES and children's dietary habits were assessed using logistic regression models. Results: The mother and father's educational attainment were strongly positively associated with breakfast consumption. Children of parents with a lower educational level consumed sweetened beverages, sweet snacks, and fast food slightly more often than children in families with a higher educational background. The mother's education was inversely associated with vegetable and cereal consumption, while the father's education was inversely associated with fruit and bakery product consumption. Meanwhile, household income per unit had a significant influence on the consumption of soft drinks and bakery products. Household size had a significant influence solely on sweet snack consumption. Conclusions: Each SES indicator showed an independent association with at least one particular dietary habit, except for the parent's employment status.

Youth Healthy Eating Index (YHEI) and Diet Adequacy in Relation to Country-Specific National Dietary Recommendations in Children and Adolescents in Five Mediterranean Countries from the DELICIOUS Project

BACKGROUND/OBJECTIVES

The diet quality of younger individuals is decreasing globally, with alarming trends also in the Mediterranean region. The aim of this study was to assess diet quality and adequacy in relation to country-specific dietary recommendations for children and adolescents living in the Mediterranean area.

METHODS

A cross-sectional survey was conducted of 2011 parents of the target population participating in the DELICIOUS EU-PRIMA project. Dietary data and cross-references with food-based recommendations and the application of the youth healthy eating index (YHEI) was assessed through 24 h recalls and food frequency questionnaires.

RESULTS

Adherence to recommendations on plant-based foods was low (less than ∼20%), including fruit and vegetables adequacy in all countries, legume adequacy in all countries except for Italy, and cereal adequacy in all countries except for Portugal. For animal products and dietary fats, the adequacy in relation to the national food-based dietary recommendations was slightly better (∼40% on average) in most countries, although the Eastern countries reported worse rates. Higher scores on the YHEI predicted adequacy in relation to vegetables (except Egypt), fruit (except Lebanon), cereals (except Spain), and legumes (except Spain) in most countries. Younger children (p < 0.005) reporting having 8-10 h adequate sleep duration (p < 0.001), <2 h/day screen time (p < 0.001), and a medium/high physical activity level (p < 0.001) displayed a better diet quality. Moreover, older respondents (p < 0.001) with a medium/high educational level (p = 0.001) and living with a partner (p = 0.003) reported that their children had a better diet quality.

CONCLUSIONS

Plant-based food groups, including fruit, vegetables, legumes, and even (whole-grain) cereals are underrepresented in the diets of Mediterranean children and adolescents. Moreover, the adequate consumption of other important dietary components, such as milk and dairy products, is rather disregarded, leading to substantially suboptimal diets and poor adequacy in relation to dietary guidelines.

Ultra-Processed Food Consumption and Its Association with Risk of Obesity, Sedentary Behaviors, and Well-Being in Adolescents

BACKGROUND/OBJECTIVES

The literature on consumption of ultra-processed food (UPF) using the NOVA classification is still limited. Therefore, the aim of the present study was twofold: (i) to compare the UPF consumption, sedentary behaviors, and well-being perception between boys and girls; and (ii) to investigate the association between the UPF consumption and risk of overweight, sedentary behaviors, and well-being in adolescents.

METHODS

The present cross-sectional study comprised a sample of 245 adolescents (131 boys) aged 12-17 years-old (M = 14.20; SD = 1.09). Height and weight were assessed, and subsequently, the BMI was computed; furthermore, total body fat percentage was measured with bioelectrical impedance. Daily consumption of UPF was assessed by the NOVA screener and time spent sedentary was assessed by the Midlands Behavior Health 2024 questionnaire. The Mental Health Continuum-Short Form (MHC-SF) was used to measure adolescents' psychosocial well-being. Pearson's correlations and logistic regression analysis were used, controlling for biological, behavioral, and socio-economic confounders.

RESULTS

No sex differences were observed for the different UPF NOVA subscales. Boys reported higher computer use levels than girls on the weekend (p = 0.025), and they spent more time playing electronic games during the week (p = 0.005) and on the weekend than their female counterparts (p < 0.001). Moreover, boys reported higher scores in all well-being dimensions (p < 0.001) than girls.

CONCLUSIONS

The findings revealed, after controlling for sex, sedentary time, and active behaviors, adolescents who consumed UPF on the previous day tended to be associated with a higher risk of being overweight, but also marginally without statistical significance (OR = 0.91, 95% CI: 0.83-1.01, p = 0.06). Of relevance, the present study revealed that both boys and girls of mothers with high educational levels were less likely to be classified as overweight or obese youth.

Exploring dietary patterns and their association with environmental sustainability and body mass index in children and adolescents: Insights from the National Food, Nutrition and Physical Activity Survey 2015-2016

OBJECTIVE

To adapt four dietary patterns for children and adolescents, and study their associations with sustainability (greenhouse-gas emissions-GHGE and land use-LU), and health (body mass index-BMI) indicators.

RESEARCH METHODS & PROCEDURES

Dietary intake of children (3-9y) and adolescents (10-17y) from the National Food, Nutrition and Physical Activity Survey 2015-2016, Portugal (n = 1153) was assessed through two non-consecutive interviews: one-day food diaries (children), and 24-h recalls (adolescents), using an automated multiple-pass method, including a picture book for portion sizes estimation. Adherence to the Eat-Lancet and World Health Organization (WHO) recommendations, Mediterranean and Atlantic diets were evaluated using adapted versions for pediatrics of the World Index for Sustainability and Health (WISH), Diet Quality Index (DQI), Mediterranean Diet Score (MDS) and Southern-European Atlantic Diet (SEAD), respectively. Diet-related GHGE and LU were estimated using the SHARP-Indicators database. BMI (measured) z-scores were classified according to WHO criteria. A standardized weighted health-sustainability composite index was created (BMI + 0.5*GHGE+0.5*LU). Adjusted linear regression models were computed.

RESULTS

WISH, DQI, MDS, and SEAD had weighted mean scores (range) of 50 (0-130), 24 (9-36), 20 (8-32), and 17 (8-32), respectively. All dietary patterns were associated with lower environmental impact, particularly in children, but not with BMI. Only MDS explained both health and sustainability indicators in childhood (composite index: sd.β = -0·223,95%CI:-0·347,-0·072,R2 = 25.1 %), and adolescence (composite index: sd.β = -0·159,95%CI:-0·315,-0·003,R2 = 31.3 %).

CONCLUSION

The Mediterranean diet was the most related to (higher) environmental sustainability and (lower) BMI. However, in children (not adolescents), the WISH, DQI, and SEAD showed then same associations.

Sleep timing behaviour, sleep duration and adherence to obesogenic dietary patterns from pre-school to school age: results from the Portuguese birth cohort Generation XXI

In an obesogenic environment, short sleeping may increase opportunistic eating. The timing of sleep might also influence the drive to eat. This study investigated the prospective association of sleep timing and duration with diet in 5286 children from the Portuguese birth cohort Generation XXI, evaluated at 4 and 7 years of age. At 4 years, sleep duration was categorised into ≤10 and >10 h. Four sleep timing categories were generated based on the median split for sleep-onset and -offset times: 'Early Sleep-Early Wake'; 'Early Sleep-Late Wake'; 'Late Sleep-Early Wake'; 'Late Sleep-Late Wake'. At 7 years, diet was obtained by a food frequency questionnaire and three dietary patterns were included: 'Healthier', 'Energy-Dense Foods (EDF)' and 'Snacking'. The Healthy Eating Index was used to evaluate diet quality. Multinomial logistic regression models and generalised linear models were performed. Children who had a late sleep, independently of the time of waking up, had higher odds of following the 'EDF' pattern, compared with the 'Healthier'. Boys who had late sleep and/or late wake had also higher odds of following the 'Snacking' pattern and had poorer diet quality. In both sexes, a late sleep or late wake were associated with a lower diet quality, compared to the group 'Early Sleep-Early Wake', and independently of nap behaviour. In boys, shorter sleep duration was associated with a poorer diet. In conclusion, pre-schoolers with late bedtimes or wake-up times have worse dietary patterns and poorer diet quality at the age of 7 years, which seems to be independent of sleep duration.

Socioeconomic and household framework influences in school-aged children's eating habits: Understanding the parental roles

Maternal influences on children's diet have been widely studied, while paternal and household frameworks require further research. This study aimed to evaluate how individual, socioeconomic and household characteristics at birth and 7 years (y) impact children's fruit and vegetable (FV) and energy-dense foods (EDF) intake at 10y, distinguishing maternal and paternal effects. The sample included 2750 children evaluated at 7 and 10y in the Portuguese birth cohort Generation XXI. The children's food intake was assessed through a Food Frequency Questionnaire at both ages, where 4 food groups were defined: FV, 'Sweet foods', 'Salty snacks', and 'Soft drinks'. The associations between food intake at 7y, parents' and children's characteristics, and food intake at 10y were evaluated via binary logistic regression models. Offspring of older mothers with higher age and education, who live with siblings and had higher family income were likelier to have 5 servings of FV daily at 10y. Children eating 5 portions/day of FV at 7y had higher odds of keeping this pattern at 10y. Higher maternal age and education, and father's education decreased the odds of having soft drinks daily at 10y. Higher family income was linked with lower odds of weekly salty snacks and daily sweet foods at 10y. In conclusion, parental education, maternal age, living with siblings, and higher family income influenced children's FV and EDF intake at 10y. Mothers' effects appear to impact children's food intake more than fathers'.

Associations between chronotype, diet quality and timing of energy intake in Portuguese children and adolescents: The potential role of summer holidays

Later chronotypes may be associated with lower diet quality and later timing of energy intake in paediatric age. Period of data collection of these variables may affect these parameters and inter-relationship. We aimed to assess the cross-sectional association of chronotype with a diet quality score (HEI) and caloric midpoint (time of achieving 50% of total daily energy intake), considering summer holidays, using data from the National Food, Nutrition and Physical Activity Survey 2015-2016 for 578 participants (6-14 years of age). Chronotype was estimated by the midpoint of sleep and categorized as Early, Intermediate and Late, using physical activity diaries, while outcomes using two food diaries/24 h recalls. Associations of chronotype with outcomes were assessed by linear regressions adjusted for sex, age, parental education (model 1), BMI, sports practice (model 2), and summer holidays (no/yes) (model 3). In model 2, a Late vs. Early chronotype was negatively associated with HEI (β ˆ = -0.74; 95% CI: -1.47, -0.07) and positively with caloric midpoint (β ˆ = 0.35; 95% CI: 0.02, 0.69). However, associations lost significance in model 3. The association between chronotype and dietary habits may be benefit from being studied considering school terms and summer holidays. Future larger prospective studies are needed to clarify the role of summer holidays on this inter-relationship.

Relationship between Diet Quality and Socioeconomic and Health-Related Factors in Adolescents by Gender

Adolescence is a key period for consolidating heathy lifestyles and proper eating habits that can last into adulthood. To analyze the diet quality of Spanish adolescents and its association with socioeconomic factors and health behaviors by gender, a cross-sectional study was conducted using data from the DESKcohort project, consisting of a biannual panel survey on health, health behaviors, and associated determinants, collected in secondary education centers. The study population consisted of 7319 students aged 12 to 18 years. Data were collected from October 2019 to March 2020. The dependent variable was diet quality score according to the Spanish adaptation of the Healthy Eating Index (S-HEI). The independent variables included were socioeconomic factors and health behaviors. We conducted linear regression separately by gender. Diet quality score was significantly higher for girls than for boys (68 and 65, respectively, p < 0.001). For both genders, poorer diet quality was associated with a low level of physical activity [-0.9 (95% CI = -1.6:-0.2) in boys, -1.2 (95% CI = -1.9:-0.4) in girls], alcohol use [-2.5 (95% CI = -3.7:-1.3) in boys, -1.0 (95% CI = -1.9:0.0) in girls], poor self-perceived health [-1.1 (95% CI = -2.4:0.2) in boys, -3.5 (95% CI = -4.6:-2.4) in girls], and having attended Intermediate Level Training Cycles [-2.9 (95% CI = -4.3:-1.5) in boys, -1.9 (95% CI = -3.5:-0.3) in girls]. In girls, poorer diet quality also was associated with low mood [-1.1 (95% CI = -1.9:-0.3)]. The variance was 9% in boys and 12% in girls. Our results highlight the need to consider socioeconomic and health-related factors, as well as gender, when conducting interventions to promote healthy eating among adolescents.

Association between Socioeconomic Factors, Food Insecurity, and Dietary Patterns of Adolescents: A Latent Class Analysis

Socioeconomic factors and food insecurity play a fundamental role in the food choices of adolescents, and in addition to influencing access to food, they also have significant effects on dietary patterns. The objectives of this study were to identify the dietary patterns of adolescents through the application of latent class analysis and to evaluate their association with socioeconomic variables and food insecurity. This cross-sectional study was conducted with adolescents aged between 11 and 17 years from public schools. Latent class analysis was used to identify the dietary patterns. Associations between socioeconomic factors, food insecurity and dietary patterns were assessed using multinomial logistic regression (odds ratio (OR); 95% confidence interval (CI)). Among the 1215 participants in the study, four dietary patterns were identified: "Mixed", "Low consumption", "Prudent" and "Diverse". A "Diverse" dietary pattern was associated with a lower economic stratum (OR:2.02; CI:1.26-3.24). There was no association between food insecurity and identified dietary patterns. These results highlight the importance of promoting healthy eating in this age group at all socioeconomic levels, especially the lowest level.

Impact of the Family Environment on the Frequency of Animal-Based Product Consumption in School-Aged Children in Central Poland

Animal-sourced foods (ASFs) have a high nutritional value, which makes them important elements of young people's diets. Several environmental factors might affect the dietary habits of children and adolescents, and their identification seems to be a principal reason to maintain their healthy eating practice. Thus, we aimed to investigate selected environmental factors (a place of residence, net income, mother's education level, number of siblings, and mother's BMI), which may be linked to the consumption frequency of ASFs among school-aged children. In total, 892 mothers of primary school children aged 7-14 years from central Poland took part in the anonymous and voluntary survey. The frequency of meat and meat product consumption was affected by the mother's education level, place of residence, and net income. Generally, meat was eaten more often by the city children (G = 0.178, p < 0.01) of better-educated mothers (G = 0.268, p < 0.001) and higher-income families (G = 0.209, p < 0.001). A higher level of education was linked to more frequent fish consumption but only in the younger group (G = 0.130, p < 0.05). The frequency of egg intake was positively associated with the maternal level of education (G = 0.185, p < 0.001), children's gender (girls > boys, G = 0.123, p < 0.05), and place of residence (city > village, G = 0.214, p < 0.001). In turn, the frequency of milk and dairy intake was related only to the place of residence (village > city, G = 0.97, p <0.05). It can be concluded that the mother's level of education is a key factor linked to the selected children's dietary habits. Thus, we believe that successful health education programs designed for young people should include the maternal capacity to interpret and adapt information into daily practice.

Modelling socioeconomic position as a driver of the exposome in the first 18 months of life of the NINFEA birth cohort children

BACKGROUND

The exposome drivers are less studied than its consequences but may be crucial in identifying population subgroups with unfavourable exposures.

OBJECTIVES

We used three approaches to study the socioeconomic position (SEP) as a driver of the early-life exposome in Turin children of the NINFEA cohort (Italy).

METHODS

Forty-two environmental exposures, collected at 18 months of age (N = 1989), were classified in 5 groups (lifestyle, diet, meteoclimatic, traffic-related, built environment). We performed cluster analysis to identify subjects sharing similar exposures, and intra-exposome-group Principal Component Analysis (PCA) to reduce the dimensionality. SEP at childbirth was measured through the Equivalised Household Income Indicator. SEP-exposome association was evaluated using: 1) an Exposome Wide Association Study (ExWAS), a one-exposure (SEP) one-outcome (exposome) approach; 2) multinomial regression of cluster membership on SEP; 3) regressions of each intra-exposome-group PC on SEP.

RESULTS

In the ExWAS, medium/low SEP children were more exposed to greenness, pet ownership, passive smoking, TV screen and sugar; less exposed to NO₂, NO_X, PM_25abs, humidity, built environment, traffic load, unhealthy food facilities, fruit, vegetables, eggs, grain products, and childcare than high SEP children. Medium/low SEP children were more likely to belong to a cluster with poor diet, less air pollution, and to live in the suburbs than high SEP children. Medium/low SEP children were more exposed to lifestyle PC1 (unhealthy lifestyle) and diet PC2 (unhealthy diet), and less exposed to PC1s of the built environment (urbanization factors), diet (mixed diet), and traffic (air pollution) than high SEP children.

CONCLUSIONS

The three approaches provided consistent and complementary results, suggesting that children with lower SEP are less exposed to urbanization factors and more exposed to unhealthy lifestyles and diet. The simplest method, the ExWAS, conveys most of the information and is more replicable in other populations. Clustering and PCA may facilitate results interpretation and communication.

Changes in dietary habits and weight status during the COVID-19 pandemic and its association with socioeconomic status among Iranians adults

Background

COVID-19 pandemic has impacted human health through sudden lifestyle changes, including isolation at home, and social distancing. Therefore, the current study aimed to investigate the effect of the COVID-19 pandemic on eating habits, weight status, and their associations with socioeconomic status.

Methods

This cross-sectional study was conducted using an online structured questionnaire that inquired demographic, anthropometric (reported weight and height); dietary habits (weekly intake of certain foods); and dietary supplement intake information.

Results

A total of 1,187 participants completed the questionnaire, and after validation of the data, 1,106 respondents were included in the study, with a mean age of 34.5 ± 9.4 years. Our findings showed that the body mass index (BMI) of the participants significantly increased during COVID-19 (P < 0.001). Also, there were significant changes in the intake of a variety of food and beverage during the COVID-19, including less consumption of milk, yogurt, red meat, fish, canned fish, homemade fast foods, take out fast foods, carbonated drinks, and more consumption of whole bread, legumes (chickpeas, lentil, peas, kidney beans, black beans, pinto beans, and navy beans), soy bean, nuts, seeds, high vitamin C vegetables, high vitamin C fruits, green-yellow fruits and vegetables, onion/garlic, dried fruits, natural fruit juices, and water (P < 0.001; for all). It is informed that individuals consumed more vitamin and mineral supplements (P < 0.001). Also, before and during COVID-19 pandemic weekly intakes of dairy, red meat, poultry, high vitamin C fruits, and whole bread were positively associated with socioeconomic status (P < 0.001).

Conclusion

Overall, this study indicates changes in body weight, dietary habits and supplement intake during the pandemic. Therefore, the findings of this study are valuable for, health professionals and politicians to better public health practice and policy making.

Intervention strategies to promote healthy and sustainable food choices among parents with lower and higher socioeconomic status

BACKGROUND

A global shift towards more healthy and sustainable diets is necessary for the prevention of obesity and chronic diseases, as well as for the growing pressure on our ecosystems. Given that parents are important actors in affecting dietary behaviors of their children, developing intervention strategies targeting families and their practices is promising to reach positive behavior change among children. Also, it is important to tailor these interventions to the needs of parents with different socioeconomic statuses (SES), given that health inequalities continue to grow. This study aims to investigate perspectives of lower and higher SES parents on the usability and acceptability of various innovative intervention strategies.

METHODS

Fourteen focus groups and four individual interviews (n = 78, n_lowerSES = 17; n_higherSES = 61) were conducted in Belgium. A semi-structured interview guide was used to facilitate the discussions. The interviews were recorded, transcribed, and analyzed via thematic content analysis using NVivo.

RESULTS

To encourage healthy and sustainable food choices, interventions via online food shopping platforms and nudging strategies in grocery stores were mostly cited by higher SES parents, but these were less applicable for lower SES parents as they buy less online and mainly consider the price of products. Mobile applications that provide inspiration for healthy and sustainable recipes and easily accessible shopping lists received moderate support among lower and higher SES parents. Furthermore, both lower and higher SES parents showed interest in meal boxes delivered at home, but lower SES parents have not yet tried such meal boxes because of their higher prices. Still, both groups of SES parents mentioned many advantages of these meal boxes, such as the convenience and time-saving component, as well as the cooking inspiration aspect.

CONCLUSION

Our study reveals the preferences of lower and higher SES parents for practical intervention strategies, providing insight in what features these strategies should have to be acceptable and useful. Hence, the findings can inform the development of a tailored family-based intervention strategy to improve parental food choices in favor of increased health and sustainability.

Association between short-term exposure to ambient PM1 and PM2.5 and forced vital capacity in Chinese children and adolescents

This study aims to examine the association between short-term exposure to ambient PM₁, PM_1-2.5, and PM_2.5 and forced vital capacity (FVC). Population data were obtained from a school-based cross-sectional survey in Shandong in 2014. Distributed lag non-linear models were used to examine the association between exposure to PM₁, PM_1-2.5, and PM_2.5 and FVC at the day of FVC measurement and the previous 6 days (lag 0 to 6 days). A total of 35,334 students aged 9 to 18 years were included in the study, and the mean exposure concentrations of ambient PM₁, PM_1-2.5, and PM_2.5 for them were 47.4 (standard deviation [SD] = 21.3) μg/m³, 32.8 (SD = 32.2) μg/m³, and 80.1 (SD = 47.7) μg/m³, respectively. An inter-quartile range (IQR, 24 μg/m³) increment in exposure to PM₁ was significantly associated with a lower FVC at lag 0 and lag 1 day (β =  - 80 mL, 95% CI =  - 119, - 42, and β =  - 37 mL, 95% CI =  - 59, - 16, respectively), and an IQR (54 μg/m³) increment in exposure to PM_2.5 was significantly associated with a lower FVC at lag 0 and lag 1 day (β =  - 57 mL, 95% CI =  - 89, - 18, and β =  - 34 mL, 95% CI =  - 56, - 12, respectively) after adjustment for gender, age, body mass index category, residence, month of the survey, intake of eggs, intake of milk, physical activity, and screen time. No significant associations were observed for PM_1-2.5. The inverse associations of PM₁ and PM_2.5 with FVC were larger in males, younger children, those overweight or obese, and those with insufficient physical activity levels. Short-term exposure to ambient PM₁ and PM_2.5 was associated with decreased FVC, and PM₁ may be the primary fraction of PM_2.5 causing the adverse pulmonary effects. Our findings emphasize the need to address ambient PM, especially PM₁, pollution for affecting pulmonary health in children and adolescents.

European mature adults and elderly are moving closer to the Mediterranean diet-a longitudinal study, 2013-19

BACKGROUND

The decreasing adherence in Mediterranean Diet (M.D.) during the last decades has been attributed to social, cultural and economic factors. However, recent efforts to improve dietary habits and the economic improvement might be reversing this trend. We analyze the changes in M.D. adherence between 2013 and 2019 among a sample of European mature adults and the elderly.

METHODS

Using data from the Survey of Health, Ageing and Retirement in Europe for adults over 50 years old, we designed a longitudinal cohort study with a sample of participants from waves 5 (2013) and 8 (2019/20). Logistic regressions were used to model the consumption of M.D. adherence as a function of the year. We then stratified the analyses by education, age and transitions in economic status, employment and self-perceived health.

RESULTS

There was in 2019/20 a significant increase in the M.D. adherence (10.8% vs. 14.3%, OR = 1.367, P < 0.01). The rise was mainly related to the decrease of meat and fish (38.4% vs. 30.5%, OR = 0.703, P < 0.01) and growth of legumes and eggs intake (36.3% vs. 41.8%, OR = 1.260 P < 0.01). The results were consistent in all European regions and most sociodemographic groups. Younger people with higher income and education had a greater rise in adherence.

CONCLUSIONS

Our analysis shows a generalized growth in adherence to the M.D. across most socioeconomic subpopulations and countries in Europe, suggesting a shift to healthier diet patterns. The more noticeable increase among affluent, educated and healthy respondents, may further entrench dietary and health inequalities.

Dietary exposure to artificial sweeteners and associated factors in the Portuguese population

This study aimed to evaluate the risk of the Portuguese population's exposure to six non-nutritive intense sweeteners (NNIS) and their main associated factors. A tiered approach was used to estimate the usual exposure to the NNIS obtained from two 1-day food diaries among children and two 24-hour recalls among adults in the Portuguese national dietary survey (IAN-AF 2015-2016; age: 3-84 y; n = 5005). The tiers considered were the following: Tier 2.1 represents the most conservative tier, in which all foods reported were matched with the respective maximum permitted levels (MPLs); in Tier 2.2, the MPLs were attributed only to the foods for which the brand's label information identified the presence of an added NNIS; finally, Tier 3 was identical to Tier 2.2, but analytical NNIS occurrence data were used, instead of MPLs. The usual exposure of the Portuguese population to each NNIS was very low in all tiers across all age groups, as was the estimated prevalence of exposure above the acceptable daily intake. Soft drinks were the main source of exposure for most sweeteners, and acesulfame K and aspartame were the most consumed NNIS. The odds of exposure to at least one NNIS were higher in more highly educated adults and elderly, obese elderly, women, and people with lower healthy diet scores. The estimated risk of exceeding the safety levels of NNIS intake was very low in all evaluated population groups, even when considering the most conservative approach.

Children's Perceived Barriers to a Healthy Diet: The Influence of Child and Community-Related Factors

A healthy diet influences the promotion and maintenance of health throughout an individual’s life. Many individuals struggle to have a healthy diet, despite it being mainly under their control. The current study aims to explore children’s perceived barriers to a healthy diet. A qualitative study with the open-ended question, “Please identify the top 5 barriers to a healthy diet”, was undertaken between January–June 2019 in which 274 students from the 5–6th grades wrote down their answers to the open-ended question. Content analysis was used to analyze responses with a codebook based on the Six C’s Model. Five categories were identified: Child, Clan, Community, Country, and Culture-related barriers. Findings showed that the barriers most highlighted were in the Child sphere (e.g., dietary intake) and the Community sphere (e.g., peer food choices). Children seldom referred to barriers from the Clan sphere, i.e., related to family (e.g., food available at home). Additionally, it seems that girls emphasize more barriers from the Child sphere, while boys emphasize more barriers from the Community sphere. Due to the qualitative nature of this study, interpretation of the data should take into account the specific characteristics and context of the sample. Nevertheless, the current data are helpful in identifying implications for practice, for example, the need to empower children with tools (e.g., self-regulation-based interventions) likely to help them overcome perceived barriers. Finally, advocacy groups may help set environmental and structural changes in the community likely to facilitate children’s healthy choices.

Associated factors to the consumption of ultra-processed foods and its relation with dietary sources in Portugal

Ultra-processed foods (UPFs) are common worldwide and associated with poorer health outcomes. This work aimed to explore the UPF consumption associated factors and its main dietary sources, by sex, in Portugal. Participants from the National Food, Nutrition and Physical Activity Survey (IAN-AF) 2015-2016, aged 3-84 years, were included (n 5005). Dietary intake was assessed through two 1-day food diaries/24 h recalls. UPFs were identified using the NOVA classification. Associations were evaluated through linear regression models. Median UPF consumption was 257 g/d (10⋅6 % of total quantity; 23⋅8 % of total energy). Adolescents were those with higher consumption (490 g/d). Compared to adults, younger ages were positively associated with UPF consumption (e.g. adolescents (-females: 192, 95 % confidence interval (CI): 135, 249; -males: 327, 95 % CI: 277, 377)). A lower educational level was associated with lower UPF consumption (-females: -63; 95 % CI: -91, -34; -males: -68; 95 % CI: -124, -12). Also, a lower UPF consumption was observed in married males/couples compared to singles (: -48, 95 % CI: -96, -1). Furthermore, female current/former smokers were associated with a higher UPF consumption v. never smokers (: 79, 95 % CI: 41, 118; : 42, 95 % CI: 8, 75, respectively). Main UPF sources were yoghurts, soft drinks and cold meats/sausages differing strongly by sex, age and education level. Yoghurts containing additives were the main contributors to the UPF consumption in children and adult females from all education (~20 %). Soft drinks were leaders in adolescents (females: 26⋅0 %; males: 31⋅6 %) and young male adults (24⋅4 %). Cold meats/sausages stood out among low-educated males (20⋅5 %). Males, younger age groups, higher education, children with less-educated parents, married/couple males and smoking females were positively associated with UPF consumption.

"More Than Buying Extra Fruits and Veggies, Please Hide the Fats and Sugars": Children's Diet Latent Profiles and Family-Related Factors

Promoting children’s healthy diets is a key public health priority. Family can play a relevant role in children’s eating patterns. The goals of the current research were to identify different latent diet profiles in children based on their food consumption and to assess the relationship between profiles and family-related factors. A total of 678 school-aged children from the fifth and sixth grades participated. The study design was cross-sectional and questionnaire based. Research assessed healthy (fruit and vegetables) and unhealthy (fast food, sugar-sweetened beverages, and candies) food consumption and family-related factors. A latent profile analysis and multivariate data analysis were developed. Four diet profiles were identified: Combined Diet, Mainly Healthy Diet, Mainly Unhealthy Diet, and Very Unhealthy Diet. Nearly half of the children (45.22%) showed a Combined Diet profile, meaning that they reported eating nearly the same amount of healthy and unhealthy types of foods. Associations between the diet profiles, family income, and food availability were found. For example, the Mainly Healthy Diet profile was statistically associated with a higher family income and less access to unhealthy foods. The present study reinforces the idea that profiling diets can allow for a tailored healthy eating intervention model according to the specific needs of each diet profile.

Socioeconomic Inequalities in Food Consumption: A Cross-Sectional Study in Portuguese Adults

Background

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.

Objectives

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.

Methods

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.

Results

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.

Conclusion

The food consumption patterns of Portuguese adults are related to their socioeconomic condition, with few variations across demographic categories.

Healthy eating: a privilege for the better-off?

BACKGROUND

Food subsidies for healthier foods and higher taxes for less healthy alternatives have been increasingly used to promote a healthy diet. Yet, some have argued that the fiscal burden on unhealthy products would fall disproportionately on the worse-off, raising equity concerns. This study estimates the association between income and the consumption of key food groups linked to the Mediterranean diet in the adult Portuguese population.

METHODS

We used data from the Portuguese National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016), which observed the daily diet of individuals aged above 18 and below 79 years old (n = 3242). Logistic regression models were used to estimate the magnitude of the association between self-reported household income categories and consumption of foods related to the Mediterranean diet (fish, vegetables, fruits and legumes), and not (sweets, sugar-sweetened beverages, cakes & pastries and processed meats). Stratified analyses were performed by education and age categories.

RESULTS

We observed that the intake of fish (35.8 vs 38.8 g p = 0.02), vegetables (146.7 vs 166.2 g p < 0.01), and fruits (119.8 vs 150.1 g p < 0.01) was positively related to income, with a clear gradient for the two latter. Yet, the positive income-consumption link for fish was only observed among low-educated people, and the one for legumes among high educated and youths. Conversely, the consumption of most non-Mediterranean foods was not positively related to income categories, with the exception of sweets (34.8 vs 31.8 g p = 0.01) and cakes (26.4 vs 21.4 g p < 0.01) (more prevalent among the better-off).

CONCLUSIONS

The consumption of healthy food is mostly consistently related to income, contrary to the intake of unhealthy ones. It may well be, therefore, that subsidies to healthy foods could allow access to the worse-off while taxing unhealthy food will not impose a disproportionate burden on them.

Social Inequalities in Changes in Diet in Adolescents during Confinement Due to COVID-19 in Spain: The DESKcohort Project

Adolescence is a critical period in the consolidation of healthy lifestyles that can last into adulthood. To analyze changes in food consumption and eating behaviors in high-school adolescents during the first confinement, a cross-sectional study was conducted at the end of confinement in Spain. Changes in the frequency or quantity of consumption of different types of food and food-related behaviors were analyzed. Socioeconomic and health-related variables were also considered. To determine whether dietary changes were related to socioeconomic position (SEP), Poisson regression models with robust variance were estimated. Overall, there were some changes towards a healthier diet such as an increase in fruit consumption (38.9%) and a decrease in the consumption of soft drinks (49.8%), sweets and pastries (39.3%), and convenience foods (49.2%). Some changes, however, were related to less healthy behaviors, such as a more irregular pattern of meal distribution (39.9%) or an increase in snacking between meals (56.4%). Changes towards less healthy eating were also related to students’ SEP. The risk of worsening the diet was found to be 21% higher in adolescents from a more disadvantaged SEP. Future public policies could be adapted to avoid increasing nutritional and health inequalities.

Obesity, Mediterranean Diet, and Public Health: A Vision of Obesity in the Mediterranean Context from a Sociocultural Perspective

Obesity is a disease that straddles medico-nutritional, psychological, and socio-cultural boundaries. There is a clear relationship between lifestyle and obesity, and today the Mediterranean diet in the Mediterranean area may represent an interesting corrective asset. However, we should not be under any misapprehension about the model’s capacity for action in non-nutritional terms. Our societies are experiencing a process of rapid change, and the Mediterranean area is no exception. The aim of this article is to present a view of obesity in the Mediterranean context from an open, mainly socio-cultural perspective, but from different points of view (medical, nutritional), seeking points of convergence and elements that contribute to the understanding of and approach to the disease in the context of the Mediterranean diet. As a public health and a multidimensional social problem, obesity must be dealt with in a holistic, open, and cross-disciplinary manner to ensure that it can be understood coherently. The only way to keep the usefulness of the Mediterranean diet within desirable limits will be our societies’ vitality and interest in rapidly adapting the Mediterranean diet to social change, thus providing valid answers to today’s needs.