Dietary patterns and socioeconomic position

Association between modified youth healthy eating index and nutritional status among Iranian children in Zabol city: a cross-sectional study

Diet quality in childhood and adolescence can affect health outcomes such as physical and cognitive growth and preventing chronic diseases in adulthood. This study aimed to evaluate the relationship between diet quality using the modified youth healthy eating index (MYHEI) with socioeconomic factors and nutrition status in 7-12-year-old children in Iran. This descriptive-cross-sectional study was performed on 580 students in Zabol, Iran, selected through multistage cluster sampling. The diet was assessed through the 168-item food frequency questionnaire (FFQ) and eating behaviors. Then, the MYHEI scoring system was used to calculate the diet quality. In addition, we used the WHO growth indices, such as weight to age, height to age, and body mass index (BMI) to age ratios, to evaluate nutrition status. The mean total MYHEI score in children was 56.3 ± 11.2. Among children with the highest MYHEI score quartile, the number of girls was significantly higher than boys (p = 0.001). The prevalence of underweight, stunting, and wasting was 25.3%, 17.4%, and 21.7%, respectively. The prevalence of underweight (OR: 2.2; 95% CI  1.26, 3.90, p = 0.001) and stunting (OR: 3.2; 95% CI   1.65, 6.14, p = 0.006) were significantly lower in the higher MYHEI score quartile compared to the lower quartile. The overall diet quality of most children should be modified. Therefore, to improve the children's health and nutrition status, it is necessary to perform nutritional interventions such as training and promotional programs, especially in schools.

Correlation of dietary inflammation index and dietary pattern with mild cognitive impairment in patients with type 2 diabetes

OBJECTIVE

We aimed to determine the dietary patterns associated with mild cognitive impairment (MCI) in type 2 diabetes (T2DM) and the correlation of dietary inflammatory index (DII) with MCI.

METHODS

The Montreal Cognitive Assessment (MoCA) was used to assess cognitive function. A semi-quantitative food frequency questionnaire was used to collect dietary data and calculate DII. Dietary patterns were determined by reduced-rank regression (RRR), grouping dietary pattern scores and DII into quartiles, with logistic regression for correlation analysis. Dose-response relationships between dietary pattern scores, DII and diabetic MCI were explored using restricted cubic splines (RCS). A mediation analysis was performed to investigate whether DII mediates the association between dietary patterns and MCI.

RESULTS

In the "Mediterranean-style dietary pattern", the multivariable-adjusted odds ratio of having MCI was 0.37 (95% CI: 0.20-0.68; p for trend=0.002) in the highest versus lowest quartiles of the dietary score. In the "high-meat and low-vegetable pattern", the multivariable-adjusted odds ratio of having MCI was 6.84 (95% CI: 3.58-13.10; p for trend<0.001) in the highest versus lowest quartiles of the dietary score. In the "Western-style dietary pattern", the multivariable-adjusted odds ratio of having MCI was 2.48 (95% CI: 1.38-4.46; p for trend=0.001). The multivariable-adjusted odds ratio of having MCI was 3.99 (95% CI: 2.14-7.42; p for trend<0.001) in the highest versus lowest quartiles of DII. There is a non-linear dose-response relationship between the "high-meat and low-vegetable pattern" score and the prevalence of MCI, as well as the DII and the prevalence of MCI. The DII partially mediated the impact of the "Mediterranean-style dietary pattern" and the "high-meat and low-vegetable pattern" on MCI.

CONCLUSION

In T2DM patients, greater adherence to the "Mediterranean-style dietary pattern" is associated with a lower probability of having MCI. However, excessive consumption of meat, especially red meat and processed meat, combined with a lack of vegetable intake, is associated with a higher probability of having MCI. Greater adherence to the "Western-style dietary pattern" is associated with a higher probability of having MCI. In addition, a pro-inflammatory diet is associated with a higher probability of having MCI, and DII partially mediates the impact of dietary patterns on MCI.

Association between healthy eating index-2015 scores and metabolic syndrome among Iranian women: a cross-sectional study

BACKGROUND

Metabolic syndrome (MetS) is one of the leading public health issues in the world with a reported prevalence of nearly 25% in the past decades in Iran. The present research aimed to identify the association between the Healthy Eating Index (HEI) and MetS components among female teachers.

METHODS

In this cross-sectional study, 97 female teachers aged 31-57 years were enrolled from 2018 to 2019 in Qom, Iran. Usual dietary intakes were assessed using a validated 168-item Food Frequency Questionnaire (FFQ). HEI-2015 was calculated according to the consumption of whole fruits, vegetables, protein foods, beans, seafood, plant proteins, total and refined grain, dairy, fatty acid ratio, saturated fats, added sugars, and sodium. We also measured anthropometric and biochemical parameters. To evaluate the association between HEI-2015 and MetS, multivariate logistic regression was performed.

RESULTS

MetS was found in 59.8% of participants. Total HEI-2015 scores were significantly lower in participants with MetS compared to those without MetS (59.69 ± 8.98 vs. 64.21 ± 8.71, respectively; p = 0.02). Daily energy intake, weight, body mass index, waist circumference, systolic and diastolic blood pressure, serum triglyceride, and fasting blood sugar levels were higher in women with MetS (all p < 0.05). Higher HEI-2015 total scores (OR: 0.94; 95% CI: 0.89-0.99; p = 0.02) and scores of total vegetables (OR: 0.62; 95% CI: 0.42-0.91; p = 0.02), dark green vegetables and beans (OR: 0.62; 95% CI: 0.39-0.98; p = 0.04), fatty acid ratio (OR: 0.83; 95% CI: 0.68-0.99; p = 0.04), refined grain (OR: 0.86; 95% CI: 0.75-0.99; p = 0.04), and added sugars (OR: 0.44; 95% CI: 0.26-0.75; p = 0.002) were all associated with lower odds of having MetS.

CONCLUSIONS

Higher HEI-2015 scores, particularly in total vegetables, dark green vegetables, beans, and fatty acid ratio, as well as refined grain and added sugars were found to be associated with reduced odds of having MetS among Iranian female teachers. However, further prospective studies are required to confirm this finding.

Dietary shifts drive the slowdown of declining methylmercury related health risk in China

Chinese population suffers severe health risk from dietary methylmercury (MeHg) exposure. However, the temporal change of such risk and socioeconomic driving factors remain unknown. This study investigates this issue by compiling time-series inventory of China's MeHg-related health risk at the provincial scale and revealing critical socioeconomic influencing factors through structural decomposition analysis. Results show that the per-fetus IQ decrements from dietary MeHg exposure have declined by 60% nationally during 2004-2019. Such decline results from the joint effects of dietary shifts (contributing 44%) and the decrease of MeHg concentrations in foods consumed (contributing 56%). However, the declining trend has slowed down since 2014 and even leveled off after 2016, which is mainly affected by dietary pattern changes. Especially, the increased intake level and proportion of fishes in underdeveloped provinces of China have dominated the slowdown of declining trend after 2016. Moreover, the affluence and education levels have significantly negative associations with per-fetus IQ decrements. Rich and well-educated people have higher ability of risk perception, which indicates the importance of rational consumption patterns. Our findings can help develop socioeconomic regulatory policies on reducing per-fetus IQ decrements from dietary MeHg exposure in China.

Dietary patterns and their socioeconomic factors of adherence among adults in urban Burkina Faso: a cross-sectional study

BACKGROUND

Sub-Saharan African populations undergo a nutrition transition towards diets associated with increased risk for metabolic and cardiovascular diseases. For targeted prevention, we aimed to characterize dietary patterns and determine their sociodemographic factors of adherence.

METHODS

We recruited 1,018 adults aged >  = 25 years from two formal and three informal settlements within the Health and Demographic Surveillance System, Ouagadougou, Burkina Faso, between February and April 2021. In a cross-sectional sample, a culture-specific food-propensity questionnaire with 134 food items and a sociodemographic questionnaire were used to collect the data. Exploratory dietary patterns were derived using principal component analysis, and sociodemographic factors of adherence were calculated using multivariable linear regression models.

RESULTS

In this study population (median age: 42 years, interquartile range 21 years; male: 35.7%), the diet relied on starchy foods and other plant-based staples with rare consumption of animal-based products. We identified three dietary patterns, explaining 10.2%, 9.8%, and 8.9% of variation in food intake, respectively: a meat and egg-based pattern associated with younger age, male sex, better education, and economic situation; a fish-based pattern prevailed among women, higher educational levels, and better economic situation; and a starchy food-based was associated with younger age and sharing a home with other adults.

CONCLUSIONS

This study population is at an early stage of the nutrition transition and shows low intakes of health-beneficial food groups. Yet, progress along the nutrition transition varies according to age, educational attainment, and economic status. Particularly, younger and well-off people seem to adhere more strongly to diets high in animal-based products. These findings can inform strategies in public health nutrition for sub-Saharan African populations.

Dietary patterns, socioeconomic disparities, and risk of type 2 diabetes in the Sister Study

AIMS

We investigated the role of socioeconomic disparities in the association between diet and risk of type 2 diabetes (T2D).

METHODS

We used prospective data from 40,243 Sister Study participants aged 35 to 74 years who were enrolled in 2003-2009. Scores for healthy eating indices (alternate Mediterranean diet, Dietary Approaches to Stop Hypertension, alternative Healthy Eating Index, and Healthy Eating Index 2015 (HEI-2015)) were calculated using data from a 110-item food frequency questionnaire completed at enrollment. Incident T2D was defined based on self-reported physician's diagnosis or use of anti-diabetic medications. Multivariable-adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models.

RESULTS

We observed inverse associations between all four dietary indices and incident T2D after multivariable adjustment. These associations were most pronounced among women with higher educational attainment, higher income, and lower area deprivation index (ADI) (e.g., for the HEI-2015: low ADI, aHRQ4vsQ1: 0.44, 95% CI: 0.35, 0.56 vs high ADI, aHRQ4vsQ1: 0.75, 95% CI: 0.63, 0.90; pinteraction: 0.0007).

CONCLUSIONS

Weaker associations among women with lower socioeconomic status and higher neighborhood deprivation suggests that other factors play a larger role in T2D incidence than diet quality among individuals with low SES.

Socioeconomic inequalities in metabolic syndrome and its components in a sample of Iranian Kurdish adults

OBJECTIVES

The worldwide incidence of metabolic syndrome (MetS) has increased in recent decades. In this study, we investigated the socioeconomic inequalities associated with MetS and its components in a sample of the Iranian Kurdish population.

METHODS

We used data from 3,996 participants, aged 35 years to 70 years, from the baseline phase of the Dehgolan Prospective Cohort Study (February 2018 to March 2019). The concentration index and concentration curve were used to measure inequality and the Blinder-Oaxaca decomposition method was used to examine the contribution of various determinants to the observed socioeconomic inequality in MetS and its components.

RESULTS

The prevalence of MetS was 34.44% (95% confidence interval [CI], 32.97 to 35.93). The prevalence of MetS was 26.18% for those in the highest socioeconomic status (SES), compared with 40.51% for participants in the lowest SES. There was a significant negative concentration index for MetS (C=-0.13; 95% CI, -0.16 to -0.09), indicating a concentration of MetS among participants with a lower SES. The most prevalent component was abdominal obesity (59.14%) with a significant negative concentration index (C=-0.21; 95% CI, -0.25 to -0.18). According to decomposition analysis, age, gender, and education were the highest contributing factors to inequality in MetS and its components.

CONCLUSIONS

This study showed socioeconomic inequality in MetS. People with a low SES were more likely to have MetS. Therefore, policymakers and health managers need to develop appropriate strategies to reduce these inequalities in MetS across age groups, genders, and education levels, especially among women and the elderly.

Associations between measures of socio-economic position and sustainable dietary patterns in the NutriNet-Santé study

OBJECTIVE

We aimed to explore the relationship between socio-economic characteristics and sustainable dietary patterns.

DESIGN

Dietary data were derived from a web-based FFQ. Diet sustainability was evaluated using a modified Sustainable Diet Index, comprising nutritional, environmental and cultural components (higher scores expressing higher sustainability). The socio-economic position markers were education, household income and occupation status. Multi-adjusted linear and Poisson regression models were used to assess the cross-sectional association of the markers of socio-economic status with a sustainable diet and sustainability subcomponents, respectively.

SETTING

France.

PARTICIPANTS

29 119 NutriNet-Santé participants.

RESULTS

Individuals with a more sustainable diet had slightly higher diet monetary cost, lower total energy intake and consumed less animal-based foods than their counterparts. Lower education level was associated with lower overall diet sustainability (βprimary v. postgraduate = -0·62, 95 % CI (-0·72, -0·51)) and nutrition, socio-cultural and environmental subscores. Manual workers and employees had a lower modified Sustainable Diet Index than intermediate professionals (βmanual workers v. intermediate professionals = -0·43, 95 % CI (-0·52, -0·33) and βemployees v. intermediate professionals = -0·56, 95 % CI (-0·64, -0·48)). Participants with the lowest v. highest incomes had a higher environmental subscore but a lower socio-cultural subscore, whereas the results were less marked for occupational status.

CONCLUSIONS

Overall, our results documented associations between socio-economic status and the level of diet sustainability, arguing for the implementation of appropriate food policies to promote sustainable diets at lower cost.

Impact of a farmers' market healthy food subsidy on the diet quality of adults with low incomes in British Columbia, Canada: a pragmatic randomized controlled trial

BACKGROUND

Adults with low incomes have lower diet quality than their higher income counterparts. In Canada, the British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) provides coupons to low-income households to purchase healthy foods in farmers' markets.

OBJECTIVE

The objective of this study was to examine the impact of the FMNCP on the diet quality of adults with low incomes.

METHOD

In a pragmatic randomized controlled trial conducted in 2019, adults with low incomes (≥18 y) were randomly assigned either to an FMNCP intervention (n = 143) or a no-intervention control group (n = 142). The FMNCP group received 16 coupon sheets valued at $21 per sheet over 10-15 wk to purchase healthy foods from farmers' markets. Participants completed a questionnaire and 2 24-h dietary recalls at baseline (0 wk), immediately post-intervention (10-15 wk), and 16-wk post-intervention (26-31 wk). Diet quality was calculated using the Healthy Eating Index-2015 (HEI-2015). Linear mixed-effects regression assessed differences in HEI-2015 total (primary outcome) and component scores (secondary outcomes) between the FMNCP and control groups at post-intervention and 16-wk post-intervention. Subgroup analyses examined program impacts by sex and age group (18-59 y, ≥60 y).

RESULTS

There were no significant differences in HEI-2015 total scores between the FMNCP and control groups at post-intervention (-0.07; 95% CI: -4.07, 3.93) or 16-wk post-intervention (1.22; 95% CI: -3.00, 5.44) overall or between subgroups. There were no significant between-group differences in HEI-2015 component scores at post-intervention, although there were significant differences in component scores for dairy and fatty acids at 16-wk post-intervention.

CONCLUSION

The FMNCP did not significantly improve diet quality among adults with low incomes over the study period. Further research is needed to explore whether higher subsidy amounts or a longer intervention period is needed to meaningfully improve diet quality among adults with low incomes. This trial was registered at [clinicaltrials.gov] as [NCT03952338].

Spatial Distribution and Temporal Trends of Dietary Niacin Intake in Chinese Residents ≥ 5 Years of Age between 1991 and 2018

Limited knowledge exists on trends in niacin consumption and the prevalence of inadequate intakes in China. Understanding trends and the spatial distribution of the prevalence of inadequate niacin intake is crucial to identifying high-risk areas and sub-populations. The dietary intakes of niacin between 1991 and 2018 were analyzed using the China Health and Nutrition Survey (CHNS) data. The estimated average requirement cut point was applied to estimate inadequacy. The geographic information system's ordinary kriging method was used to estimate the spatial distribution of the prevalence of inadequate niacin intakes. However, between 1991 and 2018, the prevalence of inadequate niacin intake increased from 13.00% to 28.40% in females and from 17.75% to 29.46% in males. Additionally, the geographically significant clusters of high and low prevalence were identified and remained stable over almost three decades. The high prevalence of insufficient niacin intake was more pronounced in Henan and Shandong over 27 years. Further, effective and tailored nutrition interventions are required to address inadequate niacin intake in China.

Sociodemographic and dietary influences on perceptions of eating habits in Jamaica

Objective.

To evaluate how sociodemographic factors and food intake affect survey respondents’ perceptions of the quality of their diet.

Methods.

This cross-sectional analysis is based on a nonprobability sample of 374 participants in Jamaica aged ≥18 years. The three-stage process used a simple random sample to select three parishes; the main commercial areas of each parish were chosen for sampling. To ensure the inclusion of a cross-section that was as representative as possible, the sample included both public and private sector businesses, such as those in retail, hospitality and tourism as well as nongovernmental organizations. Employees and patrons completed a questionnaire regarding their food consumption and their perception of their own diet. Multiple correspondence analysis was used to evaluate the nonlinear relationships among the variables. The results of the analysis guided the specification of a multivariate logistic regression model that was used to estimate the relationship between sociodemographic factors, food intake and perceived eating patterns.

Results.

The average predicted probability of perceiving a diet as unhealthy was reduced when the respondent was male, economically active, in good health, and married or in a common-law relationship. The probability of perceiving a diet as unhealthy was increased for respondents with a college degree and those living in a household that had a male as the sole head. Consuming healthful food and drink reduced the perception of having a poor diet and vice versa, indicating there are possibly connections between food intake, the perception of diet quality and actual diet quality.

Conclusions.

This exploratory analysis established links between perceived diet quality, eating habits and sociodemographic factors. The impact on the perception of diet quality can be negative or positive, depending on the variable under consideration.

Qualitative modelling of social determinants of health using group model building: the case of debt, poverty, and health

Background

Social determinants of health (SDoH) are known to have a large impact on health outcomes, but their effects are difficult to make visible. They are part of complex systems of variables largely indirect effects on multiple levels, constituting so-called wicked problems. This study describes a participatory approach using group model building (GMB) with stakeholders, in order to develop a qualitative causal model of the health effects of SDoH, taking poverty and debt in the Dutch city of Utrecht as a case study.

Methods

With GMB we utilised the perspective of stakeholders who are directly involved in policy and practice regarding poverty, debt, and/or health. This was done using system dynamic modelling, in three interactive sessions lasting three hours each. In these sessions, they constructed a model, resulting in a system of variables with causal relationships and feedback loops. Subsequently, the results of these GMB sessions were compared to scientific literature and reviewed by a panel of researchers with extensive experience in relevant scientific fields.

Results

The resulting model contains 71 causal relationships between 39 variables, 29 of which are present in feedback loops. The variables of participation in society, stress, shame, social contacts and use of services/provisions appear to hold prominent roles in the model’s mechanisms. Most of the relationships in the model are supported by scientific literature. The researchers reviewing the model in the scientific meeting agreed that the vast majority of relationships would concur with scientific knowledge, but that the model constructed by the stakeholders consists mostly of individual-level factors, while important conditions usually relate to systemic variables.

Conclusions

Building a model with GMB helps grasp the complex situation of a wicked problem, for which it is unlikely that its interrelationships result in a fully intuitive understanding with linear mechanisms. Using this approach, effects of SDoH can be made visible and the body of evidence expanded. Importantly, it elicits stakeholders’ perspectives on a complex reality and offers a non-arbitrary way of formulating the model structure. This qualitative model is also well suited to serve as conceptual input for a quantitative model, which can be used to test and estimate the relationships.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-022-01676-7.

Chemical-specific determinants for pre-conceptional exposure to emerging and legacy per- and polyfluoroalkyl substances

The exposure of preconception women to per- and polyfluoroalkyl substances (PFASs) could negatively affect her reproductive health. However, chemical-specific determinants for pre-conceptional exposure to PFASs, particularly the emerging ones, remain poorly understood. In the present study, it was found that the total PFAS concentration ranged from 8.9 to 440.3 ng/mL (median: 49.6 ng/mL) in 1060 preconception women. The PFAS exposure profile was dominated by PFOA (16.8 ng/mL), followed by PFOS (13.3 ng/mL), 6:2 Cl-PFESA (8.9 ng/mL), PFDA (2.4 ng/mL), PFNA (2.1 ng/mL), and others. The pre-conceptional exposure to the selected PFASs was significantly associated, in a chemical-specific pattern, with multiple demographic characteristics and the consumption frequency of different types of food. In particular, the exposure to 6:2 Cl-PFESA was associated with age, parity, alcohol drinking, educational level, household income, and the consumption frequency of red meat, marine and freshwater fish, shellfish, and shrimp. However, our analysis revealed that the investigated sociodemographic and diet variables only explained a relatively small proportion (1.3%-18.7%) of PFAS concentration variations, raising the need of exploring additional factors critical to pre-conceptional PFAS exposure. Overall, the identification of chemical-specific determinants would greatly facilitate the understanding of the link between pre-conceptional exposure and health outcomes, and the mitigation of human exposure to PFAS, particularly the emerging ones.

Relation of the Dietary Approaches to Stop Hypertension Dietary Pattern to Heart Failure Risk and Socioeconomic Status (from the Southern Community Cohort Study)

The Dietary Approaches to Stop Hypertension (DASH) dietary pattern has been associated with a lower risk of incident heart failure (HF); however, previous studies were conducted in mostly middle-income White populations. The association between DASH and incident HF risk in lower income and Black individuals is less well understood. We analyzed 25,300 White and Black adults without a history of HF at enrollment (2002 to 2009) in the Southern Community Cohort Study receiving Centers for Medicare and Medicaid Services. Alignment with DASH was assessed at enrollment using a validated food frequency questionnaire. Incident HF was ascertained from Centers for Medicare and Medicaid Services claims through 2016. The association between DASH diet alignment and incident HF was examined in multivariable-adjusted Cox proportional hazards regression models, including an interaction term testing effect modification by income. The cohort was predominantly middle-aged (median 54 years), Black (68%), female (63%), and low-income (88% <$25,000/year/household). Socioeconomic factors, including education and annual income, were larger contributors to the variance in DASH score than were cardiovascular co-morbidities. The association between DASH dietary alignment and HF risk was not significant overall (hazard ratio [HR] 1.00; 95% confidence interval [CI] 0.96 to 1.04) or in race-sex groups. However, the association between alignment with the DASH diet and HF risk significantly varied by income (interaction p = 0.030), with neutral and inverse associations in lower (<$25,000/year) and higher ($≥25,000) income participants, respectively. In conclusion, income modified the association between healthier dietary patterns and risk of incident HF. In lower income participants, greater alignment with the DASH diet was not associated with lower HF risk.

Mediators of differences by parental education in weight-related outcomes in childhood and adolescence in Norway

Studies exploring mediators of socioeconomic inequalities in excess weight gain in early-life and subsequent overweight/obesity (OW/OB) among youth are limited. Thus, this study examined the mediating role of prenatal and early postnatal factors and child energy balance-related behaviours (EBRB) in the effects of parental education on (i) excess weight gain from birth to 2 years and (ii) OW/OB at 5, 8 and 14 years. The Norwegian Mother, Father and Child Cohort Study was used to include participants at the ages of 2 (n = 59,597), 5 (n = 27,134), 8 (n = 28,285) and 14 (n = 11,278) years. Causal mediation analyses using the inverse odds weighting approach were conducted. Children of low-educated parents had a higher conditional excess weight gain at 2 years compared to children of high-educated parents (total effect, RRTE = 1.06; 95% CI 1.01, 1.10). The joint mediation effects of the prenatal and early postnatal factors explained most of the total effect of low education on conditional excess weight gain at 2 years. Children of low-educated parents had a higher risk of OW/OB at 5, 8 and 14 years compared to children of high-educated parents. The mediators jointly explained 63.7%, 67% and 88.9% of the total effect of parental education on OW/OB among 5, 8 and 14 year-old-children, respectively. Of the total mediated effects at 5, 8 and 14 years, the prenatal and early postnatal mediators explained 59.2%, 61.7% and 73.7%, whereas the child EBRB explained 10.3%, 15.8.0%% and 34.8%. The mediators included were found to have a considerable mediating effect in the associations explored, in particular the prenatal and early postnatal factors. If truly causal, the findings could indicate potential targets for interventions to tackle socioeconomic inequalities in OW/OB from birth to adolescence.

The Association Between Dietary Patterns and Socio-Demographic and Lifestyle Characteristics: A Sample of Saudi Arabia

Dietary intake is an important risk factor that contributes to the development or prevention of many health conditions. The objective of the current study was to identify different dietary patterns and its relation to socio-demographic and life-style characteristics. A cross-sectional study of 299 Saudi adults, aged between 35-65 years without any significant health problems. Participants were interviewed individually and completed a pre-designed questionnaire with close-ended questions including socio-demographic and lifestyle characteristics. Dietary intake was assessed using food frequency questionnaire. Anthropometric measurements were obtained by a trained nurse in the clinic. Factor analysis technique was used to derive different food patterns. Five dietary patterns were identified, namely: sweet & starch, date & coffee, healthy, traditional, and protein patterns. Following sweet & starch pattern was significantly correlated to male gender, frequently visiting fast food restaurants and breakfast consumption behavior. Adherence to healthy pattern was associated with male gender, higher education with high income, older adults, breakfast consumption behavior and high levels of physical activity. Traditional pattern was correlated with married subjects and male gender, whereas compliance to date & coffee pattern was related to reduced number of meals and snacks. The protein pattern was significantly associated with younger age and breakfast consumption behavior. Dietary patterns were influenced by socio-demographic characteristic (age, gender, marital status, education level, income) and other lifestyle factors (breakfast consumption, number of meals, physical activity). A national cohort study is needed to assess the association between dietary patterns with the risk of cardiometabolic dysregulation.

Trends in Socioeconomic Inequities in Diet Quality between 2004 and 2015 among a Nationally Representative Sample of Children in Canada

BACKGROUND

Dietary inequities in childhood may shape dietary and health inequities across the life course. Quantifying the magnitude and direction of trends in absolute and relative gaps and gradients in diet quality according to multiple indicators of socioeconomic position (SEP) can inform strategies to narrow these inequities.

OBJECTIVES

We examined trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to 3 indicators of SEP among a nationally representative sample of children in Canada.

METHODS

Data from children (aged 2-17 y; n = 18,670) who participated in the cross-sectional Canadian Community Health Survey-Nutrition in 2004 or 2015 were analyzed. SEP was based on total household income, household educational attainment, and neighborhood deprivation. Dietary intake data from 1 interviewer-administered 24-h dietary recall were used to derive a Healthy Eating Index-2015 (HEI-2015) score for each participant as a measure of diet quality. Inequities in diet quality were quantified using 4 indices: absolute and relative gaps (between highest and lowest SEP) and absolute (Slope Index of Inequality) and relative gradients (Relative Index of Inequality). Overall and age-stratified multivariable linear regression and generalized linear models examined trends in HEI-2015 scores between 2004 and 2015.

RESULTS

Although mean HEI-2015 total scores improved from 52.3 to 57.3 (maximum 100 points; P < 0.001), absolute and relative gaps and gradients in diet quality remained mostly stable for all 3 SEP indicators. However, among children aged 6-11 y, absolute and relative gradients in diet quality according to household educational attainment and neighborhood deprivation widened.

CONCLUSIONS

The diet quality of children in Canada was poor and inequitably patterned in 2004 and 2015. Although mean diet quality improved between 2004 and 2015, absolute and relative gaps and gradients in diet quality persisted, with some evidence of widening absolute and relative gradients among 6- to 11-y-olds.

Socioeconomic Determinants of Diet Quality on Overweight and Obesity in Adults Aged 40-59 Years in Inner Mongolia: A Cross-Sectional Study

Objectives: This study investigated the relationship of socioeconomic status (SES), diet quality and overweight and obesity in adults aged 40-59 years in Inner Mongolia. Methods: This cross-sectional study was based on the survey of Chronic Disease and Nutrition Monitoring in Adults in Inner Mongolia in 2015. Diet quality was evaluated by the Alternate Mediterranean Diet score (aMeds). SES was measured by household annual income. Generalized estimating equations and path analysis were performed to determine the association of SES, diet quality and overweight and obesity. Results: Among participants, 63.0% had overweight and obesity. In high SES group, 66.4% had overweight and obesity. Higher SES was associated with a higher risk of overweight and obesity (OR = 1.352, 95%CI: 1.020-1.793). And higher aMeds was associated with a lower risk of overweight and obesity (OR = 0.597, 95%CI: 0.419-0.851). There was a positive correlation between SES and the intake of red and processed meat (r = 0.132, p < 0.05). Higher intake of red and processed meat was associated with lower diet quality (β = -0.34). And lower diet quality was associated with a higher risk of overweight and obesity (β = -0.10). Conclusion: In Inner Mongolia, during the period of economic transition, people aged 40-59 years in high SES had poor diet quality, which was related to a higher risk of overweight and obesity.

Effects of the calorie content of visual food stimuli and simulated situations on event-related frontal alpha asymmetry and event-related potentials in the context of food choices

Approach and avoidance tendencies play an important role in everyday food choices when choosing between high-caloric, rather unhealthy, and low-caloric, rather healthy options. On a neuronal level, approach and avoidance motivation have been associated with asymmetrical activity of the frontal cortex, often quantified by alpha power averaged over several seconds of resting electroencephalogram (EEG). Going beyond the analysis of resting EEG, the present study aimed to investigate asymmetrical frontal activity in direct response to food stimuli in an event-related design and in combination with event-related potentials (ERPs). Therefore, a sample of 56 young and healthy participants completed a food choice task. They were asked to choose from a selection of high-caloric and low-caloric foods which they would want to eat on a normal day (baseline), when being on a diet, and in a reward situation. On the behavioural level, there was a clear preference for low-caloric foods. Well in line with that, time-frequency analyses of alpha asymmetry revealed relatively stronger temporary (950-1175 ms) left-hemispheric frontal activity, that is, a stronger approach tendency, in response to low-caloric as compared to high-caloric foods. Furthermore, larger P300 for low-caloric foods indicated an increased task relevance of low-caloric foods in the baseline and the reward situation. In contrast, the late positive potential (LPP), an index of subjective value, was larger for high-as compared to low-caloric foods, reflecting the intrinsic rewarding properties of high-caloric foods. ERPs, but not frontal alpha asymmetry, were influenced by the situational context.

Differences in Dietary Patterns among the Polish Elderly: A Challenge for Public Health

The aim of the study was to assess the diversity of dietary patterns within the elderly, in relation to the region of residence, household structure, and socioeconomic status. The questionnaire was conducted in a group of 427 Polish adults aged 60 and older from June to September 2019. The sample was selected by means of the snowball method in two regions. Principal component analysis (PCA) was used to extract and identify three dietary patterns (factors) from the frequency of eating 32 groups of foods. Logistic regression analysis was used to determine the relationship between the identified dietary patterns (DPs), region, household status, and socioeconomic index (SES). Adherence to the identified DPs, i.e., traditional, prudent, and adverse, was associated with socioeconomic status (SES) and living environment, i.e., living alone, with partner, or with family, while the region did not differentiate them. Less people living with their family were characterized by the frequent consumption of traditional food (the upper tertile of this DP), while more of them often consumed food that was typical for both prudent and adverse DPs (the upper tertiles of these DPs). The presence of a partner when living with family did not differentiate the adherence to DPs. A high SES decreased the chances of adhering to the upper tertiles of the “prudent” and “traditional” DPs, while living with family increased the chances of adhering to both the upper and middle tertiles of the “prudent” DP. Identifying the dietary patterns of the elderly contributes to a better understanding of the food intake of the senior citizens living in different social situations, in order to support public policies and nutritional counseling among this age group.

Stress-Related Poor Diet Quality Does Not Explain Socioeconomic Inequities in Health: A Structural Equation Mediation Analysis of Gender-Specific Pathways

BACKGROUND

Psychosocial stress and diet quality individually mediate associations between socioeconomic position (SEP) and health; however, it is not known whether they jointly mediate these associations. This is an important question because stress-related unhealthy eating is often invoked as an explanation for diet-related health inequities, particularly among women, seemingly with no empirical justification.

OBJECTIVE

This study examined whether psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women and men.

DESIGN

Multiple mediating pathways were modeled using data from the cross-sectional International Food Policy Study.

PARTICIPANTS AND SETTING

Data were collected from 5,645 adults (aged 18 years or older) in Canada during 2018 and 2019.

MAIN OUTCOME MEASURES

Participants reported SEP using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial pathways (subjective social status), along with psychosocial stress, dietary intake (to assess overall diet quality via Healthy Eating Index-2015 scores), and self-rated health.

STATISTICAL ANALYSES PERFORMED

Structural equation modeling modeled pathways linking SEP (ie, educational attainment, perceived income adequacy, and subjective social status) with self-rated health mediated by psychosocial stress and diet quality, stratified by gender.

RESULTS

There was no evidence that psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women or men. Diet quality mediated associations between educational attainment and self-rated health in women and men, with some evidence that it mediated associations between subjective social status and self-rated health in men (P = 0.051). Psychosocial stress mediated associations between perceived income adequacy and self-rated health in women and men, and between subjective social status and self-rated health in women.

CONCLUSIONS

Although often invoked as an explanation for diet-related health inequities, stress-related poor diet quality did not mediate associations between SEP and self-rated health in women or men. Psychosocial stress and diet quality individually mediated some of these associations, with some differences by gender.

Dietary health in the context of poverty and uncertainty around the social determinants of health

Lower household income has been consistently associated with poorer diet quality and poorer dietary health outcomes. Households experiencing poverty find themselves unable to afford enough food, and the food that they can afford is often poor quality, energy dense and low in nutrients. However, the relationship between diet, poverty and health is complex. Not everyone on a low income has a poor diet. Poverty is about more than low incomes and it is not a uniform experience. Particular aspects of the experience of poverty have implications for diet and dietary health. It is increasingly apparent that uncertainty is one of those aspects. Recession, welfare policy, employment trends and widening inequality have created more uncertainty for those on low incomes. In the context of heightened uncertainty, all aspects of household food provisioning - including budgeting, shopping, storage, meal planning and cooking - are more difficult and sometimes impossible. This review will draw on research about food practices and dietary health in low-income neighbourhoods to explore the ways in which experiences of prolonged uncertainty shape dietary practices and impact health and well-being.

An Investigation on Korean Adolescents' Dietary Consumption: Focused on Sociodemographic Characteristics, Physical Health, and Mental Health

The promotion of healthful dietary intake in adolescents is an important public health concern, as obesity is on the rise among adolescents. The current study aimed to determine the association between sociodemographic characteristics and dietary intake (breakfast, vegetables, milk, fruits, fast food, carbohydrate beverages, and caffeine beverages) and to examine the influences of physical and mental health on dietary intake. A nationally representative sample of 187,622 adolescents who attended middle and high schools and participated in the Korean Youth Risk Behavior Survey (2015, 2017, and 2019) was used. The results showed a decrease in breakfast, vegetable, milk, and fruit consumption and an increase in the obesity rate from 2015 to 2019. There was a significant association between dietary intake and gender, economic status, BMI, and academic achievement. Multiple logistic regression analysis results revealed that the consumption of breakfast, vegetables, milk, and fruit were associated with greater odds of having enough sleep. Fast food intake was shown to be a significant risk factor for depression with an odds ratio of 1.204 (95% CI = 1.169–1.239), and carbonated beverage consumption was shown to be a significant risk factor for stress with an odds ratio of 1.042 (95% CI = 1.030–1.054). These results provide fundamental data that can be used to develop an effective nutrition intervention program or nutrition policy for adolescents or school food service programs.

Socioeconomic inequities in diet quality among a nationally representative sample of adults living in Canada: an analysis of trends between 2004 and 2015

BACKGROUND

Socioeconomic inequities in diet quality are stable or widening in the United States; however, these trends have not been well characterized in other nations. Moreover, purpose-developed indices of inequities that can provide a more comprehensive and precise perspective of trends in absolute and relative dietary gaps and gradients using multiple indicators of socioeconomic position (SEP) have not yet been used, and can inform strategies to narrow dietary inequities.

OBJECTIVES

We quantified nationally representative trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to 3 indicators of SEP among adults in Canada.

METHODS

Adults (≥18 y old) who participated in the nationally representative, cross-sectional Canadian Community Health Survey-Nutrition in 2004 (n = 20,880) or 2015 (n = 13,970) were included. SEP was classified using household income (quintiles), education (5 categories), and neighborhood deprivation (quintiles). Dietary intake data from 24-h recalls were used to derive Healthy Eating Index-2015 (HEI-2015) scores. Dietary inequities were quantified using absolute and relative gaps (between the most and least disadvantaged) and absolute [Slope Index of Inequality (SII)] and relative gradients (Relative Index of Inequality). Overall and sex-stratified multivariable linear regression and generalized linear models examined trends in HEI-2015 scores between 2004 and 2015.

RESULTS

Mean HEI-2015 scores improved from 55.3 to 59.0 (maximum: 100); however, these trends were not consistently equitable. Whereas inequities in HEI-2015 scores were stable in the total population and in females, the absolute gap [from 1.60 (95% CI: 0.09, 3.10) to 4.27 (95% CI: 2.20, 6.34)] and gradient [from SII = 2.09 (95% CI: 0.45, 3.73) to SII = 4.84 (95% CI: 2.49, 7.20)] in HEI-2015 scores for household income, and the absolute gradient for education [from SII = 8.06 (95% CI: 6.41, 9.71) to SII = 10.52 (95% CI: 8.73, 12.31)], increased in males.

CONCLUSIONS

Absolute and relative gaps and gradients in overall diet quality remained stable or widened between 2004 and 2015 among adults in Canada.

Nutritional status of Moroccan pregnant women and the birth weight of their newborn: a case-control study in the province of El Jadida

<abstract><sec> <title>Background</title> <p>Maternal malnutrition is a global concern whose consequences for newborns are intrauterine growth retardation, fetal hypotrophy and exposure to risks of pathologies in adulthood.</p> </sec><sec> <title>Objective</title> <p>The aim of this study was to assess and compare the diet quality and nutritional status of pregnant women at the time of childbirth while assessing their newborn's weight at birth.</p> </sec><sec> <title>Materials and methods</title> <p>The study involved 400 parturient, divided into two groups of 200 each, the controls who have just given birth to newborns of normal weight and the cases who have just given birth to babies of low birth weight (LBW). Information on food intakes and dietary habits were collected using questionnaires and anthropometric parameters were measured.</p> </sec><sec> <title>Results</title> <p>The mean body mass index (BMI) of the cases was 25.93 ± 2.64 kg/m² vs. 28.25 ± 2.75 kg/m² in the controls. The dietary diversity and variety scores were higher in the controls than in the cases. Indeed means were 6.87 ± 1.30 vs. 8.88 ± 1.35 food groups for the diversity scores and 11.77 ± 1.57 vs. 15.90 ± 2.09 food items for the variety scores in the cases and the controls respectively. The average daily intakes of folates, calcium, iron and zinc were lower than the Recommended Daily Allowances (RDA) for both groups. The daily calcium intake represents only 1/5th of the RDI for the cases and 1/3 for the controls. Average dietary iron intake was insufficient at only 49% of the daily requirement for cases vs. 66.88% for controls while folates accounts for 64.33% of the RDA for the cases.</p> </sec><sec> <title>Conclusion</title> <p>Data from this study shows that the diets of women who have given birth to low birth weight infants are poorly diversified, poorly varied, and poor in certain nutrients essential for a successful pregnancy and childbirth.</p> </sec></abstract>

Exploration of the Principal Component Analysis (PCA) Approach in Synthesizing the Diet Quality of the Malaysian Population

(1) Background: One of the most main dietary assessments is through a posteriori application. Although extensive research has incorporated dietary assessment of a population through a posteriori application, this study is the first to examine the Malaysian population and use an a posteriori method and principal component analysis (PCA) to assess the dietary patterns of the Malaysian population. The correlation between all dietary patterns derived via PCA and selected nutrient intake were determined in this sample of study; (2) Methods: A total of 3063 respondents (18 to 59 years old) covering Peninsular Malaysia, Sabah, and Sarawak, participated in this study. PCA was applied on the food frequency questionnaire collected from the respondents, and descriptive statistics and PCA were performed using SPSS version 21; (3) Results: Six patterns were identified: "traditional", " prudent", " modern", "western", "Chinese", and "combination" diets. All together, these six patterns were able to explain 45.9% of the total variability. Few components derived from the factor loadings showed positive association with several nutrient markers. The traditional dietary pattern showed a moderate, positive correlation with total protein and total sugar intake, there was a significant moderate correlation between the prudent dietary pattern and dietary fibre, and there was a moderate positive association between the Chinese dietary pattern and total energy; and (4) Conclusions: The exploration of the PCA approach above may provide justification for assessment of dietary patterns rather than reliance on single nutrients or foods to identify potential connections to overall nutritional wellbeing as well as to explore the diet-disease relationship. However, study of pattern analysis must be conducted among the Malaysian population to produce validity and reproducibility for this dietary approach in light of the numerous methodological issues that arise when performing PCA.

Adherence to healthy and sustainable diets is not differentiated by cost, but rather source of foods among young adults in Albania

High cost of nutritious foods and eating out of home (OH) might be barriers to healthy and sustainable diets. We examined adherence to Dietary Approaches to Stop Hypertension (DASH), EAT-Lancet reference diet (EAT) and Mediterranean diet score (MDS) and the associations with dietary cost and eating OH. We evaluated cross-sectional data from single multiple-pass 24-h diet recalls from 289 young adults (18-24 years) in Tirana, Albania. Dietary cost (in Albanian Lek (ALL)) was estimated by matching food consumption data with retail prices from local fast-food chains, supermarkets, restaurants and food vendors. Poisson regression was fitted to models that included DASH, EAT and MDS as dependent variables to assess associations between healthy sustainable diet indicators and dietary cost and eating OH. Adjusted models were controlled for BMI, sex and total energy intake (kJ) using the residual method. Our findings indicate relatively poor adherence to healthy and sustainable dietary patterns among young men and women in Albania. Furthermore, better adherence to DASH, EAT or MDS was not associated with dietary cost (per 100 ALL; range incidence rate ratios (IRR): 0·97-1·00; all (un-)adjusted P > 0·05). Nonetheless, eating OH was related to lower adherence to DASH (IRR: 0·79; P = 0·003) and MDS (IRR: 0·69; P < 0·001). In conclusion, adherence to health and sustainable dietary patterns was poor and not differentiated by cost, but rather source of foods (i.e. OH or at home). Further research on the potential public and environmental health effects of these findings is warranted in Albania.

Cooking Frequency and Perception of Diet among US Adults Are Associated with US Healthy and Healthy Mediterranean-Style Dietary Related Classes: A Latent Class Profile Analysis

Background: Meal habits are associated with overall dietary quality and favorable dietary patterns determined by the Healthy Eating Index (HEI). However, within dietary patterns, complexities of food combinations that are not apparent through composite score determination may occur. Also, explorations of these food combinations with cooking and perceived diet quality (PDQ) remain unknown. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2007–2010 were utilized to determine the frequency of cooking at home and PDQ, along with sociodemographic variables. Latent class profile analysis was performed to determine person-centered data-driven analysis using the dietary index, HEI-2010, at both the daily and dinner meal-time levels. Multinomial logistic regression analysis was utilized to evaluate the association of dietary patterns with all covariates. Results: For daily HEI, five distinct dietary classes were identified. For dinner HEI, six classes were identified. In comparison to the standard American diet classes, home cooking was positively associated with daily (p < 0.05) and dinner (p < 0.001) dietary classes that had the highest amounts of total vegetable and greens/beans intake. PDQ was positively associated with these classes at the daily level (p < 0.001), but negatively associated with healthier classes at the dinner level (p < 0.001). Conclusion: The use of latent class profile analysis at the daily and dinner meal-time levels identified that food choices coalesce into diverse intakes, as shown by identified dietary classes. Home cooking frequency could be considered a positive factor associated with higher vegetable intake, particularly greens/beans, at the daily and dinner levels. At the same time, the perception of diet quality has a positive association only with daily choices.

Geographical variations in cardiovascular health in China: A nationwide population-based survey of 74,726 adults

Background

Cardiovascular disease is the leading cause of death in China. The aim of this study was to evaluate the levels of cardiovascular health among Chinese adults and to understand the geographic pattern of cardiovascular health.

Methods

In 2015, a total of 74,726 respondents aged ≥ 20 years with no history of cardiovascular disease were randomly sampled from 298 counties/districts of 31 provinces in mainland China and were interviewed. Seven metrics, including smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting glucose, were determined. Ideal cardiovascular health was defined as the simultaneous presence of all metrics at the ideal level. A score ranging from 0 to 14 was calculated as the sum of all seven metrics for each province. Scores for cardiovascular health behaviors (smoking, body mass index, physical activity and diet) and those for cardiovascular health factors (smoking, total cholesterol, blood pressure, and fasting glucose) were also calculated.

Findings

The mean age was 44.4 ± 15.9 years, and 49.3% were women. The age-sex-standardized prevalence of ideal cardiovascular health was universally poor, ranging from 0.02% [95% confidence interval (CI): 0%, 0.05%] in Tibet to 2.76% (95% CI: 0.45%, 5.07%) in Heilongjiang. Ideal diet (7.1%) was the least common factor of the seven metrics in each province and varied considerably across provinces. Other component metrics of ideal cardiovascular health were also spatially patterned. In all provinces, women had higher scores than men for cardiovascular health, health behaviors and health factors. Differences in cardiovascular health and health behavior scores between urban and rural areas were associated with levels of socio-economic development.

Interpretation

Strategies for addressing poor cardiovascular health require geographic targeting and localized consideration.

Funding

This research was supported by National Key R&D Program, the Shenzhen Strategic Emerging Industry Development Special Fund, and the Fund of "Sanming" Project of Medicine in Shenzhen.

Attitudes and Consumer Behavior toward Foods Offered in Staff Canteens

The aim of our study was to analyze the attitudes of employees toward food offered in staff canteens, to analyze their eating behavior and the factors determining the choice of meals in staff canteens. The survey was conducted on a sample of 600 adult respondents, who patronize staff canteens in Warsaw, Poland. The research enabled a detailed and comprehensive assessment of consumer behavior toward the use of staff canteens, as well as their opinions on the functioning of the canteens and meals offered. Factors determining the frequency of use of canteens, type of meals, and factors influencing the use of such establishments were identified. Respondents assessed the quality and variety of meals, with the size of portion being the most valued. They were satisfied with the functioning of the canteens and had very few comments. However, they pointed out the need for an increase in the variety of meals, including the availability of vegetarian and vegan dishes. Our research enabled us to establish consumer profiles based on the reasons for not using staff canteens and comments about staff canteens. Patrons of staff canteens were referred to as “canteen enthusiasts” or “canteen medium-enthusiasts”, who are “snack lovers”, as well as “food choice-oriented” or “quality-oriented”. The results provide the basis for practical implications for owners or managers of staff canteens, part of whose work it is to analyze the needs and expectations of their potential customers.

Análise de série temporal do consumo de bebidas açucaradas entre adultos no Brasil: 2007 a 2014

Resumo O objetivo deste artigo é analisar a tendência temporal e os fatores associados ao consumo de refrigerante ou suco artificial entre adultos no Brasil. Estudo desenvolvido a partir de dados secundários do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico, realizado com adultos brasileiros entre 2007-2014. Foi verificada a frequência e a intensidade do consumo (quantidade de copos ou latas por semana) de refrigerante ou suco artificial. Dados sociodemográficos e comportamentais foram as variáveis independentes. A tendência temporal do consumo anual foi avaliada por meio de Regressão Linear. Os fatores associados (idade, sexo, região, trabalho, escolaridade, hábito de assistir TV) ao consumo dessas bebidas foram investigados por Regressão de Poisson. Houve redução de 32,7% do consumo de refrigerante ou suco artificial entre 2007 e 2014. Os fatores associados ao maior consumo foram: sexo masculino (p = 0,000); faixa etária de 18-29 anos (p = 0,000); residência nas regiões centro-oeste, sudeste e sul (p = 0,000); menor escolaridade (p = 0,616); estar empregado (p = 0,007) e assistir TV mais de 3 horas por dia (p = 0,000). As análises descrevem uma tendência de queda no consumo de refrigerante ou suco artificial entre os adultos no Brasil de 2007 a 2014.

Impact of a farmers' market nutrition coupon programme on diet quality and psychosocial well-being among low-income adults: protocol for a randomised controlled trial and a longitudinal qualitative investigation

INTRODUCTION

Low-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers' market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers' Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers' markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts.

METHODS AND ANALYSIS

In a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10-15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers' markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25-30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants' experiences with and perceived outcomes from the programme.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT03952338.

Race, Gender, Family Structure, Socioeconomic Status, Dietary Patterns, and Cardiovascular Health in Adolescents

BACKGROUND

Dietary patterns represent a broad picture of food and nutrient consumption and may be more predictive of health outcomes than individual foods and nutrients.

OBJECTIVE

We investigated the relations among race, gender, family structure, parental socioeconomic status (SES), dietary patterns, and cardiovascular disease (CVD) profiles among adolescents in the southeastern region of the United States.

METHODS

A total of 743 adolescents from a cross-sectional study were divided into 4 dietary pattern groups by K-means cluster analysis. Multinomial logistic regression was performed to determine the relations among the parental SES, family structures, and dietary patterns of the adolescents. Associations between dietary patterns and CVD profiles were analyzed by multiple linear regression.

RESULTS

Four dietary patterns were derived: "healthy" (17%), "snacks and sweets" (26%), "processed meat" (20%), and "sugar-sweetened beverage (SSB) and fried food" (37%). Whites and females were more likely to have a "healthy" dietary pattern (Ps < 0.001). There were significant race/ethnicity differences in family structures, SES, and dietary patterns (Ps < 0.05). In whites, higher mother's education and father's education and occupation were associated with greater likelihood of a "healthy" dietary pattern (Ps < 0.05). Stay-at-home mother was associated with less likelihood of an "SSB and fried food" pattern (P = 0.023). In blacks, higher mother's occupation, father's education, and living with both parents were associated with more likelihood of a "healthy" dietary pattern (Ps < 0.05). Stay-at-home father was associated with less likelihood of the "snacks and sweets" (P = 0.025) and "SSB and fried food" dietary patterns (P = 0.044). Overall, adolescents with poor dietary patterns exhibited higher percentage body fat, waist circumference, systolic blood pressure, fasting insulin, homeostasis model assessment of insulin resistance, C-reactive protein, and total triglyceride (Ps < 0.05).

CONCLUSIONS

Our data suggest that family structure, parental working status, and SES are associated with the diet quality in adolescents. Moreover, "snacks and sweets," "processed meat," and "SSB and fried food" dietary patterns are all associated with worse CVD risk profiles.

Association between socioeconomic status and diet quality in Mexican men and women: A cross-sectional study

Examining the potential differences in diet quality among socioeconomic status (SES) subgroups in Mexican adults may help to explain SES disparities in the burden of non-communicable diseases. We determined the association between SES, gender and diet quality among Mexican adults. We analyzed data from adults participating in the subsample with dietary information from the Mexican National Health and Nutrition Survey 2012 (n = 2,400), and developed the Mexican Diet Quality Index based on the Mexican Dietary Guidelines. We tested the interaction between sex and SES indicators using multivariable linear regression models. Sex was not a modifier; therefore, the analyses were carried out in the overall sample of men and women. The mean age was 42 (SE = 0.4) years, the total diet quality score was 38 (SE = 0.4), and a high percentage of men and women were classified with reading/writing skills or 3-9 years of school. A higher percentage of adults were classified with high versus medium or low assets index. In the multivariable model further adjusted for the assets index, for adults with education in the reading and/or 3-9 years of schooling and those with ≥10 years of school, there was a 3.7 and 5.8 points lower total diet quality score than with adults with no reading/writing skills (p < 0.05). Likewise, in multivariable model further adjusted for educational level, the total diet quality score was 2.5 points and 3.3 points lower in adults classified with medium and high assets index, respectively, versus low assets index (p < 0.05). The difference between individuals with medium and high assets index was not statistically significant. Although there is currently better diet quality among adults with low SES, this needs to continue to be monitored as Mexico progress through the nutrition transition.

Social, demographic, and economic correlates of food and chemical consumption measured by wastewater-based epidemiology

Wastewater is a potential treasure trove of chemicals that reflects population behavior and health status. Wastewater-based epidemiology has been employed to determine population-scale consumption of chemicals, particularly illicit drugs, across different communities and over time. However, the sociodemographic or socioeconomic correlates of chemical consumption and exposure are unclear. This study explores the relationships between catchment specific sociodemographic parameters and biomarkers in wastewater generated by the respective catchments. Domestic wastewater influent samples taken during the 2016 Australian census week were analyzed for a range of diet, drug, pharmaceutical, and lifestyle biomarkers. We present both linear and rank-order (i.e., Pearson and Spearman) correlations between loads of 42 biomarkers and census-derived metrics, index of relative socioeconomic advantage and disadvantage (IRSAD), median age, and 40 socioeconomic index for area (SEIFA) descriptors. Biomarkers of caffeine, citrus, and dietary fiber consumption had strong positive correlations with IRSAD, while tramadol, atenolol, and pregabalin had strong negative correlation with IRSAD. As expected, atenolol and hydrochlorothiazide correlated positively with median age. We also found specific SEIFA descriptors such as occupation and educational attainment correlating with each biomarker. Our study demonstrates that wastewater-based epidemiology can be used to study sociodemographic influences and disparities in chemical consumption.

Effect of 'rice' pattern on high blood pressure by gender and obesity: using the community-based KoGES cohort

OBJECTIVE

The present study aimed to examine the association between dietary pattern and the risk of high blood pressure (BP) and to estimate the attenuated effect by gender and obesity on the association using data from a prospective cohort study in Korea.

DESIGN

Prospective study. Diet was assessed using a validated 103-item FFQ and was input into factor analysis after adjustment for total energy intake.

SETTING

Community-based Korean Genome Epidemiology Study (KoGES) cohort.

PARTICIPANTS

Healthy individuals (n 5151) without high BP at recruitment from the community-based cohort study.

RESULTS

Dietary pattern was not associated with the risk of high BP regardless of the type of covariates, with the exception of the 'rice' pattern. The effect of the 'rice' pattern was observed in both men (Ptrend = 0·013) and women (Ptrend < 0·001), but the statistical significance remained only in women after adjustment for confounders (Ptrend = 0·004). The positive association of the 'rice' pattern with high BP risk was attenuated by obesity. After stratification by gender and obese status, in particular, the harmful effect of the 'rice' pattern was predominantly observed in obese women (Ptrend < 0·001) only.

CONCLUSIONS

This longitudinal study in Korean adults found a positive association of the 'rice' pattern with long-term development of incident high BP, predominantly in women. The association is likely to be attenuated by gender and obese status.

[Socioeconomic, demographic and lifestyle factors associated with eating patterns of shift workers]

The scope of this paper was to identify the main eating patterns of shift workers and to associate them with socioeconomic, demographic and lifestyle variables. Men between 20 and 60 years of age, workers of a metallurgical company in the state of Ceará, were studied. Eating patterns were identified by factorial analysis by major components, followed by varimax orthogonal rotation. Poisson regression was used to estimate the prevalence ratios (PR) of the variables in relation to dietary patterns. Three patterns were identified: standard northeastern, popular and western. Employees of the night shift and those who smoke or have smoked showed less adherence to the common northeastern pattern, while those who consume or have consumed alcoholic beverages showed greater adherence. For the popular, the highest adherence was of employees with higher education, residents in the company's headquarter city and who only consumed alcoholic beverages in the past, while individuals with better Brazilian economic classification showed lower adherence. Older men and smokers had lower adherence to the western standard. Knowledge of these variables associated with the eating patterns identified may support the planning of healthy eating practices in the group studied.

Socioeconomic Status and the Prediction of Health Promoting Dietary Behaviours: A Systematic Review and Meta-Analysis Based on the Theory of Planned Behaviour

BACKGROUND

Dietary behaviours are strongly patterned by socioeconomic status (SES). However, the role of SES in the self-regulation of health promoting dietary behaviours is not fully understood. This systematic review with meta-analysis investigated whether four individual-level measures of SES (income, occupation, education, and ethnicity) moderate the relationships between Theory of Planned Behaviour (TPB) variables and different health promoting dietary behaviours in adults.

METHODS

A systematic literature search identified 106 studies from 77 articles providing information on TPB variables, SES, and health promoting dietary behaviours-choosing health promoting foods and restricting health compromising foods. Random-effects meta-analyses were conducted to generate pooled correlations corrected for sampling and measurement error, and meta-regression was used to test moderating effects of study-level SES.

RESULTS

All TPB variables were significantly and positively associated with both health promoting dietary behaviours, with intention having the strongest correlation with behaviour. However, none of the relationships between TPB variables and health promoting dietary behaviours were significantly moderated by study-level SES.

CONCLUSIONS

Results suggest robust associations between TPB predictors and healthy dietary behaviour that are not patterned by individual-level SES measures.

Consumption Patterns of Grain-Based Foods among Children and Adolescents in Canada: Evidence from Canadian Community Health Survey-Nutrition 2015

The current analyses used data from the Canadian Community Health Survey-Nutrition 2015 to investigate grain-based food (GBF) dietary patterns of consumptions among 6,400,000 Canadian children and adolescents 2 to 18 years old. Nutrient intakes, socioeconomic differences, body mass index (BMI) z-scores, and intakes of several food groups were examined across the identified grain patterns of consumption. We employed k-mean cluster analysis to identify the consumption patterns of grain products. Based on the contributions of 21 grain food groups to the total energy intake of each individual, seven GBF consumption patterns were identified including other bread; salty snacks; pasta; rice; cakes and cookies; white bread; and mixed grains. Individuals having less than one serving of grain products were also separately categorized as no-grain consumers. Mean energy intake (kcal/day) was lowest for the "no-grain" consumers and greatest in children/adolescents consuming a "salty snacks" pattern when all GBF patterns were compared. Children and adolescents with "no-grain" and "rice" GBF consumption patterns had significantly lower intakes of several nutrients including dietary fiber, folate, magnesium, calcium, iron, zinc, thiamin, niacin, and riboflavin. No associations were observed with any of the identified GBF patterns and BMI z-scores. In addition, the socioeconomic status (SES) indicators such as household incomes and immigration status of participants were shown to be significantly different across the identified clusters.

Prevalence of Dietary Behavior and Determinants of Quality of Diet among Beneficiaries of Government Welfare Assistance in Poland

Diet, as a modifiable factor for good health maintenance, reduces the risk of numerous non-communicable chronic diseases and prevents premature death. The aim of the study was to examine the prevalence of a dietary behavior and to find out what the determinants of diet quality among the low socio-economic status population are. The studied sample consisted of 1710 respondents. Only 3% of the beneficiaries had healthy dietary habits. Unhealthy dietary habits dominated in all the study group regardless of the subjects' level of education (p < 0.001). Higher odds of unhealthy dietary habits were reported among the respondents with primary, vocational, and secondary education than among the respondents with high education (for the primary education OR = 11.10; 95% CI: 5.86⁻21.01; p ≤ 0.001; for vocational education OR = 10.54; 95% CI: 5.79⁻19.18; p ≤ 0.001 and for secondary education OR = 5.83; 95% CI: 3.48⁻9.79; p ≤ 0.001). The unhealthy dietary behavior prevalence among beneficiaries of government welfare assistance in Poland is much higher than in the general population. Since only educational level is a determinant which is significantly correlated with the unhealthy dietary behavior, promotion of a healthy diet among disadvantaged individuals should be focused on this factor.

Investigating Items to Improve the Validity of the Five-Item Healthy Eating Score Compared with the 2015 Healthy Eating Index in a Military Population

Military researchers utilize a five-item healthy eating score (HES-5) in the Global Assessment Tool (GAT) questionnaire to quickly assess the overall diet quality of military personnel. This study aimed to modify the HES-5 to improve its validity relative to the 2015 Healthy Eating Index (HEI-2015) in active duty military personnel (n = 333). A food frequency questionnaire was used to calculate HEI-2015 scores and to assess sugar-sweetened beverage (SSB) intake in 8-oz (SSB-8) and 12-oz servings. GAT nutrition questions were used to calculate HES-5 scores and capture breakfast and post-exercise recovery fueling snack (RFsnack) frequencies. Two scoring options were considered for the highest RFsnack category: "4" vs. "5" (RFsnack-5). Potential candidates were added alone and in combination to the HES-5 and compared to the HEI-2015 with a Pearson correlation coefficient. Scores with the highest correlations were compared via a z-score equation to identify the simplest modification to the HES-5. Correlations between HES-5 and HEI-2015 scores in total participants, males, and females were 0.41, 0.45 and 0.32, respectively. Correlations were most significantly improved in total participants by adding RFsnack-5, SSB-8, RFsnack-5 + SSB-8, and RFsnack-5 + SSB-8 + breakfast, though the addition of SSB-8 + RFsnack-5 performed best (r = 0.53). Future work should consider scoring mechanisms, serving sizes, and question wording.

Comparison of individuals with low versus high consumption of home-prepared food in a group with universally high dietary quality: a cross-sectional analysis of the UK National Diet & Nutrition Survey (2008-2016)

Background

Despite inconclusive evidence, the idea that a lack of home food preparation and skills is a limiting factor in achieving a healthy diet is widespread. Cooking skills interventions proliferate, and several countries now mention cooking in their dietary guidelines. The aim of this study was to determine whether substantial consumption of home-prepared food is necessary for high dietary quality by exploring whether individuals can eat healthily while eating little home-prepared food. The diets of these individuals were characterised, and socio-demographic characteristics and prevalence of obesity were also explored.

Methods

Cross-sectional analysis of UK dietary survey data with objectively measured height and weight and a 4-day food diary for each participant was conducted. A subsample (N = 1063, aged ≥19 years) with a high dietary quality (determined using a score derived from the Dietary Approaches to Stopping Hypertension (DASH) diet) was analysed. Within this, participants were grouped as either high or low home preparation based on the proportion of energy derived from home-prepared food. Regression models were used to determine whether and how those in the high and low home preparation groups differed in terms of socio-demographic characteristics, DASH score, energy intake, prevalence of obesity, and dietary composition.

Results

The low home preparation group included 442 participants, while 621 participants were in the high home preparation group. The low home preparation group were more likely to be older and white, and less likely to have a degree level education. After adjustment for socio-demographic characteristics, there were no differences in DASH score, energy intake or obesity prevalence between the groups. After adjustment, the low home preparation group consumed more fruit (30.8 additional g/day, 95% CI 5.5–56.1), more low-fat dairy foods (24.6 additional g/day, 95% CI 1.7–47.5) and less red meat (10.4 fewer g/day, 95% CI 4.3–16.6), but also more sugar (11.6 additional g/day, 95% CI 7.5–15.6) and sodium (107.8 additional mg/day, 95% CI 13.8–201.8).

Conclusion

Home food preparation should not be presented as a prerequisite to a high quality diet. The public health community should recognise the existence of a set of food practices which allows individuals to achieve a healthy diet with little contribution from home-prepared food, and make space for it in the design of their policies and interventions.

'I've worked so hard, I deserve a snack in the worksite cafeteria': A focus group study

This study obtained insight in motivation regarding food choices of Dutch employees, especially when visiting the worksite cafeteria. We also aimed to know why employees visit the worksite cafeteria. These insights are useful for intervention development to encourage healthier purchases in worksite cafeterias. We conducted seven focus groups among 45 employees of seven Dutch companies. The topics were 1) drivers and motives for food selection; 2) motives for visiting the worksite cafeteria; 3) motives for food selection in the worksite cafeteria; 4) perceptions of healthiness of products in the worksite cafeteria and 5) solutions brought up by the employees to encourage healthier eating. Thematic analyses were conducted with MAXQDA software. Qualitative analyses revealed that this group of Dutch employees mentioned 'healthiness', 'price' and 'taste' as most important drivers food selection. These employees generally visit the worksite cafeteria to have a break from their work setting. Healthiness played a less important role in visiting or making food choices in the worksite cafeteria. Reasons for buying unhealthy food items were being tempted and the feeling to 'deserve' it. In order to choose healthier foods employees suggested a bigger offer of healthy food options, providing knowledge, changing prices and prominent placing of healthy foods. This focus group study shows that drivers for food selection can differ from motives for visiting the worksite cafeteria and when choosing food there. Health is important for food choice in general, but less important in the worksite cafeteria. The results of this study could be used in the development of strategies that aim to change people's food choice behavior.

Socioeconomic, demographic and lifestyle-related factors associated with unhealthy diet: a cross-sectional study of university students

BACKGROUND

Food habits are important to promote and maintain good health throughout life, and unhealthy diet is a modifiable and preventable risk factor. University students are a key group of adults among whom to promote healthy lifestyles. The aim of this study is to determine the factors associated with unhealthy diet in a sample of university students.

METHODS

An electronic cross-sectional survey was conducted with university students (n=593) from inland Spain, during the 2016-2017 academic year. The survey collected information on the participants' food habits using an annual food frequency questionnaire. We also collected socioeconomic and demographic data and lifestyle-related information. A multivariate logistic regression was used for analysis.

RESULTS

The multivariate logistic regression revealed that the factors associated with an unhealthy diet were: being male, being underweight compared to the reference category (normal weight), having a mother of low socioeconomic status, the family home not being in the university city and, finally, studying a non health-related course CONCLUSION: Among students of the University of Castilla-La Mancha, being male, being underweight, the family home not being in the university city, having a mother of low socioeconomic status, and, finally, not studying a health-related course are the factors associated with a lower quality diet. Following a healthy diet is key in reducing the health costs of non-communicable diseases, and ensuring an acceptable long-term quality of life in populations.

Dietary Fibre Intake in Australia. Paper I: Associations with Demographic, Socio-Economic, and Anthropometric Factors

Dietary fibre is important for regular laxation and reduces chronic disease risk. The National Health and Medical Research Council outlines daily fibre intake targets, yet the proportion of the population that meets these targets is unknown. Using the 2011⁻2012 National Nutrition and Physical Activity Survey, we profiled fibre intake among Australian children and adults. Data from one-day dietary recalls were analysed (n = 12,153, ≥2 years) as well as demographic and anthropometric factors. The median fibre intake was 18.2 g (interquartile range [IQR] 13.2⁻25.0) in children and 20.7 g (IQR 14.3⁻28.7) in adults. We found that 42.3% (95% CI 40.5⁻44.1%) of children and 28.2% (95% CI 27.3⁻29.1%) of adults met the Adequate Intake (AI), and less than 20% of adults met the Suggested Dietary Target (SDT) to reduce the risk of chronic disease. Older children (aged 14⁻18 years), girls, young adults (19⁻30 years), males, and those of lower socio-economic status were less likely to meet the AI (p < 0.001). Those with a higher energy intake were more likely to meet the AI. Anthropometric measures were not associated with fibre intake or the likelihood of meeting the AI. Fibre is a nutrient of concern in Australian diets, with most children and adults falling short of recommendations. Adolescents, girls, young adults, men, and those of lower socio-economic status were less likely to meet the recommendations and may benefit most from public health interventions.

Red blood cell folate levels in Canadian Inuit women of childbearing years: influence of food security, body mass index, smoking, education, and vitamin use

Background

The benefits of folic acid for prevention of congenital anomalies are well known. For the Inuit of Canada, where vitamin use is low and access to folate-rich foods limited, fortification is likely a major source of intake. We sought to determine whether red blood cell folate (RBCF) levels of Inuit women reached accepted target levels.

Methods

The Inuit Health Survey, 2007–2008, included evaluation of RBCF levels among 249 randomly selected non-pregnant women of reproductive age. Using descriptive statistics and linear regression analyses, RBCF levels were assessed and compared across several socio-demographic variables to evaluate the characteristics associated with RBCF status.

Results

Mean (SD) RBCF levels of 935.5 nmol/L (± 192) reached proposed target levels (> 906 nmol/L); however, 47% of women had lower than target levels. In bivariate analysis, non-smoking, higher education, higher income, food security, increased body mass index, and vitamin use were each significantly associated with higher RBCF. Increased levels of smoking had a negative association with RBCF levels (− 5.8 nmol/L per cigarette smoked per day (p = 0.001)). A total of 6.8% of women reported taking vitamin supplements, resulting in a 226 nmol/L higher RBCF level on average compared to non-users (p < 0.001).

Conclusion

While mean levels of folate reached target levels, this was largely driven by the small number of women taking vitamin supplements. Our results suggest that folate status is often too low in Inuit women of childbearing years. Initiatives to improve food security, culturally relevant education on folate-rich traditional foods, vitamin supplements, and smoking cessation/reduction programs may benefit Inuit women and improve birth outcomes.