Inequalities in education and national income are associated with poorer diet: Pooled analysis of individual participant data across 12 European countries.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Diet* ; Socioeconomic Factors*; Malnutrition/*epidemiology; Adult ; Diet Surveys ; Diet, Healthy ; Educational Status ; Energy Intake ; Europe/epidemiology ; Female ; Humans ; Income ; Linear Models ; Male ; Malnutrition/prevention & control ; Micronutrients/administration & dosage ; Middle Aged ; Multivariate Analysis ; Nutritional Status ; Poverty ; Young Adult

Background: Malnutrition linked to noncommunicable diseases presents major health problems across Europe. The World Health Organisation encourages countries to conduct national dietary surveys to obtain data to inform public health policies designed to prevent noncommunicable diseases.
Methods: Data on 27334 participants aged 19-64y were harmonised and pooled across national dietary survey datasets from 12 countries across the WHO European Region. Weighted mean nutrient intakes were age-standardised using the Eurostat 2013 European Standard Population. Associations between country-level Gross Domestic Product (GDP) and key nutrients and nutrient densities were investigated using linear regression. The potential mitigating influence of participant-level educational status was explored.
Findings: Higher GDP was positively associated with total sugar intake (5·0% energy for each 10% increase in GDP, 95% CI 0·6, 9·3). Scandinavian countries had the highest vitamin D intakes. Participants with higher educational status had better nutritional intakes, particularly within lower GDP countries. A 10% higher GDP was associated with lower total fat intakes (-0·2% energy, 95% CI -0·3, -0·1) and higher daily total folate intakes (14μg, 95% CI 12, 16) in higher educated individuals.
Interpretation: Lower income countries and lower education groups had poorer diet, particularly for micronutrients. We demonstrate for the first time that higher educational status appeared to have a mitigating effect on poorer diet in lower income countries. It illustrates the feasibility and value of harmonising national dietary survey data to inform European policy regarding access to healthy diets, particularly in disadvantaged groups. It specifically highlights the need for strong policies supporting nutritional intakes, prioritising lower education groups and lower income countries.
Competing Interests: The authors have declared that no competing interests exist.

BMJ. 2014 Apr 15;348:g2272. (PMID: 24736206)
J R Soc Med. 2008 Jun;101(6):282-9. (PMID: 18515775)
Am J Epidemiol. 2004 Jul 1;160(1):59-67. (PMID: 15229118)
Eur J Clin Nutr. 2011 Sep;65(9):1059-66. (PMID: 21559042)
Nutrients. 2017 Aug 05;9(8):. (PMID: 28783062)
Lancet Glob Health. 2015 Mar;3(3):e132-42. (PMID: 25701991)
JAMA Intern Med. 2014 Oct;174(10):1587-95. (PMID: 25179639)
Nutr Res Rev. 2019 Jun;32(1):38-69. (PMID: 30388967)
Food Nutr Res. 2018 Apr 16;62:. (PMID: 29720930)
Nutrients. 2017 Nov 27;9(12):. (PMID: 29186935)
J Health Soc Behav. 2007 Sep;48(3):223-38. (PMID: 17982865)
Br J Nutr. 2004 Oct;92 Suppl 2:S147-211. (PMID: 15522158)
Eur J Clin Nutr. 2011 Jul;65 Suppl 1:S38-47. (PMID: 21731004)
BMJ. 2005 Mar 12;330(7491):574-5. (PMID: 15760997)
Arch Dis Child. 2014 Sep;99(9):794-5. (PMID: 24947283)
Br J Nutr. 2009 Jul;101 Suppl 2:S73-85. (PMID: 19594967)
Nutrients. 2017 Oct 04;9(10):. (PMID: 28976927)
Am J Clin Nutr. 2008 May;87(5):1107-17. (PMID: 18469226)

0 (Micronutrients)

Date Created: 20200508 Date Completed: 20200731 Latest Revision: 20200731

20231215

PMC7205203

10.1371/journal.pone.0232447

32379781