Journal Article

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

Ocke, M., Warensjö Lemming, Eva, Greenwood, D. C., Nurk, E., Bakacs, M., Sharmanov, T., Jewell, J., Matthiessen, J., Hutchinson, J., Tapanainen, H., Beukers, M., Rust, P., Rippin, D. M., Kukk, M., Spiroski, I., Schindler, K., Cade, J. E., Lindroos, A. K., Sarkadi-Nagy, E., Heuer, T., Martin, A., Nelis, K., Tazhibayev, S., Valsta, L., Breda, J. J., Rippin, H. L., van Rossum, C., Fagt, S.

2020

Overview

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. 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. 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. 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Age / At risk populations / Biology and Life Sciences / Chronic diseases / Data collection / Datasets / Developing countries / Diet / Disadvantaged groups / Diseases / Economic aspects / Education / Epidemiology / Equality / Folic acid / Food intake / Food science / Health aspects / Health policy / Health problems / Health promotion / Income / Iron / Malnutrition / Medicine and Health Sciences / Micronutrients / Nutrients / Nutrition research / People and Places / Pharmacy / Physical sciences / Policies / Polls & surveys / Public health / Public health movements / Regression analysis / Risk factors / Social Sciences / Socioeconomic factors / Sugar / Surveys / Time / Vitamin D