Socio-economic factors associated with a healthy diet

Socio-economic factors associated with a healthy diet

10 Pages · 2017 · 444 KB · English

1Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Team 9, Nutrition, Hormones and. Women's Health, Gustave Roussy Institute, 114 rue Edouard Vaillant, 94805 Villejuif Cedex, France: 2Paris-South. University, Villejuif, France: 3Human Genetics Foundation (HuGeF) 

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Socioeconomic factors associated with a healthy diet: results from the E3N study Aurélie Affret 1,2 , Gianluca Severi 1,2,3,4 , Courtney Dow 1,2 , Grégoire Rey 5, Cyrille Delpierre 6, MarieChristine BoutronRuault 1,2 , Françoise ClavelChapelon 1,2 and Guy Fagherazzi 1,2, * 1Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Team 9, Nutrition, Hormones and Women’s Health, Gustave Roussy Institute, 114 rue Edouard Vaillant, 94805 Villejuif Cedex, France: 2ParisSouth University, Villejuif, France: 3Human Genetics Foundation (HuGeF), Torino, Italy: 4Cancer Epidemiology Centre, Cancer Council Victoria and The University of Melbourne, Melbourne, Australia: 5Inserm, CépiDc, Le KremlinBicêtre, France: 6Inserm U1027, Faculty of Medicine, Toulouse, France Submitted 27 July 2016: Final revision received 16 January 2017: Accepted 23 January 2017: First published online 13 March 2017 Abstract Objective:To identify individual and contextual socioeconomic factors associated with a healthy diet Design:Dietary data from a large cohort study were used to derive two mutually exclusive dietary patterns through a latent class analysis Associations between dietary patterns and socioeconomic factors were studied with logistic regression Setting:E3N, a French prospective cohort study composed of women recruited from a national health insurance plan covering people working in the national education system Subjects:E3N participants (n73 031) with dietary and socioeconomic data available Results:The‘Healthy’pattern was characterized by a large consumption of fruits and vegetables and the‘Less Healthy’pattern by a large consumption of pizza and processed meat When all socioeconomic factors were analysed together, all of the individual factors considered were associated with a healthy diet (eg women with three or more children were less likely to follow a healthy dietvwomenwithno children, OR (95 % CI): 0·70 (0·66, 0·75)) while the contextual factors associated with a healthy diet included the size of the agglomeration of residence and the area of birth and residence (eg women living in the West of France were less likely to follow a healthy dietv those living in the South of France: 0·78 (0·72, 0·83)) Conclusions:We demonstrated that individual and contextual factors are both associated with diet Rather than focusing only on individual factors, we recommend future studies or public health and nutritional strategies on diet to consider both types of factors Keywords Diet Socioeconomic environment A posteriori patterns Latent class analysis E3N cohort Epidemiology Methodology Foods and nutrients are not consumed in isolation They form a network of complex interactions that can be best considered with a dietary pattern approach (1,2) There is growing evidence of moderate to strong associations between healthy dietary patterns and decreased risk of obesity and chronic diseases such as CVD, hypertension, type 2 diabetes and some cancers (3,4) In most studies, dietary patterns are derived from principal component analysis or factor analysis These methods reduce the number of dimensions by determining factors that are linear combinations of dietary variables (2) However, one major limitation is that estimated dietary patterns are not mutually exclusive; one individual may simultaneouslyhave high adherence scores to several patterns Although this could be the result of a multifactorial reality, it makes interpretation difficult Previous studies have demonstrated that individual and contextual socioeconomic factors are strong determinants of dietary habits (5–9) , with lower socioeconomic groups being less likely to purchase and consume healthy products Among contextual factors, the area of residence has been shown to be of importance, particularly in France where an interaction between the level of education and the area of residence (South of Francev the other regions) has been previously suggested (10,11) Furthermore, overall mortality and causespecific mortality are higher in groups of Public Health Nutrition: 20(9), 1574–1583 doi:101017/S1368980017000222 *Corresponding author:Email [email protected] © The Authors 2017 lower socioeconomic status at the individual (12,13) and residential area level (14) Lower socioeconomic groups also have poorer health consciousness and are more frequently obese (15) or diabetic (16,17) In this context and despite the fact that experts agree that the socioeconomic environment is complex and multifactorial, its influence has generally been studied by considering a single specific and conventional socioeconomic factor (18) such as education (19) or income tax (11) Nevertheless, considering various socioeconomic factors together to capture the multidimensional nature of socioeconomic status, and not assuming that different socioeconomic measures are interchangeable, has been reported to be of importance (18,20) Socioeconomic variables are each operationally distinct and may influence health behaviours by conceptually different processes (20) It is therefore of interest to study the influence of the socioeconomic environment

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