Socioeconomic status and dietary patterns in children from around the world: Different associations by levels of country human development?

Taru Manyanga, Mark S. Tremblay, Jean Philippe Chaput, Peter T. Katzmarzyk, Mikael Fogelholm, Gang Hu, Rebecca Kuriyan, Anura Vishwanath Kurpad, Estelle Victoria Lambert, Carol Ann Maher, José António Maia, Victor Rodrigues Matsudo, Tim Olds, Vincent Ochieng Onywera, Olga Sarmiento, Martyn Standage, Catrine E. Tudor- Locke, Pei Zhao, Vera Mikkilä¨, Stephanie T. BroylesTimothy S. Church, Denise G. Lambert, Tiago V. Barreira, Ben P. Butitta, Catherine M. Champagne, Shannon H. Cocreham, Kara D. Denstel, Katy Drazba, Deirdre Deirdre M. Harrington, William D. Johnson, Dione Milauskas, Emily F. Mire, Allison Tohme, Ruben Q. Rodarte, Bobby Amoroso, John Luopa, Rebecca H. Neiberg, Scott Rushing, Lucy Kate Lewis, Katia Ferrar, Effie Georgiadis, Rebecca Megan Stanley, Victor Keihan Matsudo, Sandra Mahecha Matsudo, Timóteo Leandro Araújo, Luís Carlos De Oliveira, Luis Fabiano, Diogo Bezerra, Gerson Luis Ferrari, Priscilla Bélanger, Michael Marc Borghese, Charles Boyer, Allana G.W. LeBlanc, Claire E. Francis, Geneviève Leduc, Chengming Diao, Wei Li, Weiqin Li, Enquing qing Liu, Gongshu Liu, Hongyan Liu, Jian Ma, Yijuan Qiao, Huiguang Tian, Yue Wang, Tao Zhang, Fuxia Zhang, Julio Acosta, Yalta Alvira, María Paula Díaz, Rocio Gámez, Maria Paula Garcia, Luis Guillermo Gómez, Lisseth Heras González, Silvia Alejandra González, Carlos Grijalba, Leidys Gutiérrez, David Leal, Nicolás Lemus, Etelvina Mahecha, Maria Paula Mahecha, Rosalba Mahecha, Andrea Ramírez Varela, Paola Ríos, Andres Suarez, Camilo A. Triana, Elli Hovi, Jemina Kivelä, Sari M. Räsänen, Sanna Roito, Taru Saloheimo, Leena Valta, Deepa P. Lokesh, Michelle Stephanie D'Almeida, Mattilda R. Annie, Lygia F.M. Correa, Vijay Dakshina Murthy, Lucy Joy Wachira, Stella Kagwiria Muthuri, Alessandra Da Silva Borges, Sofia Oliveira Cachada, Raquel Nichele De Chaves, Thayse Natacha Gomes, Sara Isabel Pereira, Daniel Monteiro De Vilhena E Santos, Fernanda Karina Dos Santos, Pedro Gil Da Silva, Michele Caroline De Souza, Vicki E. Lambert, Matthew April, Monika Uys, Nirmala Naidoo, Nandi Synyanya, Madelaine T. Carstens, Sean P. Cumming, Clemens Drenowatz, Lydia G. Emm, Fiona Bridget Gillison, Julia Kirstey Zakrzewski, Ashley Braud, Sheletta G. Donatto, Corbin Lemon, Ana Jackson, Ashunti Pearson, Gina Pennington, Daniel Ragus, Ryan C. Roubion, John M. Schuna, Derek Wiltz, Alan Mark Batterham, Jacqueline Kerr, Michael W. Pratt, Angelo Pietrobelli

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: Although 'unhealthy' diet is a well-known risk factor for non-communicable diseases, its relationship with socio-economic status (SES) has not been fully investigated. Moreover, the available research has largely been conducted in countries at high levels of human development. This is the first study to examine relationships among dietary patterns and SES of children from countries spanning a wide range of human development. Methods: This was a multinational cross-sectional study among 9-11 year-old children (n = 6808) from urban/peri-urban sites across 12 countries. Self-reported food frequency questionnaires were used to determine the children's dietary patterns. Principal Components Analysis was employed to create two component scores representing 'unhealthy' and 'healthy' dietary patterns. Multilevel models accounting for clustering at the school and site level were used to examine the relationships among dietary patterns and SES. Results: The mean age of participants in this study (53.7% girls) was 10.4 years. Largest proportions of total variance in dietary patterns occurred at the individual, site, and school levels (individual, school, site: 62.8%; 10.8%; 26.4% for unhealthy diet pattern (UDP) and 88.9%; 3.7%; 7.4%) for healthy diet pattern (HDP) respectively. There were significant negative 'unhealthy' diet-SES gradients in 7 countries and positive 'healthy' diet-SES gradients in 5. Within country diet-SES gradients did not significantly differ by HDI. Compared to participants in the highest SES groups, unhealthy diet pattern scores were significantly higher among those in the lowest within-country SES groups in 8 countries: odds ratios for Australia (2.69; 95% CI: 1.33-5.42), Canada (4.09; 95% CI: 2.02-8.27), Finland (2.82; 95% CI: 1.27-6.22), USA (4.31; 95% CI: 2.20-8.45), Portugal (2.09; 95% CI: 1.06-4.11), South Africa (2.77; 95% CI: 1.22-6.28), India (1.88; 95% CI: 1.12-3.15) and Kenya (3.35; 95% CI: 1.91-5.87). Conclusions: This study provides evidence of diet-SES gradients across all levels of human development and that lower within-country SES is strongly related to unhealthy dietary patterns. Consistency in within-country diet-SES gradients suggest that interventions and public health strategies aimed at improving dietary patterns among children may be similarly employed globally. However, future studies should seek to replicate these findings in more representative samples extended to more rural representation.

Original languageEnglish
Article number457
JournalBMC Public Health
Volume17
Issue number1
DOIs
Publication statusPublished - 2017

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