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 Kurpad, Estelle V. Lambert, Carol Maher, Jose Maia, Victor Matsudo, Timothy Olds, Vincent Onywera, Olga L. Sarmiento, Martyn Standage, Catrine Tudor-Locke, Pei Zhao, Vera Mikkila, Stephanie T. BroylesTimothy S. Church, Denise G. Lambert, Tiago Barreira, Ben Butitta, Catherine Champagne, Shannon Cocreham, Kara D. Denstel, Katy Drazba, Deirdre Harrington, William Johnson, Dione Milauskas, Emily Mire, Allison Tohme, Ruben Rodarte, Bobby Amoroso, John Luopa, Rebecca Neiberg, Scott Rushing, Lucy Lewis, Katia Ferrar, Effie Georgiadis, Rebecca Stanley, Victor Keihan Rodrigues Matsudo, Sandra Matsudo, Timoteo Araujo, Luis Carlos De Oliveira, Luis Fabiano, Diogo Bezerra, Gerson Ferrari, Priscilla Bélanger, Mike Borghese, Charles Boyer, Allana LeBlanc, Claire Francis, Geneviève Leduc, Chengming Diao, Wei Li, Weiqin Li, Enqing Liu, Gongshu Liu, Hongyan Liu, Jian Ma, Yijuan Qiao, Huiguang Tian, Yue Wang, Tao Zhang, Fuxia Zhang, Julio Acosta, Yalta Alvira, Maria Paula Diaz, Rocio Gamez, Maria Paula Garcia, Luis Guillermo Gómez, Lisseth Gonzalez, Silvia Gonzalez, Carlos Grijalba, Leidys Gutierrez, David Leal, Nicolas Lemus, Etelvina Mahecha, Maria Paula Mahecha, Rosalba Mahecha, Andrea Ramirez, Paola Rios, Andres Suarez, Camilo Triana, Elli Hovi, Jemina Kivelä, Sari Räsänen, Sanna Roito, Taru Saloheimo, Leena Valta, Deepa P. Lokesh, Michelle Stephanie D'Almeida, Mattilda R. Annie, Lygia Correa, Vijay Dakshina Murthy, Lucy Joy Wachira, Stella Muthuri, Alessandra Da Silva Borges, Sofia Oliveira Sá Cachada, Raquel Nichele De Chaves, Thayse Natacha Queiroz Ferreira Gomes, Sara Isabel Sampaio Pereira, Daniel Monteiro De Vilhena E Santos, Fernanda Karina Dos Santos, Pedro Gil Rodrigues Da Silva, Michele Caroline De Souza, Vicki Lambert, Matthew April, Monika Uys, Nirmala Naidoo, Nandi Synyanya, Madelaine Carstens, Sean Cumming, Clemens Drenowatz, Lydia Emm, Fiona Gillison, Julia Zakrzewski, Ashley Braud, Sheletta Donatto, Corbin Lemon, Ana Jackson, Ashunti Pearson, Gina Pennington, Daniel Ragus, Ryan Roubion, John Schuna, Derek Wiltz, Alan Batterham, Jacqueline Kerr, Michael Pratt, Angelo Pietrobelli

Research output: Contribution to journalArticle

23 Scopus citations

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 (US)
Article number457
JournalBMC Public Health
Volume17
Issue number1
DOIs
StatePublished - May 16 2017

Keywords

  • Gini index
  • Hdi
  • Household income
  • Non-communicable diseases
  • Unhealthy/healthy diet

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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    Manyanga, T., Tremblay, M. S., Chaput, J. P., Katzmarzyk, P. T., Fogelholm, M., Hu, G., Kuriyan, R., Kurpad, A., Lambert, E. V., Maher, C., Maia, J., Matsudo, V., Olds, T., Onywera, V., Sarmiento, O. L., Standage, M., Tudor-Locke, C., Zhao, P., Mikkila, V., ... Pietrobelli, A. (2017). Socioeconomic status and dietary patterns in children from around the world: Different associations by levels of country human development? BMC Public Health, 17(1), [457]. https://doi.org/10.1186/s12889-017-4383-8