To what extent do dietary costs explain socio-economic differences in dietary behavior?
Hoenink, Jody C.; Beulens, Joline W.J.; Harbers, Marjolein C.; Boer, Jolanda M.A.; Dijkstra, S. Coosje; Nicolaou, Mary; van der Schouw, Yvonne T.; Sluijs, Ivonne; Verschuren, W. M.Monique; Waterlander, Wilma; Mackenbach, Joreintje D.
(2020) nutrition journal, volume 19, issue 1, pp.
(Article)
Abstract
BACKGROUND: Low socio-economic position is associated with consumption of lower quality diets, which may be partly explained by the cost of healthier diets. Therefore, we aimed to investigate the mediating role of dietary costs in the association between educational level and diet quality. METHODS: We used cross-sectional data from Dutch
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older adults (N = 9399) in the EPIC-NL cohort. Participants provided information about their own and their partners' highest attained educational level (as proxy for socio-economic position). Dietary behavior was assessed using a food frequency questionnaire from which we derived two diet-quality scores, including the Dutch Healthy Diet index 2015 (DHD15-index) and the Dietary Approaches to Stop Hypertension (DASH) diet. Dietary cost estimates were based on food price data from food stores, and linked to reported consumption of food items. Multiple regression analyses and bootstrapping were used examine the mediating role of dietary cost in the association between educational level and diet quality. RESULTS: Mean age of participants was 70 (SD: 10) years and 77% were women. Dietary costs significantly mediated the association between educational level and diet quality, except for high versus middle individual educational level and the DHD15-index. Depending on the dietary and educational indicator, dietary costs explained between 2 and 7% of the association between educational level and diet quality. Furthermore, associations were found to be modified by sex and age. For the DHD15-index, mediation effects were only present in females and adults older than 65 years, and for the DASH diet mediation effects were only present in females and strongest amongst adults older than 65 years compared to adults younger than 65 years. CONCLUSION: Dietary costs seems to play a modest role in explaining educational differences in diet quality in an older Dutch population. Further research is needed to investigate which other factors may explain SEP differences in diet quality.
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Keywords: Journal Article, Research Support, Non-U.S. Gov't
ISSN: 1475-2891
Publisher: BioMed Central
Note: Funding Information: This study is part of the SUPREME NUDGE project, which is a 5-year research project financed by the Dutch Heart Foundation and ZonMw. Furthermore, the EPIC-NL data was funded by ‘Europe against Cancer‘Program of the European Commission (DG SANCO), the Dutch Ministry of Health, Welfare and Sports (VWS), the Netherlands Organization for Health Research and Development (ZonMW) and the World Cancer Research Fund. JDM’s work was funded by an NWO VENI grant on “Making the healthy choice easier – role of the local food environment” (grant number 451–17-032). Funding Information: The Dutch Food Price database was constructed by Mary Nicolaou, Coosje Dijkstra and Joreintje Mackenbach, who were funded to do so by the Health Behaviors and Chronic Diseases (HBCD) program of the Amsterdam Public Health research institute (MN, SCD and JDM) and the Netherlands Organization for Scientific Research (JM). The EPIC-NL study was funded by ‘Europe against Cancer‘Program of the European Commission (DG SANCO), the Dutch Ministry of Health, Welfare and Sports (VWS), the Netherlands Organization for Health Research and Development (ZonMW) and the World Cancer Research Fund. None of the study sponsors had a role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Publisher Copyright: © 2020 The Author(s).
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