Abstract
BackgroundRecent studies have explored the influence of socioeconomic inequalities on the diet quality. However, there is lack of evidence regarding the level of inequalities in dietary quality and its main contributing factors from population-based follow-up studies. The primary objective of this study was to investigate the level and the determinants of inequalities in diet quality in a representative sample of adolescents, adults and older adults resident in São Paulo, Brazil.MethodsData from the Health Survey of São Paulo (ISA-Capital) were analyzed for 2003 (n = 2398), 2008 (n = 1662) and 2015 (n = 1742) surveys. Information on food consumption was obtained through 24-h dietary recall, and diet quality was assessed based on the Revised Brazilian Healthy Eating Index (BHEI-R). The descriptive variables were compared using 95% confidence interval. The scores of BHEI-R and its components were compared across age groups and year. The association between socioeconomic inequalities and diet quality was based on the estimation of concentration index.ResultsWe observed that the BHEI-R scores gradually improved over 12-years, with older adults showing the greatest improvement. The increase in overall population score was observed for total fruits, whole fruits, whole grains, oils and sodium. The main contributor to socioeconomic inequality in diet quality in 2003 was ethnic group, and in 2008 and 2015, it was per capita household income; age was a persistent factor of inequality in the population over the years. Concentration indices indicated that lower income individuals had higher BHEI-R scores in 2003; however, there was a shift in favor of higher income individuals in 2008 and 2015.ConclusionsChanges in the patterns of determination of inequalities according to age, ethnic group or income during the period analyzed show the existence of ongoing process of contribution of demographic and socioeconomic factors in the diet quality of individuals in a large urban center.
Highlights
Recent studies have explored the influence of socioeconomic inequalities on the diet quality
The analysis focuses on quality of food consumption among individuals with diverse economic status in Brazil, using the Brazilian Healthy Eating Index (BHEI-R) as measure of diet quality
There was a gradual improvement in diet quality of São Paulo residents in 12 years, with the BHEI-R score departing from 54.70 (Standard Error, SE = 0.51) in 2003 and reaching 58.38 (SE = 0.39) in 2015 (p < 0.001)
Summary
Recent studies have explored the influence of socioeconomic inequalities on the diet quality. Diet quality is a modifiable risk factor that influences the development of chronic diseases such as obesity, type 2 diabetes mellitus, and cardiovascular diseases [1, 2]. It contributes to inequalities in health and, at the same time, is influenced by socioeconomic inequalities, such as access to education and health services, which in turn are associated with living conditions, such as income, occupation and educational attainment [1, 3,4,5]. There is still no evidence regarding the level of inequality in the diet quality in population-based follow-up studies, neither is there analysis of the factors contributing to the inequalities. The present study proposes and aim to employ such methodology to investigate level and the determinants of inequalities in
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