Abstract
Higher-educated people often have healthier diets, but it is unclear whether specific dietary patterns exist within educational groups. We therefore aimed to derive dietary patterns in the total population and by educational level and to investigate whether these patterns differed in their composition and associations with the incidence of fatal and non-fatal CHD and stroke. Patterns were derived using principal components analysis in 36 418 participants of the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort. Self-reported educational level was used to create three educational groups. Dietary intake was estimated using a validated semi-quantitative FFQ. Hazard ratios were estimated using Cox Proportional Hazard analysis after a mean follow-up of 16 years. In the three educational groups, similar 'Western', 'prudent' and 'traditional' patterns were derived as in the total population. However, with higher educational level a lower population-derived score for the 'Western' and 'traditional' patterns and a higher score on the 'prudent' pattern were observed. These differences in distribution of the factor scores illustrate the association between education and food consumption. After adjustments, no differences in associations between population-derived dietary patterns and the incidence of CHD or stroke were found between the educational groups (P interaction between 0·21 and 0·98). In conclusion, although in general population and educational groups-derived dietary patterns did not differ, small differences between educational groups existed in the consumption of food groups in participants considered adherent to the population-derived patterns (Q4). This did not result in different associations with incident CHD or stroke between educational groups.
Highlights
It is well established that there are socio-economic inequalities in health[1]
The low-educated group consisted of 14 331 participants (39·4 %); 14 632 participants (40·2 %) had a medium education; and 7455 participants (20·5 %) had a high educational level (Table 1)
Food and nutrient intake by educational level is presented in the online Supplementary Table S1
Summary
It is well established that there are socio-economic inequalities in health[1]. Life expectancy at birth ranges from 46 years in a poor country like Sierra Leone up to 84 years in a wealthy country like Japan[2]. Diet is linked to a large number of health outcomes, and an improved dietary intake can help reduce the risk of many diseases – for example, CHD and stroke[9,10]. Dietary patterns that are characterised by a high consumption of fruit, vegetables, whole grains, fish and poultry and a low consumption of meat and refined grains are seen as healthy and are associated with a more adequate intake of nutrients and lower energy density[11]. Such healthy dietary patterns are more frequently observed in groups of high SES[11,12]. Improving diet may contribute to the reduction in socio-economic health inequalities
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