Abstract
BackgroundLow 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.MethodsWe used cross-sectional data from Dutch 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.ResultsMean 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.ConclusionDietary 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.
Highlights
Low socio-economic position is associated with consumption of lower quality diets, which may be partly explained by the cost of healthier diets
When taking the household educational level measure, the percentage of participants that was categorized as highly educated increased to 42.6%, whilst the percentage of participants that was categorized as low educated decreased to 46.5%
Mean dietary cost (€ per day), the DHD15-index and the Dietary Approaches to Stop Hypertension (DASH) score increased with increasing individual and household educational levels
Summary
Low socio-economic position is associated with consumption of lower quality diets, which may be partly explained by the cost of healthier diets. Individuals with a lower socio-economic position (SEP) have an increased risk of developing diet-related chronic diseases [3, 4], which is partly explained by socio-economic differences in diet [5]. A meta-analysis showed that, on average, healthier dietary patterns were more costly than less healthy dietary patterns [13]. This suggests that both perceived and actual food prices, potentially in combination with limited individual food budgets, may constrain individuals with a lower SEP in consuming a high-quality diet
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