Unhealthy Diet Pattern Mediates the Disproportionate Prevalence of Obesity among Adults with Socio-Economic Disadvantage: An Australian Representative Cross-Sectional Study.

Canaan Negash Seifu,Paul Patrick Fahey,Evan Atlantis

doi:10.3390/nu13041363

Canaan Negash Seifu, Paul Patrick Fahey + Show 1 more

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https://doi.org/10.3390/nu13041363

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Abstract

The role of unhealthy dietary pattern in the association between socio-economic factors and obesity is unclear. The aim was to examine the association between socio-economic disadvantage and obesity and to assess mediation effect of unhealthy dietary pattern defined using the Mediterranean diet criteria. The data source was the Australian National Nutrition and Physical Activity Survey. The study sample included 7744 participants aged 18 years and over, 28% of whom had obesity. We used the Australian Socio-Economic Indexes for Areas (SEIFA) classification system for categorizing socio-economic disadvantage; calculated the Mediterranean Diet Score (MDS) using standard criteria; and used measured body mass index to define obesity. We conducted a mediation analysis using log–binomial models to generate the prevalence ratio for obesity and the proportion mediated by the MDS. The most disadvantaged group was associated with higher level of obesity after controlling for covariates (1.40, 95% CI 1.25, 1.56) compared to the least disadvantaged group, and in a dose–response way for each decreasing SEIFA quintile. The relationship between socio-economic disadvantage and obesity was mediated by the MDS (4.0%, 95% CI 1.9, 8.0). Public health interventions should promote healthy dietary patterns, such as the Mediterranean diet, to reduce obesity, especially in communities with high socio-economic disadvantage.

Highlights

Obesity, defined as a body mass index (BMI) greater than or equal to 30 kg/m2, is a rising global health issue and is estimated to have affected 390 million women and 281 million men in 2016 [1]
Twenty-four-hour diet recalls were collected using the five-pass ‘Automated Multiple-Pass Method’. It was developed by the United States Department of Agriculture and it was modified with assistance from Food Standards Australia and New Zealand (FSANZ) to reflect the Australian food supply
The results showed a significant effect (PR 1.13, 95% CI 1.08, 1.19) of lowest Socio-Economic Indexes for Areas (SEIFA) associated with lower Mediterranean Diet Score (MDS) (0–4) (Path A), and a significant effect (PR 1.19, 95% CI 1.10, 1.29) of lower MDS (0–4) associated with obesity (Path B)

Summary

Introduction

Obesity, defined as a body mass index (BMI) greater than or equal to 30 kg/m2, is a rising global health issue and is estimated to have affected 390 million women and 281 million men in 2016 [1] It is one of the leading risk factors for an increased fatal and non-fatal disease burden worldwide [2,3]. There is good evidence that societal changes during this period have likely resulted in population-wide increase in food consumption, especially from energy dense and nutrient poor foods [9,10] These transitions to obesogenic environments in societies are the aspects which could help explain worldwide changes in BMI and the differences between countries in the current rates of obesity, especially among vulnerable populations.

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