Vitamin Status and Diet in Elderly with Low and High Socioeconomic Status: The Lifelines-MINUTHE Study.

Yinjie Zhu,Ineke J Riphagen,Gerjan J Navis,Sijmen A Reijneveld,Louise H Dekker,Ido P Kema,Isidor Minović,Sander K.R Van Zon,Manfred L Eggersdorfer,Stephan J.L Bakker,Jenny E Kootstra-Ros

doi:10.3390/nu12092659

Yinjie Zhu, Ineke J Riphagen + Show 9 more

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https://doi.org/10.3390/nu12092659

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Abstract

Socioeconomic health inequalities are an important global public health problem. However, it is not well known to what extent socioeconomic inequalities culminate in impaired vitamin status and whether this is mediated by diet. We, therefore, aimed to assess vitamin status in a population already at increased risk of micronutrient deficiency, i.e., elderly with high and low socioeconomic status (SES), and to investigate whether potential differences therein were mediated by diet quality. Vitamin status in 1605 individuals (60–75 years) from the Lifelines- Micronutrients and Health inequalities in Elderly (MINUTHE) Study was assessed by measuring folic acid and the vitamins B6, B12, D, A, E, and K. Multinomial logistic and linear regression analyses were applied to test the associations between SES and vitamin status. Mediation analysis was used to explore the interrelationship between SES, diet quality, and vitamin status. Low SES was associated with poorer status of vitamin B6, vitamin B12, and, notably, folic acid. Moreover, multivitamin deficiencies were more prevalent in the low SES group. Diet quality was found to mediate the associations of SES with folic acid (for 39.1%), vitamin B6 (for 37.1%), and vitamin B12 (for 37.2%). We conclude that low SES is a risk factor for a spectrum of vitamin deficiencies. Diet quality can partially explain the socioeconomic differences in vitamin status, suggesting that policymakers can mitigate socioeconomic inequality in nutritional status through improving diet quality.

Highlights

Socioeconomic status (SES) has been linked to health inequality worldwide, with low socioeconomic status (SES) being one of the modifiable determinants of morbidity and premature mortality [1,2,3]
We found that elderly subjects with low SES had a higher risk for folic acid deficiency and insufficiency (p < 0.001 and p = 0.002, respectively), vitamin B6 deficiency (p = 0.001), and vitamin E insufficiency
We found that low SES was associated with lower serum concentrations of folic acid, vitamin B12 and vitamin B6 after adjustment for age, gender, BM, and smoking behavior (p ≤ 0.007 for all) (Table S2)

Summary

Introduction

Socioeconomic status (SES) has been linked to health inequality worldwide, with low SES being one of the modifiable determinants of morbidity and premature mortality [1,2,3]. It is known that overall diet quality is worse in low SES groups. The effects of socioeconomically patterned differences on vitamin status have not been solidly characterized, since vitamin status has mainly been assessed by using food frequency questionnaire and food diaries, which are not suitable measures to assess vitamin status [11], or incompletely by measuring limited numbers of biomarkers of vitamin status [11,12,13,14]. Diet-induced differences in vitamin status may be especially relevant in the elderly population

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