Diet Quality Changes by Educational Level among Adults in Spain from 2017 to 2021

Author:

Romero Isabel1ORCID,Díez Julia2,Del Cura Isabel3456ORCID,Franco Manuel27ORCID,Gullón Pedro28ORCID,

Affiliation:

1. Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Aragón, Spain

2. Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain

3. Primary Care Research Unit, Madrid Health Service, 28035 Madrid, Spain

4. Department of Preventive Medicine and Public Health, Universidad Rey Juan Carlos, 28933 Madrid, Spain

5. Health Services Research on Chronic Patients Network (REDISSEC) & Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Institute of Health Carlos III, 28029 Madrid, Spain

6. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, 17165 Stockholm, Sweden

7. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA

8. Center for Urban Research, RMIT University, Melbourne 3004, Australia

Abstract

Despite increasing attention on addressing socioeconomic disparities in diet quality, longitudinal studies are scarce. Furthermore, the effects of the COVID-19 pandemic on diet-related outcomes are yet to be fully understood. We examined changes in diet quality by educational level among adults in Madrid, Spain. We used data from recruitment (in 2017) and from 2021. At baseline, our sample included 1358 adults aged 40–75 years who were free of cardiovascular disease and completed a validated diet quality screener. Of them, 931 answered the survey in the follow-up visit in 2021. We used participants' diet quality index scores (range: 18–54; higher scores indicate better diet quality) as the dependent variable. As our independent variable, we assessed participants’ educational levels (low, medium, and high). We fitted a multinomial regression using the categories of educational level as the main predictor, adjusting for age, sex, country of origin, and household composition. During the study period, 78.0% of participants sustained their diet quality, 11.6% improved it, and 10.4% moved away from a healthier dietary pattern. In descriptive analyses, we observed an increase in diet quality among less-educated females. Unadjusted multinomial models showed that a lower educational level predicted both increases and decreases in diet quality over the period. Even though the median diet quality scores did not change significantly, we observed heterogeneous changes over the four years. Variability within diet, with some improving and some worsening, seems to have increased among participants with lower educational levels. Future studies should look at the determinants of change in these population subgroups.

Funder

European Research Council

Publisher

MDPI AG

Subject

Food Science,Nutrition and Dietetics

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