Socioeconomic status and dietary patterns in children from around the world: different associations by levels of country human development?

BMC Public Health. 2017;17(1):1-11 DOI 10.1186/s12889-017-4383-8


Journal Homepage

Journal Title: BMC Public Health

ISSN: 1471-2458 (Online)

Publisher: BMC

LCC Subject Category: Medicine: Public aspects of medicine

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML



Taru Manyanga (Children’s Hospital of Eastern Ontario Research Institute)

Mark S. Tremblay (Children’s Hospital of Eastern Ontario Research Institute)

Jean-Philippe Chaput (Children’s Hospital of Eastern Ontario Research Institute)

Peter T. Katzmarzyk (Pennington Biomedical Research Center)

Mikael Fogelholm (University of Helsinki)

Gang Hu (Pennington Biomedical Research Center)

Rebecca Kuriyan (St. Johns Research Institute)

Anura Kurpad (St. Johns Research Institute)

Estelle V. Lambert (University of Cape Town)

Carol Maher (University of South Australia)

Jose Maia (CIFI2D, University of Porto)

Victor Matsudo (Center of Studies from the Physical Fitness Research Laboratory, de São Caetano do Sul)

Timothy Olds (University of South Australia)

Vincent Onywera (Kenyatta University)

Olga L. Sarmiento (Universidad de los Andes)

Martyn Standage (University of Bath)

Catrine Tudor-Locke (Pennington Biomedical Research Center)

Pei Zhao (Tianjin Women’s and Children’s Health Center)

Vera Mikkila (Academy of Finland, Health Research Unit)

Stephanie T. Broyles (Pennington Biomedical Research Center)

for the ISCOLE Research Group


Open peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 18 weeks


Abstract | Full Text

Abstract Background Although ‘unhealthy’ diet is a well-known risk factor for non-communicable diseases, its relationship with socio-economic status (SES) has not been fully investigated. Moreover, the available research has largely been conducted in countries at high levels of human development. This is the first study to examine relationships among dietary patterns and SES of children from countries spanning a wide range of human development. Methods This was a multinational cross-sectional study among 9–11 year-old children (n = 6808) from urban/peri-urban sites across 12 countries. Self-reported food frequency questionnaires were used to determine the children’s dietary patterns. Principal Components Analysis was employed to create two component scores representing ‘unhealthy’ and ‘healthy’ dietary patterns. Multilevel models accounting for clustering at the school and site level were used to examine the relationships among dietary patterns and SES. Results The mean age of participants in this study (53.7% girls) was 10.4 years. Largest proportions of total variance in dietary patterns occurred at the individual, site, and school levels (individual, school, site: 62.8%; 10.8%; 26.4% for unhealthy diet pattern (UDP) and 88.9%; 3.7%; 7.4%) for healthy diet pattern (HDP) respectively. There were significant negative ‘unhealthy’ diet-SES gradients in 7 countries and positive ‘healthy’ diet-SES gradients in 5. Within country diet-SES gradients did not significantly differ by HDI. Compared to participants in the highest SES groups, unhealthy diet pattern scores were significantly higher among those in the lowest within-country SES groups in 8 countries: odds ratios for Australia (2.69; 95% CI: 1.33–5.42), Canada (4.09; 95% CI: 2.02–8.27), Finland (2.82; 95% CI: 1.27–6.22), USA (4.31; 95% CI: 2.20–8.45), Portugal (2.09; 95% CI: 1.06–4.11), South Africa (2.77; 95% CI: 1.22–6.28), India (1.88; 95% CI: 1.12–3.15) and Kenya (3.35; 95% CI: 1.91–5.87). Conclusions This study provides evidence of diet-SES gradients across all levels of human development and that lower within-country SES is strongly related to unhealthy dietary patterns. Consistency in within-country diet-SES gradients suggest that interventions and public health strategies aimed at improving dietary patterns among children may be similarly employed globally. However, future studies should seek to replicate these findings in more representative samples extended to more rural representation.