Skip to main content Accessibility help

Diet quality in older age: the influence of childhood and adult socio-economic circumstances

  • Janice L. Atkins (a1), Sheena E. Ramsay (a1), Peter H. Whincup (a2), Richard W. Morris (a1), Lucy T. Lennon (a1) and S. Goya Wannamethee (a1)...


Socio-economic gradients in diet quality are well established. However, the influence of material socio-economic conditions particularly in childhood, and the use of multiple disaggregated socio-economic measures on diet quality have been little studied in the elderly. In the present study, we examined childhood and adult socio-economic measures, and social relationships, as determinants of diet quality cross-sectionally in 4252 older British men (aged 60–79 years). A FFQ provided data on daily fruit and vegetable consumption and the Elderly Dietary Index (EDI), with higher scores indicating better diet quality. Adult and childhood socio-economic measures included occupation/father's occupation, education and household amenities, which combined to create composite scores. Social relationships included social contact, living arrangements and marital status. Both childhood and adult socio-economic factors were independently associated with diet quality. Compared with non-manual social class, men of childhood manual social class were less likely to consume fruit and vegetables daily (OR 0·80, 95 % CI 0·66, 0·97), as were men of adult manual social class (OR 0·65, 95 % CI 0·54, 0·79), and less likely to be in the top EDI quartile (OR 0·73, 95 % CI 0·61, 0·88), similar to men of adult manual social class (OR 0·66, 95 % CI 0·55, 0·79). Diet quality decreased with increasing adverse adult socio-economic scores; however, the association with adverse childhood socio-economic scores diminished with adult social class adjustment. A combined adverse childhood and adulthood socio-economic score was associated with poor diet quality. Diet quality was most favourable in married men and those not living alone, but was not associated with social contact. Diet quality in older men is influenced by childhood and adulthood socio-economic factors, marital status and living arrangements.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Diet quality in older age: the influence of childhood and adult socio-economic circumstances
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Diet quality in older age: the influence of childhood and adult socio-economic circumstances
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Diet quality in older age: the influence of childhood and adult socio-economic circumstances
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

* Corresponding author: J. L. Atkins, email


Hide All
1 World Health Organization (2003) Diet, Nutrition and the Prevention of Chronic Disease. Joint WHO/FAO Expert Consultation. WHO Technical Report Series no. 916 . Geneva: WHO.
2 Bhupathiraju, SN & Tucker, KL (2011) Coronary heart disease prevention: nutrients, foods, and dietary patterns. Clin Chim Acta 412, 14931514.
3 Mente, A, de Koning, L, Shannon, HS, et al. (2009) A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 169, 659669.
4 World Health Organization (2002) Keep Fit for Life. Meeting the Nutritional Needs of Older Persons. Geneva: WHO.
5 Hu, FB (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13, 39.
6 Schulze, MB & Hoffmann, K (2006) Methodological approaches to study dietary patterns in relation to risk of coronary heart disease and stroke. Br J Nutr 95, 860869.
7 Kant, AK (2004) Dietary patterns and health outcomes. J Am Diet Assoc 104, 615635.
8 Waijers, PM, Feskens, EJ & Ocke, MC (2007) A critical review of predefined diet quality scores. Br J Nutr 97, 219231.
9 Sofi, F, Abbate, R, Gensini, GF, et al. (2010) Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 92, 11891196.
10 Trichopoulou, A, Kouris-Blazos, A, Wahlqvist, ML, et al. (1995) Diet and overall survival in elderly people. BMJ 311, 14571460.
11 Bonaccio, M, Bonanni, AE, Di Castelnuovo, A, et al. (2012) Low income is associated with poor adherence to a Mediterranean diet and a higher prevalence of obesity: cross-sectional results from the Moli-sani study. BMJ Open 2.
12 Darmon, N & Drewnowski, A (2008) Does social class predict diet quality? Am J Clin Nutr 87, 11071117.
13 James, WP, Nelson, M, Ralph, A, et al. (1997) Socioeconomic determinants of health. The contribution of nutrition to inequalities in health. BMJ 314, 15451549.
14 Martikainen, P, Brunner, E & Marmot, M (2003) Socioeconomic differences in dietary patterns among middle-aged men and women. Soc Sci Med 56, 13971410.
15 Irala-Estevez, JD, Groth, M, Johansson, L, et al. (2000) A systematic review of socio-economic differences in food habits in Europe: consumption of fruit and vegetables. Eur J Clin Nutr 54, 706714.
16 Hare-Bruun, H, Togo, P, Andersen, LB, et al. (2011) Adult food intake patterns are related to adult and childhood socioeconomic status. J Nutr 141, 928934.
17 Mishra, GD, Prynne, CJ, Paul, AA, et al. (2004) The impact of inter-generational social and regional circumstances on dietary intake patterns of British adults: results from the 1946 British Birth Cohort. Public Health Nutr 7, 737744.
18 Eng, PM, Rimm, EB, Fitzmaurice, G, et al. (2002) Social ties and change in social ties in relation to subsequent total and cause-specific mortality and coronary heart disease incidence in men. Am J Epidemiol 155, 700709.
19 Conklin, AI, Forouhi, NG, Surtees, P, et al. (2014) Social relationships and healthful dietary behaviour: evidence from over-50s in the EPIC cohort, UK. Soc Sci Med 100, 167175.
20 Sahyoun, NR & Zhang, XL (2005) Dietary quality and social contact among a nationally representative sample of the older adult population in the United States. J Nutr Health Aging 9, 177183.
21 Brennan, DS & Singh, KA (2011) Grocery purchasing among older adults by chewing ability, dietary knowledge and socio-economic status. Public Health Nutr 14, 12791284.
22 Burns, C, Bentley, R, Thornton, L, et al. (2011) Reduced food access due to a lack of money, inability to lift and lack of access to a car for food shopping: a multilevel study in Melbourne, Victoria. Public Health Nutr 14, 10171023.
23 Payette, H & Shatenstein, B (2005) Determinants of healthy eating in community-dwelling elderly people. Can J Public Health 96, Suppl. 3, S27S31, S30–S35.
24 Sharkey, JR, Johnson, CM & Dean, WR (2010) Food access and perceptions of the community and household food environment as correlates of fruit and vegetable intake among rural seniors. BMC Geriatr 10, 32.
25 Wolfe, WS, Frongillo, EA & Valois, P (2003) Understanding the experience of food insecurity by elders suggests ways to improve its measurement. J Nutr 133, 27622769.
26 Kourlaba, G, Polychronopoulos, E, Zampelas, A, et al. (2009) Development of a diet index for older adults and its relation to cardiovascular disease risk factors: the Elderly Dietary Index. J Am Diet Assoc 109, 10221030.
27 Shaper, AG, Pocock, SJ, Walker, M, et al. (1981) British Regional Heart Study: cardiovascular risk factors in middle-aged men in 24 towns. Br Med J (Clin Res Ed) 283, 179186.
28 Walker, M, Whincup, PH & Shaper, AG (2004) The British Regional Heart Study 1975–2004. Int J Epidemiol 33, 11851192.
29 World Health Organization (1988) The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol 41, 105114.
30 Bolton-Smith, C & Milne, AC (1991) Food frequency v. weighed intake data in Scottish men. Proc Nutr Soc 50, 36A (abstr).
31 Yarnell, JW, Fehily, AM, Milbank, JE, et al. (1983) A short dietary questionnaire for use in an epidemiological survey: comparison with weighed dietary records. Hum Nutr Appl Nutr 37, 103112.
32 Goldberg, GR, Black, AE, Jebb, SA, et al. (1991) Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 45, 569581.
33 Lichtenstein, AH, Rasmussen, H, Yu, WW, et al. (2008) Modified MyPyramid for older adults. J Nutr 138, 511.
34 Atkins, JL, Whincup, PH, Morris, RW, et al. (2014) High diet quality is associated with a lower risk of cardiovascular disease and all-cause mortality in older men. J Nutr 144, 673680.
35 He, FJ, Nowson, CA, Lucas, M, et al. (2007) Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies. J Hum Hypertens 21, 717728.
36 Ramsay, SE, Whincup, PH, Papacosta, O, et al. (2014) Inequalities in heart failure in older men: prospective associations between socioeconomic measures and heart failure incidence in a 10-year follow-up study. Eur Heart J 35, 442447.
37 Wannamethee, SG, Whincup, PH, Shaper, G, et al. (1996) Influence of fathers' social class on cardiovascular disease in middle-aged men. Lancet 348, 12591263.
38 Wannamethee, SG, Lowe, GD, Shaper, AG, et al. (2005) Associations between cigarette smoking, pipe/cigar smoking, and smoking cessation, and haemostatic and inflammatory markers for cardiovascular disease. Eur Heart J 26, 17651773.
39 Wannamethee, SG, Lowe, GD, Shaper, G, et al. (2003) The effects of different alcoholic drinks on lipids, insulin and haemostatic and inflammatory markers in older men. Thromb Haemost 90, 10801087.
40 Wannamethee, SG, Lowe, GD, Whincup, PH, et al. (2002) Physical activity and hemostatic and inflammatory variables in elderly men. Circulation 105, 17851790.
41 World Health Organization (2000) Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series no. 894 . Geneva: WHO.
42 Ferranti, EP, Dunbar, SB, Higgins, M, et al. (2013) Psychosocial factors associated with diet quality in a working adult population. Res Nurs Health 36, 242256.
43 Bamia, C, Orfanos, P, Ferrari, P, et al. (2005) Dietary patterns among older Europeans: the EPIC-Elderly study. Br J Nutr 94, 100113.
44 Dean, M, Raats, MM, Grunert, KG, et al. (2009) Factors influencing eating a varied diet in old age. Public Health Nutr 12, 24212427.
45 Maynard, M, Gunnell, D, Ness, AR, et al. (2006) What influences diet in early old age? Prospective and cross-sectional analyses of the Boyd Orr cohort. Eur J Public Health 16, 316324.
46 Robinson, S, Syddall, H, Jameson, K, et al. (2009) Current patterns of diet in community-dwelling older men and women: results from the Hertfordshire Cohort Study. Age Ageing 38, 594599.
47 Shatenstein, B, Gauvin, L, Keller, H, et al. (2013) Baseline determinants of global diet quality in older men and women from the NuAge Cohort. J Nutr Health Aging 17, 419425.
48 Osler, M, Godtfredsen, NS & Prescott, E (2008) Childhood social circumstances and health behaviour in midlife: the Metropolit 1953 Danish male birth cohort. Int J Epidemiol 37, 13671374.
49 Giskes, K, Lenthe Fv, F, Brug, HJ, et al. (2004) Dietary intakes of adults in the Netherlands by childhood and adulthood socioeconomic position. Eur J Clin Nutr 58, 871880.
50 Charlton, KE (1999) Elderly men living alone: are they at high nutritional risk? J Nutr Health Aging 3, 4247.
51 Donkin, AJ, Johnson, AE, Morgan, K, et al. (1998) Gender and living alone as determinants of fruit and vegetable consumption among the elderly living at home in urban Nottingham. Appetite 30, 3951.
52 Hughes, G, Bennett, KM & Hetherington, MM (2004) Old and alone: barriers to healthy eating in older men living on their own. Appetite 43, 269276.
53 Batty, GD, Lawlor, DA, Macintyre, S, et al. (2005) Accuracy of adults' recall of childhood social class: findings from the Aberdeen children of the 1950s study. J Epidemiol Community Health 59, 898903.
54 Willett, W (1998) Nutritional Epidemiology, 2nd ed. Oxford: Oxford University Press.
55 Maynard, MJ & Blane, D (2009) Dietary assessment in early old age: experience from the Boyd Orr cohort. Eur J Clin Nutr 63, Suppl. 1, S58S63.
56 Conklin, AI, Maguire, ER & Monsivais, P (2013) Economic determinants of diet in older adults: systematic review. J Epidemiol Community Health 67, 721727.
57 O'Doherty Jensen, K & Holm, L (1999) Preferences, quantities and concerns: socio-cultural perspectives on the gendered consumption of foods. Eur J Clin Nutr 53, 351359.


Type Description Title
Supplementary materials

Atkins supplementary material
Table S1

 PDF (85 KB)
85 KB

Diet quality in older age: the influence of childhood and adult socio-economic circumstances

  • Janice L. Atkins (a1), Sheena E. Ramsay (a1), Peter H. Whincup (a2), Richard W. Morris (a1), Lucy T. Lennon (a1) and S. Goya Wannamethee (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed