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Socio-economic factors associated with a healthy diet: results from the E3N study

  • Aurélie Affret (a1) (a2), Gianluca Severi (a1) (a2) (a3) (a4), Courtney Dow (a1) (a2), Grégoire Rey (a5), Cyrille Delpierre (a6), Marie-Christine Boutron-Ruault (a1) (a2), Françoise Clavel-Chapelon (a1) (a2) and Guy Fagherazzi (a1) (a2)...
Abstract Objective

To identify individual and contextual socio-economic factors associated with a healthy diet.


Dietary data from a large cohort study were used to derive two mutually exclusive dietary patterns through a latent class analysis. Associations between dietary patterns and socio-economic factors were studied with logistic regression.


E3N, a French prospective cohort study composed of women recruited from a national health insurance plan covering people working in the national education system.


E3N participants (n 73 031) with dietary and socio-economic data available.


The ‘Healthy’ pattern was characterized by a large consumption of fruits and vegetables and the ‘Less Healthy’ pattern by a large consumption of pizza and processed meat. When all socio-economic factors were analysed together, all of the individual factors considered were associated with a healthy diet (e.g. women with three or more children were less likely to follow a healthy diet v. women with no children, OR (95 % CI): 0·70 (0·66, 0·75)) while the contextual factors associated with a healthy diet included the size of the agglomeration of residence and the area of birth and residence (e.g. women living in the West of France were less likely to follow a healthy diet v. those living in the South of France: 0·78 (0·72, 0·83)).


We demonstrated that individual and contextual factors are both associated with diet. Rather than focusing only on individual factors, we recommend future studies or public health and nutritional strategies on diet to consider both types of factors.

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1. DR Jacobs Jr (2014) What comes first: the food or the nutrient? Executive summary of a symposium. J Nutr 144, 4 Suppl., 543S546S.

2. AK Kant (2004) Dietary patterns and health outcomes. J Am Diet Assoc 104, 615635.

5. K Giskes , M Avendano , J Brug et al. (2010) A systematic review of studies on socioeconomic inequalities in dietary intakes associated with weight gain and overweight/obesity conducted among European adults. Obes Rev 11, 413429.

6. H Hare-Bruun , P Togo , LB Andersen et al. (2011) Adult food intake patterns are related to adult and childhood socioeconomic status. J Nutr 141, 928934.

7. RM Leech , SA McNaughton & A Timperio (2014) The clustering of diet, physical activity and sedentary behavior in children and adolescents: a review. Int J Behav Nutr Phys Act 11, 4.

8. R Pechey , SA Jebb , MP Kelly et al. (2013) Socioeconomic differences in purchases of more vs. less healthy foods and beverages: analysis of over 25,000 British households in 2010. Soc Sci Med 92, 2226.

9. MJ Whichelow & AT Prevost (1996) Dietary patterns and their associations with demographic, lifestyle and health variables in a random sample of British adults. Br J Nutr 76, 1730.

10. G Roos , L Johansson , A Kasmel et al. (2001) Disparities in vegetable and fruit consumption: European cases from the north to the south. Public Health Nutr 4, 3543.

11. K Wyndels , J Dallongeville , C Simon et al. (2011) Regional factors interact with educational and income tax levels to influence food intake in France. Eur J Clin Nutr 65, 10671075.

12. JP Mackenbach , I Stirbu , AJ Roskam et al. (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358, 24682481.

13. G Menvielle , A Leclerc , JF Chastang et al. (2007) Changes in socioeconomic inequalities in cancer mortality rates among French men between 1968 and 1996. Am J Public Health 97, 20822087.

14. F Windenberger , S Rican , E Jougla et al. (2012) Spatiotemporal association between deprivation and mortality: trends in France during the nineties. Eur J Public Health 22, 347353.

15. M Marmot , J Allen , R Bell et al. (2012) WHO European review of social determinants of health and the health divide. Lancet 380, 10111029.

16. E Agardh , P Allebeck , J Hallqvist et al. (2011) Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol 40, 804818.

17. A Espelt , C Borrell , AJ Roskam et al. (2008) Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century. Diabetologia 51, 19711979.

18. PA Braveman , C Cubbin , S Egerter et al. (2005) Socioeconomic status in health research: one size does not fit all. JAMA 294, 28792888.

19. C Lassale , P Galan , K Castetbon et al. (2013) Differential association between adherence to nutritional recommendations and body weight status across educational levels: a cross-sectional study. Prev Med 57, 488493.

20. G Turrell , B Hewitt , C Patterson et al. (2003) Measuring socio-economic position in dietary research: is choice of socio-economic indicator important? Public Health Nutr 6, 191200.

21. P Liberatos , BG Link & JL Kelsey (1988) The measurement of social class in epidemiology. Epidemiol Rev 10, 87121.

24. E Riboli & R Kaaks (1997) The EPIC Project: rationale and study design. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26, Suppl. 1, S6S14.

25. V Cottet , M Touvier , A Fournier et al. (2009) Postmenopausal breast cancer risk and dietary patterns in the E3N-EPIC prospective cohort study. Am J Epidemiol 170, 12571267.

26. MJ van Liere , F Lucas , F Clavel et al. (1997) Relative validity and reproducibility of a French dietary history questionnaire. Int J Epidemiol 26, Suppl. 1, S128S136.

27. C Estaquio , E Kesse-Guyot , V Deschamps et al. (2009) Adherence to the French Programme National Nutrition Sante Guideline Score is associated with better nutrient intake and nutritional status. J Am Diet Assoc 109, 10311041.

28. G Rey , E Jougla , A Fouillet et al. (2009) Ecological association between a deprivation index and mortality in France over the period 1997–2001: variations with spatial scale, degree of urbanicity, age, gender and cause of death. BMC Public Health 9, 33.

30. M Bertin , M Touvier , C Dubuisson et al. (2016) Dietary patterns of French adults: associations with demographic, socio-economic and behavioural factors. J Hum Nutr Diet 29, 241254.

31. S Macintyre (2007) Deprivation amplification revisited; or, is it always true that poorer places have poorer access to resources for healthy diets and physical activity? Int J Behav Nutr Phys Act 4, 32.

32. AE Perrin , J Dallongeville , P Ducimetiere et al. (2005) Interactions between traditional regional determinants and socio-economic status on dietary patterns in a sample of French men. Br J Nutr 93, 109114.

33. MA Beenackers , CB Kamphuis , K Giskes et al. (2012) Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review. Int J Behav Nutr Phys Act 9, 116.

34. AJ Cameron , AC Spence , R Laws et al. (2015) A review of the relationship between socioeconomic position and the early-life predictors of obesity. Curr Obes Rep 4, 350362.

35. R Hiscock , L Bauld , A Amos et al. (2012) Socioeconomic status and smoking: a review. Ann N Y Acad Sci 1248, 107123.

36. ST Lanza , LM Collins , DR Lemmon et al. (2007) PROC LCA: a SAS procedure for latent class analysis. Struct Equ Modeling 14, 671694.

37. B Muthen & LK Muthen (2000) Integrating person-centered and variable-centered analyses: growth mixture modeling with latent trajectory classes. Alcohol Clin Exp Res 24, 882891.

38. JM Harrington , DL Dahly , AP Fitzgerald et al. (2014) Capturing changes in dietary patterns among older adults: a latent class analysis of an ageing Irish cohort. Public Health Nutr 17, 26742686.

39. AH Keshteli , A Feizi , A Esmaillzadeh et al. (2015) Patterns of dietary behaviours identified by latent class analysis are associated with chronic uninvestigated dyspepsia. Br J Nutr 113, 803812.

40. D Sotres-Alvarez , AM Siega-Riz , AH Herring et al. (2013) Maternal dietary patterns are associated with risk of neural tube and congenital heart defects. Am J Epidemiol 177, 12791288.

41. L Torgersen , E Ystrom , AM Siega-Riz et al. (2015) Maternal eating disorder and infant diet. A latent class analysis based on the Norwegian Mother and Child Cohort Study (MoBa). Appetite 84, 291298.

43. E Kesse-Guyot , S Bertrais , S Peneau et al. (2009) Dietary patterns and their sociodemographic and behavioural correlates in French middle-aged adults from the SU.VI.MAX cohort. Eur J Clin Nutr 63, 521528.

44. A Malon , V Deschamps , B Salanave et al. (2010) Compliance with French nutrition and health program recommendations is strongly associated with socioeconomic characteristics in the general adult population. J Am Diet Assoc 110, 848856.

45. C Bamia , P Orfanos , P Ferrari et al. (2005) Dietary patterns among older Europeans: the EPIC-Elderly study. Br J Nutr 94, 100113.

46. C Dubuisson , S Lioret , M Touvier et al. (2010) Trends in food and nutritional intakes of French adults from 1999 to 2007: results from the INCA surveys. Br J Nutr 103, 10351048.

47. E Kesse , MC Boutron-Ruault & F Clavel-Chapelon (2005) Regional dietary habits of French women born between 1925 and 1950. Eur J Nutr 44, 285292.

48. F Fillol , C Dubuisson , L Lafay et al. (2011) Accounting for the multidimensional nature of the relationship between adult obesity and socio-economic status: the French second National Individual Survey on Food Consumption (INCA 2) dietary survey (2006–07). Br J Nutr 106, 16021608.

49. S Cummins & S Macintyre (2006) Food environments and obesity – neighbourhood or nation? Int J Epidemiol 35, 100104.

50. E Eisenhauer (2001) In poor health: supermarket redlining and urban nutrition. GeoJournal 53, 125133.

51. N Wrigley , D Warm & B Margetts (2003) Deprivation, diet and food retail access: findings from the Leeds ‘food deserts’ study. Environ Plan A 35, 151188.

52. BA Laraia , AM Siega-Riz , JS Kaufman et al. (2004) Proximity of supermarkets is positively associated with diet quality index for pregnancy. Prev Med 39, 869875.

53. LV Moore , AV Diez Roux , JA Nettleton et al. (2008) Associations of the local food environment with diet quality – a comparison of assessments based on surveys and geographic information systems: the multi-ethnic study of atherosclerosis. Am J Epidemiol 167, 917924.

54. C Estaquio , N Druesne-Pecollo , P Latino-Martel et al. (2008) Socioeconomic differences in fruit and vegetable consumption among middle-aged French adults: adherence to the 5 A Day recommendation. J Am Diet Assoc 108, 20212030.

55. LE Elstgeest , GD Mishra & AJ Dobson (2012) Transitions in living arrangements are associated with changes in dietary patterns in young women. J Nutr 142, 15611567.

56. J Macdiarmid & J Blundell (1998) Assessing dietary intake: who, what and why of under-reporting. Nutr Res Rev 11, 231253.

57. MA Martinez-Gonzalez & N Martin-Calvo (2013) The major European dietary patterns and metabolic syndrome. Rev Endocr Metab Disord 14, 265271.

58. S Pereira , PT Katzmarzyk , TN Gomes et al. (2015) Profiling physical activity, diet, screen and sleep habits in Portuguese children. Nutrients 7, 43454362.

59. P Saneei , A Esmaillzadeh , AH Keshteli et al. (2015) Patterns of dietary habits in relation to obesity in Iranian adults. Eur J Nutr 55, 713728.

60. SS Padmadas , JG Dias & FJ Willekens (2006) Disentangling women’s responses on complex dietary intake patterns from an Indian cross-sectional survey: a latent class analysis. Public Health Nutr 9, 204211.

61. D Sotres-Alvarez , AH Herring & AM Siega-Riz (2010) Latent class analysis is useful to classify pregnant women into dietary patterns. J Nutr 140, 22532259.

62. B Galobardes , A Morabia & MS Bernstein (2001) Diet and socioeconomic position: does the use of different indicators matter? Int J Epidemiol 30, 334340.

63. D Zarnowiecki , K Ball , N Parletta et al. (2014) Describing socioeconomic gradients in children’s diets – does the socioeconomic indicator used matter? Int J Behav Nutr Phys Act 11, 44.

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