Skip to main content

Review Article Socio-economic determinants of micronutrient intake and status in Europe: a systematic review

  • Romana Novaković (a1) (a2), Adriënne Cavelaars (a2), Anouk Geelen (a2), Marina Nikolić (a1), Iris Iglesia Altaba (a3), Blanca Roman Viñas (a4), Joy Ngo (a4), Mana Golsorkhi (a5), Marisol Warthon Medina (a6), Anna Brzozowska (a7), Anna Szczecinska (a7), Diederik de Cock (a8), Greet Vansant (a8), Marianne Renkema (a2), Lluís Serra Majem (a4) (a9), Luis Aznar Moreno (a3), Maria Glibetić (a1), Mirjana Gurinović (a1), Pieter van't Veer (a2) and Lisette CPGM de Groot (a2)...

To provide the evidence base for targeted nutrition policies to reduce the risk of micronutrient/diet-related diseases among disadvantaged populations in Europe, by focusing on: folate, vitamin B12, Fe, Zn and iodine for intake and status; and vitamin C, vitamin D, Ca, Se and Cu for intake.


MEDLINE and Embase databases were searched to collect original studies that: (i) were published from 1990 to 2011; (ii) involved >100 subjects; (iii) had assessed dietary intake at the individual level; and/or (iv) included best practice biomarkers reflecting micronutrient status. We estimated relative differences in mean micronutrient intake and/or status between the lowest and highest socio-economic groups to: (i) evaluate variation in intake and status between socio-economic groups; and (ii) report on data availability.




Children, adults and elderly.


Data from eighteen publications originating primarily from Western Europe showed that there is a positive association between indicators of socio-economic status and micronutrient intake and/or status. The largest differences were observed for intake of vitamin C in eleven out of twelve studies (5–47 %) and for vitamin D in total of four studies (4–31 %).


The positive association observed between micronutrient intake and socio-economic status should complement existing evidence on socio-economic inequalities in diet-related diseases among disadvantaged populations in Europe. These findings could provide clues for further research and have implications for public health policy aimed at improving the intake of micronutrients and diet-related diseases.

  • 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.

      Review Article Socio-economic determinants of micronutrient intake and status in Europe: a systematic review
      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.

      Review Article Socio-economic determinants of micronutrient intake and status in Europe: a systematic review
      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.

      Review Article Socio-economic determinants of micronutrient intake and status in Europe: a systematic review
      Available formats
Corresponding author
*Corresponding author: Email
Hide All
1. Darmon, N & Drewnowski, A (2008) Does social class predict diet quality? Am J Clin Nutr 87, 11071117.
2. James, WP, Nelson, M, Ralph, A et al. (1997) Socioeconomic determinants of health. The contribution of nutrition to inequalities in health. BMJ 314, 15451549.
3. Roman-Vinas, B, Ribas-Barba, L, Ngo, J et al. (2011) Projected prevalence of inadequate nutrient intakes in Europe. Ann Nutr Metab 59, 8485.
4. Aggarwal, A, Monsivais, P, Cook, AJ et al. (2011) Does diet cost mediate the relation between socioeconomic position and diet quality? Eur J Clin Nutr 65, 10591066.
5. Giskes, K, Avendano, M, Brug, J 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. Boylan, S, Lallukka, T, Lahelma, E et al. (2011) Socio-economic circumstances and food habits in Eastern, Central and Western European populations. Public Health Nutr 14, 678687.
7. Trichopoulou, A, Naska, A & Costacou, T (2002) Disparities in food habits across Europe. Proc Nutr Soc 61, 553558.
8. Lallukka, T, Laaksonen, M, Rahkonen, O et al. (2007) Multiple socio-economic circumstances and healthy food habits. Eur J Clin Nutr 61, 701710.
9. 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.
10. Sanchez-Villegas, A, Martinez, JA, Prattala, R et al. (2003) A systematic review of socioeconomic differences in food habits in Europe: consumption of cheese and milk. Eur J Clin Nutr 57, 917929.
11. Prattala, RS, Groth, MV, Oltersdorf, US et al. (2003) Use of butter and cheese in 10 European countries: a case of contrasting educational differences. Eur J Public Health 13, 124132.
12. World Health Organization (2008) Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health. Geneva: WHO.
13. Cavelaars, AE, Doets, EL, Dhonukshe-Rutten, RA et al. (2010) Prioritizing micronutrients for the purpose of reviewing their requirements: a protocol developed by EURRECA. Eur J Clin Nutr 64, Suppl. 2, S19S30.
14. Kunst, AE, Bos, V & Mackenbach, JP ; EU Working Group on Socio-economic Inequalities in Health (2001) Monitoring Socio-economic Inequalities in Health in the European Union: Guidelines and Illustrations. Final report for the Health Monitoring Program of the European Commission. Rotterdam: Department of Public Health, Erasmus University.
15. Food and Agriculture Organization of the United Nations. (1988) Requirements of Vitamin A, Iron, Folate and Vitamin B12: Report of a Joint FAO/WHO Expert Consultation. FAO Food and Nutrition Series no. 23. Rome: FAO.
16. Ristic-Medic, D, Piskackova, Z, Hooper, L et al. (2009) Methods of assessment of iodine status in humans: a systematic review. Am J Clin Nutr 89, issue 6, 2052S2069S.
17. Manios, Y, Moschonis, G, Kolotourou, M et al. (2007) Iron deficiency prevalence and dietary patterns by school district in Istanbul. J Hum Nutr Diet 20, 549557.
18. Galobardes, B, Morabia, A & Bernstein, MS (2001) Diet and socioeconomic position: does the use of different indicators matter? Int J Epidemiol 30, 334340.
19. Sanchez, C, Lopez-Jurado, M, Planells, E et al. (2009) Assessment of iron and zinc intake and related biochemical parameters in an adult Mediterranean population from southern Spain: influence of lifestyle factors. J Nutr Biochem 20, 125131.
20. Lasheras, C, Patterson, AM, Casado, C et al. (2001) Effects of education on the quality of life, diet, and cardiovascular risk factors in an elderly Spanish community population. Exp Aging Res 27, 257270.
21. Roos, E, Prattala, R, Lahelma, E et al. (1996) Modern and healthy?: socioeconomic differences in the quality of diet. Eur J Clin Nutr 50, 753760.
22. Valeix, P, Faure, P, Peneau, S et al. (2009) Lifestyle factors related to iodine intakes in French adults. Public Health Nutr 12, 24282437.
23. Friel, S, Kelleher, CC, Nolan, G et al. (2003) Social diversity of Irish adults’ nutritional intake. Eur J Clin Nutr 57, 865875.
24. Hulshof, KF, Brussaard, JH, Kruizinga, AG et al. (2003) Socio-economic status, dietary intake and 10 y trends: the Dutch National Food Consumption Survey. Eur J Clin Nutr 57, 128137.
25. van Rossum, CT, van de, MH, Witteman, JC et al. (2000) Education and nutrient intake in Dutch elderly people. The Rotterdam Study. Eur J Clin Nutr 54, 159165.
26. Bolton-Smith, C, Smith, WC, Woodward, M et al. (1991) Nutrient intakes of different social-class groups: results from the Scottish Heart Health Study (SHHS). Br J Nutr 65, 321335.
27. Bates, CJ, Prentice, A, Cole, TJ et al. (1999) Micronutrients: highlights and research challenges from the 1994–5 National Diet and Nutrition Survey of people aged 65 years and over. Br J Nutr 82, 715.
28. Matthys, C, De, HS, Maes, L et al. (2006) Adolescents’ education and their diet recorded by 7-day food records. Soz Praventivmed 51, 8090.
29. Navia, B, Ortega, RM, Requejo, AM et al. (2003) Influence of maternal education on food consumption and energy and nutrient intake in a group of pre-school children from Madrid. Int J Vitam Nutr Res 73, 439445.
30. Rego-Iraeta, A, Perez-Fdez, R, Cadarso-Suarez, C et al. (2007) Iodine nutrition in the adult population of Galicia (Spain). Thyroid 17, 161167.
31. Arnaud, J, Touvier, M, Galan, P et al. (2010) Determinants of serum zinc concentrations in a population of French middle-age subjects (SU.VI.MAX cohort). Eur J Clin Nutr 64, 10571064.
32. Broderstad, AR, Smith-Sivertsen, T, Dahl, IM et al. (2006) Serum levels of iron in Sor-Varanger, Northern Norway – an iron mining municipality. Int J Circumpolar Health 65, 432442.
33. Cribb, VL, Jones, LR, Rogers, IS et al. (2011) Is maternal education level associated with diet in 10-year-old children? Public Health Nutr 14, 20372048.
34. Macdiarmid, J & Blundell, J (1998) Assessing dietary intake: who, what and why of under-reporting. Nutr Res Rev 11, 231253.
35. Novakovic, R, Cavelaars, AEJM, Bekkering, EG et al. (2013) Micronutrient intake and status in Central and Eastern Europe compared to other European countries, results from the EURRECA network. Public Health Nutr 16, 824840.
36. Olsen, A, Halkjaer, J, van Gils, CH et al. (2009) Dietary intake of the water-soluble vitamins B1, B2, B6, B12 and C in 10 countries in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 63, Suppl. 4, S122S149.
37. Salonen, MK, Kajantie, E, Osmond, C et al. (2009) Role of socioeconomic indicators on development of obesity from a life course perspective. J Environ Public Health 2009, 625168.
38. Kant, AK & Graubard, BI (2007) Ethnicity is an independent correlate of biomarkers of micronutrient intake and status in American adults. J Nutr 137, 24562463.
39. Walker, E, Hernandez, AV & Kattan, MW (2008) Meta-analysis: its strengths and limitations. Cleve Clin J Med 75, 431439.
40. Ovrum, A, Gustavsen, G & Rickertsen, K (2012) Health inequalities over the adult life course: the role of lifestyle choices. Paper presented at the International Association of Agricultural Economists (IAAE) Triennial Conference, Foz do Iguaçu, Brazil, 18–24 August 2012.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



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