Skip to main content Accessibility help
×
Home

Socio-economic and lifestyle parameters associated with diet quality of children and adolescents using classification and regression tree analysis: the DIATROFI study

  • Mary Yannakoulia (a1) (a2), Anastasia Lykou (a1), Christina Maria Kastorini (a1), Eirini Saranti Papasaranti (a1), Athanassios Petralias (a1) (a3), Afroditi Veloudaki (a1), Athena Linos (a1) (a4) and on behalf of the DIATROFI Program Research Team...

Abstract

Objective

To explore factors affecting children’s and adolescents’ diet quality, in the framework of a food aid and promotion of healthy nutrition programme implemented in areas of low socio-economic status of Greece, during the current financial crisis.

Design

From a total of 162 schools participating in the programme during 2012–2013, we gathered 15 897 questionnaires recording sociodemographic characteristics, lifestyle parameters and dietary habits of children and their families. As a measure of socio-economic status, the Family Affluence Scale (FAS) was used; whereas for the assessment of diet quality, the KIDMED score was computed. Associations between KIDMED and FAS, physical activity and socio-economic parameters were examined using regression and classification–regression tree analysis (CART).

Results

The higher the FAS score, the greater the percentage of children and adolescents who reported to consume, on a daily basis, fruits and vegetables, dairy products and breakfast (P<0·001). Results from CART showed that children and adolescents in the medium or high FAS groups had higher KIDMED score, compared with those in the low FAS group. For those in the low FAS group, KIDMED score is expected to increase by 12·4 % when they spend more than 0·25 h/week in sports activities. The respective threshold for the medium and high FAS groups is 1·75 h/week, while education of the mother and father affected KIDMED score significantly as well.

Conclusions

Diet quality is strongly influenced by socio-economic parameters in children and adolescents living in economically disadvantaged areas of Greece, so that lower family affluence is associated with worse diet quality.

Copyright

Corresponding author

* Corresponding author: Email a.linos@prolepsis.gr

References

Hide All
1. Mackenbach, JP, Stirbu, I, Roskam, AJ et al. (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358, 24682481.
2. Mackenbach, JP, Karanikolos, M & McKee, M (2013) The unequal health of Europeans: successes and failures of policies. Lancet 381, 11251134.
3. Chandola, T (2012) Spatial and social determinants of urban health in low-, middle- and high-income countries. Public Health 126, 259261.
4. Spencer, N, Thanh, TM & Louise, S (2013) Low income/socio-economic status in early childhood and physical health in later childhood/adolescence: a systematic review. Matern Child Health J 17, 424431.
5. Tamayo, T, Christian, H & Rathmann, W (2010) Impact of early psychosocial factors (childhood socioeconomic factors and adversities) on future risk of type 2 diabetes, metabolic disturbances and obesity: a systematic review. BMC Public Health 10, 525.
6. Fismen, AS, Samdal, O & Torsheim, T (2012) Family affluence and cultural capital as indicators of social inequalities in adolescent’s eating behaviours: a population-based survey. BMC Public Health 12, 1036.
7. Levin, KA, Kirby, J, Currie, C et al. (2012) Trends in adolescent eating behaviour: a multilevel cross-sectional study of 11–15 year olds in Scotland, 2002–2010. J Public Health (Oxf) 34, 523531.
8. McCormack, GR, Hawe, P, Perry, R et al. (2011) Associations between familial affluence and obesity risk behaviours among children. Paediatr Child Health 16, 1924.
9. De Cocker, K, Artero, EG, De Henauw, S et al. (2012) Can differences in physical activity by socio-economic status in European adolescents be explained by differences in psychosocial correlates? A mediation analysis within the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Public Health Nutr 15, 21002109.
10. Jimenez Pavon, D, Ortega, FP et al. (2010) Socioeconomic status influences physical fitness in European adolescents independently of body fat and physical activity: the HELENA study. Nutr Hosp 25, 311316.
11. Ball, K, Crawford, D & Mishra, G (2006) Socio-economic inequalities in women’s fruit and vegetable intakes: a multilevel study of individual, social and environmental mediators. Public Health Nutr 9, 623630.
12. Konttinen, H, Sarlio-Lahteenkorva, S, Silventoinen, K et al. (2013) Socio-economic disparities in the consumption of vegetables, fruit and energy-dense foods: the role of motive priorities. Public Health Nutr 16, 873882.
13. Turrell, G & Kavanagh, AM (2006) Socio-economic pathways to diet: modelling the association between socio-economic position and food purchasing behaviour. Public Health Nutr 9, 375383.
14. Euopean Commission (2014) EUROSTAT Regional Yearbook 2014. http://ec.europa.eu/eurostat/publications/regional-yearbook (accessed March 2015).
15. Rajmil, L, Fernandez de Sanmamed, MJ, Choonara, I et al. (2014) Impact of the 2008 economic and financial crisis on child health: a systematic review. Int J Environ Res Public Health 11, 65286546.
16. Lemon, SC, Roy, J, Clark, MA et al. (2003) Classification and regression tree analysis in public health: methodological review and comparison with logistic regression. Ann Behav Med 26, 172181.
17. Hearty, AP & Gibney, MJ (2008) Analysis of meal patterns with the use of supervised data mining techniques – artificial neural networks and decision trees. Am J Clin Nutr 88, 16321642.
18. Kastorini, CM, Papadakis, G, Milionis, HJ et al. (2013) Comparative analysis of a-priori and a-posteriori dietary patterns using state-of-the-art classification algorithms: a case/case–control study. Artif Intell Med 59, 175183.
19. Tyrovolas, S, Tountas, Y, Polychronopoulos, E et al. (2012) A classification and regression tree analysis for the evaluation of the role of nutritional services on cardiovascular disease risk status of older people living in Greek islands and Cyprus. Int J Food Sci Nutr 63, 522529.
20. Currie, C, Molcho, M, Boyce, W et al. (2008) Researching health inequalities in adolescents: the development of the Health Behaviour in School-Aged Children (HBSC) family affluence scale. Soc Sci Med 66, 14291436.
21. Boyce, W, Torsheim, T, Currie, C et al. (2006) The Family Affluence Scale as a measure of national health: validation of an adolescent self-report measure. Soc Indic Res 78, 473487.
22. Currie, CE, Elton, RA, Todd, J et al. (1997) Indicators of socioeconomic status for adolescents: the WHO Health Behaviour in School-aged Children Survey. Health Educ Res 12, 385397.
23. Cole, TJ, Bellizzi, MC, Flegal, KM et al. (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320, 12401243.
24. Cole, TJ, Flegal, KM, Nicholls, D et al. (2007) Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ 335, 194.
25. Naska, A & Trichopoulou, A (2014) Back to the future: the Mediterranean diet paradigm. Nutr Metab Cardiovasc Dis 24, 216219.
26. Serra-Majem, L, Ribas, L, Ngo, J et al. (2004) Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr 7, 931935.
27. Kontogianni, MD, Vidra, N, Farmaki, AE et al. (2008) Adherence rates to the Mediterranean diet are low in a representative sample of Greek children and adolescents. J Nutr 138, 19511956.
28. Honaker, J, King, G & Blackwell, M (2011) Amelia II: a program for missing data. J Stat Softw 45, 147.
29. Darmon, N & Drewnowski, A (2008) Does social class predict diet quality? Am J Clin Nutr 87, 11071117.
30. Grosso, G, Marventano, S, Buscemi, S et al. (2013) Factors associated with adherence to the mediterranean diet among adolescents living in Sicily, Southern Italy. Nutrients 5, 49084923.
31. Rasmussen, M, Krolner, R, Klepp, KI et al. (2006) Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: Quantitative studies. Int J Behav Nutr Phys Act 3, 22.
32. Ball, K, MacFarlane, A, Crawford, D et al. (2009) Can social cognitive theory constructs explain socio-economic variations in adolescent eating behaviours? A mediation analysis. Health Educ Res 24, 496506.
33. Golley, RK, Hendrie, GA & McNaughton, SA (2011) Scores on the dietary guideline index for children and adolescents are associated with nutrient intake and socio-economic position but not adiposity. J Nutr 141, 13401347.
34. Serra-Majem, L, Ribas, L, Perez-Rodrigo, C et al. (2002) Determinants of nutrient intake among children and adolescents: results from the enKid Study. Ann Nutr Metab 46, Suppl. 1, 3138.
35. Vereecken, CA, Inchley, J, Subramanian, SV et al. (2005) The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe. Eur J Public Health 15, 224232.
36. Hu, FB (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13, 39.
37. Drewnowski, A & Darmon, N (2005) The economics of obesity: dietary energy density and energy cost. Am J Clin Nutr 82, 1 Suppl., 265S273S.
38. Darmon, N, Briend, A & Drewnowski, A (2004) Energy-dense diets are associated with lower diet costs: a community study of French adults. Public Health Nutr 7, 2127.
39. Hilmers, A, Hilmers, DC & Dave, J (2012) Neighborhood disparities in access to healthy foods and their effects on environmental justice. Am J Public Health 102, 16441654.
40. Hanson, MD & Chen, E (2007) Socioeconomic status and health behaviors in adolescence: a review of the literature. J Behav Med 30, 263285.
41. Stalsberg, R & Pedersen, AV (2010) Effects of socioeconomic status on the physical activity in adolescents: a systematic review of the evidence. Scand J Med Sci Sports 20, 368383.
42. Humbert, ML, Chad, KE, Spink, KS et al. (2006) Factors that influence physical activity participation among high- and low-SES youth. Qual Health Res 16, 467483.
43. Pearson, N & Biddle, SJ (2011) Sedentary behavior and dietary intake in children, adolescents, and adults. A systematic review. Am J Prev Med 41, 178188.
44. 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.
45. Saxton, J, Carnell, S, van Jaarsveld, CH et al. (2009) Maternal education is associated with feeding style. J Am Diet Assoc 109, 894898.
46. Vereecken, CA, Keukelier, E & Maes, L (2004) Influence of mother’s educational level on food parenting practices and food habits of young children. Appetite 43, 93103.
47. Lahelma, E, Martikainen, P, Laaksonen, M et al. (2004) Pathways between socioeconomic determinants of health. J Epidemiol Community Health 58, 327332.
48. Braveman, P, Egerter, S & Williams, DR (2011) The social determinants of health: coming of age. Annu Rev Public Health 32, 381398.
49. Persson Osowski, C, Fjellstrom, C, Olsson, U et al. (2012) Agreement between child and parent reports of 10- to 12-year-old children’s meal pattern and intake of snack foods. J Hum Nutr Diet 25, 5058.

Keywords

Metrics

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