Beydoun May A, Wang Youfa
Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St. E2546, Baltimore, MD 21205, USA.
Prev Med. 2008 Feb;46(2):145-53. doi: 10.1016/j.ypmed.2007.06.016. Epub 2007 Jul 4.
We examined effects of socio-economic status (SES) factors on diet quality and fruits and vegetables intake among US adults and effect modification by nutrition knowledge and beliefs.
We used national cross-sectional data (Continuing Survey of Food Intake by Individuals) on 4356 US adults, aged 20-65 years, collected in 1994-1996. Socio-economic factors considered were education and poverty income ratio. Nutrition knowledge and belief score was measured by principal components analysis of 11 question responses. We considered three binary and two continuous outcomes related to United States Department of Agriculture recommended intake of fruits and vegetables and overall diet quality through Healthy Eating Index and alternate Mediterranean Diet Score.
Multivariate analyses indicated that better SES independently improved likelihood of adequate fruits and vegetables intake and overall diet quality. In several cases, nutrition knowledge and beliefs acted as an effect modifier. In particular, education showed no association with diet quality among subjects in the lowest nutrition knowledge and belief tertile, while the association was consistently stronger in the highest tertile (Education x Nutrition knowledge and beliefs interaction term P<0.10 for Healthy Eating Index and both fruits and vegetables guidelines). A similar interaction was noted for poverty income ratio.
For improvement in overall diet quality, socio-economic interventions must be coupled with health education programs targeting all segments of the US population.
我们研究了社会经济地位（SES）因素对美国成年人饮食质量以及水果和蔬菜摄入量的影响，以及营养知识和信念对这种影响的修正作用。
我们使用了1994 - 1996年收集的关于4356名年龄在20 - 65岁的美国成年人的全国横断面数据（个人食物摄入量持续调查）。所考虑的社会经济因素为教育程度和贫困收入比。营养知识和信念得分通过对11个问题回答的主成分分析来衡量。我们考虑了与美国农业部推荐的水果和蔬菜摄入量相关的三个二元结局以及两个连续结局，以及通过健康饮食指数和替代地中海饮食得分衡量的总体饮食质量。
多变量分析表明，更好的社会经济地位独立地提高了摄入足够水果和蔬菜以及总体饮食质量的可能性。在几种情况下，营养知识和信念起到了效应修正作用。特别是，在营养知识和信念得分最低的三分位数组中，教育程度与饮食质量之间没有关联，而在得分最高的三分位数组中，这种关联始终更强（对于健康饮食指数以及水果和蔬菜指南，教育程度×营养知识和信念交互项P<0.10）。贫困收入比也观察到类似的交互作用。
为了改善总体饮食质量，社会经济干预必须与针对美国所有人群的健康教育项目相结合。
