Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland.
Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
Nutrients. 2019 Jul 12;11(7):1573. doi: 10.3390/nu11071573.
Socioeconomically disadvantaged people are disproportionally more likely to develop obesity and obesity-related diseases. However, it remains unclear to what extent diet quality contributes to socioeconomic inequalities in obesity. We aimed to assess the role of diet quality in the association between socioeconomic status (SES) and obesity. Data originated from the national nutrition survey, a cross-sectional sample of the adult Swiss population ( = 1860). We used education and income as proxies for SES; calculated the Alternate Healthy Eating Index (AHEI) as a measure of diet quality; and used body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) as obesity markers. We applied counterfactual mediation modelling to generate odds ratios, 95% confidence intervals, and the proportion mediated by diet quality. Individuals with less than a tertiary education were two to three times more likely to be obese, regardless of the marker (OR (95% CI): 3.36 (2.01, 5.66) using BMI; 2.44 (1.58, 3.75) using WC; 2.48 (1.63, 3.78) using WHR; and 2.04 (1.43, 2.96) using WHtR). The proportion of the association between educational level and obesity that was mediated by diet quality was 22.1% using BMI, 26.6% using WC, 31.4% using WHtR, and 35.8% using WHR. Similar findings were observed for income. Our findings suggest that diet quality substantially contributes to socioeconomic inequalities in obesity while it does not fully explain them. Focusing efforts on improving the diet quality of disadvantaged groups could help reduce social inequalities in obesity.
社会经济地位较低的人更容易肥胖和出现肥胖相关疾病。然而，饮食质量在多大程度上导致肥胖的社会经济不平等仍不清楚。我们旨在评估饮食质量在社会经济地位（SES）与肥胖之间的关联中的作用。数据来自全国营养调查，这是瑞士成年人的横断面样本（n=1860）。我们使用教育程度和收入作为 SES 的代表；计算替代健康饮食指数（AHEI）作为饮食质量的衡量标准；并使用体重指数（BMI）、腰围（WC）、腰臀比（WHR）和腰高比（WHtR）作为肥胖标志物。我们应用反事实中介模型来生成优势比、95%置信区间和饮食质量介导的比例。受教育程度低于高等教育的个体肥胖的可能性是其他个体的两到三倍，无论使用哪种标志物（OR（95%CI）：使用 BMI 时为 3.36（2.01，5.66）；使用 WC 时为 2.44（1.58，3.75）；使用 WHR 时为 2.48（1.63，3.78）；使用 WHtR 时为 2.04（1.43，2.96））。饮食质量在教育程度与肥胖之间的关联中的占比分别为 22.1%（使用 BMI）、26.6%（使用 WC）、31.4%（使用 WHtR）和 35.8%（使用 WHR）。收入也有类似的发现。我们的研究结果表明，饮食质量在很大程度上导致肥胖的社会经济不平等，尽管它不能完全解释这些不平等。集中精力改善弱势群体的饮食质量可能有助于减少肥胖的社会不平等。
