Valentino Giovanna, Auchincloss Amy H, Tumas Natalia, López-Olmedo Nancy, Ortigoza Ana, de Menezes Mariana Carvalho, Mazariegos Mónica, Nazzal Carolina
Programa de Doctorado, Facultad de Medicina, Escuela de Salud Pública, Universidad de Chile, Santiago, Chile.
Departamento de Nutrición y Dietética, Escuela de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
BMC Public Health. 2025 Jul 2;25(1):2189. doi: 10.1186/s12889-025-22973-0.
In Latin America, a low proportion of the population meets the recommended fruit and vegetable (F&V) intake. The region is highly urbanized, with significant socioeconomic inequalities. The objective of this study was to analyze the association of the socio-economic environment (GDP per capita, living conditions) and women's empowerment (WE) with daily F&V intake in adults from Latin American cities, and whether these associations vary by individual education.
Cross-sectional study using secondary data from the SALURBAL project (Urban Health in Latin America), which compiled data from health surveys, censuses, and other surveys from cities with ≥ 100,000 inhabitants in 11 Latin American countries. The sample included 91,977 adults from 234 cities in 8 countries with self-reported F&V intake data. The outcome was daily F&V intake, defined as consuming F&V 7 days a week. City-level exposures included GDP per capita (tertiles), living conditions score (overcrowding, piped water, and education access; Z-scores), and WE score (labor force participation and early marriage; Z-scores). We estimated prevalence ratios (PR) for the association between each exposure and daily F&V intake using gender-stratified two-level Poisson models with random intercepts for cities adjusted by city and individual-level covariates. Interaction terms were included to evaluate effect-modification by individual education.
Participants from cities in the upper GDP tertiles (T2 and T3) showed a ~ 7% higher prevalence of daily F&V intake among men (T2 PR = 1.08, 95% CI: 1.00-1.15; T3 PR = 1.06, 95% CI: 0.99-1.14) and women (T2 PR = 1.07, 95% CI: 1.01-1.13; T3 PR = 1.06, 95% CI: 0.99-1.12). A one standard deviation increase in WE and living conditions scores was associated with a ~ 10% higher prevalence of daily F&V intake in men (WE PR = 1.10, 95% CI: 1.02-1.19; living conditions PR = 1.10, 95% CI: 1.04-1.16) and women (WE PR = 1.11, 95% CI: 1.04-1.17; living conditions PR = 1.10, 95% CI: 1.05-1.15). Individual education levels significantly modified these associations (p < 0.05), which were stronger among those with lower educational attainment.
City GDP per capita, living conditions and WE were directly associated with fruit and vegetable daily intake, particularly among individuals with lower education levels in Latin America.
在拉丁美洲，达到推荐水果和蔬菜摄入量的人口比例较低。该地区城市化程度很高，存在显著的社会经济不平等现象。本研究的目的是分析社会经济环境（人均国内生产总值、生活条件）和妇女赋权与拉丁美洲城市成年人每日水果和蔬菜摄入量之间的关联，以及这些关联是否因个人教育程度而异。
采用横断面研究，使用来自SALURBAL项目（拉丁美洲城市健康）的二手数据，该项目汇总了来自11个拉丁美洲国家居民人数≥10万的城市的健康调查、人口普查和其他调查的数据。样本包括来自8个国家234个城市的91,977名成年人，他们提供了自我报告的水果和蔬菜摄入量数据。结果变量是每日水果和蔬菜摄入量，定义为每周7天食用水果和蔬菜。城市层面的暴露因素包括人均国内生产总值（三分位数）、生活条件得分（拥挤程度、自来水供应和教育机会；Z分数）以及妇女赋权得分（劳动力参与率和早婚情况；Z分数）。我们使用按性别分层的二级泊松模型估计每种暴露因素与每日水果和蔬菜摄入量之间关联的患病率比（PR），模型带有城市的随机截距，并根据城市和个人层面的协变量进行调整。纳入交互项以评估个人教育程度的效应修正作用。
来自人均国内生产总值三分位数较高组（T2和T3）城市的参与者中，男性每日水果和蔬菜摄入量的患病率高出约7%（T2的PR = 1.08，95%置信区间：1.00 - 1.15；T3的PR = 1.06，95%置信区间：0.99 - 1.14），女性也是如此（T2的PR = 1.07，95%置信区间：1.01 - 1.13；T3的PR = 1.06，95%置信区间：0.99 - 1.12）。妇女赋权得分和生活条件得分每增加一个标准差，男性每日水果和蔬菜摄入量的患病率就高出约10%（妇女赋权的PR = 1.10，95%置信区间：1.02 - 1.19；生活条件的PR = 1.10，95%置信区间：1.04 - 1.16），女性也是如此（妇女赋权的PR = 1.11，95%置信区间：1.04 - 1.17；生活条件的PR = 1.10，95%置信区间：1.05 - 1.15）。个人教育水平显著改变了这些关联（p < 0.05），在教育程度较低的人群中关联更强。
城市人均国内生产总值、生活条件和妇女赋权与每日水果和蔬菜摄入量直接相关，尤其是在拉丁美洲教育程度较低的人群中。
