BACKGROUND: Socioeconomic differences in children's food habits are a key public health concern. In order to inform policy makers, cross-country surveillance studies of dietary patterns across socioeconomic groups are required. The purpose of this study was to examine associations between socioeconomic status (SES) and children's food habits. METHODS: The study was based on nationally representative data from children aged 6-9 years (n = 129,164) in 23 countries in the World Health Organization (WHO) European Region. Multivariate multilevel analyses were used to explore associations between children's food habits (consumption of fruit, vegetables, and sugar-containing soft drinks) and parental education, perceived family wealth and parental employment status. RESULTS: Overall, the present study suggests that unhealthy food habits are associated with lower SES, particularly as assessed by parental education and family perceived wealth, but not parental employment status. We found cross-national and regional variation in associations between SES and food habits and differences in the extent to which the respective indicators of SES were related to children's diet. CONCLUSION: Socioeconomic differences in children's food habits exist in the majority of European and Asian countries examined in this study. The results are of relevance when addressing strategies, policy actions, and interventions targeting social inequalities in children's diets.

Biomedical Sciences Department Faculty of Sport and Physical Education University of Novi Sad Novi Sad Serbia

Center for Health Ecology Institute of Public Health Podgorica Montenegro

Centre for Evaluation of Public Health Measures Norwegian Institute of Health Oslo Norway

College of Health and Agricultural Sciences University College Dublin Dublin Ireland

Croatian Institute of Public Health Zagreb Croatia

Department Food and Nutrition National Centre of Public Health and Analyses Sofia Bulgaria

Department of Cardiology Institute of Mother and Child Warsaw Poland

Department of Health and Inequality Division of Mental and Physical Health Norwegian Institute of Public Health Oslo Norway

Department of Health Promotion and Centre for Evaluation of Public Health Measures Norwegian Institute of Public Health Bergen Norway

Department of Nutrition and Epidemiology National Institute of Pharmacy and Nutrition Budapest Hungary

Department of Nutrition Research National Institute for Health Development Tallinn Estonia

Department of Pediatrics Paracelsus Medical University Salzburg Austria

Department of Preventive Medicine Lithuanian University of Health Sciences Kaunas Lithuania

Department of Research and Health Statistics Centre for Disease and Prevention Control Riga Latvia

Department of Science and Professional Development National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan Almaty Kazakhstan

Department of Social and Policy Sciences University of Bath Bath UK

Department of the Organization of Medical Services for Mothers Children and Family Planning Ministry of Health and Social Protection Dushanbe Tajikistan

Division of Noncommunicable Diseases and Promoting Health through the Life course WHO Country Office for Tajikistan Dushanbe Tajikistan

Faculty of Medicine SS Cyril and Methodius University Skopje North Macedonia

Faculty of Medicine University of Banja Luka Banja Luka Bosnia and Herzegovina

Health Authority Ministry of Health San Marino San Marino

Health Promotion and Inequality Danish Health Authority Copenhagen Denmark

Institute of Paediatric Endocrinology National Medical Research Centre for Endocrinology of the Ministry of Health of the Russian Federation Moscow Russian Federation

Institute of Public Health Skopje North Macedonia

Kazakhstan School of Public Health Kazakhstan's Medical University Almaty Kazakhstan

Maternal Child and Reproductive Health National Center for Disease Control and Public Health of Georgia Tbilisi Georgia

Medical Faculty Department of Public Health Hacettepe University Ankara Turkey

National Center for Health Assessment and Promotion National Institute of Public Health Bucharest Romania

National Centre for Disease Prevention and Health Promotion Italian National Institute of Health Rome Italy

National Institute of Public Health University of Southern Denmark Odense Denmark

Nutrition and Food Safety Sector Institute of Public Health Tirana Albania

Obesity Management Centre Institute of Endocrinology Prague Czech Republic

Primary Child Health Unit Primary Health Care Floriana Malta

Public Health Institute of Republic of Srpska Banja Luka Bosnia and Herzegovina

Republican Center for Health Promotion and Mass Communication Ministry of Health of the Kyrgyz Republic Bishkek Kyrgyzstan

School of Medicine University of Zagreb Zagreb Croatia

Scientific Research Institute of Maternal and Child Health Ashgabat Turkmenistan

Spanish Agency for Food Safety and Nutrition Ministry of Consumer Affairs Madrid Spain

WHO Europe Collaborating Center for Nutrition and Childhood Obesity Food and Nutrition Department National Institute of Health Dr Ricardo Jorge Lisbon Portugal

World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases Division of Country Health Programmes WHO Regional Office for Europe Moscow Russian Federation

Zobrazit více v PubMed

WHO. Global Strategy on Diet. Physical Activity and Health. Copenhagen: WHO; 2004.

Glei DA, Goldman N, Weinstein M. A growing socioeconomic divide: effects of the Great Recession on perceived economic distress in the United States. PLoS ONE. 2019;14(4):e0214947.

Bauer UE, Briss PA, Goodman RA, Bowman BA. Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet. 2014;384(9937):45-52.

Marmot M, Bell R. Social inequalities in health: a proper concern of epidemiology. Ann Epidemiol. 2016;26(4):238-240.

OECD. Health for Everyone?: Social Inequalities in Health and Health Systems. Paris: OECD Health Policy Studies,OECD Publishing; 2019.

2014 Nordic Council of Ministers. Nordic Nutrition Recommendations 2012 Integrating nutrition and physical activity. 2014.

OECD. Understanding the socio-economic divide in Europe http://oe.cd/cope-divide-europe-2017; 2017.

ADB. Framework of Inclusive Growth Indicators 2013. https://www.adb.org/publications/framework-inclusive-growth-indicators-2013-key-indicators-asia-and-pacific; 2013

Chung A, Backholer K, Wong E, Palermo C, Keating C, Peeters A. Trends in child and adolescent obesity prevalence in economically advanced countries according to socioeconomic position: a systematic review. Obes Rev. 2016;17(3):276-295.

Mackenbach JP, Kunst AE. Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med. 1997;44(6):757-771.

Giskes K, Avendano M, Brug J, Kunst AE. A systematic review of studies on socioeconomic inequalities in dietary intakes associated with weight gain and overweight/obesity conducted among European adults. Obes Rev. 2010;11(6):413-429.

Inchley J CD, Jewell J, Breda B, Barnekow V. Adolescent obesity and related behaviours: trends and inequalities in the WHO European Region, 2002-2014. Copenhagen, Denmark WHO Regional Office for Europe UN City.

Lissner L, Wijnhoven TM, Mehlig K, et al. Socioeconomic inequalities in childhood overweight: heterogeneity across five countries in the WHO European Childhood Obesity Surveillance Initiative (COSI-2008). Int J Obes (Lond). 2016;40(5):796-802. https://doi.org/10.1038/ijo.2016.12

Fismen AS, Samdal O, Torsheim T. Family affluence and cultural capital as indicators of social inequalities in adolescent's eating behaviours: a population-based survey. BMC Public Health. 2012;12:1036. https://doi.org/10.1186/1471-2458-12-1036

De Clercq B, Abel T, Moor I, et al. Social inequality in adolescents' healthy food intake: the interplay between economic, social and cultural capital. Eur J Public Health. 2017;27(2):279-286.

WHO. Childhood Obesity Surveillance Initiative (COSI) Data collection procedures; 2016.

WHO. Childhood Obesity Surveillance Initiative (COSI) protocol WHO regional office for Europe 2016.

Breda J, McColl K, Buoncristiano M, et al. Methodology and implementation of the WHO European Childhood Obesity Surveillance Initiative (COSI). Obes Rev. 2021;e13215. https://doi.org/10.1111/obr.13215

Whiting S, Buoncristiano M, Gelius P, et al. Physical activity, screen time, and sleep duration of children aged 6-9 years in 25 countries: an analysis within the WHO European Childhood Obesity Surveillance Initiative (COSI) 2015-2017. Obes Facts. 2020;13(6):1-13.

Aune D, Giovannucci E, Boffetta P, et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol. 2017;46(3):1029-1056.

Evans CEL. Sugars and health: a review of current evidence and future policy. Proc Nutr Soc. 2017;76(3):400-407.

Narain A, Kwok CS, Mamas MA. Soft drinks and sweetened beverages and the risk of cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Clin Pract. 2016;70(10):791-805.

Petrovic D, de Mestral C, Bochud M, et al. The contribution of health behaviors to socioeconomic inequalities in health: a systematic review. Prev Med. 2018;113:15-31.

Williams J, Buoncristiano M, Nardone P, et al. A snapshot of European children's eating habits: results from the fourth round of the WHO European Childhood Obesity Surveillance Initiative (COSI). Nutrients. 2020;12(8):2481. https://doi.org/10.3390/nu12082481

Musić Milanović S, Buoncristiano M, Križan H, et al. Socioeconomic disparities in physical activity, sedentary behavior and sleep patterns among 6- to 9-year-old children from 24 countries in the WHO European region, 2021. Obes Rev. 2021;e13209. https://doi.org/10.1111/obr.13209

Nations U. United Nations Standard Country Code, Series M: Miscellaneous Statistical Papers, No. 49 [cited 2020 Oct 4]. New York: United Nations. ST/ESA/STAT/SER.M/49. Available from: https://unstats.un.org/unsd/methodology/m49/2020

https://millenniumindicators.un.org/unsd/mi/worldbank.htm

Novakovic R, Cavelaars A, Geelen A, et al. Socio-economic determinants of micronutrient intake and status in Europe: a systematic review. Public Health Nutr. 2014;17(5):1031-1045.

Cameron AJ, Spence AC, Laws R, Hesketh KD, Lioret S, Campbell KJ. A review of the relationship between socioeconomic position and the early-life predictors of obesity. Curr Obes Rep. 2015;4(3):350-362.

Desbouys L, Mejean C, De Henauw S, Castetbon K. Socio-economic and cultural disparities in diet among adolescents and young adults: a systematic review. Public Health Nutr. 2020;23(5):843-860.

Mackenbach JP, Bopp M, Deboosere P, et al. Determinants of the magnitude of socioeconomic inequalities in mortality: a study of 17 European countries. Health Place. 2017;47:44-53.

Vereecken CA, Inchley J, Subramanian SV, Hublet A, Maes L. 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. 2005;15(3):224-232.

Ahluwalia N, Dalmasso P, Rasmussen M, et al. Trends in overweight prevalence among 11-, 13- and 15-year-olds in 25 countries in Europe, Canada and USA from 2002 to 2010. Eur J Public Health. 2015;25(Suppl 2):28-32.

Rokholm B, Baker JL, Sorensen TI. The levelling off of the obesity epidemic since the year 1999-a review of evidence and perspectives. Obes Rev. 2010;11(12):835-846.

Cash Versus CB. Services: ‘worlds of welfare’ and the decommodification of cash benefits and health care services. J Soc Policy. 2005;34:195-213.

Nordic Council of Ministers. A better life through diet and physical activity. Nordic Plan of Action on better health and quality of life through diet and physical activity. Copenhagen 2006.

Mackenbach JP, Stirbu I, Roskam AJ, et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358(23):2468-2481.

Zaborskis A, Grincaite M, Kavaliauskiene A, Tesler R. Family structure and affluence in adolescent eating behaviour: a cross-national study in forty-one countries. Public Health Nutr. 2020;1-12. https://doi.org/10.1017/S1368980020003584

Mayen AL, Marques-Vidal P, Paccaud F, Bovet P, Stringhini S. Socioeconomic determinants of dietary patterns in low- and middle-income countries: a systematic review. Am J Clin Nutr. 2014;100(6):1520-1531.

Lee J, Allen J. Mother's educational attainment and their young adult daughters' fast food intake: the role of race/ethnicity. Health Care Women Int. 2020;41(2):169-187.

Uher R, Dragomirecka E, Papezova H, Pavlova B. Use of socioeconomic status in health research. JAMA. 2006;295(15):1770. https://doi.org/10.1001/jama.295.15.1770-a

Lehto E, Ray C, Te Velde S, et al. Mediation of parental educational level on fruit and vegetable intake among schoolchildren in ten European countries. Public Health Nutr. 2015;18(1):89-99.

Rao M, Afshin A, Singh G, Mozaffarian D. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open. 2013;3(12):e004277.

Drewnowski A. Obesity and the food environment: dietary energy density and diet costs. Am J Prev Med. 2004;27(3 Suppl):154-162.

London Child Obesity Taskforce. What makes it harder for London's children to be healthier?; 2019.

Birch LL, Ventura AK. Preventing childhood obesity: what works? Int J Obes (Lond). 2009;33(Suppl 1):S74-S81.

Horning ML, Fulkerson JA, Friend SE, Story M. Reasons parents buy prepackaged, processed meals: it is more complicated than “I don't have time”. J Nutr Educ Behav. 2017;49(1):60-66.e1

Fernandez MA, Marquis M, Desroches S, Turcotte M, Provencher V. Full-time employment, diet quality, and food skills of Canadian parents. Can J Diet Pract Res. 2019;80(2):63-71.

McGill R, Anwar E, Orton L, et al. Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact. BMC Public Health. 2015;15:457. https://doi.org/10.1186/s12889-015-1781-7

Williams K, Sassler S, Frech A, Addo F, Cooksey E. Does nonmarital childbearing and mother's later marriage influence child health in adolescence? Policy brief. J Health Soc Behav. 2013;54(3):277. https://doi.org/10.1177/0022146513501993