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The Contribution of Diet Quality to Socioeconomic Inequalities in Obesity: A Population-based Study of Swiss Adults

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
Department of Internal Medicine, Internal Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1005 Lausanne, Switzerland
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Nutrients 2019, 11(7), 1573;
Received: 19 June 2019 / Revised: 5 July 2019 / Accepted: 10 July 2019 / Published: 12 July 2019
(This article belongs to the Special Issue Diet, Lifestyle and Cardiometabolic Health in Vulnerable Populations)
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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 (N = 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. View Full-Text
Keywords: diet quality; socioeconomic status; inequalities; education; income; obesity; 24 h dietary recall diet quality; socioeconomic status; inequalities; education; income; obesity; 24 h dietary recall
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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de Mestral, C.; Chatelan, A.; Marques-Vidal, P.; Stringhini, S.; Bochud, M. The Contribution of Diet Quality to Socioeconomic Inequalities in Obesity: A Population-based Study of Swiss Adults. Nutrients 2019, 11, 1573.

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