A systematic review of socio-economic differences in food habits in Europe: consumption of fruit and vegetables

Objective: To evaluate the differences in the consumption of fruit and vege tables between groups with different socio-economic status (SES) in the adu lt population of European countries. Design: A systematic review of published and unpublished surveys of food ha bits conducted between 1985 and 1999 in 15 European countries. Educational level and occupational status were used as indicators of SES. a pooled esti mate of the mean difference between the highest and the lowest level of edu cation and occupation was calculated separately for men and women, using De rSimonian and Laird's random effects model. Setting: The inclusion criteria of studies were: use of a validated method for assessing intake at the individual level; selection of a nationwide sam ple or a representative sample of a region; and providing the mean and stan dard deviation of overall fruit and vegetable consumption for each level of education or occupation, and separately for men and women. Subjects: Participants in the individual surveys had to be adults (18 - 85 y). Results: Eleven studies from seven countries met the criteria for being inc luded in the meta-analysis. A higher SES was associated with a greater cons umption of both fruit and vegetables. The pooled estimate of the difference in the intake of fruit was 24.3 g/person/day (95% confidence interval (CI) 14.0-34.7) between men in the highest level of education and those in the lowest level of education. Similarly, this difference was 33.6g/person/day for women (95% CI 22.5-44.8). The differences regarding vegetables were 17. 0g/person/day (95% CI 8.6-25.5) for men and 13.4g/person/day (95% CI 7.1-19 .7) for women. The results were in the same direction when occupation inste ad of education was used as an indicator of SES. Conclusions: Although we cannot exclude over-reporting of intake by those w ith highest SES, it is unlikely that this potential bias could fully explai n the differences we have found. Our results suggest that an unhealthier nu trition pattern may exist among adults belonging to lower socio-economic le vels in Europe.