H L Rippin1, J Hutchinson1, D C Greenwood2, J Jewell3, J J Breda3, A Martin4, D M Rippin5, K Schindler6, P Rust6, S Fagt7, J Matthiessen7, E Nurk8,9, K Nelis8, M Kukk8, H Tapanainen10, L Valsta10, T Heuer11, E Sarkadi-Nagy12, M Bakacs12, S Tazhibayev13, T Sharmanov13, I Spiroski14, M Beukers15, C van Rossum15, M Ocke15, A K Lindroos16, Eva Warensjö Lemming16, J E Cade1. 1. Nutritional Epidemiology Group (NEG), School of Food Science and Nutrition, University of Leeds, Leeds, England, United Kingdom. 2. Clinical and Population Science Department, Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, England, United Kingdom. 3. Division of Noncommunicable Diseases and Promoting Health through the Life-Course, World Health Organization Regional Office for Europe, UN City, Copenhagen, Denmark. 4. Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, United Kingdom. 5. Department of Environment and Geography, University of York, Wentworth Way, Heslington, York, England, United Kingdom. 6. Department of Nutritional Sciences, University of Vienna, Vienna, Austria. 7. National Food Institute, Kemitorvet, Lyngby, Denmark. 8. Department of Nutrition Research, National Institute for Health Development, Tallinn, Estonia. 9. Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway. 10. Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland. 11. Department of Nutritional Behaviour, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany. 12. National Institute of Pharmacy and Nutrition; Budapest, Hungary. 13. Kazakh Academy of Nutrition, Almaty, Republic of Kazakhstan. 14. Institute of Public Health, Skopje, North Macedonia. 15. National Institute for Public Health and the Environment, Bilthoven, The Netherlands. 16. Livsmedelsverket Swedish National Food Agency, Uppsala, Sweden.
Abstract
BACKGROUND: Malnutrition linked to noncommunicable diseases presents major health problems across Europe. The World Health Organisation encourages countries to conduct national dietary surveys to obtain data to inform public health policies designed to prevent noncommunicable diseases. METHODS: Data on 27334 participants aged 19-64y were harmonised and pooled across national dietary survey datasets from 12 countries across the WHO European Region. Weighted mean nutrient intakes were age-standardised using the Eurostat 2013 European Standard Population. Associations between country-level Gross Domestic Product (GDP) and key nutrients and nutrient densities were investigated using linear regression. The potential mitigating influence of participant-level educational status was explored. FINDINGS: Higher GDP was positively associated with total sugar intake (5·0% energy for each 10% increase in GDP, 95% CI 0·6, 9·3). Scandinavian countries had the highest vitamin D intakes. Participants with higher educational status had better nutritional intakes, particularly within lower GDP countries. A 10% higher GDP was associated with lower total fat intakes (-0·2% energy, 95% CI -0·3, -0·1) and higher daily total folate intakes (14μg, 95% CI 12, 16) in higher educated individuals. INTERPRETATION: Lower income countries and lower education groups had poorer diet, particularly for micronutrients. We demonstrate for the first time that higher educational status appeared to have a mitigating effect on poorer diet in lower income countries. It illustrates the feasibility and value of harmonising national dietary survey data to inform European policy regarding access to healthy diets, particularly in disadvantaged groups. It specifically highlights the need for strong policies supporting nutritional intakes, prioritising lower education groups and lower income countries.
BACKGROUND: Malnutrition linked to noncommunicable diseases presents major health problems across Europe. The World Health Organisation encourages countries to conduct national dietary surveys to obtain data to inform public health policies designed to prevent noncommunicable diseases. METHODS: Data on 27334 participants aged 19-64y were harmonised and pooled across national dietary survey datasets from 12 countries across the WHO European Region. Weighted mean nutrient intakes were age-standardised using the Eurostat 2013 European Standard Population. Associations between country-level Gross Domestic Product (GDP) and key nutrients and nutrient densities were investigated using linear regression. The potential mitigating influence of participant-level educational status was explored. FINDINGS: Higher GDP was positively associated with total sugar intake (5·0% energy for each 10% increase in GDP, 95% CI 0·6, 9·3). Scandinavian countries had the highest vitamin D intakes. Participants with higher educational status had better nutritional intakes, particularly within lower GDP countries. A 10% higher GDP was associated with lower total fat intakes (-0·2% energy, 95% CI -0·3, -0·1) and higher daily total folate intakes (14μg, 95% CI 12, 16) in higher educated individuals. INTERPRETATION: Lower income countries and lower education groups had poorer diet, particularly for micronutrients. We demonstrate for the first time that higher educational status appeared to have a mitigating effect on poorer diet in lower income countries. It illustrates the feasibility and value of harmonising national dietary survey data to inform European policy regarding access to healthy diets, particularly in disadvantaged groups. It specifically highlights the need for strong policies supporting nutritional intakes, prioritising lower education groups and lower income countries.
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