Nutrition and Health Disparities

The diets of those in lower income households are especially poor in relation to dietary recommendations, according to a study from the National Cancer Institute and published in the Journal of the Academy of Nutrition and Dietetics.

This article originally published on Food, Nutrition & Science.

The diets of those in lower income households are especially poor in relation to dietary recommendations, according to a study from the National Cancer Institute and published in the Journal of the Academy of Nutrition and Dietetics.

Individuals living in low socioeconomic conditions, as well as members of minority subgroups, are more prone to a host of chronic diseases, including obesity, and diet is a huge contributing factor. Researchers in this study sought to understand the extent of differences in dietary intakes in relation to income and race/ethnicity, comparing intakes of various food groups with dietary guidelines.

The researchers found that a greater proportion of adults in the highest income group compared with the two other income groups (middle and lowest) met the minimum recommendations for total fruits, whole fruits, total vegetables, dark green vegetables, other vegetables, whole grains, meat and beans, milk and oils. There was a greater chance of exceeding maximum recommendations for most food groups in the higher income group as well.

Among race and ethnic groups, smaller proportions of non-Hispanic black adults met the minimum recommendations for whole fruits, total vegetables, other vegetables, total grains and milk as compared with both non-Hispanic white and Mexican-American adults. Smaller proportions of Mexican-American adults met the minimum recommendations for dark green vegetables, starchy vegetables, and oils compared with both non-Hispanic white and non-Hispanic black adults. However, Mexican-Americans were more likely to meet the recommendations for beans and peas.

“In the United States, race and ethnicity are tightly tied to income, with high rates of poverty observed among non-Hispanic blacks and Hispanics. It is likely that differences in income are a key driver of the differences observed by race/ethnicity in this study. A higher income may allow consumers to be less sensitive to price and more able to purchase healthier foods, such as fruits, vegetables and whole grains. A more adequate income may also allow individuals and families to live and work in settings that facilitate healthier eating.

Cultural and psychosocial factors likely also play a role. For example, low prevalences of meeting the recommendations for milk among non-Hispanic blacks are likely associated with cultural norms regarding milk consumption and higher rates of lactose intolerance among African Americans. "The complexity of factors that underlie disparities in diet point to the need for comprehensive strategies to address them,” says Dr. Sharon Kirkpatrick, the study’s lead author.

Compared to those in the highest income group, smaller proportions of children in the middle income group met the minimum recommendations for whole fruits and whole grains; smaller proportions of children in the lowest income group met the minimum recommendations for milk and oils. The finding of fewer differences in the prevalences of children as compared to adults meeting food-based dietary recommendations by income group may reflect adults’ efforts to buffer children from the effects of low income, says Kirkpatrick, and there is some evidence of a similar phenomenon in terms of fewer dietary effects among children compared to adults in families struggling with limited food access, or food insecurity.

Additional research would be needed to understand at what point children begin to experience marked dietary consequences of low income and food insecurity, but there is already sufficient evidence to warrant interventions to reduce these problems based on their deleterious effects on children’s health and well-being, she says.

Kirkpatrick says that retailers are only one piece of the puzzle in terms of reducing disparities in diet. They may be able to increase access to healthier foods such as fruits and vegetables in areas that do not have good access to healthy and affordable foods. However, individuals and families must have adequate incomes to purchase these foods. It is thus important to understand and address the underlying drivers of disparities. For example, policies that address the adequacy of minimum wages and provide supports for families and individuals struggling with unemployment or inadequate incomes could be one means of reducing income-related disparities.

”Many approaches are being suggested and implemented in the U.S. in an effort to promote healthier eating and curb obesity, such as more prominent nutrition labeling on packaged foods and calorie labeling on restaurant menus, subsidizing the purchase of healthier items such as fruits and vegetables, taxing foods high in fat or sugar, reducing marketing of foods high in fat and sugar, and stocking healthier foods in neighborhoods thought to be lacking in food access,” says Kirkpatrick. “In planning, implementing and evaluating such strategies, it will be important to assess the consequences for vulnerable subgroups to ensure that they are not being impacted negatively or left behind.”
 

This article originally published on Food, Nutrition & Science.