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Epidemiology

Trends in the inequality of fruit and vegetable consumption between education levels indicated by the Korea National Health and Nutrition Examination Surveys

Abstract

Background/Objectives:

The objective of this study was to investigate whether an inequality in fruit and/or vegetable (FV) consumption exists between adults of different educational levels in Korea and whether this has changed over the past decade.

Subjects/Methods:

This study included adults (20 years) who participated in the Korea National Health and Nutrition Examination Survey (1998–2009). The FV intakes were examined using 24-h dietary-recall surveys (n=35 725) and food frequency questionnaires (n=35 400). The relative index of inequality (RII) was used to examine the magnitude and trend of inequality in insufficient FV intake (<500 gram/day for total FV; <100 gram/day, less than once per day for fruits) between educational levels.

Results:

The low-education group had lower intakes of total FV, vegetables excluding Kimchi and fruit (both by frequency and quantity), but higher intakes of Kimchi, in both sexes in most years in which surveys were conducted. This group also had a higher proportion of adults with insufficient total FV and fruit intakes. The inequality, as indicated by the RII, was apparent in both sexes and in each survey year. The inequality in insufficient total FV intake increased between 1998 and 2009 in both sexes (P<0.05). An increase in the inequality in fruit intake was only detected in women (P<0.0001 for frequency and P=0.0285 for quantity, from 2007 to 2009).

Conclusion:

There is a wide discrepancy in total FV and fruit consumption across education levels among Korean adults. This inequality has increased over time for total FV intake in both sexes and for fruit intake in women.

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References

  1. Liu S, Manson JE, Lee IM, Cole SR, Hennekens CH, Willett WC et al. Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study. Am J Clin Nutr 2000; 72: 922–928.

    Article  CAS  Google Scholar 

  2. Hung HC, Joshipura KJ, Jiang R, Hu FB, Hunter D, Smith-Warner SA et al. Fruit and vegetable intake and risk of major chronic disease. J Natl Cancer Inst 2004; 96: 1577–1584.

    Article  Google Scholar 

  3. James W, Nelson M, Ralph A, Leather S . Socioeconomic determinants of health. The contribution of nutrition to inequalities in health. BMJ 1997; 314: 1545–1549.

    Article  CAS  Google Scholar 

  4. Davey Smith G, Brunner E . Socio-economic differentials in health: the role of nutrition. Proc Nutr Soc 1997; 56(1A): 75–90.

    Article  Google Scholar 

  5. Kwon J, Shim J, Park M, Paik H . Evaluation of fruits and vegetables intake for prevention of chronic disease in korean adults aged 30 years and over: using the third korea national health and nutrition examination survey (KNHANES III), 2005. Korean J Nutr 2009; 42: 146–157.

    Article  CAS  Google Scholar 

  6. Satheannoppakao W, Aekplakorn W, Pradipasen M . Fruit and vegetable consumption and its recommended intake associated with sociodemographic factors: Thailand National Health Examination Survey III. Public Health Nutr 2009; 12: 2192–2198.

    Article  Google Scholar 

  7. Kanungsukkasem U, Ng N, Van Minh H, Razzaque A, Ashraf A, Juvekar S et al. Fruit and vegetable consumption in rural adults population in INDEPTH HDSS sites in Asia. Glob Health Action 2009; 2 doi:10.3402/gha.v2i0.1988.

  8. Estaquio C, Druesne-Pecollo N, Latino-Martel P, Dauchet L, Hercberg S, Bertrais S . Socioeconomic differences in fruit and vegetable consumption among middle-aged French adults: adherence to the 5A Day recommendation. J Am Diet Assoc 2008; 108: 2021–2030.

    Article  Google Scholar 

  9. Prättälä R, Hakala S, Roskam AJ, Roos E, Helmert U, Klumbiene J et al. Association between educational level and vegetable use in nine European countries. Public Health Nutr 2009; 12: 2174–2182.

    Article  Google Scholar 

  10. Popkin BM, Zizza C, Siega-Riz AM . Who is leading the change? U.S. dietary quality comparison between 1965 and 1996. Am J Prev Med 2003; 25: 1–8.

    Article  Google Scholar 

  11. Hulshof KF, Brussaard JH, Kruizinga AG, Telman J, Lowik MR . Socio-economic status, dietary intake and 10 y trends: the Dutch National Food Consumption Survey. Eur J Clin Nutr 2003; 57: 128–137.

    Article  CAS  Google Scholar 

  12. Roos E, Talala K, Laaksonen M, Helakorpi S, Rahkonen O, Uutela A et al. Trends of socioeconomic differences in daily vegetable consumption, 1979–2002. Eur J Clin Nutr 2008; 62: 823–833.

    Article  CAS  Google Scholar 

  13. Paalanen L, Prättälä R, Palosuo H, Laatikainen T . Socio-economic differences in the consumption of vegetables, fruit and berries in Russian and Finnish Karelia: 1992–2007. Eur J Public Health 2010; 21: 35–42.

    Article  Google Scholar 

  14. Krieger N, Williams DR, NE M . Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health 1997; 18: 341–378.

    Article  CAS  Google Scholar 

  15. Roos E, Prättälä R, Lahelma E, Kleemola P, Pietinen P . Modern and healthy?: socioeconomic differences in the quality of diet. Eur J Clin Nutr 1996; 50: 753–760.

    CAS  PubMed  Google Scholar 

  16. Liberatos P, Link BG, Kelsey JL . The measurement of social class in epidemiology. Epidemiol Rev 1988; 10: 87–121.

    Article  CAS  Google Scholar 

  17. Irala-Estevez JD, Groth M, Johansson L, Oltersdorf U, Prattala R, Martinez-Gonzalez MA . A systematic review of socio-economic differences in food habits in Europe: consumption of fruit and vegetables. Eur J Clin Nutr 2000; 54: 706–714.

    Article  CAS  Google Scholar 

  18. Turrell G, Kavanagh A . Socio-economic pathways to diet: modelling the association between socio-economic position and food purchasing behaviour. Public Health Nutr 2006; 9: 375–383.

    Article  Google Scholar 

  19. Giskes K, Turrell G, van Lenthe FJ, Brug J, Mackenbach JP . A multilevel study of socio-economic inequalities in food choice behaviour and dietary intake among the Dutch population: the GLOBE study. Public Health Nutr 2006; 9: 75–83.

    Article  Google Scholar 

  20. Kang SW, Shin YS, Lee TJ, Kang EJ, Kim TW, Choi HS et al. A Study on Social Polarization in Korea. Korea Institute for Health and Social Affairs: Seoul, 2006.

    Google Scholar 

  21. Korea Centers for Disease Control and Prevention. Korean National Health and Nutrition Examination Survey. From http://knhanescdcgokr/ (accessed on 13 January 2011).

  22. Choi J, Moon H . Comparison of dietary patterns by sex and urbanization in different economic status. Korean J Community Nutr 2008; 13: 346–358.

    Google Scholar 

  23. Korean Health Industry Development Institute and Korea Centers for Disease Control and Prevention. In-Depth Analysis on the 3rd (2005) Korea Health and Nutrition Examination Survey–Nutrition Survey. Korean Health Industry Development Institute and Korea Centers for Disease Control and Prevention. Ministry of Health and Welfare: Seoul, Korea, 2007.

  24. Ministry of Health and Welfare. Health Plan 2010. Ministry of Health and Welfare: Seoul, Korea, 2002.

  25. The Korean Nutrition Society. Dietary Reference Intakes for Koreans. The Korean Nutrition Society: Seoul, Korea, 2005.

  26. 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: 757–771.

    Article  CAS  Google Scholar 

  27. Davey Smith G, Hart C, Hole D, MacKinnon P, Gillis C, Watt G et al. Education and occupational social class: which is the more important indicator of mortality risk? J Epidemiol Community Health 1998; 52: 153–160.

    Article  CAS  Google Scholar 

  28. Davey-Smith G, Dorling D, Mitchell R, Shaw M . Health inequalities in Britain: continuing increases up to the end of the 20th century. J Epidemiol Community Health 2002; 56: 434–435.

    Article  Google Scholar 

  29. Regidor E . Measures of health inequalities: part 2. J Epidemiol Community Health 2004; 58: 900–903.

    Article  Google Scholar 

  30. Khang YH, Yun SC, Lynch JW . Monitoring trends in socioeconomic health inequalities: it matters how you measure. BMC Public Health 2008; 8: 66.

    Article  Google Scholar 

  31. Spiegelman D, Hertzmark E, Easy SAS . calculations for risk or prevalence ratios and differences. Am J Epidemiol 2005; 162: 199–200.

    Article  Google Scholar 

  32. Turrell G, Hewitt B, Patterson C, Oldenburg B, Gould T . Socioeconomic differences in food purchasing behaviour and suggested implications for diet-related health promotion. J Hum Nutr Diet 2002; 15: 355–364.

    Article  CAS  Google Scholar 

  33. Azagba S, Sharaf MF . Disparities in the frequency of fruit and vegetable consumption by socio-demographic and lifestyle characteristics in Canada. Nutr J 2011; 10: 118.

    Article  Google Scholar 

  34. Li Y, Li D, Ma CY, Liu CY, Hui D, Wen ZM et al. Consumption and factors influencing consumption of fruit and vegetables among elderly Chinese people. Nutrition 2011; 28: 504–508.

    Article  Google Scholar 

  35. Dehghan M, Akhtar-Danesh N, Merchant AT . Factors associated with fruit and vegetable consumption among adults. J Hum Nutr Diet 2011; 24: 128–134.

    Article  CAS  Google Scholar 

  36. Lee J, Jeong Y . Cholesterol-lowering effect and anticancer activity of Kimchi and Kimchi ingredients. Korean J Life Sci 1999; 9: 743–752.

    Google Scholar 

  37. Clark AM, Duncan AS, Trevoy JE, Heath S, Chan M . Healthy diet in Canadians of low socioeconomic status with coronary heart disease: Not just a matter of knowledge and choice. Heart Lung 2011; 40: 156–163.

    Article  Google Scholar 

  38. Perrin AE, Simon C, Hedelin G, Arveiler D, Schaffer P, Schlienger JL . Ten-year trends of dietary intake in a middle-aged French population: relationship with educational level. Eur J Clin Nutr 2002; 56: 393–401.

    Article  CAS  Google Scholar 

  39. Darmon N, Drewnowski A . Does social class predict diet quality? Am J Clin Nutr 2008; 87: 1107–1117.

    Article  CAS  Google Scholar 

  40. Turrell G, Hewitt B, Patterson C, Oldenburg B . Measuring socio-economic position in dietary research: is choice of socio-economic indicator important? Public Health Nutr 2003; 6: 191–200.

    PubMed  Google Scholar 

  41. Kim H . Influence of age and education on food consumption and nutrient intakes of older women living alone. J East Asian Soc Dietary Life 2001; 11: 82–88.

    Google Scholar 

  42. Giskes K, Turrell G, Patterson C, Newman B . Socioeconomic differences among Australian adults in consumption of fruit and vegetables and intakes of vitamins A, C and folate. J Hum Nutr Dietet 2002; 15: 375–385.

    Article  CAS  Google Scholar 

  43. Worsley A . Nutrition knowledge and food consumption: can nutrition knowledge change food behaviour? Asia Pac J Clin Nutr 2002; 11(Suppl 3): S579–S585.

    Article  Google Scholar 

  44. Leganger A, Kraft P . Control constructs: do they mediate the relation between educational attainment and health behaviour? J Health Psychol 2003; 8: 361–372.

    Article  Google Scholar 

  45. Steptoe A, Perkins-Porras L, Rink E, Hilton S, Cappuccio F . Psychological and social predictors of changes in fruit and vegetable consumption over 12 months following behavioral and nutrition education counseling. Health Psychol 2004; 23: 574–581.

    Article  Google Scholar 

  46. Willette WC Nutritional epidemiology. Oxford University Press, Inc.: New York, 1998.

    Book  Google Scholar 

Download references

Acknowledgements

We thank Professor Young-Ho Khang and Sung-Cheol Yun for their comments on the statistical analyses.

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Correspondence to M K Kim.

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Hong, S., Kim, K. & Kim, M. Trends in the inequality of fruit and vegetable consumption between education levels indicated by the Korea National Health and Nutrition Examination Surveys. Eur J Clin Nutr 66, 942–949 (2012). https://doi.org/10.1038/ejcn.2012.39

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