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Interventions and public health nutrition

Attitudes toward healthy eating: a mediator of the educational level–diet relationship



A higher educational level is associated with a healthier diet. The goal of this study was to establish whether this association is mediated by attitudes toward healthy eating.


The cross-sectional MONA LISA-NUT study was performed in 2005–2007 on adults aged 35–64 years from northern and north-eastern France. Diet quality was assessed on the basis of a 3-day food record and a validated score based on French national dietary guidelines. Specific questions investigated attitudes toward healthy eating. Multivariate analyses were used to quantify the proportion of the educational level–diet relationship that was mediated by attitudes toward healthy eating.


Among the 1631 subjects, favourable attitudes toward healthy eating were associated with both higher educational level and diet quality. In the mediation analysis, ‘organic food consumption’ explained 14% (95% confidence interval (8;24)) of the educational level–diet relationship and ‘attention paid to health when buying food’ explained 9% (3;16). In contrast, ‘attention to food choice’, ‘searching for information about food’ and ‘perceived role of eating’ were not mediators of the association between educational level and diet. In a multivariate model, the attitude items together accounted for 25% (10;45) of the relationship. The mediation was more pronounced in women than in men (37% (15;54) vs 16% (1;27), respectively) and was significant for consumption of fruits and vegetables (23% (13;37)), whole-grain food (32% (15;58)) and seafood (22% (9;55)).


Our results suggest that poor attitudes toward healthy eating in groups with low socioeconomic status constitute an additional factor (along with cost constraints) in the choice of unhealthy foods.

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We thank the nurses, physicians, dieticians, computer scientists and secretarial staff variously in Lille, Strasbourg, Toulouse, the Centre de Médecine Préventive de Lille, the Laboratoire d’Analyses Génomiques, the Service de Biologie Spécialisée de l’Institut Pasteur de Lille, the Centre de Santé de la MGEN de Strasbourg, the Unité de Coordination de la Biologie des Essais Cliniques des Hôpitaux Universitaires de Strasbourg, the Department of Cardiology of the Toulouse University Hospital and the participating city councils in the three regions. The third MONA LISA survey was made possible by an unrestricted grant from Pfizer and a grant from the French National Research Agency (ANR-05-PNRA-018).

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Correspondence to L Dauchet.

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Lê, J., Dallongeville, J., Wagner, A. et al. Attitudes toward healthy eating: a mediator of the educational level–diet relationship. Eur J Clin Nutr 67, 808–814 (2013).

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  • attitude to health
  • diet
  • food habits
  • social class
  • socioeconomic factors
  • educational status

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