Objective: To evaluate the differences in the consumption of fruit and vegetables between groups with different socio-economic status (SES) in the adult population of European countries. Design: A systematic review of published and unpublished surveys of food habits conducted between 1985 and 1999 in 15 European countries. Educational level and occupational status were used as indicators of SES. A pooled estimate of the mean difference between the highest and the lowest level of education and occupation was calculated separately for men and women, using DerSimonian 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 sample or a representative sample of a region; and providing the mean and standard 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 included in the meta-analysis. A higher SES was associated with a greater consumption of both fruit and vegetables. The pooled estimate of the difference in the intake of fruit was 24.3 gapersonaday (95% con®dence 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 33.6 gapersonaday for women (95% CI 22.5 ± 44.8). The differences regarding vegetables were 17.0 gapersonaday (95% CI 8.6 ± 25.5) for men and 13.4 gapersonaday (95% CI 7.1 ± 19.7) for women. The results were in the same direction when occupation instead of education was used as an indicator of SES. Conclusions: Although we cannot exclude over-reporting of intake by those with highest SES, it is unlikely that this potential bias could fully explain the differences we have found. Our results suggest that an unhealthier nutrition pattern may exist among adults belonging to lower socio-economic levels in Europe. Sponsorship: The present study was supported by the European Union's FAIR programme .

Ultraprocessed food consumption was associated with a higher risk of overweight and obesity in a prospective cohort of Spanish middle-aged adult university graduates. Further longitudinal studies are needed to confirm our results. This trial was registered at clinicaltrials.gov as NCT02669602.