Disparities in fruit and vegetable intake at the intersection of gender and education in northern Sweden: a cross-sectional study

Abstract

Background Even though the existence of inequalities in fruit and vegetable consumption has been well established, it is not clear how it is patterned across intersections of multiple social positions and identities. This study aims to investigate disparities in fruit and vegetable intake between groups at the intersection of education and gender in northern Sweden, and to estimate the discriminatory accuracy of the intersectional groups. Methods Cross-sectional data from the 2018 Health on Equal Terms survey conducted in four regions in northern Sweden was used (N = 21,853). Four intersectional groups were created: high and low educated men, and high and low educated women. Prevalence differences corresponding to joint, referent, and excess intersectional inequalities, were estimated for three outcomes: inadequate fruit and vegetable intake combined, inadequate fruit intake, and inadequate vegetable intake. The discriminatory accuracy of the intersectional groups was estimated by the area under the receiver operating characteristic curve. Results Low educated men had the highest prevalence of inadequate intake of fruits and vegetables combined (81.4%), fruits (83.4%), and vegetables (84.9%), while high educated women had the lowest (47.7, 60.2, and 51.8%, respectively). The joint disparities between high educated women and low educated men were both significant and substantial for all outcomes (34.6 percentage points (pp.), 25.2 pp., and 31.2 pp., adjusted), although differences in magnitude were noted between fruit and vegetable intake. The joint disparities were mostly explained by the two referent disparities for gender and education. The excess intersectional disparity - the part of the joint disparity not explained by either referent disparity – was negative for all three outcomes (-5.5 pp., − 4.2 pp., and − 4.6 pp. respectively, adjusted). The discriminatory accuracy of the intersectional groups was moderate (0.67, 0.65, and 0.68 respectively). Conclusions An intersectional approach can provide a more detailed view of inequalities in fruit and vegetable consumption between groups combining several social positions. The moderate discriminatory accuracy observed here suggests that interventions and policies aiming to reduce diet inequalities should not solely be targeted at certain groups, but also be universal.

Fruit and vegetable intake, physical activity, and functional fitness among older adults in urban Alaska

“…This means that hypothesis one was not supported, but this outcome does not necessarily mean that the older adults in this study meet the recommended intake amount for fruit and vegetables, as per the U.S. Department of Agriculture dietary recommendations for seniors [ 15 ]. Research has found that men reportedly consume fewer fruit and vegetables daily than their women counterparts [ 9 , 53 ], but this study was unable to explore this directly due to an insufficient number of male participants. Increased fruit and vegetable intake promotes healthy aging, minimizes development and impact of chronic conditions, and offers many health benefits from the increased consumption of phytochemicals, which can lower oxidative stress and inflammation [ 54 ].…”

Fruit and vegetable intake, physical activity, and functional fitness among older adults in urban Alaska

“…This means that hypothesis one was not supported, but this outcome does not necessarily mean that the older adults in this study meet the recommended intake amount for fruit and vegetables, as per the U.S. Department of Agriculture dietary recommendations for seniors [ 15 ]. Research has found that men reportedly consume fewer fruit and vegetables daily than their women counterparts [ 9 , 53 ], but this study was unable to explore this directly due to an insufficient number of male participants. Increased fruit and vegetable intake promotes healthy aging, minimizes development and impact of chronic conditions, and offers many health benefits from the increased consumption of phytochemicals, which can lower oxidative stress and inflammation [ 54 ].…”

Fruit and Vegetable, Fish, and Sugar-Sweetened Beverage Consumption Among Adults Aged 40–65 Years: A Cross-Sectional Study of Dietary Patterns and Sociodemographic Correlates in North-Eastern Poland

“…These similarities support the robustness and generalisability of our findings. A Swedish study using an intersectional approach found that inadequate fruit and vegetable intake was most common among men with low educational attainment (81.4%) and least common among women with high educational attainment (47.7%) [ 13 ].…”

Food Choices and Diet-Related Disparities Among Socioeconomically Diverse White and African American Urban Women

“…Fruits and vegetables were among the top commonly consumed foods only for women with higher incomes. Others have observed that differences in fruit and vegetable intake in high-income countries are associated with socioeconomic status, and gender, as well as demographic characteristics such as age, marital status, age, and the region of residence [60]. There is strong evidence of the association of fruits and vegetables and unprocessed or minimally processed foods [55] with a lower risk of developing dietrelated chronic conditions [61].…”

Fruit and vegetable intake, physical activity, and functional fitness among older adults in urban Alaska

“…This means that hypothesis one was not supported, but this outcome does not necessarily mean that the older adults in this study meet the recommended intake amount for fruit and vegetables, as per the U.S. Department of Agriculture dietary recommendations for seniors [ 15 ]. Research has found that men reportedly consume fewer fruit and vegetables daily than their women counterparts [ 9 , 53 ], but this study was unable to explore this directly due to an insufficient number of male participants. Increased fruit and vegetable intake promotes healthy aging, minimizes development and impact of chronic conditions, and offers many health benefits from the increased consumption of phytochemicals, which can lower oxidative stress and inflammation [ 54 ].…”

Fruit and Vegetable, Fish, and Sugar-Sweetened Beverage Consumption Among Adults Aged 40–65 Years: A Cross-Sectional Study of Dietary Patterns and Sociodemographic Correlates in North-Eastern Poland

“…These similarities support the robustness and generalisability of our findings. A Swedish study using an intersectional approach found that inadequate fruit and vegetable intake was most common among men with low educational attainment (81.4%) and least common among women with high educational attainment (47.7%) [ 13 ].…”

Food Choices and Diet-Related Disparities Among Socioeconomically Diverse White and African American Urban Women

“…Fruits and vegetables were among the top commonly consumed foods only for women with higher incomes. Others have observed that differences in fruit and vegetable intake in high-income countries are associated with socioeconomic status, and gender, as well as demographic characteristics such as age, marital status, age, and the region of residence [60]. There is strong evidence of the association of fruits and vegetables and unprocessed or minimally processed foods [55] with a lower risk of developing dietrelated chronic conditions [61].…”

Fruit and vegetable intake, physical activity, and functional fitness among older adults in urban Alaska

“…This means that hypothesis one was not supported, but this outcome does not necessarily mean that the older adults in this study meet the recommended intake amount for fruit and vegetables, as per the U.S. Department of Agriculture dietary recommendations for seniors [ 15 ]. Research has found that men reportedly consume fewer fruit and vegetables daily than their women counterparts [ 9 , 53 ], but this study was unable to explore this directly due to an insufficient number of male participants. Increased fruit and vegetable intake promotes healthy aging, minimizes development and impact of chronic conditions, and offers many health benefits from the increased consumption of phytochemicals, which can lower oxidative stress and inflammation [ 54 ].…”

Fruit and Vegetable, Fish, and Sugar-Sweetened Beverage Consumption Among Adults Aged 40–65 Years: A Cross-Sectional Study of Dietary Patterns and Sociodemographic Correlates in North-Eastern Poland

“…These similarities support the robustness and generalisability of our findings. A Swedish study using an intersectional approach found that inadequate fruit and vegetable intake was most common among men with low educational attainment (81.4%) and least common among women with high educational attainment (47.7%) [ 13 ].…”

Food Choices and Diet-Related Disparities Among Socioeconomically Diverse White and African American Urban Women

“…Fruits and vegetables were among the top commonly consumed foods only for women with higher incomes. Others have observed that differences in fruit and vegetable intake in high-income countries are associated with socioeconomic status, and gender, as well as demographic characteristics such as age, marital status, age, and the region of residence [60]. There is strong evidence of the association of fruits and vegetables and unprocessed or minimally processed foods [55] with a lower risk of developing dietrelated chronic conditions [61].…”