Abstract
Background
Socioeconomic status (SES) patterned health disparities have been related to differences in dietary intake, especially in the elderly. Still, it is not known to what extent these differences culminate in vitamin deficiencies, as most studies have assessed nutrient intake, instead of measuring nutritional biomarkers. Hence, we aimed to objectively assess nutritional status in elderly with low and high SES and to investigate whether potential differences therein were mediated by diet.
Methods
1605 individuals (60-75 years) were selected from the LifeLines Cohort Study to create two gender-matched groups with different SES. Nutritional status was assessed by measuring folic acid, vitamin B6, B12, D, A, E and K in the collected samples. SES-groups were defined according to highest completed education as high and low, and dietary quality was assessed the Lifelines Diet Score. Multiple linear regression and logistic regression were first used for the association between SES and vitamin status; and mediation analysis was used to explore the relationship of SES, diet and vitamin status.
Results
The overall prevalence of vitamin deficiency ranged from 4.1% (vitamin B6) to 19.5% (folic acid). The low SES group had significantly poorer status (p ≤ 0.04) of most vitamins, including the B vitamins (i.e., folic acid, B12 and B6) as well as multivitamin deficiencies (p ≤ 0.02). Low SES was independently associated with decreased folic acid, vitamin B6, vitamin B12, and vitamin A serum concentrations (p ≤ 0.03 for all). Diet quality was found to partially mediate the association between SES, and folic acid (39.1%), vitamin B6 (37.1%) and vitamin B12 (37.2%)(P ≤ 0.03).
Conclusions
Low SES is a risk factor for suboptimal nutritional status. The association between SES and nutritional status can be partially explained by diet quality, suggesting that policy makers can mitigate socioeconomic inequality in nutritional status by improving diet quality among elderly.
Key messages
Revealed that low SES was a risk factor for a suboptimal nutritional status among the elderly and a possible self-reinforcing trap has formed which causes low SES and hidden hunger to persist. Highlighted the importance of diet quality in socioeconomically patterned health disparities and indicating the need for SES-tailored public health strategies.
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