Does social class predict diet quality?

Darmon, Nicole; Drewnowski, Adam

doi:10.1093/ajcn/87.5.1107

Cited by 2,250Nutritional Studies and DietFood Security and Health in Diverse PopulationsNutrition, Health and Food Behavior

Does social class predict diet quality?

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Darmon, Nicole, Drewnowski, Adam·2008·The American Journal of Clinical Nutrition

DOI 10.1093/ajcn/87.5.1107

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Abstract

A large body of epidemiologic data show that diet quality follows a socioeconomic gradient. Whereas higher-quality diets are associated with greater affluence, energy-dense diets that are nutrient-poor are preferentially consumed by persons of lower socioeconomic status (SES) and of more limited economic means. As this review demonstrates, whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher SES. In contrast, the consumption of refined grains and added fats has been associated with lower SES. Although micronutrient intake and, hence, diet quality are affected by SES, little evidence indicates that SES affects either total energy intakes or the macronutrient composition of the diet. The observed associations between SES variables and diet-quality measures can be explained by a variety of potentially causal mechanisms. The disparity in energy costs ($/MJ) between energy-dense and nutrient-dense foods is one such mechanism; easy physical access to low-cost energy-dense foods is another. If higher SES is a causal determinant of diet quality, then the reported associations between diet quality and better health, found in so many epidemiologic studies, may have been confounded by unobserved indexes of social class. Conversely, if limited economic resources are causally linked to low-quality diets, some current strategies for health promotion, based on recommending high-cost foods to low-income people, may prove to be wholly ineffective. Exploring the possible causal relations between SES and diet quality is the purpose of this review.

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Individuals with high intakes of whole grains, fruits, vegetables, fish, nuts, or legumes may differ in lifestyle or socioeconomic status from those with lower intakes, which are important confounders.
“People with a high intake of whole grains, fruits, vegetables, fish, nuts, or legumes might have different lifestyles or a different socioeconomic status from those with lower intakes, representing important confounders (141).”
From Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies , (2017) · cites this paper as [141]

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“This lower rate of fruit and vegetable consumption may be due in part to the relatively low cost of energydense foods (Darmon and Drewnowski 2008), though Dibsdall et al. (2003) claim that motivational and lifestyle factors have an even greater impact.”
Background
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Authors: Darmon, N., & Drewnowski, A.
Affiliations: Inserm (FR)
Corresponding author: Darmon, Nicole
ORCID: Darmon, Nicole
Drewnowski, Adam
Venue: The American Journal of Clinical Nutrition
Publisher: Elsevier BV
Published: 2008-05
Volume: 87
Issue: 5
Pages: 1107-1117
ISSN: 0002-9165 (ISSN-L)
DOI: 10.1093/ajcn/87.5.1107
OpenAlex: W1945293409
Cited by: 2,250
References: 194
Citations by year: 2026: 117 · 2025: 147 · 2024: 110 · 2023: 107 · 2022: 116 · 2021: 159 · 2020: 191 · 2019: 163 · 2018: 160 · 2017: 160 · 2016: 172 · 2015: 150 · 2014: 118 · 2013: 111 · 2012: 81
FWCI: 8.82
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 5416 d)
Locations: American Journal of Clinical Nutrition (publishedVersion)
PubMed (publishedVersion)
HAL AMU (submittedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Health Sciences › Health Professions › General Health Professions › Food Security and Health in Diverse Populations
Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords: social class, socioeconomic status, diet quality, social gradient, energy-dense foods, nutrient-dense foods, food costs, food access, whole grains, refined grains, added fat, micronutrient intake, macronutrient composition, energy intake, health disparities, health promotion
MeSH terms: Energy Intake, Diet, Food, Food Supply, Health Status, Humans, Nutritive Value, Social Class, Socioeconomic Factors, United States

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Does social class predict diet quality?

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