title: Secular trends in the association of socio-economic position with self-reported dietary attributes and biomarkers in the US population: National Health and Nutrition Examination Survey (NHANES) 1971-1975 to NHANES 1999-2002.
abstract: OBJECTIVE
  Recent reports suggest persistence of health disparities related to socio-economic position (SEP). To understand if diet may be a contributor to these trends, we examined secular trends in the association of diet and indicators of SEP from 1971-1975 to 1999-2002.
  
  
  METHODS
  We used data from the National Health and Nutrition Examination Surveys (NHANES) I (1971-1975), II (1976-1980), III (1988-1994) and 1999-2002 to examine the independent associations of poverty income ratio (PIR) and education with diet and biomarkers of diet and disease in 25-74-year-olds (n = 36,600). We used logistic and linear regression methods to adjust for multiple covariates and survey design to examine these associations.
  
  
  RESULTS
  A large PIR differential in the likelihood of reporting a fruit or all five food groups and vitamin C intake, and an education differential in likelihood of obesity and carbohydrate intake, was noted in 1971-1975 but narrowed in 1999-2002 (P < 0.007). The positive association of education with intake of a fruit, vegetable or all five food groups, vitamins A and C, calcium and potassium intake remained unchanged across surveys (P < 0.001). Similarly, the positive association of PIR with the amount of foods and intakes of energy and potassium remained unchanged over three decades (P < 0.001). The education and the PIR differential in energy density, and the PIR differential in the likelihood of obesity, persisted over the period of the four surveys (P < 0.001).
  
  
  CONCLUSIONS
  Persistence of unfavourable dietary and biomarker profiles in Americans with low income and education suggests continued need for improvement in the quality of diets of these high-risk groups.
authors.affiliation: Department of Family, Nutrition, and Exercise Sciences, Remsen Hall, Room 306E, Queens College of City University of New York, Flushing, NY 11367, USA. ashima.kant@qc.cuny.edu
authors.forename: Ashima K
authors.initials: AK
authors.lastname: Kant
authors.forename: Barry I
authors.initials: BI
authors.lastname: Graubard
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D004032:Diet / Q000639:trends*; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000453:epidemiology* / Q000209:etiology; D012650:Self Disclosure; D012923:Social Class; D012959:Socioeconomic Factors; D014481:United States