title: Regional factors interact with educational and income tax levels to influence food intake in France.
abstract: OBJECTIVE
  The goal of the present study was to assess whether geographic factors affect the relationship between socioeconomic indicators and adherence to the French National Nutritional Health Programme (Programme National Nutrition Santé (PNNS)) guidelines.
  
  
  METHODS
  The MONA LISA-NUT study (2005-2007) is a cross-sectional survey of a representative sample from northern, northeastern and southwestern France. Educational level and household income tax were recorded by trained interviewers. Food intake was assessed with a 3-day food diary in 3188 subjects aged from 35-64 years. Adherence to the PNNS guidelines was assessed with a validated score (the French score of indicators of the PNNS objective (FSIPO)). Multivariate analyses were adjusted for gender, age, marital status, body mass index, energy intake and medically prescribed diets.
  
  
  RESULTS
  The FSIPO score was higher in southwestern France than in the two other regions (P<0.0001). The FSIPO score was correlated with the educational level in northern and northeastern France (P<0.0001) but not in southwestern France (region-education interaction: P<0.001). This interaction was accounted for by fruit and vegetable (P<0.0001), calcium (P=0.03), saturated fatty acid (P<0.0001), and fibre (P=0.0001) components of the FSIPO score. In contrast, the income tax level and the FSIPO score were positively correlated (P<0.0001) to a similar extent in all three regions (region × income tax interaction: P=0.09).
  
  
  CONCLUSIONS
  The relationship between educational level and adherence to the national nutritional health guidelines differs from one region of France to another, suggesting that nutrition education programmes should perhaps be adapted on a regional basis. In contrast, guideline adherence is correlated with income tax level independently of geographical factors, suggesting that financial constraints on food choices are uniform across France.
authors.affiliation: Service d'Épidémiologie et Santé Publique, INSERM 744, Institut Pasteur de Lille, Université Nord de France, Lille, France.
authors.forename: K
authors.initials: K
authors.lastname: Wyndels
authors.forename: J
authors.initials: J
authors.lastname: Dallongeville
authors.forename: C
authors.initials: C
authors.lastname: Simon
authors.forename: V
authors.initials: V
authors.lastname: Bongard
authors.forename: A
authors.initials: A
authors.lastname: Wagner
authors.forename: J-B
authors.initials: JB
authors.lastname: Ruidavets
authors.forename: D
authors.initials: D
authors.lastname: Arveiler
authors.forename: J
authors.initials: J
authors.lastname: Ferrières
authors.forename: P
authors.initials: P
authors.lastname: Amouyel
authors.forename: L
authors.initials: L
authors.lastname: Dauchet
mesh_terms: D000328:Adult; D001823:Body Composition; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004032:Diet / Q000592:standards*; D004522:Educational Status; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D005602:France; D005843:Geography; D017408:Guidelines as Topic; D006801:Humans; D007183:Income Tax; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D010349:Patient Compliance; D012923:Social Class; D012959:Socioeconomic Factors