title: The role of perceived barriers in explaining socio-economic status differences in adherence to the fruit, vegetable and fish guidelines in older adults: a mediation study.
abstract: OBJECTIVE
  We aimed to identify barriers for meeting the fruit, vegetable and fish guidelines in older Dutch adults and to investigate socio-economic status (SES) differences in these barriers. Furthermore, we examined the mediating role of these barriers in the association between SES and adherence to these guidelines.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Longitudinal Aging Study Amsterdam (LASA), the Netherlands.
  
  
  METHODS
  We used data from 1057 community-dwelling adults, aged 55-85 years. SES was measured by level of education and household income. An FFQ was used to assess dietary intake and barriers were measured with a self-reported lifestyle questionnaire.
  
  
  RESULTS
  Overall, 48.9 % of the respondents perceived a barrier to adhere to the fruit guideline, 40.0 % for the vegetable and 51.1 % for the fish guideline. The most frequently perceived barriers to meet the guidelines were the high price of fruit and fish and a poor appetite for vegetables. Lower-SES groups met the guidelines less often and perceived more barriers. The association between income and adherence to the fruit guideline was mediated by 'perceiving any barrier to meet the fruit guideline' and the barrier 'dislike fruit'. The association between income and adherence to the fish guideline was mediated by 'perceiving any barrier to meet the fish guideline' and the barrier 'fish is expensive'.
  
  
  CONCLUSIONS
  Perceived barriers for meeting the dietary guidelines are common in older adults, especially in lower-SES groups. These barriers and in particular disliking and cost concerns explained the lower adherence to the guidelines for fruit and fish in lower-income groups in older adults.
authors.affiliation: 1Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences,VU University Amsterdam,De Boelelaan 1085,1081 HV Amsterdam,The Netherlands.
authors.forename: S Coosje
authors.initials: SC
authors.lastname: Dijkstra
authors.affiliation: 1Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences,VU University Amsterdam,De Boelelaan 1085,1081 HV Amsterdam,The Netherlands.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Neter
authors.affiliation: 1Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences,VU University Amsterdam,De Boelelaan 1085,1081 HV Amsterdam,The Netherlands.
authors.forename: Maartje M
authors.initials: MM
authors.lastname: van Stralen
authors.affiliation: 3Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences,VU University Amsterdam,Amsterdam,The Netherlands.
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Knol
authors.affiliation: 1Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences,VU University Amsterdam,De Boelelaan 1085,1081 HV Amsterdam,The Netherlands.
authors.forename: Ingeborg A
authors.initials: IA
authors.lastname: Brouwer
authors.affiliation: 3Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences,VU University Amsterdam,Amsterdam,The Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Huisman
authors.affiliation: 1Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences,VU University Amsterdam,De Boelelaan 1085,1081 HV Amsterdam,The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Visser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004032:Diet / Q000009:adverse effects* / Q000191:economics; D058620:Elder Nutritional Physiological Phenomena; D005260:Female; D005399:Fishes; D005518:Food Preferences; D005638:Fruit / Q000191:economics; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018673:Nutrition Policy; D010349:Patient Compliance; D011203:Poverty; D017747:Seafood / Q000191:economics; D012959:Socioeconomic Factors; D014675:Vegetables / Q000191:economics
keywords: Dietary guidelines
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