title: Variety more than quantity of fruit and vegetable intake varies by socioeconomic status and financial hardship. Findings from older adults in the EPIC cohort.
abstract: BACKGROUND
  Beyond quantity, variety of fruit and vegetable (FV) intake prevents chronic conditions and is widely recommended as critical to healthful eating. FV consumption is socially patterned, especially for women, but little is known about multiple economic determinants of variety or whether they differ from those of quantity.
  
  
  OBJECTIVE
  To examine socioeconomic status and financial hardships in relation to variety and quantity of FV intakes among older British women and men.
  
  
  METHODS
  Cross-sectional study of 9580 adults (50-79 years) in the nationally representative EPIC cohort who responded to a postal Health and Life Experiences Questionnaire (1996-2000) and Food Frequency Questionnaire (1998-2002). Variety counted unique items consumed (items/month) and quantity measured total intake (g/day).
  
  
  RESULTS
  No consistent differences by any economic factor were observed for quantity of fruits or vegetables, except education in men. Lower education, lower social class and renting were independently associated with lower fruit variety and vegetable variety (p-trend < 0.001), with differences stronger in men. Mean vegetable variety differed between top and bottom social classes by 2.9 items/month for men and 2.5 for women. Greater financial hardships were also independently associated with lower variety, with differences stronger in women for fruits and in men for vegetables.
  
  
  CONCLUSIONS
  British older adults reporting greater economic disadvantage consistently consumed fewer different fruits or vegetables, but not lower amounts. Further nutrition studies of the protective effects, and underlying mechanisms, of FV variety are warranted for addressing social inequalities in older adults' diet quality. Dietary guidance should separately emphasise variety, and interventions should aim to address financial barriers to older adults' consumption of diverse FV.
authors.affiliation: MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, UK; Centre for Diet and Activity Research University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge, CB2 0QQ, United Kingdom.
authors.forename: Annalijn I
authors.initials: AI
authors.lastname: Conklin
authors.affiliation: MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, UK.
authors.forename: Nita G
authors.initials: NG
authors.lastname: Forouhi
authors.affiliation: Centre for Diet and Activity Research University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge, CB2 0QQ, United Kingdom; Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
authors.forename: Marc
authors.initials: M
authors.lastname: Suhrcke
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Surtees
authors.affiliation: MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, UK; Centre for Diet and Activity Research University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge, CB2 0QQ, United Kingdom.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.affiliation: Centre for Diet and Activity Research University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge, CB2 0QQ, United Kingdom; Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, UK. Electronic address: pm491@medschl.cam.ac.uk.
authors.forename: Pablo
authors.initials: P
authors.lastname: Monsivais
mesh_terms: D000368:Aged; D000375:Aging; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004032:Diet / Q000009:adverse effects* / Q000191:economics; D004034:Diet Surveys; D004522:Educational Status; D004739:England; D005260:Female; D005500:Follow-Up Studies; D005638:Fruit; D054624:Health Status Disparities; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D018673:Nutrition Policy; D010349:Patient Compliance; D011446:Prospective Studies; D012727:Sex Characteristics; D012959:Socioeconomic Factors; D014675:Vegetables
keywords: Aging; Financial hardship; Healthy eating; Socioeconomic inequality; UK; Variety