title: Socioeconomic determinants of dietary patterns in low- and middle-income countries: a systematic review.
abstract: BACKGROUND
  In high-income countries, high socioeconomic status (SES) is generally associated with a healthier diet, but whether social differences in dietary intake are also present in low- and middle-income countries (LMICs) remains to be established.
  
  
  OBJECTIVE
  We performed a systematic review of studies that assessed the relation between SES and dietary intake in LMICs.
  
  
  METHODS
  We carried out a systematic review of cohort and cross-sectional studies in adults in LMICs and published between 1996 and 2013. We assessed associations between markers of SES or urban and rural settings and dietary intake.
  
  
  RESULTS
  A total of 33 studies from 17 LMICs were included (5 low-income countries and 12 middle-income countries; 31 cross-sectional and 2 longitudinal studies). A majority of studies were conducted in Brazil (8), China (6), and Iran (4). High SES or living in urban areas was associated with higher intakes of calories; protein; total fat; cholesterol; polyunsaturated, saturated, and monounsaturated fatty acids; iron; and vitamins A and C and with lower intakes of carbohydrates and fiber. High SES was also associated with higher fruit and/or vegetable consumption, diet quality, and diversity. Although very few studies were performed in low-income countries, similar patterns were generally observed in both LMICs except for fruit intake, which was lower in urban than in rural areas in low-income countries.
  
  
  CONCLUSIONS
  In LMICs, high SES or living in urban areas is associated with overall healthier dietary patterns. However, it is also related to higher energy, cholesterol, and saturated fat intakes. Social inequalities in dietary intake should be considered in the prevention and control of noncommunicable diseases in LMICs.
authors.affiliation: From the Institute of Social and Preventive Medicine (A-LM, FP, PB, and SS) and the Department of Internal Medicine, Internal Medicine (PM-V), Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Ana-Lucia
authors.initials: AL
authors.lastname: Mayén
authors.affiliation: From the Institute of Social and Preventive Medicine (A-LM, FP, PB, and SS) and the Department of Internal Medicine, Internal Medicine (PM-V), Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Pedro
authors.initials: P
authors.lastname: Marques-Vidal
authors.affiliation: From the Institute of Social and Preventive Medicine (A-LM, FP, PB, and SS) and the Department of Internal Medicine, Internal Medicine (PM-V), Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Fred
authors.initials: F
authors.lastname: Paccaud
authors.affiliation: From the Institute of Social and Preventive Medicine (A-LM, FP, PB, and SS) and the Department of Internal Medicine, Internal Medicine (PM-V), Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Bovet
authors.affiliation: From the Institute of Social and Preventive Medicine (A-LM, FP, PB, and SS) and the Department of Internal Medicine, Internal Medicine (PM-V), Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Stringhini
mesh_terms: D001938:Brazil; D002681:China; D004032:Diet; D004043:Dietary Fiber / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005227:Fatty Acids / Q000008:administration & dosage; D005229:Fatty Acids, Monounsaturated / Q000008:administration & dosage; D005231:Fatty Acids, Unsaturated / Q000008:administration & dosage; D005247:Feeding Behavior; D058870:Food, Organic; D005638:Fruit; D015438:Health Behavior; D006801:Humans; D007492:Iran; D018977:Micronutrients / Q000008:administration & dosage; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population; D014675:Vegetables
chemical_list: D004043:Dietary Fiber; D004044:Dietary Proteins; D005227:Fatty Acids; D005229:Fatty Acids, Monounsaturated; D005231:Fatty Acids, Unsaturated; D018977:Micronutrients
keywords: diet; diet patterns; education; income; low- and middle-income countries; nutrients; rural; socioeconomic status; urban