Gender inequalities in diet quality and their socioeconomic patterning in a nutrition transition context in the Middle East and North Africa: a cross-sectional study in Tunisia.
Identifieur interne : 000267 ( PubMed/Curation ); précédent : 000266; suivant : 000268Gender inequalities in diet quality and their socioeconomic patterning in a nutrition transition context in the Middle East and North Africa: a cross-sectional study in Tunisia.
Auteurs : Mohamed Mehdi Abassi [Tunisie] ; Sonia Sassi [Tunisie] ; Jalila El Ati [Tunisie] ; Houda Ben Gharbia [Tunisie] ; Francis Delpeuch [France] ; Pierre Traissac [France]Source :
- Nutrition journal [ 1475-2891 ] ; 2019.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Adulte d'âge moyen (MeSH), Facteurs sexuels (MeSH), Facteurs socioéconomiques (MeSH), Femelle (MeSH), Humains (MeSH), Mâle (MeSH), Obésité (épidémiologie), Ration calorique (MeSH), Régime alimentaire (MeSH), Tunisie (épidémiologie), État nutritionnel (MeSH), Études transversales (MeSH).
- MESH :
- Wicri :
- geographic : Tunisie.
English descriptors
- KwdEn :
- MESH :
- geographic , epidemiology : Tunisia.
- epidemiology : Obesity.
- Adult, Cross-Sectional Studies, Diet, Diet, Healthy, Energy Intake, Female, Humans, Male, Middle Aged, Nutritional Status, Sex Factors, Socioeconomic Factors.
Abstract
BACKGROUND
In a context of nutrition transition and major shifts in lifestyle and diet, the Middle East and North Africa features a marked gender excess adiposity gap detrimental to women. In this setting, where gender issues are especially acute, we investigated gender differences in dietary intake with a focus on diet quality, and how the differences varied with the area of residence and socio-demographic characteristics.
METHODS
The study was conducted in 2009-2010 in the Greater Tunis region (Tunisia), as a case study of an advanced nutrition transition context in the region. A cross-sectional survey used a random, stratified, clustered sample of households: 1689 women and 930 men aged 20-49 years were analyzed. Dietary intake was assessed using a 3-day food record. Nutrient content was derived from a specific Tunisian food composition database. We analysed the Diet Quality Index-International (DQI-I) and sub-scores (variety, adequacy, moderation and balance). A score of DQI-I > 60 defined good diet quality. Inequality measures were women vs. men differences in means for interval variables and odds-ratios (OR) for DQI-I > 60. Their variation with socio-demographic characteristics was estimated using models featuring gender x covariate interactions.
RESULTS
Mean energy intake/day was 2300 ± 15 kcal for women vs. 2859 ± 32 kcal for men. By 1000 g/kcal/d women consumed more fruits and sweets but less red meat and soft drinks than men. Women had a higher mean moderation sub-score than men (+ 1.8[1.4, 2.2], P < 0.0001) but lower variety (- 2.0[- 2.3, - 1.6], P < 0.0001) and adequacy (- 1.8[- 2.0, - 1.5], P < 0.0001). Thus, the overall mean DQI-I was lower among women than men (58.6 ± 0.3 vs. 60.4 ± 0.3, - 1.8[- 2.6, - 1.0], P < 0.0001) as was the proportion of DQI-I > 60 (45.2% vs. 55.7%, OR = 0.7[0.5, 0.8], P < 0.0001). Adjusted gender differences in DQI-I decreased with age but were higher in larger households and extreme categories of education (no-schooling and university) vs. the middle categories.
CONCLUSION
In this nutrition transition context with only average diet quality, it was somewhat lower for women. Socioeconomic patterning of gender contrasts was mild. Beyond, that women had lower adequacy and variety scores but better moderation is a possible pathway for gender specific prevention messages.
DOI: 10.1186/s12937-019-0442-6
PubMed: 30898119
PubMed Central: PMC6427851
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Mehdi Abassi</name><affiliation wicri:level="1"><nlm:affiliation>Faculté des Sciences de Tunis, Université Tunis El Manar, 2092, Tunis, Tunisia.</nlm:affiliation><country xml:lang="fr">Tunisie</country><wicri:regionArea>Faculté des Sciences de Tunis, Université Tunis El Manar, 2092, Tunis</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:affiliation>INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, Tunis, Tunisia.</nlm:affiliation><country xml:lang="fr">Tunisie</country><wicri:regionArea>INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, Tunis</wicri:regionArea></affiliation></author><author><name sortKey="Sassi, Sonia" sort="Sassi, Sonia" uniqKey="Sassi S" first="Sonia" last="Sassi">Sonia Sassi</name><affiliation wicri:level="1"><nlm:affiliation>Faculté des Sciences de Tunis, Université Tunis El Manar, 2092, Tunis, Tunisia.</nlm:affiliation><country xml:lang="fr">Tunisie</country><wicri:regionArea>Faculté des Sciences de Tunis, Université Tunis El Manar, 2092, Tunis</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:affiliation>INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, Tunis, Tunisia.</nlm:affiliation><country xml:lang="fr">Tunisie</country><wicri:regionArea>INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, Tunis</wicri:regionArea></affiliation></author><author><name sortKey="El Ati, Jalila" sort="El Ati, Jalila" uniqKey="El Ati J" first="Jalila" last="El Ati">Jalila El Ati</name><affiliation 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(National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, Tunis</wicri:regionArea></affiliation></author><author><name sortKey="Delpeuch, Francis" sort="Delpeuch, Francis" uniqKey="Delpeuch F" first="Francis" last="Delpeuch">Francis Delpeuch</name><affiliation wicri:level="1"><nlm:affiliation>IRD (French Research Institute for Sustainable Development), NUTRIPASS Unit, IRD - Université de Montpellier - SupAgro Montpellier, 911 avenue Agropolis, 34394, Montpellier, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>IRD (French Research Institute for Sustainable Development), NUTRIPASS Unit, IRD - Université de Montpellier - SupAgro Montpellier, 911 avenue Agropolis, 34394, Montpellier</wicri:regionArea></affiliation></author><author><name sortKey="Traissac, Pierre" sort="Traissac, Pierre" uniqKey="Traissac P" first="Pierre" last="Traissac">Pierre Traissac</name><affiliation wicri:level="1"><nlm:affiliation>IRD (French Research Institute for Sustainable Development), NUTRIPASS Unit, IRD - Université de Montpellier - SupAgro Montpellier, 911 avenue Agropolis, 34394, Montpellier, France. pierre.traissac@ird.fr.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>IRD (French Research Institute for Sustainable Development), NUTRIPASS Unit, IRD - Université de Montpellier - SupAgro Montpellier, 911 avenue Agropolis, 34394, Montpellier</wicri:regionArea></affiliation></author></analytic><series><title level="j">Nutrition journal</title><idno type="eISSN">1475-2891</idno><imprint><date when="2019" type="published">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Cross-Sectional Studies (MeSH)</term><term>Diet (MeSH)</term><term>Diet, Healthy (MeSH)</term><term>Energy Intake (MeSH)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Nutritional Status (MeSH)</term><term>Obesity (epidemiology)</term><term>Sex Factors (MeSH)</term><term>Socioeconomic Factors (MeSH)</term><term>Tunisia (epidemiology)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Facteurs sexuels (MeSH)</term><term>Facteurs socioéconomiques (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Mâle (MeSH)</term><term>Obésité (épidémiologie)</term><term>Ration calorique (MeSH)</term><term>Régime alimentaire (MeSH)</term><term>Tunisie (épidémiologie)</term><term>État nutritionnel (MeSH)</term><term>Études transversales (MeSH)</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Tunisia</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Obesity</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Obésité</term><term>Tunisie</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Cross-Sectional Studies</term><term>Diet</term><term>Diet, Healthy</term><term>Energy Intake</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Nutritional Status</term><term>Sex Factors</term><term>Socioeconomic Factors</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Facteurs sexuels</term><term>Facteurs socioéconomiques</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Ration calorique</term><term>Régime alimentaire</term><term>État nutritionnel</term><term>Études transversales</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Tunisie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>In a context of nutrition transition and major shifts in lifestyle and diet, the Middle East and North Africa features a marked gender excess adiposity gap detrimental to women. In this setting, where gender issues are especially acute, we investigated gender differences in dietary intake with a focus on diet quality, and how the differences varied with the area of residence and socio-demographic characteristics.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>The study was conducted in 2009-2010 in the Greater Tunis region (Tunisia), as a case study of an advanced nutrition transition context in the region. A cross-sectional survey used a random, stratified, clustered sample of households: 1689 women and 930 men aged 20-49 years were analyzed. Dietary intake was assessed using a 3-day food record. Nutrient content was derived from a specific Tunisian food composition database. We analysed the Diet Quality Index-International (DQI-I) and sub-scores (variety, adequacy, moderation and balance). A score of DQI-I > 60 defined good diet quality. Inequality measures were women vs. men differences in means for interval variables and odds-ratios (OR) for DQI-I > 60. Their variation with socio-demographic characteristics was estimated using models featuring gender x covariate interactions.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Mean energy intake/day was 2300 ± 15 kcal for women vs. 2859 ± 32 kcal for men. By 1000 g/kcal/d women consumed more fruits and sweets but less red meat and soft drinks than men. Women had a higher mean moderation sub-score than men (+ 1.8[1.4, 2.2], P < 0.0001) but lower variety (- 2.0[- 2.3, - 1.6], P < 0.0001) and adequacy (- 1.8[- 2.0, - 1.5], P < 0.0001). Thus, the overall mean DQI-I was lower among women than men (58.6 ± 0.3 vs. 60.4 ± 0.3, - 1.8[- 2.6, - 1.0], P < 0.0001) as was the proportion of DQI-I > 60 (45.2% vs. 55.7%, OR = 0.7[0.5, 0.8], P < 0.0001). Adjusted gender differences in DQI-I decreased with age but were higher in larger households and extreme categories of education (no-schooling and university) vs. the middle categories.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>In this nutrition transition context with only average diet quality, it was somewhat lower for women. Socioeconomic patterning of gender contrasts was mild. Beyond, that women had lower adequacy and variety scores but better moderation is a possible pathway for gender specific prevention messages.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">30898119</PMID><DateCompleted><Year>2020</Year><Month>04</Month><Day>23</Day></DateCompleted><DateRevised><Year>2020</Year><Month>04</Month><Day>23</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1475-2891</ISSN><JournalIssue CitedMedium="Internet"><Volume>18</Volume><Issue>1</Issue><PubDate><Year>2019</Year><Month>03</Month><Day>21</Day></PubDate></JournalIssue><Title>Nutrition journal</Title><ISOAbbreviation>Nutr J</ISOAbbreviation></Journal><ArticleTitle>Gender inequalities in diet quality and their socioeconomic patterning in a nutrition transition context in the Middle East and North Africa: a cross-sectional study in Tunisia.</ArticleTitle><Pagination><MedlinePgn>18</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1186/s12937-019-0442-6</ELocationID><Abstract><AbstractText Label="BACKGROUND">In a context of nutrition transition and major shifts in lifestyle and diet, the Middle East and North Africa features a marked gender excess adiposity gap detrimental to women. In this setting, where gender issues are especially acute, we investigated gender differences in dietary intake with a focus on diet quality, and how the differences varied with the area of residence and socio-demographic characteristics.</AbstractText><AbstractText Label="METHODS">The study was conducted in 2009-2010 in the Greater Tunis region (Tunisia), as a case study of an advanced nutrition transition context in the region. A cross-sectional survey used a random, stratified, clustered sample of households: 1689 women and 930 men aged 20-49 years were analyzed. Dietary intake was assessed using a 3-day food record. Nutrient content was derived from a specific Tunisian food composition database. We analysed the Diet Quality Index-International (DQI-I) and sub-scores (variety, adequacy, moderation and balance). A score of DQI-I > 60 defined good diet quality. Inequality measures were women vs. men differences in means for interval variables and odds-ratios (OR) for DQI-I > 60. Their variation with socio-demographic characteristics was estimated using models featuring gender x covariate interactions.</AbstractText><AbstractText Label="RESULTS">Mean energy intake/day was 2300 ± 15 kcal for women vs. 2859 ± 32 kcal for men. By 1000 g/kcal/d women consumed more fruits and sweets but less red meat and soft drinks than men. Women had a higher mean moderation sub-score than men (+ 1.8[1.4, 2.2], P < 0.0001) but lower variety (- 2.0[- 2.3, - 1.6], P < 0.0001) and adequacy (- 1.8[- 2.0, - 1.5], P < 0.0001). Thus, the overall mean DQI-I was lower among women than men (58.6 ± 0.3 vs. 60.4 ± 0.3, - 1.8[- 2.6, - 1.0], P < 0.0001) as was the proportion of DQI-I > 60 (45.2% vs. 55.7%, OR = 0.7[0.5, 0.8], P < 0.0001). Adjusted gender differences in DQI-I decreased with age but were higher in larger households and extreme categories of education (no-schooling and university) vs. the middle categories.</AbstractText><AbstractText Label="CONCLUSION">In this nutrition transition context with only average diet quality, it was somewhat lower for women. Socioeconomic patterning of gender contrasts was mild. Beyond, that women had lower adequacy and variety scores but better moderation is a possible pathway for gender specific prevention messages.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Abassi</LastName><ForeName>Mohamed Mehdi</ForeName><Initials>MM</Initials><AffiliationInfo><Affiliation>Faculté des Sciences de Tunis, Université Tunis El Manar, 2092, Tunis, Tunisia.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, Tunis, Tunisia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sassi</LastName><ForeName>Sonia</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Faculté des Sciences de Tunis, Université Tunis El Manar, 2092, Tunis, Tunisia.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, Tunis, Tunisia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>El Ati</LastName><ForeName>Jalila</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, Tunis, Tunisia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ben Gharbia</LastName><ForeName>Houda</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, Tunis, Tunisia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Delpeuch</LastName><ForeName>Francis</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>IRD (French Research Institute for Sustainable Development), NUTRIPASS Unit, IRD - Université de Montpellier - SupAgro Montpellier, 911 avenue Agropolis, 34394, Montpellier, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Traissac</LastName><ForeName>Pierre</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>IRD (French Research Institute for Sustainable Development), NUTRIPASS Unit, IRD - Université de Montpellier - SupAgro Montpellier, 911 avenue Agropolis, 34394, Montpellier, France. pierre.traissac@ird.fr.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D003160">Comparative Study</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2019</Year><Month>03</Month><Day>21</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Nutr J</MedlineTA><NlmUniqueID>101152213</NlmUniqueID><ISSNLinking>1475-2891</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003430" MajorTopicYN="N">Cross-Sectional Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004032" MajorTopicYN="Y">Diet</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000072001" MajorTopicYN="Y">Diet, Healthy</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002149" MajorTopicYN="N">Energy Intake</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009752" MajorTopicYN="Y">Nutritional Status</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009765" MajorTopicYN="N">Obesity</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012737" MajorTopicYN="Y">Sex Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012959" MajorTopicYN="Y">Socioeconomic Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014416" MajorTopicYN="N" Type="Geographic">Tunisia</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">Diet Quality Index-International (DQI-I)</Keyword><Keyword MajorTopicYN="Y">Diet quality</Keyword><Keyword MajorTopicYN="Y">Gender inequality</Keyword><Keyword MajorTopicYN="Y">Middle East and North Africa</Keyword><Keyword MajorTopicYN="Y">Nutrition transition</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2018</Year><Month>12</Month><Day>03</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2019</Year><Month>03</Month><Day>04</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2019</Year><Month>3</Month><Day>23</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2019</Year><Month>3</Month><Day>23</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate 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