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Nutrient intakes of different social-class groups: results from the Scottish Heart Health Study (SHHS)

Published online by Cambridge University Press:  09 March 2007

C. Bolton-Smith
Affiliation:
Cardiovascular Epidemiology Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY
W. C. S. Smith
Affiliation:
Cardiovascular Epidemiology Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY
M. Woodward
Affiliation:
Cardiovascular Epidemiology Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY
H. Tunstall-Pedoe
Affiliation:
Cardiovascular Epidemiology Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY
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Abstract

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Food frequency questionnaire and socio-demographic data were collected from over 10000 Scottish men and women aged 40–59 years in a cross-sectional study of coronary heart disease (CHD) risk factors. Dietary intake, including the antioxidant vitamins C and E and β-carotene, was assessed for different socio-economic groups. Trends in nutrient intakes were found with social-class (occupational) groups I–V. The non-manual-manual distinctions were clear even after standardizing for serum cotinine, and alternative classification by housing tenure and level of education did not confound the social-class effect. Total energy intake was significantly higher in the manual (men 10363 KJ, women 7507 KJ) than in the non-manual (men 9156 KJ, women 7169 KJ) groups, and all nutrient amounts except for vitamin C, vitamin E, β-carotene and fiber were significantly higher in the manual than the non-manual groups. Alcohol intake was lower in manual women, but higher in manual men compared with their respective non-manual groups. Sex and social-class differences were maintained after adjusting for total energy. Women in general, and manual women in particular, had the highest percentage energy from total fat (40.2) and saturated fat (18.2), while the percentage energy from polyunsaturated fat was lower in men than women, and lowest in manual men (4.4). The polyunsaturated: saturated fat (P:S) ratios were, for non-manual and manual men 0.32 and 0.31, and for non-manual and manual women 0.31 and 0.28. Fibre and antioxidant vitamin intakes, when expressed as nutrient densities, were lower in men than women, and lowest in manual men. Overall, men and women in manual occupations had a poorer-quality diet than did those in non-manual occupations. The coincident low P:S ratios and low antioxidant vitamin intakes in manual groups may contribute to an increased risk of CHD. Thus, the findings are compatible with the view that poor diet may be a contributory factor to the higher mortality rates for CHD which occur in the lower socio-economic groups.

Type
Nutrient Intake and Status
Copyright
Copyright © The Nutrition Society 1991

References

REFERENCES

Baker, I. A., Sweetnam, P. M., Yarnell, J. W. G., Bainton, D. & Elwood, P. C. (1988). Haemostatic and other risk factors for ischaemic heart disease and social class: evidence from the Caerphilly and Speedwell Studies. International Journal of Epidemiology 17, 759765.CrossRefGoogle ScholarPubMed
Barker, M. E., McClean, S. I., McKenna, P. G., Reid, N. G., Strain, J. J., Thompson, K. A., Williamson, A. P. & Wright, M. E. (1989). Diet, Lifestyle and Health in Northern Ireland. Coleraine: University of Ulster, Northern Ireland.Google Scholar
Bingham, S., McNeil, N. I. & Cummings, J. H. (1981). The diet of individuals: a study of a randomly-chosen cross section of British adults in a Cambridgeshire village. British Journal of Nutrition 45, 2335.CrossRefGoogle Scholar
Black, A. E., Wiles, S. J. & Paul, A. A. (1986). The nutrient intakes of pregnant and lactating mothers of good socio-economic status in Cambridge, U.K: some implications for recommended daily allowances of minor nutrients. British Journal of Nutrition 56, 5972.CrossRefGoogle Scholar
Bolton-Smith, C., Casey, C. E., Gey, K. F., Smith, W. C. S. & Tunstall-Pedoe, H. (1991). Antioxidant vitamin intakes assessed using a food-frequency questionnaire: correlation with biochemical status in smokers and non-smokers. British Journal of Nutrition 65, 337346.CrossRefGoogle ScholarPubMed
Bolton-Smith, C. & Milne, A. C. (1991). Food frequency ν. weighed intake data in Scottish men. Proceedings of the Nutrition Society (In the Press.)Google Scholar
Bolton-Smith, C., Smith, W. C. S., Woodward, M., Brown, C. A. & Tunstall-Pedoe, H. (1990 a). Dietary differences between social-class groups in the Scottish Heart Health Study. Proceedings of the Nutrition Society 49, 62A.Google Scholar
Bolton-Smith, C., Smith, W. C. S., Woodward, M. & Tunstall-Pedoe, H. (1990 b). Age trends in nutrient intakes for non-manual and manual occupational groups: the Scottish Heart Health Study. Proceedings of the Nutrition Society 49, 63A.Google Scholar
Braddon, F. E. M., Wadsworth, M. E. J., Davies, J. M. C. & Cripps, H. A. (1988). Social and regional differences in food and alcohol consumption and their measurement in a national birth cohort. Journal of Epidemiology and Community Health 42, 341349.CrossRefGoogle Scholar
Bull, N. L. & Buss, D. H. (1982). Biotin, pantothenic acid and vitamin E in the British household food supply. Human Nutrition: Applied Nutrition 36A, 190196.Google Scholar
Caerphilly and Speedwell Collaborative Group (1984). The Caerphilly and Speedwell Collaborative Study. Journal of Epidemiology and Community Health 38, 259262.CrossRefGoogle Scholar
Cameron, M. E. & Van Staveren, W. A. (1988). Manual on Methodology for Food Consumption Studies. New York: Oxford University Press.Google Scholar
Cox, B., Blaxter, M., Buckle, A. L. J., Fenner, N. P., Golding, J. F., Gore, M., Huppert, F. A., Nickson, J., Roth, M., Stark, J., Wadsworth, M. E. J. & Whichelow, M. (1987). The Health and Lifestyle Survey. London: Health Promotion Research Trust.Google Scholar
Crombie, I. K., Kenicer, M. B., Smith, W. C. S. & Tunstall-Pedoe, H. D. (1989). Unemployment, socio-environmental factors and coronary heart disease in Scotland. British Heart Journal 61, 172177.CrossRefGoogle Scholar
Duijkers, T. J., Kromhout, D., Spruit, I. P. & Doornbos, G. (1989). Inter-mediating risk factors in the relation between socioeconomic status and 25-year mortality (the Zutphen Study). International Journal of Epidemiology 18, 658662.CrossRefGoogle ScholarPubMed
Fehily, A. M., Phillips, K. M. & Yarnell, J. W. G. (1984). Diet, smoking, social class and body mass index in the Caerphilly Heart Disease Study. American Journal of Clinical Nutrition 40, 827833.CrossRefGoogle ScholarPubMed
Fulton, M., Thomson, M., Elton, R. A., Brown, S., Wood, D. A. & Oliver, M. F. (1988). Cigarette smoking, social class and nutrient intake: relevance to coronary heart disease. European Journal of Clinical Nutrition 42, 797803.Google ScholarPubMed
Gey, K. F., Puska, P., Jordan, P. & Moser, U. K. (1991). Inverse correlation between plasma vitamin E and mortality from ischaemic heart disease in cross-cultural epidemiology. American Journal of Clinical Nutrition 53, 52655345.CrossRefGoogle ScholarPubMed
Gordon, T., Kagan, A., Garcia-Palmieri, M., Kannel, W. B., Zukel, W. J., Tillotson, J., Sorlie, P. & Hjortland, M. (1981). Diet and its relation to coronary heart disease and death in three populations. Circulation 63, 500515.CrossRefGoogle ScholarPubMed
Gregory, J., Foster, K., Tyler, H. & Wiseman, M. (1990). The Dietary and Nutritional Survey of British Adults. London: H.M. Stationery Office.Google Scholar
Heller, R. F., Williams, H. & Sittampalam, Y. (1984). Social class and ischaemic heart disease: use of the male: female ratio to identify possible occupational hazards. Journal of Epidemiology and Community Health 38, 198202.CrossRefGoogle ScholarPubMed
Holme, I., Helgeland, A., Hjermann, I., Leren, P. & Lund-Larsen, P. G. (1981). Physical activity at work and leisure in relation to coronary risk factors and social class. Acta Medico Scandinavica 209, 277283.CrossRefGoogle ScholarPubMed
Inequalities in Health (1988). The Black Report and the Health Divide. London: Penguin Books.Google Scholar
Kaufmann, N. A., Kark, J. D., Friedlander, Y., Dennis, B. H., McClish, D. & Stein, Y. (1982). Nutrient intake in Jerusalem – effects of origin, social class and education. Israel Journal of Medical Sciences 18, 11981209.Google ScholarPubMed
Keys, A., Aravanis, C., Blackburn, H. W., van Buchem, F. S. P., Buzina, R., Djordjevic, B. S., Dontas, A. S., Fidanza, F., Karvonen, M. J., Kimura, N., Lekos, D., Monti, M., Puddu, V. & Taylor, H. L. (1967). Epidemiological studies related to coronary heart disease: characteristics of men aged 40–59 in seven countries. Acta Medico Scandinavica 460, Suppl.Google Scholar
Knight, I. (1984). The Heights and Weights of Adults in Great Britain. London: H.M. Stationery Office.Google Scholar
Kromhout, D. & Coulander, C. de L. (1984). Diet, prevalence and 10-year mortality from coronary heart disease in 871 middle-aged men. American Journal of Epidemiology 119, 733741.CrossRefGoogle ScholarPubMed
Kushi, L. H., Lew, R. A., Stare, F. J., Ellison, C. R., Lozy, M., Bourke, G., Daly, L., Graham, I., Hickey, N., Mulcahy, R. & Kevaney, J. (1985). Diet and 20-year mortality from coronary heart disease. New England Journal of Medicine 312, 811818.CrossRefGoogle ScholarPubMed
Lapidus, L., Andersson, H., Bengtsson, C. & Bosaeus, I. (1986). Dietary habits in relation to incidence of cardiovascular disease and death in women: a 12-year follow-up of participants in the population study of women in Gothenburg, Sweden. American Journal of Clinical Nutrition 44, 444448.CrossRefGoogle ScholarPubMed
Lewis, J. & Buss, D. H. (1988). Trace nutrients: minerals and vitamins in the British household food supply. British Journal of Nutrition 60, 413424.CrossRefGoogle ScholarPubMed
McDowall, M. E. (1983). Measuring women's occupational mortality. Population Trends 34, 25.Google Scholar
Marmot, M. G. & McDowall, M. E. (1986). Mortality decline and widening social inequalities. Lancet ii, 274276.CrossRefGoogle Scholar
Marmot, M. G., Rose, G., Shipley, M. & Hamilton, P. J. S. (1978). Employment grade and coronary heart disease in British civil servants. Journal of Epidemiology and Community Health 32, 244249.CrossRefGoogle ScholarPubMed
Marmot, M. G., Syme, S. L., Kagan, A., Kato, H., Cohen, J. B. & Belsky, J. (1975). Epidemiological studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: prevalence of coronary and hypertensive heart disease and associated risk factors. American Journal of Epidemiology 120, 514525.CrossRefGoogle Scholar
Ministry of Agriculture, Fisheries and Food (1986). Household Food Consumption and Expenditure: 1985. London: H.M. Stationery Office.Google Scholar
Ministry of Agriculture, Fisheries and Food (1987). Household Food Consumption and Expenditure: 1986. London: H.M. Stationery Office.Google Scholar
Morgan, M., Heller, R. F. & Swerdlaw, A. (1989). Changes in diet and coronary heart disease mortality among social classes in Great Britain. Journal of Epidemiology and Community Health 43, 162167.CrossRefGoogle ScholarPubMed
Morris, J. N., Marr, J. W. & Clayton, D. G. (1977). Diet and heart disease: a postscript. British Medical Journal ii, 13071314.CrossRefGoogle Scholar
Nelson, M., Black, A. E., Morris, J. A. & Cole, T. J. (1989). Between- and within-subject variation in nutrient intake from infancy to old age: estimating the number of days required to rank dietary intakes with desired precision. American Journal of Clinical Nutrition 50, 155167.CrossRefGoogle ScholarPubMed
Office of Populations, Censuses and Surveys (1980). Classification of Occupation. London: H.M. Stationery Office.Google Scholar
Paffenbarger, R. S., Hyde, R. T., Wing, A. L. & Steinmetz, C. H. (1984). A natural history of athleticism and cardiovascular health. Journal of the American Medical Association 252, 491495.CrossRefGoogle ScholarPubMed
Paul, A. A. & Southgate, D. A. T. (1978). McCance and Widdowson's Composition of Foods, 4th ed. London: H.M. Stationery Office.Google Scholar
Pocock, S. J., Shaper, A. G., Cook, D. G., Phillips, A. N. & Walker, M. (1987). Social class differences in ischaemic heart disease in British men. Lancet ii, 197201.CrossRefGoogle Scholar
Pooling Project Research Group (1978). Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: final report of the Pooling Project. Journal of Chronic Disease 31, 201306.CrossRefGoogle Scholar
Registrar General Scotland (1984). Economic Activity (10% Sample) Census 1981, Scotland. Edinburgh: H.M. Stationery Office.Google Scholar
Schofield, C., Wheeler, E. & Stewart, J. (1987). The diets of pregnant and post-pregnant women in different social-class groups in London and Edinburgh: energy, protein, fat and fibre. British Journal of Nutrition 58, 369381.CrossRefGoogle ScholarPubMed
Schofield, W. N. (1985). Predicting basal metabolic rate, new standards and review of previous work. Human Nutrition: Clinical Nutrition 39C, Suppl. 1, 541.Google Scholar
Shaper, A. G., Pocock, S. J., Walker, M., Cohen, N. M., Wale, C. J. & Thomson, A. G. (1981). British Regional Heart Study: Cardiovascular risk factors in middle-aged men in 24 towns. British Medical Journal 283, 179186.CrossRefGoogle ScholarPubMed
Smith, W. C. S., Crombie, I. K., Irving, J. M., Kenicer, M. B. & Tunstall-Pedoe, H. D. (1987). The Scottish Heart Health Study: objectives and development of methods. Health Bulletin 45, 211217.Google ScholarPubMed
Smith, W. C. S., Shewry, M. C., Tunstall-Pedoe, H., Crombie, I. K. & Tavendale, R. (1990). Cardiovascular disease in Edinburgh and North Glasgow - a tale of two cities. Journal of Clinical Epidemiology 43, 637643.CrossRefGoogle Scholar
Smith, W. C. S., Tunstall-Pedoe, H., Crombie, I. K. & Tavendale, R. (1989). Concomitants of excess coronary deaths – major risk factor and lifestyle findings from 10 359 men and women in the Scottish Heart Health Study. Scottish Medical Journal 34, 530555.CrossRefGoogle Scholar
SPSSx (1986). Users' Guide, 2nd ed. Chicago: Statistical Package for Social Sciences Inc.Google Scholar
Thomson, M., Fulton, M., Wood, D. A., Brown, S., Elton, R. A., Birtwistle, A. & Oliver, M. F. (1985). A comparison of the nutrient intake of some Scotsmen with dietary recommendations. Human Nutrition: Applied Nutrition 39A, 443455.Google Scholar
Tunstall-Pedoe, H., Smith, W. C. S. & Crombie, I. K. (1986). Levels and trends of coronary heart disease mortality in Scotland compared with some other countries. Health Bulletin 44, 153161.Google ScholarPubMed
Tunstall-Pedoe, H., Smith, W. C. S., Crombie, I. K. & Tavendale, R. (1989). Coronary risk factors and lifestyle variation across Scotland. Results from the Scottish Heart Health Study. Scottish Medical Journal 34, 556560.CrossRefGoogle ScholarPubMed
Uemura, K. & Pisa, Z. (1988). Trends in cardiovascular disease mortality in industrialised countries since 1950. World Health Statistics Quarterly 41, 155178.Google Scholar
Whichelow, M. J. (1989). Choice of spread by a random sample of the British population. European Journal of Clinical Nutrition 43, 110.Google ScholarPubMed
Willett, W. C., Sampson, L., Stampfer, M. J., Rosner, B., Bain, C., Witschi, J., Hennekens, C. H. & Speizer, F. E. (1985). Reproducibility and validity of a semi-quantitative food-frequency questionnaire. American Journal of Epidemiology 122, 5156.CrossRefGoogle Scholar
Yano, K., Rhoads, G. G., Kagan, A. & Tillotson, J. (1978). Dietary intake and the risk of coronary heart disease in Japanese men living in Hawaii. American Journal of Clinical Nutrition 31, 12701279.CrossRefGoogle ScholarPubMed
Yarnell, J. W. G., Fehily, A. M., Milbank, J. E., Sweetnam, P. M. & Walker, C. L. (1983). A short dietary questionnaire for use in an epidemiological survey: comparison with weighed dietary records. Human Nutrition: Applied Nutrition 37A, 103112.Google Scholar