Social determinants of food group consumption based on Mediterranean diet pyramid: A cross-sectional study of university students

Economic, cultural, and social resources are known to contribute to the unequal distribution of health outcomes [1], and people with fewer economic resources have shorter life expectancies and suffer more illness than the wealthy [2]. Socioeconomic disparities have been shown to be associated with a greater level of all-cause mortality [3], and although treating current disease is an urgent priority, we should not disregard taking action on the underlying social determinants of health [4]. The literature has evidenced the importance of socioeconomic conditions on health and has demonstrated that socioeconomic adversity is a modifiable risk factor [5,6]. Diet and nutrition are important factors in the promotion and the maintenance of good health throughout the entire life course [7]. A healthy diet helps protect against malnutrition in all its forms as well as a range of noncommunicable diseases, including diabetes, heart disease, stroke and cancer [8]. However, diet is associated with individual, life-style, social, economic, and geographical factors, among others [9–14]. In other words, social and economic conditions can generate a social gradient in diet quality that contributes to health inequalities [2]. There is evidence showing that adverse childhood and adulthood socioeconomic status in older men is associated with poor diet quality [15]. In addition, most studies have shown that women follow a healthier dietary pattern than men [13,14,16–18], underlining differences in food habits. These inequalities in health–due to gender or material issues–are avoidable [4]; adequate policies could help counterbalance social and cultural behaviour. In terms of a healthy dietary pattern, Mediterranean diet meets requirements from various perspectives. Mediterranean diet is a healthy dietary pattern that may improve individual health and also obtain social and environmental benefits, among others [19,20], but there is a clear shift away from this food pattern [21]. The westernization of diets -increased intake of meat, fat, processed foods, sugar and salt- is also driven by socioeconomic factors, among other variables [22], and lower-quality diets -usually more economical- tend to be selected by groups of lower socioeconomic status [23]. University students are an important group for the promotion of healthy dietary patterns, because unhealthy lifestyles -including unhealthy diet- are shaped in youth [24–26], and bad habits can compromise health across one’s life. There are different determinants of eating behaviour in university students [27]: individual and environmental (physical, social and macro) factors, and even the characteristics of the university. The literature has reported that parental socioeconomic position is associated with children’s dietary patterns [14,28], showing that higher parental occupation and education level are associated with higher diet quality [29]. Geographical factors can also interact with others in a complex manner, shaping dietary patterns [8]. Furthermore, young adults usually exhibit bad eating behaviours during the transition from adolescence to adulthood, such as skipping meals (or irregular meal consumption) and frequent snacking, among others, compromising diet quality [30,31]. For this reason, an early intervention in youth through food and health policies could help to combat different social gaps and to reduce future economic burden on health systems. This work uses a sample of students that was used in an earlier work aiming to study the factors associated with an unhealthy diet [14]. That study analysed diet quality through the use of an index, while the current work has adopted a different approach, using new variables. The aim of this new study is dual. On the one hand, we investigate the level of compliance with the recommendations of the Mediterranean diet pyramid [32] based on individual food group consumption among university students according to social determinants, specifically gender, socioeconomic status, location of the family home, the degree course, and whether the students cook for themselves. On the other hand, we analyse how these social determinants and the interaction with gender may affect the consumption of different food groups, the aim being to illustrate problems related to the intake of these groups, and to encourage the elaboration of specific public policies in this regard.