Browsing by Author "Kirkpatrick, Sharon I"

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    Socioeconomic inequities in diet quality among a nationally representative sample of adults living in Canada: an analysis of trends between 2004 and 2015
    (Oxford University Press, 2021-09-03) Olstad, Dana Lee; Nejatinamini, Sara; Victorino, Charlie; Kirkpatrick, Sharon I; Minaker, Leia M; McLaren, Lindsay
    Background: Socioeconomic inequities in diet quality are stable or widening in the US, however these trends have not been well characterized in other nations. Moreover, purpose-developed indices of inequities that can provide a more comprehensive and precise perspective of trends in absolute and relative dietary gaps and gradients using multiple indicators of socioeconomic position have not yet been used, and can inform strategies to narrow dietary inequities. Objective: We quantified nationally representative trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to three indicators of socioeconomic position among adults in Canada. Design: Adults (≥18 years) who participated in the nationally representative, cross-sectional Canadian Community Health Survey-Nutrition in 2004 (n=20,880) or 2015 (n=13,970) were included. Socioeconomic position was classified using household income (quintiles), education (five categories) and neighborhood deprivation (quintiles). Dietary intake data from 24-hour recalls were used to derive Healthy Eating Index-2015 (HEI-2015) scores. Dietary inequities were quantified using absolute and relative gaps (between most and least disadvantaged), and absolute (Slope Index of Inequality) and relative gradients (Relative Index of Inequality). Overall and sex-stratified multivariable linear regression and generalized linear models examined trends in HEI-2015 scores between 2004 and 2015. Results: Mean HEI-2015 scores improved from 55.3 to 59.0 (maximum 100); however, these trends were not consistently equitable. While inequities in HEI-2015 scores were stable in the total population and in females, the absolute gap [1.60 (95% CI 0.09, 3.10) to 4.27 (2.20, 6.34)] and gradient [SII=2.09 (0.45, 3.73) to SII=4.84 (2.49, 7.20)] in HEI-2015 scores for household income, and the absolute gradient for education [SII=8.06 (6.41, 9.71) to SII=10.52 (8.73, 12.31)], increased in males. Conclusions: Absolute and relative gaps and gradients in overall diet quality remained stable or widened between 2004 and 2015 among adults in Canada.
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    Stress-Related Poor Diet Quality Does Not Explain Socioeconomic Inequities in Health: A Structural Equation Mediation Analysis of Gender-Specific Pathways
    (Elsevier, 2021-10-07) Olstad, Dana Lee; Nejatinamini, Sara; Kirkpatrick, Sharon I; Vanderlee, Lana; Livingstone, Katherine M; Campbell, David J T; Tang, Karen; Minaker, Leia M; Hammond, David
    Psychosocial stress and diet quality individually mediate associations between socioeconomic position (SEP) and health; however, it is not known whether they jointly mediate these associations. This is an important question because stress-related unhealthy eating is often invoked as an explanation for diet-related health inequities, particularly among women, seemingly with no empirical justification. Objective: This study examined whether psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women and men. Design: Multiple mediating pathways were modeled using data from the cross-sectional International Food Policy Study. Participants and setting: Data were collected from 5,645 adults (aged 18 years or older) in Canada during 2018 and 2019. Main outcome measures: Participants reported SEP using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial pathways (subjective social status), along with psychosocial stress, dietary intake (to assess overall diet quality via Healthy Eating Index-2015 scores), and self-rated health. Statistical analyses performed: Structural equation modeling modeled pathways linking SEP (ie, educational attainment, perceived income adequacy, and subjective social status) with self-rated health mediated by psychosocial stress and diet quality, stratified by gender. Results: There was no evidence that psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women or men. Diet quality mediated associations between educational attainment and self-rated health in women and men, with some evidence that it mediated associations between subjective social status and self-rated health in men (P = 0.051). Psychosocial stress mediated associations between perceived income adequacy and self-rated health in women and men, and between subjective social status and self-rated health in women. Conclusions: Although often invoked as an explanation for diet-related health inequities, stress-related poor diet quality did not mediate associations between SEP and self-rated health in women or men. Psychosocial stress and diet quality individually mediated some of these associations, with some differences by gender.
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    The effect of different methods to identify, and scenarios used to address energy intake misestimation on dietary patterns derived by cluster analysis
    (2021-05-08) Siou, Geraldine L; Akawung, Alianu K; Solbak, Nathan M; McDonald, Kathryn L; Rajabi, Ala A; Whelan, Heather K; Kirkpatrick, Sharon I
    Abstract Background All self-reported dietary intake data are characterized by measurement error, and validation studies indicate that the estimation of energy intake (EI) is particularly affected. Methods Using self-reported food frequency and physical activity data from Alberta’s Tomorrow Project participants (n = 9847 men 16,241 women), we compared the revised-Goldberg and the predicted total energy expenditure methods in their ability to identify misreporters of EI. We also compared dietary patterns derived by k-means clustering under different scenarios where misreporters are included in the cluster analysis (Inclusion); excluded prior to completing the cluster analysis (ExBefore); excluded after completing the cluster analysis (ExAfter); and finally, excluded before the cluster analysis but added to the ExBefore cluster solution using the nearest neighbor method (InclusionNN). Results The predicted total energy expenditure method identified a significantly higher proportion of participants as EI misreporters compared to the revised-Goldberg method (50% vs. 47%, p < 0.0001). k-means cluster analysis identified 3 dietary patterns: Healthy, Meats/Pizza and Sweets/Dairy. Among both men and women, participants assigned to dietary patterns changed substantially between ExBefore and ExAfter and also between the Inclusion and InclusionNN scenarios (Hubert and Arabie’s adjusted Rand Index, Kappa and Cramer’s V statistics < 0.8). Conclusions Different scenarios used to account for EI misreporters influenced cluster analysis and hence the composition of the dietary patterns. Continued efforts are needed to explore and validate methods and their ability to identify and mitigate the impact of EI misestimation in nutritional epidemiology.