Socioeconomic Status and Diet Quality in Children With and Without Food Allergy

To explore the effect of socioeconomic status (SES) on diet quality in children with and without food allergy.Cross-sectional study of 173 children 2 to 19 years (92 children [53%] diagnosed with IgE-mediated food allergy) recruited from the general pediatric and allergy clinics in the Mount Sinai Health System in New York.Parents completed a 168-item food frequency questionnaire and daily nutrient intakes were quantified and converted into diet quality scores using the Diet Quality Index-International (DQI-I). Family SES was categorized as high if there was at least one parent with a bachelor’s degree or higher and a household income greater than $70,000. Multivariable linear regression analysis was performed to analyze the effect of SES and food allergy on DQI-I.High SES participants (n = 130) were more likely to be white (61.5% in high SES versus 18.2% in low SES) and to have a food allergy (63.1% versus 9.11%). There was a positive association between SES and DQI-I. High SES children scored higher on the DQI-I (P = .001) compared with low + SES. High SES also demonstrated higher diet variety (P = .006) and adequacy (P = .002) specifically with higher intake of vegetables, fruit, fiber, and vitamin C foods. There was no difference noted when examining the SES-to-diet quality relationship between children with or without food allergies.A positive association between SES and diet quality was demonstrated, with greater diet variety in those with higher SES. Investigators did not find significantly higher “balance” or “moderation” components in DQI-I in high SES. Having a food allergy did not change the SES-diet quality relationship, though there were few food-allergic children from low SES families in the cohort.This study reinforces that children from higher SES backgrounds have higher dietary variety and adequacy; however, dietary balance and moderation were poor regardless of SES status. Unfortunately, the sample size of food allergic children with low SES was very small, limiting conclusions in this population. The take home points for the clinician are (1) it is important to address dietary balance and moderation across the SES spectrum, and (2) be particularly mindful of access to nutritious, safe alternatives for food allergic children from low SES backgrounds who may have more barriers to dietary variety. More studies are needed, in a larger sample of the low SES food allergic population, to better understand where barriers exist and solutions for dietary adequacy.