The Educational Gradient in the Adherence to the Healthy Nordic Food Index Among Adult Men and Women in Tromsø: The Tromsø study 2015–2016

Background: There is a well-established relation between socioeconomic position (SEP) and diet. People with lower SEPs tend to eat high-calorie, low-nutrient foods, while those with a higher SEP tend to consume foods associated with better health. However, the underlying mechanisms are yet to be understood. Objective: To examine the association between education and the Healthy Nordic Food Index (HNFI) in men and women in Tromsø, and investigate the role of three intermediate variables: household income, subjective occupational social status, and self-rated health. Design: Dietary information from Food Frequency Questionnaires were used to construct the HNFI based on six food items and categorised as low, medium, and high adherence. Education and intermediate variables were self-reported. Multinomial logistic regression models stratified by sex were performed to assess the association between education and the HNFI among 8,610 women and 6,896 men aged 40–99 years. Results: Median intake of all food items increased across categories of the HNFI for all participants. High adherers to the HNFI were slightly older, more educated, had higher household income, perceived their occupational social status as high, and rated their health as good/excellent. We observed an educational gradient in the adherence to the HNFI where men (odds ratios [OR] TertiaryLong 1.92 [95% confidence intervals [CI] 1.47–2.5]) and women (OR TertiaryLong 2.35 [1.94–2.85]) with higher education had higher odds of adhering to the HNFI compared to those with primary education. Household income partly attenuated this gradient in men only. Conclusion: The association between education and adherence to the HNFI followed an educational gradient, which was partly attenuated by income in men but not in women. Our study highlights potential mechanisms underlying the relationship between education and diet. A deeper understanding of socioeconomic disparities in healthy eating is crucial for enhancing overall nutrition, especially among the socially disadvantaged.