Consumer attitudes towards dietary behaviors: a mediator between socioeconomic status and diet quality in European adults.

Background: Socioeconomic disparities in dietary behaviors are well-known, but underlying mechanisms are not fully understood. We investigated whether consumer attitudes toward dietary behaviors mediate the relationship between socioeconomic factors and diet quality.

Methods: This analysis included 4051 adult participants from eight European countries of the I.Family study (2013/2014). Dietary intake was assessed using a food frequency questionnaire, and diet quality was measured by adherence to dietary recommendations using the Healthy Dietary Adherence Score. Socioeconomic factors included education, income, and social vulnerabilities (migrant background, experiencing unemployment in the household, single parenthood). Structural equation modeling was used to model pathways between predictors, outcome, and mediators, which also allowed for accounting of the clustered study design, incorporating random intercepts for country.

Results: Education and income were positively, and unemployment was negatively associated with diet quality. Attitudes reflecting favorable dietary behaviors were positively associated with diet quality, while unfavorable attitudes were inversely associated. Analysis of the path between socioeconomic factors and attitudes revealed a heterogeneous association pattern. Trusting food advertisements and frequently using ready-to-eat foods partially mediated the association between education, income, and diet quality. The association between single parenthood and diet quality was fully mediated by comparing food labels, valuing organic products, and using ready-to-eat foods.

Conclusion: Our findings suggest a mediating role of consumer attitudes in the association between socioeconomic factors and diet quality, but results were not consistent across socioeconomic factors. Our findings may inform the development of interventions and regulations promoting healthy diet, such as restricting food advertisments.