Gender differences in perceived food health and food avoidance in a Swedish population survey: a cross-sectional study (2024)

Background

The aim of this work was to investigate potential gender differences in perceived food health and food avoidance in a population-representative sample of the Swedish adult population.

Methods

A diet and health questionnaire was sent to 2000 randomly selected residents of Sweden between the ages of 20 and 65. Questions were asked about which foods or food components participants avoided due to perceived unhealthiness and how healthy they thought the foods were. The pre-specified food components include sugar, carbohydrates, gluten, lactose, dairy products, fat, saturated fat, red meat, white flour, salt, alcohol and food additives (particularly glutamate, sweeteners, preservatives and colourants). Chi-square tests were used to examine differences in perceived food healthiness and food avoidance depending on gender.

Results

About 50% reported avoiding sugar (51.6%) and sweeteners (45.2%), while fewer reported avoiding saturated fat (16.8%) and salt (10.6%). Women were more likely than men to avoid gluten (AOR [95% CI] 2.84 [1.33–6.05]), red meat (3.29 [1.86–5.80]), white flour (2.64 [1.65–4.21]), preservatives (1.7 [1.65–4.21]). 1.07–2.70]) and dyes (2.10 [1.29–3.41]) due to perceived unhealthiness. Gender differences were also evident in the perceived healthfulness of sugar, gluten, dairy products, red meat, white flour, alcohol and food additives, with women tending to be more negative than men in their attitudes. Women more often read new results in the media about nutrition (16% versus 9%,S= 0.029) and prioritizing a healthy lifestyle (35% vs. 25%,S= 0.015). More than a third of both women and men reported being concerned about the health of their diet, and a greater proportion of women than men (18% vs. 11%,S= 0.015) agreed with the statement that they often worried about an unhealthy diet.

Conclusions

Women in this population-based study of residents of Sweden were more likely than men to avoid eating gluten, red meat, white flour and food additives due to perceived unhealthiness, and reported more diet- and health-related fears. Future research to identify effective ways to promote healthy eating for both women and men, while minimizing diet-related anxiety, is highly warranted.

Nutrition is an important lifestyle determinant of health. Improving dietary habits by reducing sodium intake and increasing intake of whole grains and fruits can significantly reduce both morbidity and mortality from non-communicable diseases.1]. Furthermore, limiting the intake of sugar and saturated fatty acids and increasing the intake of fiber and unsaturated fatty acids is also beneficial to public health [2]. Women generally report a healthier diet than men [3,4,5], which could partly explain why female mortality is lower [6]. A 2011 national Swedish survey found that women reported higher intake of fruits, berries, vegetables, water, tea, sweets and desserts. Men reported higher intakes of potatoes, bread, pasta, pizza, cake, red meat, sausages, coffee, soft drinks, lemonade, energy and sports drinks and alcohol [4].

Because a diet consistent with current evidence-based guidelines reduces the risk of all-cause and specific-cause mortality [1,2] – to an even greater extent among men than among women, according to a Swedish study [5] – it is important to study the factors that determine dietary intake. A multinational study with participants from 23 countries showed that women attach more importance to healthy eating than men and that health beliefs explain a large part of dietary behavior.7]. Finnish research has also shown gender differences in health information behavior, as women are more interested in and actively seek out health-related information than men. Moreover, women are more aware than men of how the goods they buy in daily life affect their health.8]. Because health beliefs related to food likely contribute to dietary intake, greater knowledge about gender differences in health and food avoidance can help facilitate public health initiatives to promote healthy eating among both women and men. However, little is known about gender differences in health beliefs or food avoidance for specific foods. The aim of this study was to compare perceived food health and food avoidance among women and men using a population-representative sample of residents of Sweden.

Study design

A questionnaire was sent by email to 2,000 people in January and February 2017. The study and the representativeness of the participants have been described previously [9]. The potential participants were randomly selected from the Swedish Population Register, which contains the addresses of all persons registered as residents of Sweden. Participants from all parts of Sweden, aged 20–65 years, were eligible. This age group was chosen to primarily recruit participants with autonomy over their nutritional intake. The exclusion criteria were classified personal information or residents who did not have a registered Swedish address. This study was approved by the regional ethics committee in Gothenburg, Sweden. All participants were informed that returning the answered questionnaire was considered informed consent to participate in the study. All questionnaires were completely anonymous and the data could not be traced back to individual participants. So no reminders were sent.

Data collection

The questionnaire was six pages long and took approximately 10 to 15 minutes to complete. The questionnaire included questions about demographic variables, general health, perceived healthiness of food, and statements about diet and health. The questionnaire was tested for clarity in a convenience sample of 10 participants across a broad age range, and only minor adjustments were made to the language and age ranges. Questionnaires with more than 20% missing data were excluded from the analyses. Additionally, participants with a non-binary gender identity were excluded from the current analyses.

The demographic data collected included gender, age, income, education and employment. The health data collected included self-reported weight and height, illness or food intolerance. Questions were asked about the avoidance and perceived healthiness of specific foods or food ingredients for sugar, carbohydrates, fat, saturated fat, alcohol, red meat, dairy products, white flour, salt, gluten, lactose and food additives (E numbers, sweeteners). , preservatives and colorants). These dietary components were chosen because they are often mentioned in connection with healthy eating, both in dietary recommendations and nutritional practices (e.g., clean eating, anti-inflammatory diets, etc.). Questions were formulated as“Which of the following food components do you avoid because you consider it unhealthy?”In"What is your perception of the following nutritional components?".Options werevery unhealthy, partly unhealthy, partly healthy, very healthy or no opinion. Participants were also asked to agree or disagree with the following statements about health and nutrition:I am interested in nutrition, I often read new findings about nutrition in the media, A healthy lifestyle is important to me, I am afraid that my diet is unhealthy, and I am often afraid that the diet is unhealthy. The choices werecompletely agree, partially agree, partially disagree, completely disagree or no opinion. This article complies with the STROBE reporting format (Supplementary file1).

Statistical analysis

Median and quartiles 1–3 (Q1–Q3) and N (%) are used for continuous and categorical data, respectively. Gender differences in sociodemographic characteristics and in avoidance of certain foods or food components were examined using chi-square tests for categorical data and Mann-Whitney U tests for continuous variables. To check for potential confounders, a sensitivity analysis of food avoidance was also performed using multivariable logistic regression analysis (avoidance: no=0, yes=1), adjusting for age, education, income and employment. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) are presented from these analyses. Gender differences in the perceived healthiness of foods and agreement with nutrition and health claims were examined using chi-square tests. The statistical software SPSS 22.0 (Armonk, New York: IBM Corp.) was used for all analyses. The meaning was accepted onS< 0,05.

The sample size was based on recruiting a representative sample of the population, assuming a margin of error of 5% and a confidence interval of 95%, which would require 385 respondents. Assuming a response rate of 20%, questionnaires were sent to 2000 people.

A total of 561 questionnaires were answered, bringing the response rate to 28% (Fig.1). A total of seven questionnaires were excluded because the missing data threshold was exceeded (N= 6) or non-binary gender identity (N= 1), and the total number of included participants was 554. In total, 55% of the included participants were women. A total of 17% (N= 90) reported having a food allergy or intolerance with no clear differences between genders (Table1).

Perceived food health

The proportions of participants who consider foods or food components to be unhealthy can be seen in the table2. The most common food ingredients considered 'very unhealthy' were sugar (53%), sweeteners (51%), colors (43%), alcohol (41%), preservatives (33%) and saturated fat (29%) . ) and white flour (26%). There were gender differences in perceived health, as women rated the food components sugar, gluten, dairy products, red meat, white flour, alcohol and food additives as less healthy than men.

Avoidance of food

The proportion of reported avoidance of foods or food components was as follows; 52% for sugar, 45% for sweeteners, 25% for white flour, 22% for alcohol, 22% for preservatives, 22% for colorings, 17% for saturated fat, 17% for red meat, 11% for fat, 11% for salt, 9% for gluten, 9% for lactose and 6% for dairy products (fig.2). When subjects with self-reported celiac disease, lactose intolerance or cow's milk allergy were excluded from the respective analyses, 7% still avoided gluten, 3% lactose and 5% dairy. Women were two to three times more likely than men to eat gluten (AOR [95% CI] 2.84 [1.33–6.05]), red meat (3.29 [1.86–5.80]), white flour (2.64 [1.65–4.21]), to be avoided. preservative (1.70 [1.07–2.70]) and colorants (2.10 [1.29–3.41]) due to perceived unhealthiness (Table3). When subjects with self-reported celiac disease were excluded from the respective analyses, the proportion avoiding gluten was still higher among women than among men (9% vs. 4%,S= 0,020).

Interest and fear about nutrition and health

A greater proportion of women than men reported that they often read nutritional results in the media (16% vs. 9%,S= 0.029) and found a healthy lifestyle important (35% vs. 25%,S= 0.015). More than a third of both women and men say they are concerned about the health of their diet, but a greater proportion of women than men say they are concerned that their diet is unhealthy (3% vs. 0%,S= 0.015) (table4).

The results of this study show that differences exist between men and women in Sweden in perceived food health and food avoidance. Overall, women reported more negative health perceptions of sugar, gluten, dairy products, red meat, white flour, alcohol and food additives. In addition, women were more likely to avoid gluten, red meat, white flour and food additives. Women also reported more anxiety related to food and health.

We found that there are gender differences in the perceived healthiness of food, which influences dietary behavior. Previous research shows that women focus on the nutritional value of food [10] and prioritize healthy eating [7] more than men. We found that the foods or food ingredients most often considered 'very unhealthy' and avoided were sugar, food additives, alcohol, saturated fat and white flour. This is consistent with previous findings that women view sweet foods as less healthy [11] and avoid the consumption of fatty foods to a greater extent [7], compared to men. A 2016 Swedish national survey found that women perceive the risk of becoming ill from harmful substances such as chemicals in their diet to be higher than men [12]. This could at least partially explain why women had a more negative view of food additives such as sweeteners, colorings and preservatives. Although all approved food additives are considered safe for human consumption, our results suggest that there is widespread concern about the health effects of these substances.

It is notable that both women and men (but women more than men) had more negative attitudes towards food additives than towards established dietary risk factors such as salt, saturated fat and alcohol. This may be due to the past year's trend towards 'clean' eating [13], which refers to the consumption of whole, unprocessed foods and sometimes the elimination of entire food groups (e.g., dairy, sugar, or gluten) [14]. Although it is considered healthy by many [14] 'clean eating' does not guarantee a high-quality diet [15] and may be associated with eating disorders [16]. Because women's dietary behavior appears to be influenced by perceived health to a greater extent than men's, and is more likely to change over time [17] – diet mom can have a greater influence on women's diets. Previous findings from the current research project showed that women were actually more likely than men to follow a specific diet and try to lose weight [9]. This may also reflect women's greater tendency to be influenced by diet fads and trends. The specific diet, or foods or food components avoided, is likely to vary over time, but this needs to be verified in longitudinal studies.

The sex differences observed in the current and previous studies could have significant public health implications. The results are consistent: women are more aware of their health than men – both in general [8] and in particular with regard to their diet [7]. This can have parallel effects, with women eating healthier than men, but also more concerned about body shape and diet-related anxieties. Perceived diet-related risks are assessed based on both emotional and cognitive considerations, in both women and men.18]. Thus, simply providing more information about nutrition and health is unlikely to eliminate gender differences in food perception and avoidance. More research is needed to identify effective ways to promote healthy eating for both women and men while minimizing diet-related anxiety.

Strengths and limitations

Strengths of the current study include the relatively high response rate (28%) for this type of study and that the study sample is considered representative of the population. We previously concluded that the sample appears representative of the general Swedish population in terms of overweight prevalence and income, while the level of education was slightly higher than that of the general Swedish population.9]. The ratios of women to men in the survey are 55 and 45%, indicating that women are somewhat over-represented (as the national gender distribution is 50% women and 50% men). Thus, there are small differences in the sociodemographics in this study sample compared to the general population. The study results are therefore likely to be generalizable to the Swedish population in the current age range. Limitations include a lack of detailed dietary intake data to verify that reported food avoidance was also reflected in actual diet. In addition, a number of statistical tests were conducted on various variables in this articleSvalues ​​should therefore be interpreted with caution. A further limitation is the pre-specified answers which may have limited the range of possible answers to the questions. Although free text options were available, they were not commonly used. Future studies should consider combining quantitative and qualitative approaches to shed light on the motivations for women's increased food avoidance.

Authors and affiliations

1. Institute of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Box 459, 40530, Gothenburg, Sweden

   Linnea Bärebring, Maria Palmqvist, Anna Winkvist and Hanna Augustin

Contribution

The study was designed by Linnea Bärebring, Hanna Augustin and Anna Winkvist. Data was collected by Linnea Bärebring and Maria Palmqvist and analyzed by Linnea Bärebring. Linnea Bärebring wrote the first draft of the article, but all authors contributed to writing the manuscript and approved the final version.

Corresponding author

Correspondence toLinnea Bärebring.

Ethical approval and consent to participate

This study was approved by the regional ethics committee in Gothenburg, Sweden (Dnr 976–16). All participants were informed that returning the answered questionnaire was considered informed consent to participate in the study. All questionnaires were completely anonymous and the data could not be traced back to individual participants.

Consent for publication

Not usable.

Competing interests

The authors declare that they have no competing interests.

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