Socioeconomic differences in food habits among 6- to 9-year-old children from 23 countries—WHO European Childhood Obesity Surveillance Initiative (COSI 2015/2017)

Anne Siri Fismen, Marta Buoncristiano, Julianne Williams, Arnfinn Helleve, Márta Bakacs, Ingunn Holden Bergh, Vesselka Duleva, Anna Fijałkowska, Andrea Gualtieri, Tatjana Hejgaard, Jolanda Hyska, Cecily C. Kelleher, Lene Kierkegaard, Enisa Kujundžić, Marie Kunešová, Sanja Musić Milanović, Paola Nardone, Eha Nurk, Sergej M. Ostojic, Ausra PetrauskieneIvo Rakovac, Ana Isabel Rito, Harry Rutter, Elena Sacchini, Dragana Stojisavljević, Victoria Farrugia Sant'Angelo, Lela Shengelia, Angela Spinelli, Igor Spiroski, Maya Tanrygulyyeva, Daniel Weghuber, João Breda

Research output: Contribution to journalArticlepeer-review

32 Citations (SciVal)


Background: Socioeconomic differences in children's food habits are a key public health concern. In order to inform policy makers, cross-country surveillance studies of dietary patterns across socioeconomic groups are required. The purpose of this study was to examine associations between socioeconomic status (SES) and children's food habits. Methods: The study was based on nationally representative data from children aged 6–9 years (n = 129,164) in 23 countries in the World Health Organization (WHO) European Region. Multivariate multilevel analyses were used to explore associations between children's food habits (consumption of fruit, vegetables, and sugar-containing soft drinks) and parental education, perceived family wealth and parental employment status. Results: Overall, the present study suggests that unhealthy food habits are associated with lower SES, particularly as assessed by parental education and family perceived wealth, but not parental employment status. We found cross-national and regional variation in associations between SES and food habits and differences in the extent to which the respective indicators of SES were related to children's diet. Conclusion: Socioeconomic differences in children's food habits exist in the majority of European and Asian countries examined in this study. The results are of relevance when addressing strategies, policy actions, and interventions targeting social inequalities in children's diets.

Original languageEnglish
Article numbere13211
JournalObesity Reviews
Issue numberS6
Early online date7 Jul 2021
Publication statusPublished - 30 Nov 2021

Bibliographical note

Funding Information:
The authors gratefully acknowledge support from a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs.

Funding Information:
The CO‐CREATE project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No. 774210.

Funding Information:
Data collection in the countries was made possible through funding from Albania: WHO through the Joint Programme on Children, Food Security and Nutrition “Reducing Malnutrition in Children,” funded by the Millennium Development Goals Achievement Fund, and the Institute of Public Health; Bulgaria: Ministry of Health, National Center of Public Health and Analyses, WHO Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health and WHO Regional Office for Europe; Czechia: Ministry of Health of the Czech Republic, grant nr. AZV MZČR 17‐31670 A and MZČ–VO EÚ 00023761; Denmark: Danish Ministry of Health; Georgia: WHO; Ireland: Health Service Executive; Italy: Ministry of Health and Italian National Institute of Health; Kazakhstan: Ministry of Health of the Republic of Kazakhstan and WHO Country Office; Kyrgyzstan: World Health Organization; Latvia: Ministry of Health, Centre for Disease Prevention and Control; Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and WHO; Malta: Ministry of Health; Montenegro: WHO and Institute of Public Health of Montenegro; Norway: Ministry of Health and Norwegian Institute of Public Health; Poland: National Health Programme, Ministry of Health; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS); Romania: Ministry of Health; Russian Federation: WHO; San Marino: Health Ministry, Educational Ministry; Serbia: This study was supported by the World Health Organization (Ref. File 2015‐540940); Spain: Spanish Agency for Food Safety and Nutrition (AESAN); Tajikistan: WHO Country Office in Tajikistan and Ministry of Health and Social Protection; Turkmenistan: WHO Country Office in Turkmenistan and Ministry of Health; Turkey: Turkish Ministry of Health and World Bank.


  • children
  • food habits
  • social inequalities
  • socioeconomic differences

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Public Health, Environmental and Occupational Health


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