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Prev Med. 2013 Nov;57(5):488-93. doi: 10.1016/j.ypmed.2013.06.030. Epub 2013 Jul 9.

Differential association between adherence to nutritional recommendations and body weight status across educational levels: a cross-sectional study.

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  • 1Université Paris 13 Sorbonne Paris Cité UREN (Nutritional Epidemiology Research Unit) Inserm (U557), Inra (U1125), Cnam, CRNH IdF, SMBH, 74 rue Marcel Cachin, Bobigny, F-93017, France. Electronic address:



The impact of diet quality and physical activity (PA) on weight might be different according to socioeconomic status. Our aim was to estimate associations between adherence to nutritional guidelines and BMI and the interaction with socioeconomic characteristics.


A total of 11,931 men and 39,737 women from the NutriNet-Santé cohort (France, 2009-2012) were included in this cross-sectional analysis. The association between PNNS-GS (a score estimating adherence to French nutritional guidelines) and BMI was assessed by multivariate linear regression. A modified score (mPNNS-GS) separating diet quality from PA was also used.


BMI, overweight and obesity displayed an inverse gradient from less to more educated groups, whereas PNNS-GS increased. A higher PNNS-GS was associated with a lower BMI, more importantly in the less educated: BMI decrease ranged from -1.1% in less educated to -0.7% in more educated men and from -0.6% to -0.3% in women. The effect of mPNNS-GS and PA in particular was also stronger among less educated subjects.


Overall, better adherence to nutritional recommendations was inversely associated with BMI, and this association was stronger in the less educated groups. This suggests that nutritional policies should still concentrate on promoting access to a healthier diet and PA, especially among less educated individuals.

© 2013.


Anthropometry; BMI; Body weight; CI; Diet quality; Dietary score; Education; LCL; PA; PNNS-GS; Programme National Nutrition Santé — Guideline Score; SD; SES; UCL; body mass index; confidence interval; lower confidence limit; mPNNS-GS; modified Programme National Nutrition Santé — Guideline Score; physical activity; socioeconomic status; standard deviation; upper confidence limit

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