Does diet quality explain socioeconomic difference in metabolic syndrome in French West Indies

Background: Obesity and metabolic diseases represent a major health burden in the Caribbean, particularly since a large part of the population is disadvantaged. However, socioeconomic inequalities in chronic diseases are poorly explored in this region, and the contribution of diet to explain these inequalities has not yet been studied. We investigated the association between socioeconomic position and the prevalence of metabolic syndrome (MetS), and explored whether this association was mediated by diet quality among adults in the French West Indies. Methods: This cross-sectional analysis included 1,144 subjects (≥16 y) from a multistage sampling survey conducted in 2013-2014 on a representative sample of the Guadeloupean and Martinican population. The prevalence of MetS was assessed using the Joint Interim Statement. Dietary intakes were estimated using 24 hours dietary recalls, and diet quality was assessed through the Diet Quality Index-International (DQI-I). Associations between socioeconomic indicators (education, employment status, social assistance benefits) and prevalence of MetS, and the potential mediating effect of diet quality in this association were assessed using multivariable logistic regression models, adjusted for location (Guadeloupe or Martinique), age, sex, single-parent household, presence of at least one child in the household and body mass index. Results: MetS prevalence adjusted for age and sex was 21% and 30% among Guadeloupean and Martinican, respectively. Compared to those with a high education level, low- and middle-educated subjects were more likely to be at risk of MetS (OR = 1.9; 95%CI = [1.0-3.6] and OR = 2.7; 95%CI = [1.4-5.1], respectively), as were recipients of social assistance benefits compared to non-recipients (OR = 2.2; 95%CI = [1.1-4.2]). The DQI-I explained 11% of the overall variation in MetS due to education. Conclusions: Socioeconomic inequalities in MetS prevalence, reflected by education and financial resources, were found in a Caribbean population. However, diet quality contributed only to socioeconomic inequalities due to education. Further prospective studies are now needed to improve our understanding of the mechanisms of social inequalities in MetS in a context of high poverty rates. Conflict of Interest: There is no conflict of interest