Association of socio-economic environment and women’s empowerment with daily fruit and vegetable intake in Latin American cities: A multilevel study

Abstract

Background In Latin America, a low proportion of the population meets the recommended fruit and vegetable (F&V) intake. The region is highly urbanized, with significant socioeconomic inequalities. The objective of this study was to analyze the association of the socio-economic environment (GDP per capita, living conditions) and women’s empowerment (WE) with daily F&V intake in adults from Latin American cities, and whether these associations vary by individual education. Methods Cross-sectional study using secondary data from the SALURBAL project (Urban Health in Latin America), which compiled data from health surveys, censuses, and other surveys from cities with≥100,000 inhabitants in 11 Latin American countries. The sample included 91,977 adults from 234 cities in 8 countries with self-reported F&V intake data. The outcome was daily F&V intake, defined as consuming F&V 7 days a week. City-level exposures included GDP per capita (tertiles), living conditions score (overcrowding, piped water, and education access; Z-scores), and WE score (labor force participation and early marriage; Z-scores). We estimated prevalence ratios (PR) for the asso‑ ciation between each exposure and daily F&V intake using gender-stratified two-level Poisson models with random intercepts for cities adjusted by city and individual-level covariates. Interaction terms were included to evaluate effectmodification by individual education. Results Participants from cities in the upper GDP tertiles (T2 and T3) showed a~7% higher prevalence of daily F&V intake among men (T2 PR=1.08, 95% CI: 1.00–1.15; T3 PR=1.06, 95% CI: 0.99–1.14) and women (T2 PR=1.07, 95% CI: 1.01–1.13; T3 PR=1.06, 95% CI: 0.99–1.12). A one standard deviation increase in WE and living conditions scores was associated with a~10% higher prevalence of daily F&V intake in men (WE PR=1.10, 95% CI: 1.02–1.19; living conditions PR=1.10, 95% CI: 1.04–1.16) and women (WE PR=1.11, 95% CI: 1.04–1.17; living conditions PR=1.10, 95% CI: 1.05–1.15). Individual education levels significantly modified these associations (p<0.05), which were stronger among those with lower educational attainment. Conclusions City GDP per capita, living conditions and WE were directly associated with fruit and vegetable daily intake, particularly among individuals with lower education levels in Latin America.