The Relationship between Social Support and Diet Quality in Middle-Aged and Older Adults in the United States

Abstract

Background: Social support has been associated with physical and mental health; however, the relationship between social support and diet quality is not well understood.

Objective: The purpose of this research was to assess the relationship between social support and overall diet quality among US adults.

Design/participants: This study was a secondary analysis of data from adults aged 40 years and older who participated in the cross-sectional 2007-2008 National Health and Nutrition Examination Survey (N=3,243).

Main outcome measures: Social support was determined by a modification of the Rees Social Support Index (SSI), which is the sum of five dichotomized variables addressing emotional support, financial support, marital status, close friends, and religious service attendance. Overall diet quality was measured by the Healthy Eating Index-2010 (HEI-2010) and calculated from the mean of two 24-hour dietary recalls.

Statistical analyses performed: SAS survey procedures were used to incorporate the appropriate sample design weights. Unweighted frequencies are reported along with weighted means and standard errors (SE). Multivariable linear regression was used to compare the total HEI-2010 scores among the six SSI groups with additional models controlling for sex, age, race/ethnicity, income level, and education level, and stratifying by sex.

Results: In an unadjusted model, the mean total HEI-2010 score for those with an SSI score of 0 (n=37) was 50.0 (SE=2.83) compared to 57.1 (SE=0.89) for those with SSI score of 5 (n=676) (P<0.0001). The results were no longer statistically significant when adjusted for age, sex, race/ethnicity, income, and education level (P=0.14). However, when stratified by sex and adjusted for other demographics, higher SSI scores were associated with higher HEI-2010 scores compared to lower SSI scores in men (P=0.02), but there was no significant difference among SSI scores and HEI-2010 scores in women (P=0.43).

Conclusions: This study suggests a positive relationship between social support and overall diet quality among middle-aged and older men, but not women, in the United States.

Keywords: Americans; Diet quality; Healthy Eating Index-2010; National Health and Nutrition Examination Survey (NHANES); Social support.