Regional variations in diet in England

Despite countless studies and interventions globally, sub-optimal diet continues to account for more death and disease than physical inactivity, excessive alcohol consumption and smoking combined. Although the relationship between unhealthy diets and chronic diseases is a well-established fact globally, very few studies have truly investigated possible differences in dietary patterns across and within the regions of England. Research in this area has tended to focus on childhood obesity, the individual determinants of dietary choice, geographical access to healthy food choices, and general public health promotion campaigns such as ‘5-A-Day’. However, rather less attention has been placed on how diets vary geographically, beyond generally negative assessments of the ‘Scottish diet’. This project aimed to contribute to the literature by examining the extent to which fruit and vegetable consumption and dietary patterns vary at the regional and sub-regional level amongst persons aged 16-64 years in England.Data from the National Diet and Nutrition Survey (NDNS), 2008-2016 and the Health Survey for England (HSE), 2008-2016 were used to explore whether ‘regional diets’ are evident within England and to uncover small area level variations in diet. Two-way cross-classified multi-level modelling was used to model and explore the effect of region on fruit and vegetable consumption. Principal Components Analysis (PCA) was used to derive dietary patterns at the national level and for each of the nine regions of England. Thereafter, two-way cross-classified multi-level modelling was used to examine the effect of region on dietary patterns identified within the national sample. Small area microsimulation, specifically the Iterative Proportional Fitting (IPF) method, was used to explore possible variations in fruit and vegetable consumption across populations in Middle Layer Super Output Areas (MSOAs) in England. Overall, this project found no statistically significant differences in fruit and vegetable consumption and dietary patterns across the regions of England, but more variation across smaller areas (MSOAs), particularly in and around urban centres within the North of England and Midlands. It is expected that the results obtained from this project will contribute to ongoing research by enhancing the understanding of the dietary challenges facing the UK and more specifically, England. The findings presented could help to inform social and health policy as well as more localised interventions (such as voucher schemes and subsidies) aimed at improving the diets of individuals, especially among more disadvantaged groups