Effect of dietary counselling on educational disparities in cardiometabolic health from childhood to adulthood

AIM: We examined whether parental education was associated with long-term cardiometabolic health and whether the effectiveness of a dietary counselling intervention differed by parental education level, hypothesizing greater effectiveness among highly educated families. METHODS: The study comprised 839 participants from the Special Turku Coronary Risk Factor Intervention Project (STRIP), in which the intervention group (n=417) received individualized dietary counselling during 20 years, while the control group (n=422) received routine care. Parental education was categorized as low, average, or high at study baseline. Outcomes were assessed repeatedly over 26 years and included dietary intakes, adiposity and metabolic regulation, lipid profile, and blood pressure. Mixed-effects regression models tested the main effects of education and education-by-intervention interactions on outcome trajectories. RESULTS: Higher parental education was associated with higher intake of dietary fiber and lower intake of saturated fatty acids throughout adolescence and early adulthood, as well as with more favourable body-mass index (22.5 vs. 24.2 kg/m2 in the high versus low education groups), homeostatic model assessment of insulin resistance (HOMA-IR; 1.6 vs. 1.8, respectively), and high-density lipoprotein cholesterol levels (1.4 vs. 1.3 mmol/L) in adulthood. No significant associations were observed for other lipid outcomes or blood pressure. No consistent education-by-intervention interactions were observed for the dietary and cardiometabolic trajectories (interaction p-values > 0.05, except isolated findings for dietary cholesterol and systolic blood pressure). Sensitivity analyses with parental occupational status replicated these findings. CONCLUSIONS: Contrary to the study hypothesis, this study suggests no differential effects of the intervention across educational groups.