Clear differences in dietary intake have been reported in residents of urban compared to rural areas. This has been frequently reported in developing countries (Bowen et al, 2012) but also in the USA and Canada (Downs et al, 2012). Differences have been reported in children/adolescents as well as adults. However, little is known about any differences in the UK.

It has generally been shown that residents of rural areas have a poorer nutrient intake compared to residents of urban areas. In developed countries, the primary reason put forward to explain these differences is down to the the food environment whereby food is generally reported to be more expensive in rural communities, with less availability and variety. It is unlikely that families living in rural communities in the UK exclusively purchase food in their immediate suroundings and we hypothesise that there will be no obvious differences in dietary profile. However, differences have been reported in obesity levels in the UK in rural versus urban areas through secondary analyses of the Health Survey for Englanddary analyses of the Health Survey for nhtat dietary intake is a driverand it is possible that dietary intake is a driver in this, so warrants attention. In addition, previous studies examining areas of residence and dietary intake suffer from residual confounding; not taking into account familial factors such as socio-economic status.

Exposures:

We plan to use the Rural/Urban Definition (England and Wales), a detailed rural/urban indicator defined by the Rural Evidence Research Centre at Birkbeck College (RERC) based on 2001 Census data and will be derived from our address information. The use of this indicator will allow us to distinguish between rural and urban areas using eight categories: Urban, Town and Fringe, Village, Hamlet and Isolated Dwellings; each on two sparsity levels) to examine detailed rural and urban residential effects on dietary patterns.

Given the heavily urban-weighted spatial distribution of the ALSPAC cohort and the potential lack of geographical representation of data in more remote areas, we also request Output Area (from which the Rural/Urban Indicator is built) and Super Output Area (Lower & Middle) to permit analysis in the event of unsatisfactory statistical power at the preferred (OA) scale.

Outcomes:

At each time point (7, 10 and 13 years) we will examine differences in selected energy-adjusted macro- and micronutrients and food group intakes derived from diet diaries according to the divisons described above using t-tests/ANOVAs as appropriate and will use general linear models to adjust for a variety of potential confounding factors.

We will also examine any differences in the clusters of dietary patterns previously described (Northstone 2012). When examining effects at ages seven and thirteen, population changes will be used to assess the accuracy of using the 2001 data for earlier/later years and extrapolating data appropriately if necessary.

If possible (dependent on relevant numbers) we will determine whether any changes in rural/urban indicator lead to any changes in dietary intake over time in an attempt to infer causality.

References

Downs SM, Fraser SN, Storey KE, Forbes LE, Spence JC, Plotnikoff RC, Raine KD, Hanning RM, McCargar LJ. Geography influences dietary intake, physical acitivity and weight status of adolescents. Journal of Nutrition and Metabolism 2012; doi:10.1155/2012/816834.

Bowen L, Ebrahim S, De Stavola B, Ness A, Kinra S, Bharathi AV, Prabhakaran D, Reddy KS. Dietary Intake and Rural-Urban Migration in India: A Cross-Sectional Study. PLoS ONE 6(6):

e14822. doi:10.1371/journal.pone.0014822.

K Northstone, AD Smith, PK Newby, and P Emmett. Longitudinal comparisons of dietary patterns derived by cluster analysis in 7 to 13 year old children. Br J Nutr 2012; 15: 1-9.