Time to address the double inequality of differences in dietary intake between Scotland and England

Geographical disparities in health outcomes have been evident across the UK for decades. Recent analysis on the dietary differences between Scotland and England that might go some way to explain these health differences is limited. This study aimed to assess whether, and to what degree, aspects of diet and nutrition differ between Scottish and English populations, specifically between those with similar household incomes. A period of 12 years of UK food purchase data (2001-2012) were pooled and used to estimate household-level consumption data for Scotland and England. Population mean food consumption and nutrient intakes were estimated, adjusting for known confounders (year, age of household reference person, age they left full-time education and income). Comparison was also made within equivalised income quintiles. Analysis showed that the foods and nutrients that should be increased in the diet (highlighted in the Scottish Dietary Goals) were lower in Scotland than in England (e.g. fruit and vegetables 267 g/d; 99 % CI 259, 274 v. 298 g/d; 99 % CI 296, 301), P<0·001). Similarly, foods and drinks linked with poor health outcomes were higher in Scotland. These regional inequalities in diet were even more pronounced in the lower-income groups (e.g. red and processed meat consumption in the lowest-income quintile was 65 g/d; 99 % CI 61, 69 in Scotland v. 58 g/day; 99 % CI 57, 60 in England, P<0·001, but similar in the highest-income quintile (58 g/d; 99 % CI 54, 61 v. 59 g/d; 99 % CI 58, 60, respectively). A poorer diet in Scotland compared with England, particularly among disadvantaged groups, may contribute to differences in excess mortality between countries.