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Luongo G, Mah CL, Cahill LE, Hajizadeh M, Kennedy LJ, Wong H, Yi Y, Tarasuk V. The Relationship between Diet Costs and Dietary Adequacy: A Scoping Review of Measures and Methods with a Focus on Cost Estimation using Food Supply Data. J Nutr 2025; 155:788-803. [PMID: 39724962 PMCID: PMC11934247 DOI: 10.1016/j.tjnut.2024.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 11/28/2024] [Accepted: 12/13/2024] [Indexed: 12/28/2024] Open
Abstract
BACKGROUND "Diet cost" refers to a methodological approach developed by Drewnowski et al. to estimate individual daily diet costs, where cost vectors are derived by matching prices from food supply data to the food sources of reported intakes from dietary assessment tools. The dietary assessment method and food price collection approach have been found to vary diet cost estimates. There is a need to better understand how food supply prices might be better standardized and attached to price individuals' diets. OBJECTIVES To conduct a scoping review to examine Drewnowski's diet cost method, with a focus on a detailed description and charting of cost estimation measures and methods used to price individuals' consumed diets. METHODS Five databases were searched from the inception of each database to March 2023. Included articles comprised analyses of individual-level dietary assessment data matched to food prices to assign estimates of individual daily diet costs. RESULTS A total of 55 articles were included, published between 1999 and 2022 from 17 countries. In all studies, cost estimates were intended to be representative of price exposures among individual respondents' dietary assessment data. All studies derived cost estimates from separately collected food prices. 34 (62%) of included articles collected food prices from retail (supermarket) audits. A minority of studies (19, 35%) reported the number of food prices used to cost diets, and those varied widely, ranging from 57 to nearly 4600 distinct food prices per study. CONCLUSIONS In the absence of a standardized approach to study the relationship between diet costs and dietary adequacy, this scoping review has described methodological concepts and parameters used to price individuals' consumed diets. Our review shows that despite common arithmetic to calculate cost vectors, there is substantial variation in the methods used to select and attach prices from the food supply to self-reported dietary intake assessments.
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Affiliation(s)
- Gabriella Luongo
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Catherine L Mah
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leah E Cahill
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Laura J Kennedy
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Helen Wong
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yanqing Yi
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Valerie Tarasuk
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Russell C, Whelan J, Love P. Assessing the Cost of Healthy and Unhealthy Diets: A Systematic Review of Methods. Curr Nutr Rep 2022; 11:600-617. [PMID: 36083573 PMCID: PMC9461400 DOI: 10.1007/s13668-022-00428-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Poor diets are a leading risk factor for chronic disease globally. Research suggests healthy foods are often harder to access, more expensive, and of a lower quality in rural/remote or low-income/high minority areas. Food pricing studies are frequently undertaken to explore food affordability. We aimed to capture and summarise food environment costing methodologies used in both urban and rural settings. RECENT FINDINGS Our systematic review of high-income countries between 2006 and 2021 found 100 relevant food pricing studies. Most were conducted in the USA (n = 47) and Australia (n = 24), predominantly in urban areas (n = 74) and cross-sectional in design (n = 76). All described a data collection methodology, with just over half (n = 57) using a named instrument. The main purpose for studies was to monitor food pricing, predominantly using the 'food basket', followed by the Nutrition Environment Measures Survey for Stores (NEMS-S). Comparatively, the Healthy Diets Australian Standardised Affordability and Price (ASAP) instrument supplied data on relative affordability to household incomes. Future research would benefit from a universal instrument reflecting geographic and socio-cultural context and collecting longitudinal data to inform and evaluate initiatives targeting food affordability, availability, and accessibility.
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Affiliation(s)
- Cherie Russell
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
| | - Jillian Whelan
- School of Medicine, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Penelope Love
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Valluri S, French SA, Elbel B, Oakes JM, Rydell SA, Harnack LJ. Within- and Between-Household Variation in Food Expenditures Among Low-Income Households Using a Novel Simple Annotated Receipt Method. Front Nutr 2020; 7:582999. [PMID: 33195373 PMCID: PMC7642585 DOI: 10.3389/fnut.2020.582999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Household food purchasing behavior has gained interest as an intervention to improve nutrition and nutrition-associated outcomes. However, evaluating food expenditures is challenging in epidemiological studies. Assessment methods that are both valid and feasible for use among diverse, low-income populations are needed. We therefore developed a novel simple annotated receipt method to assess household food purchasing. First, we describe and evaluate the extent to which the method captures food purchasing information. We then evaluate within- and between-household variation in weekly food purchasing to determine sample sizes and the number of weeks of data needed to measure household food purchasing with adequate precision. Methods: Four weeks of food purchase receipt data were collected from 260 low-income households in the Minneapolis-St. Paul metropolitan area. The proportion of receipt line items that could not be coded into one of 11 food categories (unidentified) was calculated, and a zero-inflated negative binomial regression was used to evaluate the association between unidentified receipt items and participant characteristics and store type. Within- and between-household coefficients of variation were calculated for total food expenditures and several food categories. Results: A low proportion of receipt line items (1.6%) could not be coded into a food category and the incidence of unidentified items did not appreciably vary by participant characteristics. Weekly expenditures on foods high in added sugar had higher within- and between-household coefficients of variation than weekly fruit and vegetable expenditures. To estimate mean weekly food expenditures within 20% of the group's usual (“true”) expenditures, 72 households were required. Nine weeks of data were required to achieve an r = 0.90 between observed and usual weekly food expenditures. Conclusions: The simple annotated receipt method may be a feasible tool for use in assessing food expenditures of low-income, diverse populations. Within- and between-household coefficients of variation suggest that the number of weeks of data or group sizes required to precisely estimate usual household expenditures is higher for foods high in added sugar compared to fruits and vegetables.
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Affiliation(s)
- Sruthi Valluri
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States.,Medical Scientist Training Program, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Simone A French
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Brian Elbel
- School of Medicine and Wagner School of Public Service, New York University, New York, NY, United States
| | - J Michael Oakes
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Sarah A Rydell
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Lisa J Harnack
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
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Mackenbach JD, Dijkstra SC, Beulens JWJ, Seidell JC, Snijder MB, Stronks K, Monsivais P, Nicolaou M. Socioeconomic and ethnic differences in the relation between dietary costs and dietary quality: the HELIUS study. Nutr J 2019; 18:21. [PMID: 30922320 PMCID: PMC6440156 DOI: 10.1186/s12937-019-0445-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/20/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Healthier dietary patterns are generally more costly than less healthy patterns, but dietary costs may be more important for dietary quality in lower educated and ethnic minority groups. The aim of this study was to investigate the association between dietary costs and dietary quality and interactions with ethnicity and socioeconomic position (SEP). METHODS We used cross-sectional data from 4717 Dutch, Surinamese, Turkish and Moroccan origin participants of the multi-ethnic HELIUS study (the Netherlands), who completed an ethnic-specific food frequency questionnaire (FFQ). The primary outcome measure was dietary quality according to adherence to the Dutch Healthy Diet index 2015 (DHD15-index, range 0-130). Individual dietary costs (the monetary value attached to consumed diets in Euros) were estimated by merging a food price variable with the FFQ nutrient composition database. Regression analyses were used to examine main and interaction effects. Analyses were adjusted for age, sex, smoking, energy intake, physical activity, ethnicity and educational level. RESULTS Having higher dietary costs was associated with higher dietary quality. Analyses stratified by educational level showed that associations were stronger in higher educated (Btertile3 = 8.06, 95%CI = 5.63; 10.48) than in lower educated participants (Btertile3 = 5.09, 95%CI = 2.74; 7.44). Stratification by ethnic origin showed strongest associations in Turkish participants (Btertile2 = 9.31, 95%CI = 5.96; 12.65) and weakest associations in Moroccan participants (Btertile3 = 4.29, 95%CI = 0.58; 8.01). Regardless of their level of education, Turkish and Moroccan individuals consumed higher quality diets at the lowest cost than Dutch participants. CONCLUSIONS The importance of dietary costs for dietary quality differs between socioeconomic and ethnic subgroups. Increasing individual food budgets or decreasing food prices may be effective for the promotion of healthy diets, but differential effects across socioeconomic and ethnic subgroups may be expected.
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Affiliation(s)
- Joreintje D. Mackenbach
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, de Boelelaan 1117, Amsterdam, the Netherlands
| | - S. Coosje Dijkstra
- Department of Health Sciences, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, the Netherlands
| | - Joline W. J. Beulens
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, de Boelelaan 1117, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jacob C. Seidell
- Department of Health Sciences, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marieke B. Snijder
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, location AMC, Meibergdreef 9, Amsterdam, the Netherlands
| | - Karien Stronks
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, location AMC, Meibergdreef 9, Amsterdam, the Netherlands
| | - Pablo Monsivais
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, USA
| | - Mary Nicolaou
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, location AMC, Meibergdreef 9, Amsterdam, the Netherlands
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Healthy and sustainable diets that meet greenhouse gas emission reduction targets and are affordable for different income groups in the UK. Public Health Nutr 2019; 22:1503-1517. [PMID: 30782231 DOI: 10.1017/s1368980018003774] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To model dietary changes required to shift the UK population to diets that meet dietary recommendations for health, have lower greenhouse gas emissions (GHGE) and are affordable for different income groups. DESIGN Linear programming was used to create diets that meet dietary requirements for health and reduced GHGE (57 and 80 % targets) by income quintile, taking account of food budgets and foods currently purchased, thereby keeping dietary change to a minimum.Setting/ParticipantsNutrient composition, GHGE and price data were mapped to 101 food groups in household food purchase data (UK Living Cost and Food Survey (2013), 5144 households). RESULTS Current diets of all income quintiles had similar total GHGE, but the source of GHGE differed by types of meat and amount of fruit and vegetables. It was possible to create diets with a 57 % reduction in GHGE that met dietary and cost restraints in all income groups. In the optimised diets, the food sources of GHGE differed by income group due to the cost and keeping the level of deviation from current diets to a minimum. Broadly, the changes needed were similar across all groups; reducing animal-based products and increasing plant-based foods but varied by specific foods. CONCLUSIONS Healthy and lower-GHGE diets could be created in all income quintiles but tailoring changes to income groups to minimise deviation may make dietary changes more achievable. Specific attention must be given to make interventions and policies appropriate for all income groups.
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Pondor I, Gan WY, Appannah G. Higher Dietary Cost Is Associated with Higher Diet Quality: A Cross-Sectional Study among Selected Malaysian Adults. Nutrients 2017; 9:nu9091028. [PMID: 28926947 PMCID: PMC5622788 DOI: 10.3390/nu9091028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/06/2017] [Accepted: 09/13/2017] [Indexed: 11/16/2022] Open
Abstract
Food price is a determining factor of food choices; however its relationship with diet quality is unclear in Malaysia. This study aimed to examine socio-economic characteristics and daily dietary cost (DDC) in relation to diet quality in the state of Selangor, Malaysia. Dietary intake was assessed using a Food Frequency Questionnaire (FFQ) and diet quality was estimated using a Malaysian Healthy Eating Index (M-HEI). DDC in Malaysian Ringgit (RM) was calculated from dietary intake and national food prices. Linear regression models were fitted to determine associations between DDC and M-HEI scores and predictors of diet quality. The mean M-HEI score of respondents was 61.31 ± 10.88 and energy adjusted DDC was RM10.71/2000 kcal (USD 2.49). The highest quintile of adjusted DDC had higher M-HEI scores for all respondents (Q1: 57.14 ± 10.07 versus Q5: 63.26 ± 11.54, p = 0.001). There were also positive associations between DDC and M-HEI scores for fruits (p < 0.001) and vegetables (p = 0.017) for all respondents. Predictors of diet quality included carbohydrate (β = 0290; p < 0.001) and fat intakes (β = −0.242; p < 0.001) and energy adjusted DDC (β= 0.196; p < 0.001). Higher dietary cost is associated with healthy eating among Malaysian adults.
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Affiliation(s)
- Ibnteesam Pondor
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43300, Malaysia.
| | - Wan Ying Gan
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43300, Malaysia.
| | - Geeta Appannah
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43300, Malaysia.
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Accessibility and Affordability of Supermarkets: Associations With the DASH Diet. Am J Prev Med 2017; 53:55-62. [PMID: 28336352 PMCID: PMC5478361 DOI: 10.1016/j.amepre.2017.01.044] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/09/2016] [Accepted: 01/31/2017] [Indexed: 11/05/2022]
Abstract
INTRODUCTION It is unknown whether there is an interplay of affordability (economic accessibility) and proximity (geographic accessibility) of supermarkets in relation to having a Dietary Approaches to Stop Hypertension (DASH)-accordant diet. METHODS Data (collected: 2005-2015, analyzed: 2016) were from the cross-sectional, population-based Fenland Study cohort: 9,274 adults aged 29-64 years, living in Cambridgeshire, United Kingdom. Dietary quality was evaluated using an index of DASH dietary accordance, based on recorded consumption of foods and beverages in a validated 130-item, semi-quantitative food frequency questionnaire. DASH accordance was defined as a DASH score in the top quintile. Dietary costs (£/day) were estimated by attributing a food price variable to the foods consumed according to the questionnaire. Individuals were classified as having low-, medium-, or high-cost diets. Supermarket affordability was determined based on the cost of a 101-item market basket. Distances between home address to the nearest supermarket (geographic accessibility) and nearest economically-appropriate supermarket (economic accessibility) were divided into tertiles. RESULTS Higher-cost diets were more likely to be DASH-accordant. After adjustment for key demographics and exposure to other food outlets, individuals with lowest economic accessibility to supermarkets had lower odds of being DASH-accordant (OR=0.59, 95% CI=0.52, 0.68) than individuals with greatest economic accessibility. This association was stronger than with geographic accessibility alone (OR=0.85, 95% CI=0.74, 0.98). CONCLUSIONS Results suggest that geographic and economic access to food should be taken into account when considering approaches to promote adherence to healthy diets for the prevention of cardiovascular diseases and other chronic disease.
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Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev 2015; 73:643-60. [PMID: 26307238 PMCID: PMC4586446 DOI: 10.1093/nutrit/nuv027] [Citation(s) in RCA: 728] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
CONTEXT It is well established in the literature that healthier diets cost more than unhealthy diets. OBJECTIVE The aim of this review was to examine the contribution of food prices and diet cost to socioeconomic inequalities in diet quality. DATA SOURCES A systematic literature search of the PubMed, Google Scholar, and Web of Science databases was performed. STUDY SELECTION Publications linking food prices, dietary quality, and socioeconomic status were selected. DATA EXTRACTION Where possible, review conclusions were illustrated using a French national database of commonly consumed foods and their mean retail prices. DATA SYNTHESIS Foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. Food budgets in poverty were insufficient to ensure optimum diets. CONCLUSIONS Socioeconomic disparities in diet quality may be explained by the higher cost of healthy diets. Identifying food patterns that are nutrient rich, affordable, and appealing should be a priority to fight social inequalities in nutrition and health.
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Affiliation(s)
- Nicole Darmon
- N. Darmon is with the Unité Mixte de Recherche "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique 1260, Institut National de la Santé et de la Recherche Médicale 1062, Aix-Marseille Université, Marseille, France. A. Drewnowski is with the Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA.
| | - Adam Drewnowski
- N. Darmon is with the Unité Mixte de Recherche "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique 1260, Institut National de la Santé et de la Recherche Médicale 1062, Aix-Marseille Université, Marseille, France. A. Drewnowski is with the Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
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Marty L, Dubois C, Gaubard MS, Maidon A, Lesturgeon A, Gaigi H, Darmon N. Higher nutritional quality at no additional cost among low-income households: insights from food purchases of "positive deviants". Am J Clin Nutr 2015; 102:190-8. [PMID: 26016868 DOI: 10.3945/ajcn.114.104380] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 04/30/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is unknown whether diet quality is correlated with actual food expenditure. According to the positive deviance theory, the study of actual food expenditure by people with limited economic resources could help identify beneficial food-purchasing behavior. OBJECTIVES The aims were to investigate the relation between actual expenditure on food and nutritional quality and to identify "positive deviants" among low-income households. DESIGN Individuals in deprived social situations (n = 91) were recruited as part of the "Opticourses" nutrition intervention conducted in 2012-2014 in poor districts of Marseille, France. Opticourses participants collected food-purchase receipts for their household over a 1-mo period. "Actual diet costs" and "estimated diet costs" were calculated per 2000 kcal of food purchases by using actual expenditures and a standard food price database of food consumed by a representative sample of French adults, respectively. Mean adequacy ratio (MAR), mean excess ratio (MER), and energy density (ED) were used as nutritional quality indicators. "Positive deviants" were defined as having a higher MAR and a lower MER than the respective median values. RESULTS Opticourses participants selected less-expensive food options than the average French population, both within a food group and for a given food item. Higher diet costs were associated with higher nutritional quality (higher MAR, lower ED), regardless of whether costs were calculated from actual expenditure or on the basis of standard food prices. Twenty-one positive deviants were identified. They made significantly healthier purchases than did other participants (MAR: +13%; MER: -90%. ED: -22%) at higher estimated diet costs. Yet, they did not spend more on food (having the same actual diet costs), which showed that they purchased food with a higher nutritional quality for their price. CONCLUSION In this low-income population, actual diet cost was positively correlated with nutritional quality, yet the results showed that higher diet quality is not necessarily more costly when foods with higher nutritional quality for their price are selected. The Opticourses intervention was registered at clinicaltrials.gov as NCT02383875.
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Affiliation(s)
- Lucile Marty
- Unité Mixte de Recherche (UMR) "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique (INRA) 1260, Institut National de la Santé et de la Recherche Médicale (INSERM) 1062, University of Aix-Marseille, Marseille, France
| | - Christophe Dubois
- Unité Mixte de Recherche (UMR) "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique (INRA) 1260, Institut National de la Santé et de la Recherche Médicale (INSERM) 1062, University of Aix-Marseille, Marseille, France
| | - Malu S Gaubard
- Unité Mixte de Recherche (UMR) "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique (INRA) 1260, Institut National de la Santé et de la Recherche Médicale (INSERM) 1062, University of Aix-Marseille, Marseille, France
| | - Audrey Maidon
- Unité Mixte de Recherche (UMR) "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique (INRA) 1260, Institut National de la Santé et de la Recherche Médicale (INSERM) 1062, University of Aix-Marseille, Marseille, France
| | - Audrey Lesturgeon
- Unité Mixte de Recherche (UMR) "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique (INRA) 1260, Institut National de la Santé et de la Recherche Médicale (INSERM) 1062, University of Aix-Marseille, Marseille, France
| | - Hind Gaigi
- Unité Mixte de Recherche (UMR) "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique (INRA) 1260, Institut National de la Santé et de la Recherche Médicale (INSERM) 1062, University of Aix-Marseille, Marseille, France
| | - Nicole Darmon
- Unité Mixte de Recherche (UMR) "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique (INRA) 1260, Institut National de la Santé et de la Recherche Médicale (INSERM) 1062, University of Aix-Marseille, Marseille, France
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Morris MA, Hulme C, Clarke GP, Edwards KL, Cade JE. What is the cost of a healthy diet? Using diet data from the UK Women's Cohort Study. J Epidemiol Community Health 2014; 68:1043-9. [PMID: 25053614 DOI: 10.1136/jech-2014-204039] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A healthy diet is important to promote health and well-being while preventing chronic disease. However, the monetary cost of consuming such a diet can be a perceived barrier. This study will investigate the cost of consuming a range of dietary patterns. METHODS A cross-sectional analysis, where cost of diet was assigned to dietary intakes recorded using a Food Frequency Questionnaire. A mean daily diet cost was calculated for seven data-driven dietary patterns. These dietary patterns were given a healthiness score according to how well they comply with the UK Department of Health's Eatwell Plate guidelines. This study involved ∼35 000 women recruited in the 1990s into the UK Women's Cohort Study. RESULTS A significant positive association was observed between diet cost and healthiness of the diet (p for trend >0.001). The healthiest dietary pattern was double the price of the least healthy, £6.63/day and £3.29/day, respectively. Dietary diversity, described by the patterns, was also shown to be associated with increased cost. Those with higher education and a professional or managerial occupation were more likely to consume a healthier diet. CONCLUSIONS A healthy diet is more expensive to the consumer than a less healthy one. In order to promote health through diet and reduce potential inequalities in health, it seems sensible that healthier food choices should be made more accessible to all.
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Affiliation(s)
- Michelle A Morris
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Claire Hulme
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Kimberley L Edwards
- Centre for Sports Medicine, School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
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