Less-energy-dense diets of low-income women in California are associated with higher energy-adjusted diet costs

Alzheimer's disease and Alzheimer's disease-related dementias in Hispanics: Identifying influential factors and supporting caregivers

Alzheimer's disease (AD) and Alzheimer's disease-related dementias (ADRD) are the primary public health concerns in the United States and around the globe. AD/ADRD are irreversible mental illnesses that primarily impair memory and thought processes and may lead to cognitive decline among older individuals. The prevalence of AD/ADRD is higher in Native Americans, followed by African Americans and Hispanics. Increasing evidence suggests that Hispanics are the fastest-growing ethnic population in the USA and worldwide. Hispanics develop clinical symptoms of AD/ADRD and other comorbidities nearly seven years earlier than non-Hispanic whites. The consequences of AD/ADRD can be challenging for patients, their families, and caregivers. There is a significant increase in the burden of illness, primarily affecting Hispanic/Latino families. This is partly due to their strong sense of duty towards family, and it is exacerbated by the inadequacy of healthcare and community services that are culturally and linguistically suitable and responsive to their needs. With an increasing age population, low socioeconomic status, low education, high genetic predisposition to age-related conditions, unique cultural habits, and social behaviors, Hispanic Americans face a higher risk of AD/ADRD than other racial/ethnic groups. Our article highlights the status of Hispanic older adults with AD/ADRD. We also discussed the intervention to improve the quality of life in Hispanic caregivers.

Dietary Costs among Midwestern Adult Food-Pantry Users by Food-Security Status

Evidence of the relationship between dietary cost, diet quality, and socio-economic status is mixed. No studies have directly evaluated food-security status and dietary cost. This study investigated whether food-pantry clients with low and very low food-security status had less expensive daily diets than food-secure clients by comparing total cost, cost per gram, and cost per calorie of total daily dietary intake both per person and by individual food item, followed by evaluations of each food group. Mixed-model regression and Tukey-Kramer comparisons were used to compare food-security groups. There was no clear association between food-security status and cost of daily diet. Analyzed per person, total price and price per gram showed significant differences between low food-secure and food-secure groups. When analyzing individual food items, prices per calorie were significantly different between food-secure and very low food-secure groups. The directionality of the relationships by food-security status was inconsistent. Per person, those with lower food security had lower mean prices, and for individual foods this association was reversed. Therefore, the metric of food cost and the unit of analysis are critical to determining the relationship between food-security status and dietary cost.

Assessing the Cost of Healthy and Unhealthy Diets: A Systematic Review of Methods

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.

Moderate and Severe Level of Food Insecurity Is Associated with High Calorie-Dense Food Consumption of Filipino Households

Food insecurity is often deeply rooted in poverty. Hence, accessibility and the quality of foods consumed may affect the dietary pattern. The study aims to assess the relationship between food insecurity and dietary consumption. This investigation analyzed the data from the 2015 Updating of Nutritional Nutrition Survey. The Household Food Insecurity Access Scale (HFIAS) was used to determine household food security status and the prevalence of food insecurity. Food weighing, food inventory, and food recall were the methods used to collect food consumption data of sampled households. The study revealed poor nutrient quality and a greater likelihood of inadequacy of nutrients among moderate and severe food insecure households. Mild, moderate, and severe levels of food insecurity were found to affect 12%, 32%, and 22% of the population, respectively. The test showed that both moderate and severe food insecure families have significantly lower mean consumption of meat, milk, and fats and oils in contrast to food secure households. In comparison with food secure households, moderate and severe food insecure households consume higher amounts of cereals and cereal products, rice, and vegetables. Moderate and severe food insecure households have higher consumption of total carbohydrates but have significantly lower average intake of vitamin A, riboflavin, niacin, and total fat related to food stable households. Moreover, the results of the multiple logistic regression revealed that food insecure households have a higher likelihood to be deficient in energy, protein, calcium, vitamin A, thiamin, riboflavin, niacin, and vitamin C intakes, but except for iron (p value <0.05). Indeed, household food insecurity was associated with the higher consumption of calorie-dense food among Filipino households. This explains a lower nutrient quality and a higher likelihood of inadequacy of nutrients among moderate and severe food insecure households.

Racial Differences in Dietary Relations to Cognitive Decline and Alzheimer's Disease Risk: Do We Know Enough?

The elderly population in the US is increasing and projected to be 44% minority by 2060. African Americans and Hispanics are at increased risk of cognitive impairment and Alzheimer’s disease compared to non-Hispanic whites. These conditions are associated with many other adverse health outcomes, lower quality of life, and substantial economic burden. In the past few decades, diet has been identified as an important modifiable risk factor for cognitive decline and Alzheimer’s disease. Some studies report poor diet quality among African American and Hispanic older adult populations compared to their white counterparts. We have a limited understanding of how diet affects brain health in different racial-ethnic groups. One primary reason for our lack of knowledge is that most cohort studies are of majority non-Hispanic white participants. Moreover, those that do include minority participants do not publish their findings stratified by racial-ethnic groups, and likely have a less accurate measurement of dietary intake among minority groups. In this review, we summarize the current, albeit limited, literature on racial/ethnic differences in dietary relations to dementia outcomes. We will also discuss methodological issues in conducting nutrition studies in diverse cultures, and suggestions for future research directions. Overcoming the gaps will make it possible to make dietary recommendations for Alzheimer’s prevention that are more relevant for different racial/ethnic groups and set us on a faster track to reduce health disparities.

Environmental, social, and economic factors related to the intersection of food security, dietary quality, and obesity: an introduction to a special issue of the Translational Behavioral Medicine journal

This special issue of Translational Behavioral Medicine solicited papers focusing on the intersection of food security, dietary quality, and obesity. Specifically, the special issue seeks to highlight research that provides actionable takeaways related to policy, systems, and environmental (PSE) approaches for practitioners and policymakers. The purpose of this introduction was to summarize relevant background literature and then briefly introduce topics covered by the articles included in the special issue. There are economic, environmental, and social factors that create systemic barriers that drive persistent poverty in communities and underlay the intersection of food security, dietary quality, and obesity. Although equitable healthful food access is needed, the issue is exceedingly complicated. Understanding and operationalizing effective and efficient PSE approaches is in its infancy. More research is needed to better understand how to appropriately measure determinants of health (and how they relate to the conditions that ultimately promote obesity through food insecurity and compromises to dietary quality), implement deliberate interventions that address the underlying factors, and disseminate that information to policymakers and practitioners in the field. This special issue of Translational Behavioral Medicine includes articles that relay practical findings, measurement methods, and lessons learned related to PSE approaches such as federal food assistance programs (e.g., National School Lunch Program), systems-based interventions (e.g., clinic-community connections), and environmental modifications(e.g., food retail marketing). Although much more practical and action-oriented research is needed in this area, these articles will contribute to the evidence base supporting better future assessment and PSE interventions that address food security, dietary quality, and obesity.

Longitudinal Associations between Monetary Value of the Diet, DASH Diet Score and the Allostatic Load among Middle-Aged Urban Adults

Lower cost can lead to poorer-quality diets, potentially worsening metabolic profiles. We explored these pathways among urban adults. Longitudinal data were extracted from 1224-1479 participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. DASH_(mean) (Dietary Approaches to Stop Hypertension) score was computed using four 24 h recalls (v1/v2: 2004-2013) linked with a national food price database to estimate monetary value of the diet [MVD_(mean)]. Allostatic load (AL) was measured at visits 2 (v2) and 3 (v3) in 2009-2018. Mixed-effects regression and structural equation modeling (SEM) were conducted, linking MVD_(mean)/DASH_(mean) to AL [v2 and annual change(v3-v2)] and exploring mediating pathways between MVD_(mean) and AL_(v3) through DASH_(mean), stratifying by sex, race and poverty status. MVD_(mean) tertiles were linearly associated with contemporaneous DASH_(mean), after energy adjustment. In mixed-effects regression models, DASH_(mean) was consistently linked to lower AL_(v2). DASH_(mean) and MVD_(mean) were positively associated with higher serum albumin_(v2). In SEM, MVD_(mean) was linked to AL_(v3) through DASH_(mean), mainly among Whites and specifically for the cholesterol and Waist-Hip-Ratio AL components. In summary, energy and other covariate-adjusted increase in MVD may have a sizeable impact on DASH which can reduce follow-up AL among urban White middle-aged adults. More studies are needed to replicate findings in comparable samples of urban adults.

Longitudinal change in the diet's monetary value is associated with its change in quality and micronutrient adequacy among urban adults

Background

Reducing diet costs may lead to the selection of energy-dense foods, such as refined grains or foods high in added sugars and/or fats, which can lower overall dietary quality. We examined the longitudinal association between the monetary value of the diet (MVD) and the overall dietary quality across sex, race and income groups.

Methods and findings

Longitudinal data from 1,466 adult urban participants from Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used. Healthy Eating Index–2010 (HEI–2010) and Mean Adequacy Ratio (MAR) were computed and a national food price database was used to estimate MVD. Multiple linear regression analyses were conducted linking annual rates of change (Δ) in MVD to ΔHEI-2010 and ΔMAR, stratifying by sex, race and income groups. Among key findings, ΔHEI-2010 was comparable across socio-demographic groups, while ΔMAR was higher among women and individuals above poverty. Adjusting for key covariates, ΔMVD was positively associated with both ΔHEI-2010 and ΔMAR, and with a consistently stronger association among individuals above poverty, specifically for the total proteins and empty calories components of HEI-2010 and several nutrient adequacy ratios (NARs: vitamins C, E, B-6 and Zinc). ΔMVD-ΔMAR association was stronger in women, mainly influenced by ΔMVD’s positive associations with B-vitamins, copper, calcium, magnesium and phosphorus NARs. ΔMVD-Δvitamin D NAR’s positive relationship was stronger among Whites, while ΔMVD-Δvitamin B-12 NAR’s association was stronger among African-Americans.

Conclusions

In sum, a potential increase in MVD may have a stronger impact on dietary quality among urban adult women and above-poverty individuals.

The Relative Costs of High- vs. Low-Energy-Density Foods and More vs. Less Healthful Beverages Consumed by Children

OBJECTIVE

To compare grocery costs between relatively high energy density foods and sugar-sweetened/high-fat beverages and lower energy density foods and more healthful beverages in children's diets.

METHODS

Sixty foods were divided into high and low energy density baskets. Fourteen beverages were designated to either basket based on fat and added-sugar content. Prices were collected at 60 grocery stores and composite costs compared between baskets using Wilcoxon tests.

RESULTS

The cost per kilogram of high energy density foods was greater, but the cost per quart of sugar-sweetened/high-fat beverages was lower than more healthful beverages. The cost per 1000 calories and the cost per serving of the high energy density basket were lower.

CONCLUSIONS

The relative cost of high and low energy density foods in children's diets depends on how cost is quantified. "Pound-for-pound," lower energy density foods and more healthful beverages are generally less expensive, but high energy density foods and less healthful beverages are cheaper per serving. Cost metrics including other factors (e.g. time cost) may further clarify the role of grocery prices in children's diets.

Identifying foods with good nutritional quality and price for the Opticourses intervention research project

Objective

People on a limited budget want to know the ‘good price’ of foods. Here we report the methodology used to produce an educational tool designed to help recognize foods with good nutritional quality and price, and assess the validity and relevancy of the tool.

Design

A ‘Good Price Booklet’ presenting a list of foods with good nutritional quality and price was constructed. The validity of the in-booklet prices was assessed by comparing them with prices actually paid by households from the Opticourses project. The relevancy of the booklet tool was assessed by semi-structured interviews with Opticourses participants.

Setting

Socio-economically disadvantaged neighbourhoods of Marseille, France.

Subjects

Ninety-one participants collected household food-purchase receipts over a 1-month period.

Results

Based on the French food database, foods with higher-than-median nutritional quality were identified. After grouping similar foods, 100 foods were selected and their corresponding in-booklet prices were derived based on the distribution of average national prices by food group. Household food purchases data revealed that of the 2386 purchases of foods listed in the booklet, 67·1 % were bought at prices lower than the in-booklet prices. Nineteen semi-structured interviews showed that participants understood the tool and most continued using it more than a month after the intervention.

Conclusions

A method was developed to ease the identification of foods with good nutritional quality and price. The Good Price Booklet is an effective tool to help guide people shopping on a low budget.

Nutritional correlates of monetary diet cost in young, middle-aged and older Japanese women

Studies in many Western countries have consistently shown that monetary diet cost is positively associated with diet quality, but this may not necessarily be the case in Japan. This cross-sectional study examined the nutritional correlates of monetary diet cost among 3963 young (all 18 years old), 3800 middle-aged (mean age 48 years) and 2211 older (mean age 74 years) Japanese women. Dietary intakes were assessed using a comprehensive self-administered diet history questionnaire for young and middle-aged women and a brief self-administered diet history questionnaire for older women. Monetary diet cost was estimated using retail food prices. Total vegetables, fish and shellfish, green and black tea, white rice, meat, fruit and alcoholic beverages contributed most (79–89 %) to inter-individual variation in monetary diet cost. Multiple regression analyses showed that monetary diet cost was negatively associated with carbohydrate intake, but positively with intakes of all other nutrients examined (including not only dietary fibre and key vitamins and minerals but also saturated fat and Na) in all generations. For food group intakes, irrespective of age, monetary diet cost was associated inversely with white rice and bread but positively with pulses, potatoes, fruit, total vegetables, fruit and vegetable juice, green and black tea, fish and shellfish, and meat. In conclusion, in all three generations of Japanese women and contrary to Western populations, monetary diet cost was positively associated with not only healthy dietary components (including fruits, vegetables, fish and shellfish, dietary fibre, and key vitamins and minerals), but also less healthy components (including saturated fat and Na).

Cooking at Home: A Strategy to Comply With U.S. Dietary Guidelines at No Extra Cost

INTRODUCTION

Cooking at home is associated with better diet quality. This study examined the frequency of home-cooked dinners versus eating out in relation to the Healthy Eating Index (HEI), and food expenditures.

METHODS

The Seattle Obesity Study used a stratified random sample of 437 King County adults. In-person computer-assisted interviews collected sociodemographic and behavioral data during 2011-2013. HEI-2010 and 2005 were computed using Food Frequency Questionnaires. Multivariable regression analyses, conducted in 2015, examined associations among HEI scores, food expenditures, and frequency of cooking at home versus eating out variables.

RESULTS

Frequent home-cooked dinners were associated with being married, unemployed, larger households, presence of children aged <12 years, and lower frequency of eating out, but unrelated to education or income. In adjusted models, frequent at-home cooking was associated with higher HEI-2010 (β=7.4, p<0.001), whereas frequent eating out was associated with lower HEI-2010 (β= -6.6, p<0.001). Frequent home cooking was linked with reduced per capita food expenditures overall ($330/month among low vs $273/month among high cooking group, p<0.001), and reduced away-from-home expenditures ($133 and $65, respectively), without any significant increase in at-home food expenditures. However, frequent eating out was associated with significantly higher per capita food expenditures overall ($261 in low vs $364 among high eating out group, p=0.001), and higher away-from-home expenditures.

CONCLUSIONS

Home-cooked dinners were associated with greater dietary guideline compliance, without significant increase in food expenditures. By contrast, frequent eating out was associated with higher expenditures and lower compliance. Home cooking may be a component of nutrition resilience.

How expensive is a cardioprotective diet? Analysis from the CRESSIDA study

OBJECTIVE

To determine whether a cardioprotective dietary intervention based on UK dietary guidelines was more expensive than a conventional UK diet.

DESIGN

Cost analysis of food records collected at baseline and after a 12-week dietary intervention of a cardioprotective diet v. conventional UK diet.

SETTING

A randomized controlled dietary intervention study (CRESSIDA; ISRCTN 92382106) investigating the impact of following a diet consistent with UK dietary guidelines on CVD risk.

SUBJECTS

Participants were healthy UK residents aged 40-70 years. A sub-sample of participants was randomly selected from those who completed the cardioprotective dietary intervention (n 20) or the conventional UK dietary intervention (n 20).

RESULTS

Baseline diet costs did not differ between groups; mean daily food cost for all participants was £6·12 (sd £1·83). The intervention diets were not more expensive: at end point the mean daily cost of the cardioprotective diet was £6·43 (sd £2·05) v. the control diet which was £6·53 (sd £1·53; P=0·86).

CONCLUSIONS

There was no evidence that consumption of a cardioprotective diet was more expensive than a conventional dietary pattern. Despite the perception that healthier foods are less affordable, these results suggest that cost may not be a barrier when modifying habitual intake and under tightly controlled trial conditions. The identification of specific food groups that may be a cost concern for individuals may be useful for tailoring interventions for CVD prevention for individuals and populations.

"Are you eating healthy?" Nutrition discourse in Midwestern clinics for the underserved

OBJECTIVE

To investigate nutrition information provided and exchanged between patients and health providers in Midwestern clinics for underserved populations.

METHODS

Forty-six clinic visits were observed to determine content and direction of nutrition information. In-depth data were collected with clinicians and clinic administrators regarding nutrition education provided to patients.

RESULTS

All patients were diagnosed with multiple obesity-related morbidities. Although women more often posed nutrition questions, few patients asked about dietary intake. Two-thirds of healthcare professionals initiated discussion about dietary intake; however, nutrition education was not provided regardless of clinician's profession.

CONCLUSIONS

Patients did not appear to link morbidity with diet. Providers did not share comprehensive nutrition knowledge during clinic visits. Dietitians, who specialize in nutrition education, rarely had access to patients.

IMPLICATIONS

Nutrition education during clinic visits is essential for reducing obesity rates. Nutrition students need clinic experience and could provide important patient education at low cost.

Preço dos alimentos no Brasil: prefira preparações culinárias a alimentos ultraprocessados

Resumo: Estudo com objetivo de descrever o preço dos grupos de alimentos consumidos no Brasil considerando a natureza, a extensão e o propósito de seu processamento. Dados provenientes da Pesquisa de Orçamentos Familiares de 2008-2009 foram utilizados. O preço médio dos grupos (in natura, ingredientes culinários, processados e ultraprocessados) e seus respectivos subgrupos de alimentos foram estimados para o Brasil segundo renda, região e área. Os produtos in natura e ingredientes culinários apresentaram menor preço por caloria quando comparado aos demais grupos, sugerindo uma vantagem econômica no preparo de refeições no lar em comparação a sua substituição por ultraprocessados. As famílias de maior nível econômico pagaram preço mais elevado por suas aquisições, enquanto as regiões Nordeste, Norte e a área rural pagaram os menores preços. Enquanto alimentos frescos (como carnes, leite, frutas e hortaliças) tendem a custar mais caro que alimentos ultraprocessados, grãos secos (como o arroz e o feijão) despontam como uma alternativa mais econômica para adoção de práticas alimentares saudáveis.

Did the 2009 American Recovery and Reinvestment Act affect dietary intake of low-income individuals?

This paper examines the relationship between increased Supplemental Nutritional Assistance Program (SNAP) benefits following the 2009 American Recovery and Reinvestment Act (ARRA) and the diet quality of individuals from SNAP-eligible compared to ineligible (those with somewhat higher income) households using data from the 2007-2010 National Health and Nutrition Examination Survey. The ARRA increased SNAP monthly benefits by 13.6% of the maximum allotment for a given household size, equivalent to an increase of $24 to $144 for one-to-eight person households respectively. In the full sample, we find that these increases in SNAP benefits are not associated with changes in nutrient intake and diet quality. However, among those with no more than a high school education, higher SNAP benefits are associated with a 46% increase in the mean caloric share from sugar-sweetened beverages (SSBs) and a decrease in overall diet quality especially for those at the lower end of the diet quality distribution, amounting to a 9% decline at the 25th percentile.

Monetary Value of Diet Is Associated with Dietary Quality and Nutrient Adequacy among Urban Adults, Differentially by Sex, Race and Poverty Status

OBJECTIVE

The association between monetary value of the diet (MVD, $/day) with dietary quality was examined using a large sample of urban US adults, differentially by socio-demographic factors.

METHODS

This was a cross-sectional study of 2,111 participants, aged 30-64y, using data from the Healthy Aging in Neighborhoods of Diversity across the Life Span Study. Dietary quality indices included Healthy Eating Index-2010 (HEI-2010) and Mean Adequacy Ratio (MAR), (two 24-hr recalls). A national food price database was used to estimate MVD. Multiple linear/logistic regression analyses were conducted stratifying separately by sex, race and poverty status.

RESULTS

Women had significantly higher HEI-2010 scores than men (43.35 vs 41.57 out of 100, respectively), whereas MAR scores were higher for men (76.8 vs 69.9, out of 100), reflecting energy intake gender differentials. Importantly, a $3/day higher MVD (IQR: $3.70/d (Q1) to $6.62/d (Q4)) was associated with a 4.98±0.35 higher total HEI-2010 and a 3.88±0.37 higher MAR score, after energy-adjustment and control for key confounders. For HEI-2010 and MAR, stronger associations were observed among participants above poverty and among women, whilethe MVD vs. HEI-2010 association was additionally stronger among Whites. Sex and poverty status differentials were observed for many MAR and some HEI-2010 components.

CONCLUSIONS

Despite positive associations between measures of dietary quality and MVD, particularly above poverty and among women, approaching compliance with the Dietary Guidelines (80 or more for HEI-2010) requires a substantially higher MVD. Thus, nutrition education may further improve people's decision-making regarding food venues and dietary choices.

Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis

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.

Household food insufficiency is associated with dietary intake in Korean adults

Objective

To examine the association of food insufficiency with dietary intake and eating and health behaviours.

Design

A cross-sectional study.

Setting

Data were obtained from a secondary source, the Fifth Korea National Health and Nutrition Examination Survey (2010–2012).

Subjects

The sample size consisted of 15 603 adults over 19 years of age (8898 households).

Results

Significant differences in socio-economic factors were observed according to food insufficiency level (P<0·05), but BMI was similar among groups. Regarding macronutrients, lower protein intake and higher carbohydrate intake were found in the severely food-insufficient group, but we found no association with fat intake. Regarding micronutrients, Ca, Fe, vitamin A, thiamin, riboflavin niacin and vitamin C intakes were negatively associated with food insufficiency level (Ptrend<0·05). Consumption of different food groups, such as meat, fish, eggs and beans, vegetables and fruits, was significantly lower as food insufficiency level decreased after controlling for all possible variables; food group consumption also differed by sex. Overall eating and health behaviours were poorer in the mildly and severely food-insufficient groups, who received more food assistance but less nutritional education.

Conclusions

Our results showed that dietary intake as well as eating and health behaviours are adversely associated with food insufficiency. These findings suggest that specific strategies to help food-insufficient individuals should be developed in order to improve their dietary quality and health status.

Associations between food insecurity and healthy behaviors among Korean adults

BACKGROUND/OBJECTIVES

Food insecurity has been suggested as being negatively associated with healthy behaviors and health status. This study was performed to identify the associations between food insecurity and healthy behaviors among Korean adults.

SUBJECTS/METHODS

The data used were the 2011 Community Health Survey, cross-sectional representative samples of 253 communities in Korea. Food insecurity was defined as when participants reported that their family sometimes or often did not get enough food to eat in the past year. Healthy behaviors were considered as non-smoking, non-high risk drinking, participation in physical activities, eating a regular breakfast, and maintaining a normal weight. Multiple logistic regression and multinomial logistic regression analyses were used to identify the association between food insecurity and healthy behaviors.

RESULTS

The prevalence of food insecurity was 4.4% (men 3.9%, women 4.9%). Men with food insecurity had lower odds ratios (ORs) for non-smoking, 0.75 (95% CI: 0.68-0.82), participation in physical activities, 0.82 (95% CI: 0.76-0.90), and eating a regular breakfast, 0.66 (95% CI: 0.59-0.74), whereas they had a higher OR for maintaining a normal weight, 1.19 (95% CI: 1.09-1.30), than men with food security. Women with food insecurity had lower ORs for non-smoking, 0.77 (95% CI: 0.66-0.89), and eating a regular breakfast, 0.79 (95% CI: 0.72-0.88). For men, ORs for obesity were 0.78 (95% CI: 0.70-0.87) for overweight and 0.56 (95% CI: 0.39-0.82) for mild obesity. For women, the OR for moderate obesity was 2.04 (95% CI: 1.14-3.63) as compared with normal weight.

CONCLUSIONS

Food insecurity has a different impact on healthy behaviors. Provision of coping strategies for food insecurity might be critical to improve healthy behaviors among the population.

Beyond the sticker price: including and excluding time in comparing food prices

BACKGROUND

An ongoing debate in the literature is how to measure the price of food. Most analyses have not considered the value of time in measuring the price of food. Whether or not the value of time is included in measuring the price of a food may have important implications for classifying foods based on their relative cost.

OBJECTIVE

The purpose of this article is to compare prices that exclude time (time-exclusive price) with prices that include time (time-inclusive price) for 2 types of home foods: home foods using basic ingredients (home recipes) vs. home foods using more processed ingredients (processed recipes). The time-inclusive and time-exclusive prices are compared to determine whether the time-exclusive prices in isolation may mislead in drawing inferences regarding the relative prices of foods.

DESIGN

We calculated the time-exclusive price and time-inclusive price of 100 home recipes and 143 processed recipes and then categorized them into 5 standard food groups: grains, proteins, vegetables, fruit, and dairy. We then examined the relation between the time-exclusive prices and the time-inclusive prices and dietary recommendations.

RESULTS

For any food group, the processed food time-inclusive price was always less than the home recipe time-inclusive price, even if the processed food's time-exclusive price was more expensive. Time-inclusive prices for home recipes were especially higher for the more time-intensive food groups, such as grains, vegetables, and fruit, which are generally underconsumed relative to the guidelines.

CONCLUSION

Focusing only on the sticker price of a food and ignoring the time cost may lead to different conclusions about relative prices and policy recommendations than when the time cost is included.

Higher nutritional quality at no additional cost among low-income households: insights from food purchases of "positive deviants"

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.

Food Resource Management Education With SNAP Participation Improves Food Security

OBJECTIVE

To determine the influence of Supplemental Nutrition Assistance Program (SNAP) and participant demographics on nutrition education outcomes.

METHODS

At program enrollment (pre) and 1 month later (post), a statewide convenience sample of adults, who participated in the Plan, Shop, Save, and Cook program, completed a 7-item questionnaire to evaluate change in resource management skills (RMS) and running out of food before the end of the month.

RESULTS

Percent of participants (n = 3,744) who reported behavioral improvements in RMS ranged from 38.8% in comparing prices to 54% in reading labels. Female gender and Hispanic ethnicity were positively related to pre-post RMS change (P = .001). Participants who received SNAP food assistance and made greater pre-post improvement in RMS reported the greatest decrease in running out of food (P = .001).

CONCLUSIONS AND IMPLICATIONS

Both food assistance and education on nutrition and resource management are needed to reduce food insecurity in SNAP-eligible audiences.

Little variation in diet cost across wide ranges of overall dietary quality among youth with type 1 diabetes

We examined the association of diet quality with diet cost in a sample of youth with type 1 diabetes, for whom diet is an important component of medical management. Differences in food group spending by diet quality were also examined to identify potential budgetary reallocation to improve overall diet quality. Families of 252 youth with type 1 diabetes aged 8 to 18 years completed 3-day youth diet records. Cost of each food reported was calculated based on the average price obtained from two online grocery stores. Diet cost was estimated as average daily cost of foods consumed. The Healthy Eating Index 2005 (HEI2005), Nutrient Rich Foods Index version 9.3, and Whole Plant Food Density scores were evaluated. Differences in mean daily diet cost across tertiles of HEI2005, Nutrient Rich Foods Index version 9.3, and Whole Plant Food Density were modest, with none reaching statistical significance. Those in the upper tertile of HEI2005 spent more on whole fruit, whole grains, lean meat, and low-fat dairy, and less on high-fat meat and high-fat dairy compared with those in the lower tertiles. Higher-quality diets can be obtained at comparable costs to lesser-quality diets, suggesting that cost need not be an insurmountable barrier to more healthful eating. Reallocation of spending may increase overall quality without substantially increasing overall spending. Findings suggest potential strategies for assisting families of youth with type 1 diabetes in identifying cost-effective ways to achieve a more healthful diet.

The relation of potassium and sodium intakes to diet cost among U.S. adults

The 2010 Dietary Guidelines recommended that Americans increase potassium and decrease sodium intakes to reduce the burden of hypertension. One reason why so few Americans meet the recommended potassium or sodium goals may be perceived or actual food costs. This study explored the monetary costs associated with potassium and sodium intakes using national food prices and a representative sample of US adults. Dietary intake data from the 2001-2002 National Health and Nutrition Examination Survey were merged with a national food prices database. In a population of 4744 adults, the association between the energy-adjusted sodium and potassium intakes, and the sodium-to-potassium ratio (Na:K) and energy-adjusted diet cost was evaluated. Diets that were more potassium-rich or had lower Na:K ratios were associated with higher diet costs, while sodium intakes were not related to cost. The difference in diet cost between extreme quintiles of potassium intakes was $1.49 (95% confidence interval: 1.29, 1.69). A food-level analysis showed that beans, potatoes, coffee, milk, bananas, citrus juices and carrots are frequently consumed and low-cost sources of potassium. Based on existing dietary data and current American eating habits, a potassium-dense diet was associated with higher diet costs, while sodium was not. Price interventions may be an effective approach to improve potassium intakes and reduce the Na:K ratio of the diet. The present methods helped identify some alternative low-cost foods that were effective in increasing potassium intakes. The identification and promotion of lower-cost foods to help individuals meet targeted dietary recommendations could accompany future dietary guidelines.

The inverse relationship between food price and energy density: is it spurious?

Objective

An important debate in the literature is whether or not higher energy-dense foods are cheaper than less energy-dense foods. The present communication develops and applies an easy statistical test to determine if the relationship between food price and energy density is an artifact of how the data units are constructed (i.e. is it ‘spurious’ or ‘real’?).

Design

After matching data on 4430 different foods from the National Health and Nutrition Examination Survey with corresponding prices from the Center for Nutrition Policy and Promotion’s Food Prices Database, we use a simple regression model to test if the relationship between food price and energy density is ‘real’ or ‘spurious’.

Setting

USA.

Subjects

Total sample size is 4430 observations of consumed foods from 4578 participants from the non-institutionalized US adult population (aged 19 years and over).

Results

Over all 4430 foods, the null hypothesis of a spurious inverse relationship between food price per energy density and energy density is not rejected. When the analysis is broken down by twenty-five food groups, there are only two cases where the inverse relationship is not spurious. In fact, the majority of non-spurious relationships between food price and energy density are positive, not negative.

Conclusions

One of the main arguments put forth regarding the poor diet quality of low-income households is that high energy-dense food is cheaper than lower energy-dense food. We find almost no statistical support for higher energy-dense food being cheaper than low energy-dense food. While economics certainly plays a role in explaining low nutritional quality, more sophisticated economic arguments are required and discussed.

Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis

OBJECTIVE

To conduct a systematic review and meta-analysis of prices of healthier versus less healthy foods/diet patterns while accounting for key sources of heterogeneity.

DATA SOURCES

MEDLINE (2000-2011), supplemented with expert consultations and hand reviews of reference lists and related citations.

DESIGN

Studies reviewed independently and in duplicate were included if reporting mean retail price of foods or diet patterns stratified by healthfulness. We extracted, in duplicate, mean prices and their uncertainties of healthier and less healthy foods/diet patterns and rated the intensity of health differences for each comparison (range 1-10). Prices were adjusted for inflation and the World Bank purchasing power parity, and standardised to the international dollar (defined as US$1) in 2011. Using random effects models, we quantified price differences of healthier versus less healthy options for specific food types, diet patterns and units of price (serving, day and calorie). Statistical heterogeneity was quantified using I(2) statistics.

RESULTS

27 studies from 10 countries met the inclusion criteria. Among food groups, meats/protein had largest price differences: healthier options cost $0.29/serving (95% CI $0.19 to $0.40) and $0.47/200 kcal ($0.42 to $0.53) more than less healthy options. Price differences per serving for healthier versus less healthy foods were smaller among grains ($0.03), dairy (-$0.004), snacks/sweets ($0.12) and fats/oils ($0.02; p<0.05 each) and not significant for soda/juice ($0.11, p=0.64). Comparing extremes (top vs bottom quantile) of food-based diet patterns, healthier diets cost $1.48/day ($1.01 to $1.95) and $1.54/2000 kcal ($1.15 to $1.94) more. Comparing nutrient-based patterns, price per day was not significantly different (top vs bottom quantile: $0.04; p=0.916), whereas price per 2000 kcal was $1.56 ($0.61 to $2.51) more. Adjustment for intensity of differences in healthfulness yielded similar results.

CONCLUSIONS

This meta-analysis provides the best evidence until today of price differences of healthier vs less healthy foods/diet patterns, highlighting the challenges and opportunities for reducing financial barriers to healthy eating.

The new nordic diet--consumer expenditures and economic incentives estimated from a controlled intervention

Background

Several studies suggest that a healthy diet with high emphasis on nutritious, low-energy components such as fruits, vegetables, and seafood tends to be more costly for consumers. Derived from the ideas from the New Nordic Cuisine – and inspired by the Mediterranean diet, the New Nordic Diet (NND) has been developed as a palatable, healthy and sustainable diet based on products from the Nordic region. The objective of the study is to investigate economic consequences for the consumers of the NND, compared with an Average Danish Diet (ADD).

Methods

Combine quantity data from a randomized controlled ad libitum dietary 6 month intervention for central obese adults (18–65 years) and market retail price data of the products consumed in the intervention. Adjust consumed quantities to market price incentives using econometrically estimated price elasticities.

Results

Average daily food expenditure of the ADD as represented in the unadjusted intervention (ADD-i) amounted to 36.02 DKK for the participants. The daily food expenditure in the unadjusted New Nordic Diet (NND-i) costs 44.80 DKK per day per head, and is hence about 25% more expensive than the Average Danish Diet (or about 17% when adjusting for energy content of the diet). Adjusting for price incentives in a real market setting, the estimated cost of the Average Danish Diet is reduced by 2.50 DKK (ADD-m), compared to the unadjusted ADD-i diet, whereas the adjusted cost of the New Nordic Diet (NND-m) is reduced by about 3.50 DKK, compared to the unadjusted NND-i. The distribution of food cost is however much more heterogeneous among consumers within the NND than within the ADD.

Conclusion

On average, the New Nordic Diet is 24–25 per cent more expensive than an Average Danish Diet at the current market prices in Denmark (and 16–17 per cent, when adjusting for energy content). The relatively large heterogeneity in food costs in the NND suggests that it is possible to compose an NND where the cost exceeds that of ADD by less than the 24–25 per cent.

Vegetable variety is a key to improved diet quality in low-income women in California

Primary prevention education interventions, including those sponsored by the US Department of Agriculture for low-income families, encourage and support increases in vegetable intake. Promoting vegetable variety as a focal point for behavior change may be a useful strategy to increase vegetable consumption. A simple vegetable variety evaluation tool might be useful to replace the time-intensive 24-hour dietary recall. The purpose of our study was to determine whether vegetable variety is associated with vegetable consumption and diet quality among US Department of Agriculture program participants. Variety of vegetable intake and measures of total vegetable intake, diet quality, and diet cost were evaluated. Low-income, female participants (N=112) aged 20 to 55 years with body mass index 17.7 to 68.5 who were the primary food purchasers/preparers for their households were recruited from four California counties representing rural, urban, and suburban areas. Energy density and Healthy Eating Index-2005 were used to assess diet quality. Vegetable variety was based on number of different vegetables consumed per week using a food frequency questionnaire, and three groups were identified as: low variety, ≤5 different vegetables per week; moderate variety, 6 to 9 vegetables per week; and high variety, ≥10 vegetables per week. Compared with the low-variety group, participants in the high-variety group ate a greater quantity of vegetables per day (P<0.001); their diets had a higher Healthy Eating Index score (P<0.001) and lower energy density (P<0.001); and costs of their daily diet and vegetable use were higher (P<0.001). Thus, greater vegetable variety was related to better overall diet quality, a larger quantity of vegetables consumed, and increased diet cost.

Measuring diet cost at the individual level: a comparison of three methods

Background/objectives:

Household-level food spending data are not suitable for population-based studies of the economics of nutrition. This study compared three methods of deriving diet cost at the individual level.

Subjects/methods:

Adult men and women (n=164) completed 4-day diet diaries and a food frequency questionnaire (FFQ). Food expenditures over 4 weeks and supermarket prices for 384 foods were obtained. Diet costs (US$/day) were estimated using: (1) diet diaries and expenditures; (2) diet diaries and supermarket prices; and (3) FFQs and supermarket prices. Agreement between the three methods was assessed on the basis of Pearson correlations and limits of agreement. Income-related differences in diet costs were estimated using general linear models.

Results:

Diet diaries yielded mean (s.d.) diet costs of $10.04 (4.27) based on Method 1 and $8.28 (2.32) based on Method 2. FFQs yielded mean diet costs of $7.66 (2.72) based on Method 3. Correlations between energy intakes and costs were highest for Method 3 (r²=0.66), lower for Method 2 (r²=0.24) and lowest for Method 1 (r²=0.06). Cost estimates were significantly associated with household incomes.

Conclusion:

The weak association between food expenditures and food intake using Method 1 makes it least suitable for diet and health research. However, merging supermarket food prices with standard dietary assessment tools can provide estimates of individual diet cost that are more closely associated with food consumed. The derivation of individual diet cost can provide insights into some of the economic determinants of food choice, diet quality and health.

Dietary health behaviors of women living in high rise dwellings: a case study of an urban community in Malaysia

Diet-related non-communicable disease (DR-NCD) occurrence is a serious problem amongst Malaysian women and urbanization is probably a challenge to their achieving the nutritional environment conducive to healthy eating. This case study aimed to determine diet quality of an urban community using women respondents from high rise dwellings in Kuala Lumpur. The sample consisted of 135 households and a healthy eating index (HEI) scale was used to evaluate the women’s diet quality. A total of 128 women (Malays = 45, Chinese = 56, Indian = 27) participated. Total HEI score was significantly different (P < 0.05) within ethnicity (Indians = 75.7 ± 8.1 <Malays = 80.5 ± 7.4 <Chinese = 80.1 ± 8.1) and affected by component scores for fruit (range 3.8–6.2, P = 0.044), sodium (range 7.8–9.0, P = 0.006) and food variety (range 9.3–9.9, P = 0.001). Dairy foods rated poorly (range 2.0–3.9, P > 0.05) regardless of ethnicity. Income strata (ρ = 0.159, P = 0.048) and eating out frequency (ρ = −0.149, P = 0.046) also independently affected HEI scores. Income negatively correlated with sodium restriction score (ρ = −0.294, P = 0.001) but positively with cereals (ρ = 0.181; P = 0.025), fruits (ρ = 0.178; P = 0.022), dairy products (ρ = 0.198; P = 0.013) and food variety (ρ = 0.219, P = 0.007). Decreased vegetable intake (ρ = −0.320; P < 0.001) and sodium excess (ρ = −0.135, P = 0.065) were associated with eating out frequency and poor HEI scores. This case study suggests health promotion for DR-NCD prevention is needed at the community level to improve diet quality of urban women.

Hunger and Obesity

The Hunger and Obesity workshop, organized by the Institute of Medicine, examined the relationship between food insecurity and the obesity pandemic that the United States is facing today. The workshop brought together a diverse group of experts and discussed these issues among special subpopulation groups, examined variables through a socioecological model, suggested effective government programs demonstrating positive impact, proposed key research questions, methods, and measures, and also pointed to research gaps for future works. Health promotion practitioners and researchers, either new or experienced, could gain a broader perspective on important current issues surrounding obesity and food insecurity. This workshop summary pdf file is free and can be downloaded from http://www.nap.edu/catalog/13102.html .

Food habits, socioeconomic status and body mass index among premenopausal and post-menopausal women in Mauritius

BACKGROUND

Although many health disparities arise as a result of socioeconomic inequalities, less is known about the diet quality of women after menopause. The present study aimed to determine the factors affecting food habits and body mass index (BMI) among premenopausal and post-menopausal Mauritian working women.

METHODS

The study was conducted as a cross-sectional survey in different workplaces located in the nine districts of Mauritius. Mauritian women (n = 400; 215 premenopausal, 185 post-menopausal) were recruited using stratified random sampling. Participants completed a self-reported questionnaire comprising a food frequency questionnaire previously constructed and used to address dietary guidelines that assess the intake of vegetables, fruits, dairy products, cereals, high- and low-fat protein sources, fats and sweetened beverages, as well as questions aiming to elicit socioeconomic profile, menopausal status, physical activity level and demographic data. Height, weight, waist and hip circumferences were measured. An independent sample t-test, chi-squared test and one-way analysis of variance were used for the statistical analyses.

RESULTS

The mean dietary guideline score was significantly higher for post-menopausal than premenopausal women, (P = 0.017). Each socioeconomic status (SES) category of post-menopausal women also demonstrated a higher dietary guideline score than that of premenopausal women (P > 0.05). A high BMI was significantly associated with a low SES of participants (P = 0.042) and post-menopausal stage (P = 0.001).

CONCLUSIONS

Low SES and post-menopausal stage are risk factors for obesity among female workers in Mauritius. Although post-menopausal women ate a better diet, their mean BMI was higher than that of premenopausal women.

Food expenditures, cariogenic dietary practices and childhood dental caries in southern Brazil

Family expenditures on food for children may represent an important barrier to the adoption of healthy feeding practices in populations of low socioeconomic status. The aim of this study was to explore the relationship between cariogenic feeding practices, expenditures on food for children and dental caries. This cross-sectional study included 329 four-year-old children from São Leopoldo in southern Brazil. Cariogenic dietary practices were assessed at 4 years of age using two 24-hour recalls conducted with the children's mothers. Expenditures on food for children were estimated based on all reported food items and the respective amounts ingested. Early childhood caries and severe early childhood caries were assessed by clinical examination at 4 years of age. Cariogenic dietary habits were not associated with lower food expenditures. On the contrary, in multivariable regression analysis, the intake of chocolate (p = 0.007), soft drinks (p = 0.027) and a higher number of meals and snacks per day (p < 0.001) was associated with greater expenditures on food for children. No statistically significant differences were observed in food expenditures or in the proportion of household income spent on feeding children between caries-free children, those with early childhood caries and those with severe early childhood caries. In conclusion, keeping children free of dental caries does not necessarily increase food expenditures or the proportion of household income spent on feeding children in low-socioeconomic status populations. Some cariogenic dietary practices were associated with greater expenditures on child feeding.

Estimating dietary costs of low-income women in California: a comparison of 2 approaches

BACKGROUND

Currently, no simplified approach to estimating food costs exists for a large, nationally representative sample.

OBJECTIVE

The objective was to compare 2 approaches for estimating individual daily diet costs in a population of low-income women in California.

DESIGN

Cost estimates based on time-intensive method 1 (three 24-h recalls and associated food prices on receipts) were compared with estimates made by using less intensive method 2 [a food-frequency questionnaire (FFQ) and store prices]. Low-income participants (n = 121) of USDA nutrition programs were recruited. Mean daily diet costs, both unadjusted and adjusted for energy, were compared by using Pearson correlation coefficients and the Bland-Altman 95% limits of agreement between methods.

RESULTS

Energy and nutrient intakes derived by the 2 methods were comparable; where differences occurred, the FFQ (method 2) provided higher nutrient values than did the 24-h recall (method 1). The crude daily diet cost was $6.32 by the 24-h recall method and $5.93 by the FFQ method (P = 0.221). The energy-adjusted diet cost was $6.65 by the 24-h recall method and $5.98 by the FFQ method (P < 0.001).

CONCLUSIONS

Although the agreement between methods was weaker than expected, both approaches may be useful. Additional research is needed to further refine a large national survey approach (method 2) to estimate daily dietary costs with the use of this minimal time-intensive method for the participant and moderate time-intensive method for the researcher.

Nutrient density score of typical Indonesian foods and dietary formulation using linear programming

OBJECTIVE

The present research aimed to analyse the nutrient density (ND), nutrient adequacy score (NAS) and energy density (ED) of Indonesian foods and to formulate a balanced diet using linear programming.

DESIGN

Data on typical Indonesian diets were obtained from the Indonesian Socio-Economic Survey 2008. ND was investigated for 122 Indonesian foods. NAS was calculated for single nutrients such as Fe, Zn and vitamin A. Correlation analysis was performed between ND and ED, as well as between monthly expenditure class and food consumption pattern in Indonesia. Linear programming calculations were performed using the software POM-QM for Windows version 3.

SETTING

Republic of Indonesia, 2008.

SUBJECTS

Public households (n 68 800).

RESULTS

Vegetables had the highest ND of the food groups, followed by animal-based foods, fruits and staple foods. Based on NAS, the top ten food items for each food group were identified. Most of the staple foods had high ED and contributed towards daily energy fulfillment, followed by animal-based foods, vegetables and fruits. Commodities with high ND tended to have low ED. Linear programming could be used to formulate a balanced diet. In contrast to staple foods, purchases of fruit, vegetables and animal-based foods increased with the rise of monthly expenditure.

CONCLUSIONS

People should select food items based on ND and NAS to alleviate micronutrient deficiencies in Indonesia. Dietary formulation calculated using linear programming to achieve RDA levels for micronutrients could be recommended for different age groups of the Indonesian population.

Custo da alimentação e densidade energética da dieta no Brasil, 2008-2009

Este estudo tem por objetivo avaliar a relação entre o custo da alimentação e a densidade energética da dieta consumida nos domicílios brasileiros. Utilizaram-se dados da Pesquisa de Orçamentos Familiares (POF-2008/2009) para identificação dos alimentos com consumo mais relevante e seus preços. Tais alimentos foram agrupados, resultando em uma cesta de 67 produtos. Empregou-se a programação linear para composição de cestas isoenergéticas, minimizando o afastamento da dieta média encontrada nos domicílios. Foram impostos limites para quantidade de inclusão dos itens e contribuição energética dos grupos de alimentos; e uma redução no custo médio da dieta foi aplicada a intervalos de R$0,15 até o menor custo possível. Identificou-se associação inversa entre densidade energética e preço da dieta (p < 0,05), e, no menor custo possível, obteve-se o valor máximo de densidade energética. Verificou-se que restrições no custo da alimentação resultaram na seleção de dietas com maior densidade energética, indicando que o custo da alimentação pode conduzir à adoção de dietas inadequadas no Brasil.

Diet costs and energy density in the diet of German children and adolescents

This study examined the association between energy density (ED, g/kJ) and diet costs (\[euro]/day) in a sample of 494 German children and adolescents aged 4-18 years using 1100 3-day-weighed dietary records from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study (open cohort study) and retail food prices of 341 empirically selected recorded food items including special brands. ED was negatively associated with diet costs (β=-0.20 kJ/g, P<0.0007) with a non-linear term (β=0.01 kJ/g*kJ/g, P=0.0440). Diet costs increased with age (β=0.32 yr, P<0.0001) with a negative non-linear term (β=-0.01 yr*yr; P<0.0001). In conclusion, the inverse association between diet costs and ED was more pronounced in the older than in the younger age groups and in low-ED diets than in high-ED diets. Higher % diet costs of fruit/vegetables could be compensated by lower % diet costs of meat/sausage to lower ED without increasing diet costs.

Nutrient intakes linked to better health outcomes are associated with higher diet costs in the US

PURPOSE

Degrees of nutrient intake and food groups have been linked to differential chronic disease risk. However, intakes of specific nutrients may also be associated with differential diet costs and unobserved differences in socioeconomic status (SES). The present study examined degrees of nutrient intake, for every key nutrient in the diet, in relation to diet cost and SES.

METHODS

Socio-demographic data for a stratified random sample of adult respondents in the Seattle Obesity Study were obtained through telephone survey. Dietary intakes were assessed using food frequency questionnaire (FFQ) (n = 1,266). Following standard procedures, nutrient intakes were energy-adjusted using the residual method and converted into quintiles. Diet cost for each respondent was estimated using Seattle supermarket retail prices for 384 FFQ component foods.

RESULTS

Higher intakes of dietary fiber, vitamins A, C, D, E, and B12, beta carotene, folate, iron, calcium, potassium, and magnesium were associated with higher diet costs. The cost gradient was most pronounced for vitamin C, beta carotene, potassium, and magnesium. Higher intakes of saturated fats, trans fats and added sugars were associated with lower diet costs. Lower cost lower quality diets were more likely to be consumed by lower SES.

CONCLUSION

Nutrients commonly associated with a lower risk of chronic disease were associated with higher diet costs. By contrast, nutrients associated with higher disease risk were associated with lower diet costs. The cost variable may help somewhat explain why lower income groups fail to comply with dietary guidelines and have highest rates of diet related chronic disease.

Socioeconomic status, energy cost, and nutrient content of supermarket food purchases

BACKGROUND

The relative affordability of energy-dense versus nutrient-rich foods may promote socioeconomic disparities in dietary quality and obesity. Although supermarkets are the largest food source in the American diet, the associations between SES and the cost and nutrient content of freely chosen food purchases have not been described.

PURPOSE

To investigate relationships of SES with the energy cost ($/1000 kcal) and nutrient content of freely chosen supermarket purchases.

METHODS

Supermarket shoppers (n=69) were recruited at a Phoenix AZ supermarket in 2009. The energy cost and nutrient content of participants' purchases were calculated from photographs of food packaging and nutrition labels using dietary analysis software. Data were analyzed in 2010-2011.

RESULTS

Two SES indicators, education and household income as a percentage of the federal poverty guideline (FPG), were associated with the energy cost of purchased foods. Adjusting for covariates, the amount spent on 1000 kcal of food was $0.26 greater for every multiple of the FPG, and those with a baccalaureate or postbaccalaureate degree spent an additional $1.05 for every 1000 kcal of food compared to those with no college education. Lower energy cost was associated with higher total fat and less protein, dietary fiber, and vegetables per 1000 kcal purchased.

CONCLUSIONS

Low-SES supermarket shoppers purchase calories in inexpensive forms that are higher in fat and less nutrient-rich.

The effect of a recessionary economy on food choice: implications for nutrition education

OBJECTIVE

To determine the effect of an economic recession on food choice behaviors.

DESIGN

A qualitative study using semistructured, in-depth interviews followed by completion of a nutrition knowledge questionnaire and the Food Choice Questionnaire was conducted.

SETTING AND PARTICIPANTS

A convenience sample from a metropolitan city in the Midwest. Women with children younger than 18 years in the household who had experienced unemployment, underemployment, or loss of a house because of foreclosure in the previous year participated (n = 25).

MAIN OUTCOME MEASURE

Reported behaviors for food choices when grocery shopping and dining out and educational resources requested to inform nutrition education programs.

ANALYSIS

Interviews were coded with a matrix derived from participant statements. Common behaviors were grouped and broad themes were identified.

RESULTS

Numerous shopping strategies were recently used to save money (eg, buying only sale items, using coupons). Participants believed a healthful diet included a variety of foods with less sugar, salt, and fat. Recipes and menus that required little cost or preparation time and resources to track food expenditures were desired.

CONCLUSIONS AND IMPLICATIONS

Nutrition education should include money-saving shopping strategies, facilitate menu planning and cooking skills, and address food resource management to enable participants to acquire sufficient, acceptable, and nutritionally adequate food.

Concepts of healthful food among low-income African American women

OBJECTIVE

Describe beliefs about what makes foods healthful among low-income African American women.

METHODS

In one-on-one interviews, 28 low-income African American mothers viewed 30 pairs of familiar foods and explained which food in the pair was more healthful and why. Responses were grouped into codes describing concepts of food healthfulness.

RESULTS

Nutrient content, physical effects of food, and food categories were used to judge the healthfulness of foods. Fruits, vegetables, and dairy foods were considered the most healthful and starchy foods the least healthful because they were believed to cause weight gain. Beliefs about which foods contain which nutrients and which foods have particular physical effects varied widely across participants.

CONCLUSIONS AND IMPLICATIONS

Participants demonstrated awareness of which foods are healthful but lacked understanding of why those foods are more healthful than others. Knowledge about the health effects of foods may be necessary to motivate individuals to choose healthful foods.

Do economic constraints on food choice make people fat? A critical review of two hypotheses for the poverty-obesity paradox

In low income countries worldwide, rising standards of living have spurred an unprecedented rise in obesity. However, in numerous wealthy countries the trend frequently reverses with poorer and less educated women more likely to be overweight than their wealthier compatriots. One prominent explanation for this reverse gradient is that economic deprivation leads to food choices which paradoxically increase energy intake. If true, this would challenge current evolutionary accounts for the modern obesity epidemic and have serious implications for how policy makers tackle increasing obesity in the US and worldwide. In this article, we critically review the hypothesis that deprivation leads people to choose cheaper foods which in turn foster overconsumption of energy. Though the hypothesis is consistent with numerous cross-sectional studies, available longitudinal studies from high-, middle-, and low-income countries show the reverse-that when populations experience resource declines, they experience either declines in BMI or decelerations in BMI growth. Most notably, the recent recession in the US coincides with a clear deceleration in women's obesity across income groups. We conclude by briefly reviewing other plausible explanations for the reverse gradient among women in developing countries. Finally, we discuss how theoretical perspectives and comparative, historical approaches from human biology are useful tools for examining the current wealth of hypotheses about obesity in population health.

Price and healthfulness of snacks in 32 YMCA after-school programs in 4 US metropolitan areas, 2006-2008

Introduction

A common perception is that healthful foods are more expensive than less healthful foods. We assessed the cost of beverages and foods served at YMCA after-school programs, determined whether healthful snacks were more expensive, and identified inexpensive, healthful options.

Methods

We collected daily snack menus from 32 YMCAs nationwide from 2006 to 2008 and derived prices of beverages and foods from the US Department of Agriculture price database. Multiple linear regression was used to assess associations of healthful snacks and of beverage and food groups with price (n = 1,294 snack-days). We identified repeatedly served healthful snacks consistent with Child and Adult Care Food Program guidelines and reimbursement rate ($0.74/snack).

Results

On average, healthful snacks were approximately 50% more expensive than less healthful snacks ($0.26/snack; SE, 0.08; P = .003). Compared to water, 100% juice significantly increased average snack price, after controlling for other variables in the model. Similarly, compared to refined grains with trans fats, refined grains without trans fat significantly increased snack price, as did fruit and canned or frozen vegetables. Fresh vegetables (mostly carrots or celery) or whole grains did not alter price. Twenty-two repeatedly served snacks met nutrition guidelines and the reimbursement rate.

Conclusion

In this sample of after-school programs, healthful snacks were typically more expensive than less healthful options; however, we identified many healthful snacks served at or below the price of less healthful options. Substituting tap water for 100% juice yielded price savings that could be used toward purchasing more healthful foods (eg, an apple). Our findings have practical implications for selecting snacks that meet health and reimbursement guidelines.

Diet quality is related to eating competence in cross-sectional sample of low-income females surveyed in Pennsylvania

Women participants of two federally administered nutrition education programs (n=149, 56% white, 64% food secure, 86% 18-50 years of age,) completed telephone interviews that included three 24-hour dietary recalls and the Satter Eating Competence Inventory. Eating competence is delineated by an Inventory score≥32. Competent eaters had significantly greater intakes of fiber, vitamin A, vitamin E, vitamin C, most B-vitamins, magnesium, iron, zinc, potassium and a higher Healthy Eating Index. Two dietary patterns defined as Prudent and Western were observed. The Prudent pattern was correlated with eating competence and characterized by more healthful foods such as fruits, vegetables and low-fat dairy products. The Western pattern, characterized by foods higher in fat, salt, and sugar, was not related to eating competence. Findings suggest that dietary guidance using an eating competence approach for low-income women is compatible with goals to improve dietary quality and eating patterns.