Monitoring the price and affordability of foods and diets globally

Changes in UK price disparities between healthy and less healthy foods over 10 years: An updated analysis with insights in the context of inflationary increases in the cost-of-living from 2021

Food prices and affordability play an important role in influencing dietary choices, which in turn have implications for public health. With inflationary increases in the cost-of-living in the UK since 2021, understanding the dynamics of food prices becomes increasingly important. In this longitudinal study, we aimed to examine changes in food prices from 2013 to 2023 by food group and by food healthiness. We established a dataset spanning the years 2013-2023 by combining price data from the UK Consumer Price Index for food and beverage items with nutrient and food data from the UK nutrient databank and UK Department of Health & Social Care's National Diet and Nutrition Survey data. We calculated the price (£/100 kcal) for each food item by year as well as before and during the period of inflationary pressure, and classified items into food groups according to the UK Eatwell Guide and as either "more healthy" or "less healthy" using the UK nutrient profiling score model. In 2023, bread, rice, potatoes and pasta was cheapest (£0.12/100 kcal) and fruit and vegetables most expensive (£1.01/100 kcal). Less healthy food was cheaper than more healthy food (£0.33/100 kcal versus £0.81/100 kcal). Before the inflationary pressure period (from 2013 to late 2021), the price of foods decreased by 3%. After this period, the price of food increased by 22%: relative increases were highest in the food group milk and dairy food (31%) and less healthy category (26%). While healthier foods saw smaller relative price increases since 2021, they remain more expensive, potentially exacerbating dietary inequalities. Policy responses should ensure food affordability and mitigate price disparities via, for example, healthy food subsidies.

Monitoring Food Affordability: Reliability and Validity of an Online Nutritious Food Basket

Purpose: This study aimed to assess the reliability and validity of an online approach to monitoring food affordability in Ontario using the updated Ontario Nutritious Food Basket (ONFB).Methods: The ONFB was priced online in 12 large multi-chain grocery stores to test intra-/inter-rater reliability using percent agreement and intra-class correlations (ICCs). Then, the ONFB was priced in-store and online in 28 stores to estimate food price differences using paired t-tests and Pearson's correlation for all (n =1708) and matched items (same product/brand and purchase unit) (n = 1134).Results: Intra-/inter-rater agreement was high (95.4%/81.6%; ICC = 0.972, F = 69.9, p < 0.001). On average, in-store prices were less than $0.02 lower than online prices. There were no significant differences between mean in-store and online prices for all items (t = 0.504 p = 0.614). The mean price was almost perfectly correlated between in-store and online (fully matched: R = 0.993 p < 0.001; all items: R = 0.967 p < 0.001). Online monthly ONFB estimates for a family of four were strongly correlated (R = 0.937 p < 0.001) with estimates calculated using in-store data.Conclusions: Online pricing is a reliable and valid approach to food costing in Ontario that contributes to modernizing the monitoring of food affordability in Canada and abroad.

Barriers to consumption of fruits and vegetables and strategies to overcome them in low- and middle-income countries: a narrative review

This review provides an overview of the barriers to the consumption of fruits and vegetables (FVs) as well as strategies to improve the intake of FVs in low- and middle-income countries (LMICs). The importance of the consumption of FVs and its role in disease prevention are discussed briefly. Trends in the consumption of FVs in LMICs are also summarised. The WHO recommends that every individual should consume at least five servings or 400 grams of FVs per day. Epidemiological and clinical investigations have demonstrated that FVs contain numerous bioactive compounds with health-protecting activities. Despite their health benefits, the intake of FVs in LMICs remains low. Major barriers identified were socio-demographic factors, environmental conditions, individual and cultural factors, and macrosystem influences. These barriers may be lowered at the household, school, community, and national level through multi-component interventions including behaviour change communication (BCC) initiatives, nutrition education (NE), gardening initiatives, farm to institution programs (FIPs), food baskets, cash transfers, nutrition-agriculture policy and program linkages, and food-market environment-based strategies. This review has research implications due to the positive outcomes of strategies that lower such barriers and boost consumption of FVs in LMICs.

Food security definition, measures and advocacy priorities in high-income countries: a Delphi consensus study

OBJECTIVE

To establish an international consensus on the definition of food security, measures and advocacy priorities in high-income countries.

DESIGN

A two-round online Delphi survey with closing in March 2020 and December 2021. Consensus was set a priori at 75 %. Qualitative data were synthesised and priorities were ranked.

SETTING

High-income countries.

PARTICIPANTS

Household food security experts in academia, government and non-government organisations who had published in the last 5 years.

RESULTS

Up to thirty-two participants from fourteen high-income countries responded to the Delphi with a 25 % response rate in Round 1 and a 38 % response rate in Round 2. Consensus was reached on the technical food security definition and its dimensions. Consensus was not reached on a definition suitable for the general public. All participants agreed that food security monitoring systems provide valuable data for in-country decision-making. Favoured interventions were those that focused on upstream social policy influencing income. Respondents agreed that both national and local community level strategies were required to ameliorate food insecurity, reinforcing the complexity of the problem.

CONCLUSIONS

This study furthers the conceptual understanding of the commonly used definition of food security and its constituent dimensions. Strong advocacy is needed to ensure food security monitoring, policy and mitigation strategies are implemented. The consensus on the importance of prioritising actions that address the underlying determinants of household food security by experts in the field from across wealthy nations provides evidence to focus advocacy efforts and generate public debate.

Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system

This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.

Factors affecting fruit and vegetable consumption and purchase behavior of adults in sub-Saharan Africa: A rapid review

In order to achieve the Sustainable Development Goals, considerable dietary shifts, including an increase in the consumption of fruit and vegetables (FV) will be required. However, worldwide consumption of FV is far below international recommendations, including in many low- and middle-income countries (LMICs), particularly in Africa. Understanding what, where, when, and how people choose to eat requires an understanding of how individuals are influenced by factors in their social, physical, and macro-level environments. In order to develop effective interventions to increase fruit and vegetable consumption, the factors influencing consumer behavior need to be better understood. We conducted a rapid review to assess and synthesize data on individual, social, physical, and macro-level factors that enable or constrain fruit and vegetable consumption and purchase among adults living in sub-Saharan Africa. Our conceptual framework is based on a socio-ecological model which has been adapted to settings in LMICs and Africa. We systematically searched four electronic databases including Scopus, Medline (PubMed), PsycInfo, and African Index Medicus, and screened Google Scholar for gray literature. We included a total of 52 studies and narratively summarized the existing evidence for each identified factor across the different levels. We found that most studies assessed demographic factors at the individual level including household or family income, socio-economic status and education. Furthermore we identified a variety of important factors that influence FV consumption, in the social, physical, and macro environment. These include women's empowerment and gender inequalities, the influence of neighborhood and retail food environment such as distance to market and price of FV as well as the importance of natural landscapes including forest areas for FV consumption. This review identified the need to develop and improve indicators both for exposure and outcome variables but also to diversify research approaches.

Observational study of population level disparities in food costs in 2021 in Canada: A digital national nutritious food basket (dNNFB)

The aim of this work was to assess the feasibility and effect of applying a nationally representative and highly disaggregated food costing measure across Canada, through the novel application of web-scraping technology to the methods of the National Nutritious Food Basket (NNFB). Further, this study tested the hypothesis that a product-matched digital NNFB (dNNFB) correlates with existing market basket measures and quantified any differences in costs. This was an observational cross-sectional study using web scraped food price data collected in November 2021. Food price data was collected from the majority of Loblaw's banners across Canada, resulting in a final store sample of 751 stores sourced from 11 retail banners. Stores were located across all five Statistics Canada regions, including all provinces and territories with the exception of Nunavut. Store-level dNNFB costs were computed, adjusted by age-sex group, and summarized by geographic region and banner. dNNFB costs were then compared with existing national statistics office estimates (Market Basket Measure thresholds for reference families). dNNFB costs varied widely across the country, with notable differences by regional, store-level, and age-sex group characteristics. When compared to reported national statistics, our estimates exceeded the national market basket measure in every comparison in corresponding sub-national geography across the country, with correlation varying from 0.49 to 0.78 dependent on summary comparator. Digital collection of food price data was a feasible strategy for market basket costing. Our findings suggest we may be routinely underestimating the impact of food inflation for consumers, particularly those restricted to certain food environments.

The COVID-19 Pandemic, Rising Inflation, and Their Influence on Dining Out Frequency and Spending

Background: High intake of food away from home is associated with poor diet quality. This study examines how the COVID-19 pandemic period and Food Away from Home (FAFH) inflation rate fluctuations influenced dining out behaviors. Methods: Approximately 2800 individuals in Texas reported household weekly dining out frequency and spending. Responses completed prior to the COVID-19 pandemic (2019 to early 2020) were compared to the post-COVID-19 period (2021 through mid-2022). Multivariate analysis with interaction terms was used to test study hypotheses. Results and Conclusion: From the COVID-19 period (before vs. after), the unadjusted frequency of dining out increased from 3.4 times per week to 3.5 times per week, while the amount spent on dining out increased from $63.90 to $82.20. Once the relationship between dining out (frequency and spending) was adjusted for FAFH interest rate and sociodemographic factors, an increase in dining out frequency post-COVID-19 remained significant. However, the unadjusted increase in dining out spending did not remain significant. Further research to understand the demand for dining out post-pandemic is warranted.

Healthy Food Prices Increased More Than the Prices of Unhealthy Options during the COVID-19 Pandemic and Concurrent Challenges to the Food System

Food prices have escalated due to impacts of the COVID-19 pandemic on global food systems, and other regional shocks and stressors including climate change and war. Few studies have applied a health lens to identify the most affected foods. This study aimed to assess costs and affordability of habitual (unhealthy) diets and recommended (healthy, equitable and more sustainable) diets and their components in Greater Brisbane, Queensland, Australia from 2019 to 2022 using the Healthy Diets Australian Standardised Affordability and Pricing protocol. Affordability was determined for reference households at three levels of income: median, minimum wage, and welfare-dependent. The recommended diet cost increased 17.9%; mostly in the last year when the prices of healthy foods, such as fruit, vegetables and legumes, healthy fats/oils, grains, and meats/alternatives, increased by 12.8%. In contrast, the cost of the unhealthy foods and drinks in the habitual diet 'only' increased 9.0% from 2019 to 2022, and 7.0% from 2021 to 2022. An exception was the cost of unhealthy take-away foods which increased by 14.7% over 2019-2022. With government COVID-19-related payments, for the first time recommended diets were affordable for all and food security and diets improved in 2020. However, the special payments were withdrawn in 2021, and recommended diets became 11.5% less affordable. Permanently increasing welfare support and providing an adequate minimum wage, while keeping basic, healthy foods GST-free and increasing GST to 20% on unhealthy foods, would improve food security and diet-related health inequities. Development of a Consumer Price Index specifically for healthy food would help highlight health risks during economic downturns.

Revisiting fruit and vegetable determinants: Evidence from Latin America

Introduction

In the past decade, the public health discussion regarding fruit and vegetable (FV) consumption has been dominated by economic and physical accessibility.

Methods

Using an online survey in four Latin American countries, we applied a set of tobit models to compare the determinants of desirable and current consumption of FV levels for satisfied and unsatisfied respondents.

Results

We found that, even when consuming less than five FV portions a day, most of the respondents were satisfied with their current FV consumption level. Satisfied respondents consumed significantly more FV than unsatisfied ones. In general, the desirable and current consumption of FV levels were associated with different sets of determinants, while years of education were relevant in both cases. Finally, in a hypothetical case where unsatisfied respondents would not face any physical or economic access restrictions, unsatisfied respondents would not reach the goal of five FV portions a day.

Discussion

Assuming that physical and economic access improved, this would automatically increase FV to reach the five-a-day recommendation may be inaccurate in some cases. We also need to take mental access into account. We may ask how to improve the desirable level of FVs and then how to close the gap between the current and desirable FV levels.

Influence of income on diet quality and daily iron and zinc intake: analysis of the National Diet and Nutrition Survey of British females aged 11-14 and 15-18 years

PURPOSE

A negative socio-economic gradient exists for diet and health outcomes. Since cheaper diets are associated with increased energy and lower nutrient density, we investigated the influence of income on iron and zinc intakes and overall diet quality for adolescent (DQI-A) females aged 11-18 years.

METHODS

National Diet and Nutrition Survey (NDNS years 7 and 8) data for iron and zinc intake and overall diet quality was assessed by household income quintile across females aged 11-18 years.

RESULTS

Equivalised household income positively correlated with Diet quality index for adolescents (DQI-A) (P < 0.001) Females aged 15-18 years in income quintiles (IQs) I and 2, had a greater proportion of respondents with low to intermediate DQI-A score compared to higher IQs (P = 0.002). NDNS data showed intake was negatively influenced by income amongst females aged 11-14 years for iron (P = 0.009) and zinc (P = 0.001) with those from the lowest incomes consistently consuming significantly less than those from the highest. DQI-A was positively correlated with iron intakes for 11-14 (P = 0.001) and 15-18 years (P < 0.001). Forty-one percent of 15-18-year-olds plasma ferritin stores were below the 15 µg L^-1 and 21% had some form of anaemia. Cereal and cereal products were the greatest contributors to iron in all groups.

CONCLUSION

Females in the lowest income groups are at greater risk of lower overall diet quality and inadequate iron and zinc intakes. Amongst older adolescents, there is evidence of iron stores being depleted and an increased prevalence of anaemia.

Nutrient density and cost of commonly consumed foods: a South African perspective

Food-based dietary guidelines promote consumption of a variety of nutritious foods for optimal health and prevention of chronic disease. However, adherence to these guidelines is challenging because of high food costs. The present study aimed to determine the nutrient density of foods relative to cost in South Africa, with the aim to identify foods within food groups with the best nutritional value per cost. A checklist of 116 food items was developed to record the type, unit, brand and cost of foods. Food prices were obtained from the websites of three national supermarkets and the average cost per 100 g edible portion was used to calculate cost per 100 kcal (418 kJ) for each food item. Nutrient content of the food items was obtained from the South African Food Composition Tables. Nutrient density was calculated using the Nutrient Rich Food (NRF9.3) Index. Nutrient density relative to cost was calculated as NRF9.3/price per 100 kcal. Vegetables and fruits had the highest NRF9.3 score and cost per 100 kcal. Overall, pulses had the highest nutritional value per cost. Fortified maizemeal porridge and bread had the best nutritional value per cost within the starchy food group. Foods with the least nutritional value per cost were fats, oils, foods high in fat and sugar, and foods and drinks high in sugar. Analysis of nutrient density and cost of foods can be used to develop tools to guide low-income consumers to make healthier food choices by identifying foods with the best nutritional value per cost.

Food availability and affordability in a Mediterranean urban context: associations by store type and area-level socio-economic status

OBJECTIVE

Although food environments have been highlighted as potentially effective targets to improve population diets, evidence on Mediterranean food environments is lacking. We examined differences in food availability and affordability in Madrid (Spain) by store type and area-level socio-economic status (SES).

DESIGN

Cross-sectional study. Trained researchers conducted food store audits using the validated Nutrition Environment Measures Survey in Stores for Mediterranean contexts (NEMS-S-MED) tool to measure the availability and price of twelve food groups (specific foods = 35). We computed NEMS-S-MED scores and summarised price data with a Relative Price Index (RPI, comparing prices across stores) and an Affordability Index (normalising prices by area-level income). We compared the availability and affordability of 'healthier-less healthy' food pairs, scores between food store types (supermarkets, specialised, convenience stores and others) and area-level SES using ANOVA and multi-level regression models.

SETTING

City of Madrid. 2016 and 2019 to cover a representative sample.

PARTICIPANTS

Food stores within a socio-economically diverse sample of sixty-three census tracts (n 151).

RESULTS

Supermarkets had higher food availability (37·5/49 NEMS-S-MED points), compared to convenience stores (13·5/49) and specialised stores (8/49). Supermarkets offered lower prices (RPI: 0·83) than specialised stores (RPI: 0·97) and convenience stores (RPI: 2·06). Both 'healthy' and 'less healthy' items were more available in supermarkets. We found no differences in food availability or price by area-level SES, but affordability was higher in higher-income areas.

CONCLUSIONS

Supermarkets offered higher food availability and affordability for healthy and less healthy food items. Promoting healthy food availability through supermarkets and specialised stores and/or limiting access to convenience stores are promising policy options to achieve a healthier food environment.

Comparative cost of diets for low-income families in the Caribbean

Objective.

To assess the ability of low-income families to obtain a standard basket of healthy foods before and during the COVID-19 pandemic.

Methods.

The costs of 191 food items were averaged from supermarkets, municipal markets, wholesalers, and community food outlets in high- and low-income areas in three Caribbean countries. The analysis compared foods not only by selecting high- and low-ranked commodities but by the proportions of those foods, by food group, that will be required to meet a low-cost, nutritionally balanced diet of 2 400 kcal.

Results.

The main finding was that low-income households will need between 22% and 47% of their earnings to obtain a healthy diet. Despite higher food prices in Saint Kitts and Nevis, low-income households there will need a smaller proportion of their income to obtain a similar basket of foods than in Jamaica or Saint Vincent and the Grenadines.

Conclusions.

While the COVID-19 pandemic has added economic stressors to low-income households the basic vulnerability of the poor to obtain a healthy diet remains. Despite country variations, the findings point to the need for an increase in the minimum wage, particularly in Jamaica. It is essential to embed policies that ensure reduced economic and social vulnerability at the household level.

Emergency food supplies and food security in Wuhan and Nanjing, China, during the COVID-19 pandemic: Evidence from a field survey

MOTIVATION

Detailed empirical work on the impact of the COVID-19 pandemic on food security is scant. Local management of food security has received little attention.

PURPOSE

This article describes emergency food policies in Wuhan and Nanjing, China during lockdown in 2020 and their implications for household food security in the two cities.

METHODS AND APPROACH

Policy documents and background data describe the emergency measures. Online surveys of residents of two Chinese cities were used to gauge household food security.

FINDINGS

Despite the determined efforts of provincial and city governments to ensure that food reached people who were locked down in Wuhan, or subject to restrictions on movement in Nanjing, households experienced some decline in food security. Most households found they could not access their preferred foods. But a minority of households did not get enough to eat.Government had contingency plans for the pandemic that ensured that most people had sufficient, if not preferred, food. But not all households were fully covered.

POLICY IMPLICATIONS

A more resilient system of food distribution is needed, including a relatively closed and independent home delivery system. Grassroots organizations such as residential community committees, property management organizations, and spontaneous volunteer groups need to be brought into the management of emergency food provision.

Mapping food and physical activity environments in low- and middle-income countries: A systematised review

This systematised literature review synthesised evidence on approaches to mapping food and physical activity (PA) environments in low- and middle-income countries (LMICs). Of the 60 articles included, 25 and 35 mapped food and PA environments respectively. All studies were cross-sectional with researcher-led data collection. Three types of mapping tools were identified - maps (n = 18), GPS (n = 10), and GIS (n = 37). Our findings point to a paucity of research mapping food and PA environments, overall and particularly subjective domains. We highlight a need for future studies that utilise innovative, inexpensive and participatory research methods to understand dynamic exposures to obesogenic environment features in resource-constrained contexts undergoing rapid urbanisation.

Feasibility and measurement error in using food supply data to estimate diet costs in Canada

OBJECTIVE

The cost of food is a key influence on diet. The majority of diet cost studies match intake data from population-based surveys to a single source of food supply prices. Our aim was to examine the methodological significance of using food supply data to price dietary intakes.

METHODS

Nationally representative 24-hour dietary recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS-N) was matched to the 2015 Canadian Consumer Price Index (CPI) food price list. Proportions and means of reported intakes covered by the 2015 CPI price list were used to compare reported intakes of food groups and food components of interest and concern overall, and by quartile of CPI coverage.

SETTING

Canada.

PARTICIPANTS

20,487 Canadians ages one and older.

RESULTS

The CPI covered on average 76.3% of total dietary intake (g) without water. Staple food groups that were more commonly consumed had better CPI price coverage than those less commonly consumed. Yet some food groups (vegetables, additions, sweets) that were also commonly consumed by Canadians were not well covered by price data. Individuals in the poorest CPI coverage quartile reported consuming significantly greater fibre (g), gram weight (g), dietary fibre (g), and energy (kcal) as compared to those with the best coverage.

CONCLUSIONS

Differential CPI price coverage exists among food components and commonly consumed food groups; additionally dietary intake differs significantly in the population by CPI coverage. Methodological refinements are needed to better account for error when using prices from food supply data to estimate diet costs.

Perspective: Food Environment Research Priorities for Africa-Lessons from the Africa Food Environment Research Network

Over the last 2 decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization, and development. These changes have altered African food environments and, subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transition have contributed to Africa's complex burden of malnutrition-obesity and other diet-related noncommunicable diseases (DR-NCDs)-along with persistent food insecurity and undernutrition. Available evidence links unhealthy or obesogenic food environments (including those that market and offer energy-dense, nutrient-poor foods and beverages) with suboptimal diets and associated adverse health outcomes. Elsewhere, governments have responded with policies to improve food environments. However, in Africa, the necessary research and policy action have received insufficient attention. Contextual evidence to motivate, enable, and create supportive food environments in Africa for better population health is urgently needed. In November 2020, the Measurement, Evaluation, Accountability, and Leadership Support for Noncommunicable Diseases Prevention Project (MEALS4NCDs) convened the first Africa Food Environment Research Network Meeting (FERN2020). This 3-d virtual meeting brought researchers from around the world to deliberate on future directions and research priorities related to improving food environments and nutrition across the African continent. The stakeholders shared experiences, best practices, challenges, and opportunities for improving the healthfulness of food environments and related policies in low- and middle-income countries. In this article, we summarize the proceedings and research priorities identified in the meeting to advance the food environment research agenda in Africa, and thus contribute to the promotion of healthier food environments to prevent DR-NCDs, and other forms of malnutrition.

Food security, poverty and household resilience to COVID-19 in Burkina Faso: Evidence from urban small traders' households

Analyses of the effects of the COVID-19 pandemic on food security of urban households and their resilience are increasingly receiving scholarly interest. In Burkina Faso, urban households whose primary activity is trade were the most immediately impacted by COVID-19 due to the closure of markets. The objective of this research was to analyze the effect of income loss due to COVID-19 on food security and poverty among urban small traders' households by considering their resilience capacity. A survey was performed on 503 households of small traders operating in 5 markets in Ouagadougou. Objective and subjective indicators of food security were calculated, as well as several indices of resilience capacity. A simple logit model and ordered logit model were used for the socioeconomic analysis. Three main results emerge. First, COVID-19 has increased the likelihood of households being food insecure due to their lower food consumption scores. Second, estimates show that COVID-19 has reduced households' incomes by increasing their likelihood of entering poverty. Finally, at all levels of analysis, households with adaptive capacity were able to adjust to the shock, but social security was not a mitigating factor. Implications in terms of economic policies are discussed.

Costing recommended (healthy) and current (unhealthy) diets in urban and inner regional areas of Australia using remote price collection methods

OBJECTIVE

To compare the cost and affordability of two fortnightly diets (representing the national guidelines and current consumption) across areas containing Australia's major supermarkets.

DESIGN

The Healthy Diets Australian Standardised Affordability and Pricing protocol was used.

SETTING

Price data were collected online and via phone calls in fifty-one urban and inner regional locations across Australia.

PARTICIPANTS

Not applicable.

RESULTS

Healthy diets were consistently less expensive than current (unhealthy) diets. Nonetheless, healthy diets would cost 25-26 % of the disposable income for low-income households and 30-31 % of the poverty line. Differences in gross incomes (the most available income metric which overrepresents disposable income) drove national variations in diet affordability (from 14 % of the median gross household incomes in the Australian Capital Territory and Northern Territory to 25 % of the median gross household income in Tasmania).

CONCLUSIONS

In Australian cities and regional areas with major supermarkets, access to affordable diets remains problematic for families receiving low incomes. These findings are likely to be exacerbated in outer regional and remote areas (not included in this study). To make healthy diets economically appealing, policies that reduce the (absolute and relative) costs of healthy diets and increase the incomes of Australians living in poverty are required.

Evidence Gaps in Assessments of the Healthiness of Online Supermarkets Highlight the Need for New Monitoring Tools: a Systematic Review

PURPOSE OF REVIEW

Online grocery shopping is increasingly popular, but the extent to which these food environments encourage healthy or unhealthy purchases is unclear. This review identifies studies assessing the healthiness of real-world online supermarkets and frameworks to support future efforts.

RECENT FINDINGS

A total of 18 studies were included and 17 assessed aspects of online supermarkets. Pricing and promotional strategies were commonly applied to unhealthy products, while nutrition labelling may not meet regulated requirements or support consumer decision-making. Few studies investigated the different and specific ways online supermarkets can influence consumers. One framework for comprehensively capturing the healthiness of online supermarkets was identified, particularly highlighting the various ways retailers can tailor the environment to target individuals. Comprehensive assessments of online supermarkets can identify the potential to support or undermine healthy choices and dietary patterns. Common, validated instruments to facilitate consistent analysis and comparison are needed, particularly to investigate the new opportunities the online setting offers to influence consumers.

Price Trends of Healthy and Less Healthy Foods and Beverages in Mexico from 2011-2018

BACKGROUND

Cost is one of the main drivers of food selection; thus it is important to monitor food prices. Evidence from low- and middle-income countries such as Mexico is limited.

OBJECTIVE

The aim of this study was to evaluate the prices and price trends of healthy and less healthy food/beverage groups in Mexico from 2011 to 2018.

DESIGN

This study used a time series of the prices of foods and beverages classified by 1) healthiness, 2) processing level, and 3) pairs of healthy/less healthy substitutes.

SETTING

Food and beverage prices used to estimate the Consumer Price Index were obtained. Prices were collected weekly from 46 cities (>20,000 habitants) distributed across the country.

MAIN OUTCOME MEASURES

Price trend (% change/year) from 2011 to 2018 for all food/beverage groups and price/100 g in 2018 for pairs of healthy/less healthy substitutes were obtained.

STATISTICAL ANALYSES

Linear regression models were used for each food/beverage group, with the logarithm of deflated price as the dependent variable and time (years) as the independent variable.

RESULTS

On average, prices for less healthy foods and beverages increased more than prices of healthy foods and beverages (foods: 1.72% vs 0.70% change/year; beverages: 1.61% vs -0.19% change/year). The price change was similar for unprocessed/minimally processed foods and ultraprocessed foods (1.95% vs 1.85% change/year); however, within each processing category, the price of less healthy foods increased more. By pairs of substitutes (within food/beverage groups), the healthier option for bread, sodas, and poultry was more expensive (price/100 g) in 2018, whereas for red meat, cheese, mayonnaise, and milk, the healthier option was cheaper.

CONCLUSIONS

Overall, the food prices of less healthy foods and beverages increased more than the food prices of healthy foods and beverages. However, by processing level there was no difference, and for pairs of healthy/less healthy substitutes results were mixed. Continued monitoring of food prices is warranted, and future research is needed to understand how these price changes affect dietary quality.

Replacing ultra-processed foods with fresh foods to meet the dietary recomendations: a matter of cost?

The study aimed to analyze the economic impact of the adoption of optimized and nutritionally balanced diets to Brazilian families, considering the Brazilian dietary guidelines and the economic disparities of the population. Data from the Brazilian Household Budget Survey from 2008-2009 (550 strata; 55,970 households) were used. About 1,700 foods and beverages purchased by the Brazilians were classified into 4 groups according to NOVA system. Linear programming models estimated isoenergetic diets preserving the current diet as baseline and optimizing healthier diets gradually based on the "golden rule" of the Brazilian dietary guidelines, respecting nutritional restrictions for macronutrients and micronutrients (based on international recommendations) and food acceptance limits (10th and 90th percentiles of the per capita calorie distribution from the population). The diet cost was defined based on the sum of the average cost of each food group, both in the current and optimized diets (BRL per 2,000Kcal/person/day). The economic impact of the Brazilian dietary guidelines to Brazilian household budget was analyzed by comparison the cost of the optimized diets to the cost of the current diet, calculated for the total population and by income level. Three healthier diets were optimized. Current diet cost was BRL 3.37, differed among low- and high-income strata (BRL 2.62 and BRL 4.17, respectively). Regardless of income, diet cost decreased when approaching the guidelines. However, low-income strata compromised their household budget more than two times the high-income strata (20.2% and 7.96%, respectively). Thus, the adoption of healthier eating practices can be performed with the same or lower budget.

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.

Dietary Intake, Cost, and Affordability by Socioeconomic Group in Australia

Few Australians consume diets consistent with the Australian Dietary Guidelines. A major problem is high intake of discretionary food and drinks (those not needed for health and high in saturated fat, added sugar, salt and/or alcohol). Low socioeconomic groups (SEGs) suffer particularly poor diet-related health. Surprisingly, detailed quantitative dietary data across SEGs was lacking. Analysis of the most recent national nutrition survey data produced habitual intakes of a reference household (two adults and two children) in SEG quintiles of household income. Cost and affordability of habitual and recommended diets for the reference household were determined using methods based on the Healthy Diets Australian Standardised Affordability and Pricing protocol. Low SEGs reported significantly lower intakes of healthy food and drinks yet similarly high intakes of discretionary choices to high SEGs (435 serves/fortnight). Total habitual diets of low SEGs cost significantly less than those of high SEGs (AU$751/fortnight to AU$853/fortnight). Results confirmed low SEGs cannot afford a healthy diet. Lower intakes of healthy choices in low SEGs may help explain their higher rates of diet-related disease compared to higher SEGs. The findings can inform potential policy actions to improve affordability of healthy foods and help drive healthier diets for all Australians.

Affordability of Heathy, Equitable and More Sustainable Diets in Low-Income Households in Brisbane before and during the COVID-19 Pandemic

The COVID-19 pandemic has increased food insecurity worldwide, yet there has been limited assessment of shifts in the cost and affordability of healthy, equitable and sustainable diets. This study explores the impact of the COVID-19 pandemic and income supplements provided by the Australian government on diet cost and affordability for low-income households in an Australian urban area. The Healthy Diets ASAP method protocol was applied to assess the cost and cost differential of current and recommended diets before (in 2019) and during the COVID-19 pandemic (late 2020) for households with a minimum-wage and welfare-only disposable household income, by area of socioeconomic disadvantage, in Greater Brisbane, Queensland, Australia. Data were collected between August and October, 2020, from 78 food outlets and compared with data collected in the same locations between May and October, 2019, in an earlier study. The price of most healthy food groups increased significantly during the pandemic-with the exception of vegetables and legumes, which decreased. Conversely, the price of discretionary foods and drinks did not increase during the pandemic. The cost of the current and recommended diets significantly increased throughout this period, but the latter continued to be less expensive than the former. Due to income supplements provided between May and September 2020, the affordability of the recommended diet improved greatly, by 27% and 42%, for households with minimum-wage and welfare-only disposable household income, respectively. This improvement in the affordability of the recommended diet highlights the need to permanently increase welfare support for low-income families to ensure food security.

Food, energy, and nutrient supply in Mexican households from 1984 to 2018

INTRODUCTION

information about changes in food and energy supply, macronutrient and micronutrient availability by processing level is required to understand the nutritional transition in Mexican society.

OBJECTIVE

to describe the food, energy, and nutrient supply in Mexican households from 1984 to 2018.

METHODS

five waves of a Mexican cross-sectional survey were analyzed to identify changes in food, energy, and nutrient supplies in households. Food groups were created using the NOVA classification. The content of energy and nutrients was estimated using Mexican and U.S. databases. The education and income interaction with energy and nutritional supply was analyzed.

RESULTS

in this period, the supply of fresh and processed fruits and vegetables, processed meat and dairy, fish and seafood, prepared food, and ultra-processed food and drinks increased, whereas unprocessed or minimally processed (UMP) cereals and tubers, legumes, meat, dairy, eggs, and all processed culinary ingredients decreased. These changes have implied a higher supply of protein, total fat, cholesterol, vitamins A and C, calcium and sodium. Total energy, energy density, carbohydrates, and magnesium and potassium density decreased. Across waves, UMP and processed cereals were the main supply for energy, carbohydrates, fiber, iron and potassium. Dairy was the main supply of saturated fat. UMP and processed cereals were the main source of sodium in 1984, whereas ultra-processed cereals were the main source of sodium in 2018.

CONCLUSIONS

although UMP foods remain the main group in most Mexican households, their supply has decreased over the years, whereas the supply of ultra-processed foods has increased.

Using Linear Programming to Determine the Role of Plant- and Animal-Sourced Foods in Least-Cost, Nutritionally Adequate Diets for Adults

BACKGROUND

The respective roles of plant- and animal-sourced foods in sustainable healthy diets for humans remain unclear. Nutritional quality and the monetary cost of diets are key criteria among others for sustainable food production.

OBJECTIVE

Linear programming (LP) was used to determine the composition of nutritionally adequate dietary patterns formulated at the lowest cost. The hypothesis tested was that animal-sourced foods would be included in least-cost diets due to their high density of particular essential nutrients.

METHODS

The LP modeling work was based on eating patterns, retail food prices (2020), and the daily energy (11,150 kJ, 2665 kcal) and essential nutrient requirements (29 nutrients in total) of a reference adult in New Zealand (NZ). The LP modeling approach is publicly and freely available to readily illustrate the change in dietary profiles and daily diet cost, in the simulation of changes in energy and nutrient requirements, and price fluctuations within food groups.

RESULTS

A nutrient-adequate, least-cost dietary pattern formulated from 883 foods, with a daily cost of NZ $3.23, included both animal- and plant-based foods. The nutrients found to be equally first-limiting were biotin, calcium, molybdenum, potassium, selenium, vitamin A, pantothenic acid, and vitamin C. When a dietary scenario with no animal-sourced foods was modeled, by increasing the retail prices of animal-sourced foods by 1.05 to 10.3 times, the daily cost of this plant-only dietary pattern was NZ $4.34. Additional nutrients, such as zinc, vitamin B-12, and vitamin D, were met at their daily minimum required levels.

CONCLUSIONS

Dietary patterns formulated at the lowest cost and meeting the daily minimum requirements for energy and essential nutrients for an adult in New Zealand relied on foods sourced from animals and plants.

A Typology of Food Environments in the Pacific Region and Their Relationship to Diet Quality in Solomon Islands

Extensive literature describes the importance of food environments (FEs) as a driver of food choices and nutrition outcomes; yet existing FE frameworks do not adequately capture the diversity of FEs relevant to the Pacific Region. This limits identification of opportunities in food systems to reduce the multiple burden of malnutrition. We present a conceptual typology of FEs including six primary FEs relevant in the Pacific; wild; cultivated; kin and community; informal retail; formal retail; and food aid and services. We then apply this typology to food acquisition data from Solomon Islands 2012/13 Household Income and Expenditure Survey and analyse the relationship between FEs and diet quality. The cultivated FE accounts for 60% of the quantity of food acquired nationally, followed by wild (15%), kin and community (9%), and formal and informal retail FEs (8% each), with wide variation between urban and rural households, provinces and wealth groups. Reliance on different FEs is a significant predictor of diet quality and affirms the importance of subsistence fisheries and agriculture, and community and kinship networks. Integration of a FE typology such as the one presented here in commonly conducted household expenditure surveys offers significant opportunity to advance our understanding of food system leverage points to improve nutrition and health.

Adoption of healthy and sustainable diets in Mexico does not imply higher expenditure on food

The relative cost of healthy and sustainable diets is key for their adoption in different countries. Using a newly developed modelling tool that generates different diet baskets, we compared the costs of diets following the EAT-Lancet healthy reference diet, the Mexican dietary guidelines and locals' current food intake. On average, the cost of the EAT-Lancet healthy reference diet baskets was 21% lower than that of the Mexican dietary guidelines baskets, and 40% lower than that of the current intake baskets (29% lower if the comparison was isocaloric). Findings were similar over time (2011-2018) and by geographic region. The higher cost associated with the larger amount of fruits, vegetables, legumes and nuts in healthy and sustainable diets was surpassed by the savings associated with their lower amount of animal protein sources, sugar-sweetened beverages and discretionary foods. We conclude that transitioning to better diets in Mexico is possible without a higher expenditure on food.

Food promotions and the cost of a healthy diet

With approximately two in three UK adults overweight or obese, one in five living in poverty and our emergence from the Covid-19 pandemic with implications for employment and income status there is an urgent need to understand what it costs to eat healthily and the role that promotions can play in helping householders manage food budgets. The literature suggests that, in affluent countries, price promotions appear to increase consumer food purchases and are applied more frequently to less healthy products than their healthy counterparts. This review discusses the cost of a healthy diet, identifies the prevalence of promotions in both the supermarket setting generally and a typical shopping basket specifically, and discusses the barriers to affording a healthy diet. Given the current policy focus on the cost of living and population health emphasising the need for food shopping to represent health and value for money for better public health outcomes, this review contributes to the evidence base for retailers' and policymakers' consideration as policy solutions are sought to reduce population obesity levels, while ensuring the affordability and accessibility of nutritious food. It is important, given the shift in consumer purchasing behaviour to online shopping as a result of self-isolating or reticence to physically access stores in response to the Covid-19 pandemic, that retail food promotions are available irrespective of the chosen mode of shopping (in-store or online).

Cost and Affordability of Healthy, Equitable and Sustainable Diets in Low Socioeconomic Groups in Australia

Few Australians consume a healthy, equitable and more sustainable diet consistent with the Australian Dietary Guidelines (ADGs). Low socioeconomic groups (SEGs) suffer particularly poor diet-related health problems. However, granular information on dietary intakes and affordability of recommended diets was lacking for low SEGs. The Healthy Diets Australian Standardised Affordability and Pricing protocol was modified for low SEGs to align with relevant dietary intakes reported in the National Nutrition Survey 2011–2012(which included less healthy and more discretionary options than the broader population), household structures, food purchasing habits, and incomes. Cost and affordability of habitual and recommended diets of low SEGs were calculated using prices of ‘standard brands’ and ‘cheapest options’. With ‘standard brands’, recommended diets cost less than habitual diets, but were unaffordable for low SEGs. With ‘cheapest options’, both diets were more affordable, but recommended diets cost more than habitual diets for some low SEGs, potentially contributing to perceptions that healthy food is unaffordable. The study confirms the need for an equity lens to better target dietary guidelines for low SEGs. It also highlights urgent policy action is needed to help improve affordability of recommended diets.

Affordability of current, and healthy, more equitable, sustainable diets by area of socioeconomic disadvantage and remoteness in Queensland: insights into food choice

Background

Poor diet is the leading preventable risk factor contributing to the burden of disease globally and in Australia, and is inequitably distributed. As the price of healthy foods is a perceived barrier to improved diets, evidence on the cost and affordability of current (unhealthy) and recommended (healthy, more equitable and sustainable) diets is required to support policy action.

Methods

This study applied the Healthy Diets ASAP (Australian Standardised Affordability and Pricing) methods protocol to measure the cost, cost differential and affordability of current and recommended diets for a reference household in Queensland, Australia. Food prices were collected in 18 randomly selected locations stratified by area of socioeconomic disadvantage and remoteness. Diet affordability was calculated for three income categories.

Results

Surprisingly, recommended diets would cost 20% less than the current diet in Queensland as a whole. Households spent around 60% of their food budget on discretionary choices (that is, those not required for health that are high in saturated fat, added sugar, salt and/or alcohol). Queensland families would need to spend around 23% of their income on recommended diets. However, recommended diets would not be affordable in low socioeconomic or very remote areas, costing 30 and 35% of median household income respectively. The government supplements due to the SARS-CoV-2 pandemic would improve affordability of recommended diets by 29%.

Conclusions

Study findings highlight that while price is one factor affecting consumer food choice, other drivers such as taste, convenience, advertising and availability are important. Nevertheless, the study found that recommended diets would be unaffordable in very remote areas, and that low-income families are likely experiencing food stress, irrespective of where they live in Queensland. Policy actions, such as increasing to 20% the current 10% tax differential between basic healthy, and unhealthy foods in Australia, and supplementing incomes of vulnerable households, especially in remote areas, are recommended to help improve diet equity and sustainability, and health and wellbeing for all.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01481-8.

Availability, Nutritional Profile and Processing Level of Food Products Sold in Vending Machines in a Spanish Public University

BACKGROUND

Given the lack of data about the nutritional value and other determinants of the consumption of foods and drinks sold in vending machines in European universities and the relevance of this sector in Spain, it is necessary to obtain scientific data on this topic. The present study aimed to assess the availability, nutritional profile and processing level of food products from vending machines at a Spanish public university and to investigate differences in nutritional profile according to the cost and promotion.

METHODS

Cross-sectional descriptive study. Data from all products available (3894) were collected and analysed using the criteria of the Spanish Agency for Consumption, Food Safety and Nutrition and the United Kingdom nutrient profiling model. The items were also classified according to the degree of industrial processing through the NOVA system. Promotion was assessed, taking into account where products were displayed in vending machines.

RESULTS

The most common products were sweets (23.4% of the total options), coffee (20.3%) and salty snacks (11.7%). According to the combination of the two criteria used to assess nutritional profile, 48.6% of the products were classified as with low nutritional quality (LNQ). In addition, 73.8% of the items were categorised as "ultra-processed". Foods (β = 0.31, 95% CI 0.24, 0.39, p < 0.001) and hot drinks (β = 0.46, 95% CI 0.39, 0.52, p < 0.001) with high nutritional quality (HNQ) were more likely to have higher prices than alternatives with LNQ. Both foods and cold drinks that support healthy dietary recommendations were promoted to a lesser extent than those with LNQ (p < 0.001).

CONCLUSION

Almost half of the products were of LNQ and three-quarters had a high level of processing. Moreover, foods and cold drinks with LNQ were less expensive and more often promoted than alternatives with HNQ.

Cost and greenhouse gas emissions of current, healthy, flexitarian and vegan diets in Aotearoa (New Zealand)

Objective

To compare the costs and climate impact (greenhouse gas emissions) associated with current and healthy diets and two healthy and environmentally friendly dietary patterns: flexitarian and vegan.

Design

Modelling study

Setting

Aotearoa (New Zealand).

Main outcome measures

The distribution of the cost and climate impact (kgCO₂e/kg of food per fortnight) of 2 weekly current, healthy, vegan and flexitarian household diets was modelled using a list of commonly consumed foods, a set of quantity/serves constraints for each, and constraints for food group and nutrient intakes based on dietary guidelines (Eating and Activity Guidelines for healthy diets and EAT-Lancet reference diet for vegan and flexitarian diets) or nutrition survey data (current diets).

Results

The iterative creation of 210–237 household dietary intakes for each dietary scenario was achieved using computer software adapted for the purpose (DIETCOST). There were stepwise differences between diet scenarios (p<0.001) with the current diet having the lowest mean cost in New Zealand Dollars (NZ$584 (95% CI NZ$580 to NZ$588)) per fortnight for a family of four) but highest mean climate impact (597 kgCO₂e (95% CI 590 to 604 kgCO₂e)), followed by the healthy diet (NZ$637 (95% CI NZ$632 to NZ$642), 452 kgCO₂e (95% CI 446 to 458 kgCO₂e)), the flexitarian diet (NZ$728 (95% CI NZ$723 to NZ$734), 263 kgCO₂e (95% CI 261 to 265 kgCO₂e)) and the vegan diet, which had the highest mean cost and lowest mean climate impact (NZ$789, (95% CI NZ$784 to NZ$794), 203 kgCO₂e (95% CI 201 to 204 kgCO₂e)). There was a negative relationship between cost and climate impact across diets and a positive relationship within diets.

Conclusions

Moving from current diets towards sustainable healthy diets (SHDs) will reduce climate impact but generally at a higher cost to households. The results reflect trade-offs, with the larger constraints placed on diets, the greater cost and factors such as nutritional adequacy, variety, cost and low-emissions foods being considered. Further monitoring and policies are needed to support population transitions that are country specific from current diets to SHD.

Food environment solutions for childhood obesity in Latin America and among Latinos living in the United States

The food environment is a major contributor to unhealthy diets in children and, therefore, to the increasing rates of obesity. Acclaimed by scholars across the world, Latin American countries have been leaders in implementing policies that target different aspects of the food environment. Evidence on the nature and to what extent children are exposed and respond to unhealthy food environments in the region and among Latinos in the United States is, however, deficient. The objective of this review is to use the integrated International Network for Food and Obesity/noncommunicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) framework to create healthy food environment to (i) compare the key elements of childhood obesity-related food environments in Latin America and for Latinos living in the United States; (ii) describe the evidence on solutions to improve childhood obesity-related food environments; and (iii) identify research priorities to inform solutions to fight childhood obesity in these populations. We found that an integrated body of evidence is needed to inform an optimal package of policies to improve food environments to which children in Latin America and Latino children in the United States are exposed and more efficiently translate policy solutions to help curb growing childhood obesity levels across borders.

Diet and Economic Modelling to Improve the Quality and Affordability of the Australian Diet for Low and Medium Socioeconomic Households

Food costs are a barrier to healthier diet selections, particularly for low socioeconomic households who regularly choose processed foods containing refined grains, added sugars, and added fats. In this study, the objectives were to: (i) identify the nutrient density-to-cost ratio of Australian foods; (ii) model the impact of substituting foods with lower nutrient density-to-cost ratio with those with the highest nutrient density-to-cost ratio for diet quality and affordability in low and medium socioeconomic households; and (iii) evaluate food processing levels. Foods were categorized, coded for processing level, analysed for nutrient density and cost, and ranked by nutrient density-to-cost ratio. The top quartile of nutrient dense, low-cost foods included 54% unprocessed (vegetables and reduced fat dairy), 33% ultra-processed (fortified wholegrain bread and breakfast cereals <20 g sugars/100 g), and 13% processed (fruit juice and canned legumes). Using substitution modelling, diet quality improved by 52% for adults and 71% for children across all households, while diet affordability improved by 25% and 27% for low and medium socioeconomic households, respectively. The results indicate that the quality and affordability of the Australian diet can be improved when nutritious, low-cost foods are selected. Processing levels in the healthier modelled diets suggest that some ultra-processed foods may provide a beneficial source of nutrition when consumed within national food group recommendations.

Measuring cost and affordability of current vs. healthy diets in Argentina: an application of linear programming and the INFORMAS protocol

BACKGROUND

Food cost and affordability is one of the main barriers to improve the nutritional quality of diets of the population. However, in Argentina, where over 60% of adults and 40% of children and adolescents are overweight or obese, little is known about the difference in cost and affordability of healthier diets compared to ordinary, less healthy ones.

METHODS

We implemented the "optimal approach" proposed by the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS). We modelled the current diet and two types of healthy diets, one equal in energy with the current diet and one 6.3% lower in energy by linear programming. Cost estimations were performed by collecting food product prices and running a Monte Carlo simulation (10,000 iterations) to obtain a range of costs for each model diet. Affordability was measured as the percentage contribution of diet cost vs. average household income in average, poor and extremely poor households and by income deciles.

RESULTS

On average, households must spend 32% more money on food to ensure equal energy intake from a healthy diet than from a current model diet. When the energy intake target was reduced by 6.3%, the difference in cost was 22%. There are no reasonably likely situations in which any of these healthy diets could cost less or the same than the current unhealthier one. Over 50% of households would be unable to afford the modelled healthy diets, while 40% could not afford the current diet.

CONCLUSIONS

Differential cost and affordability of healthy vs. unhealthy diets are germane to the design of effective public policies to reduce obesity and NCDs in Argentina. It is necessary to implement urgent measures to transform the obesogenic environment, making healthier products more affordable, available and desirable, and discouraging consumption of nutrient-poor, energy-rich foods.

Identifying trends over time in food affordability: The Illawarra Healthy Food Basket survey, 2011-2019

OBJECTIVE

To determine the affordability of a healthy food basket (HFB) for welfare recipients and average income earners in 2019 and to compare trends from 2011.

METHODS

Fifty-seven food items' prices were collected from fifteen stores across five suburbs representing low, medium and high socio-economic status. Costs were compared with average weekly income and welfare payments to assess the baskets' affordability for a family of four and five.

RESULTS

In 2019, a HFB was affordable (below 30% of household income) for a five-person reference family with a pensioner, representing 24.8% of weekly welfare payments, but not for a four-person reference family (33.0%). The cost of the HFB increased slightly over time from AU$288.91 in 2011 to AU$291.79 in 2019. The food affordability improved for a family of five including a pensioner over this period due to an increase of average weekly earnings and welfare payments.

CONCLUSION

In 2019, the HFB was affordable for a five-person family; however, a four-person family receiving welfare benefits would have experienced significant "food stress," with the food basket costing above 30% of household income.

IMPLICATIONS FOR HEALTH PROMOTION

Inequity in the affordability of healthy food is a major public health concern and one that demands recognition and national action. The impact of policies affecting welfare support and wages needs to be considered, as well as food pricing strategies and possible food subsidies for those at greatest risk of food insecurity.

The composite alliance of FTO locus with obesity-related genetic variants

Obesity has become a genuine global pandemic due to lifestyle and environmental modifications, and is associated with chronic lethal comorbidities. Various environmental factors such as lack of physical activity due to modernization and higher intake of energy-rich diets are primary obesogenic factors in pathogenesis of obesity. Genome-wide association study has identified the crucial role of FTO (fat mass and obesity) in human obesity. A bunch of SNPs in the first intron of FTO has been identified and subsequently correlated to body mass index and body composition. Findings of in silico, in vitro, and in vivo studies have manifested the robust role of FTO in regulation of energy expenditure and food consumption. Numerous studies have highlighted the mechanistic pathways behind the concomitant functions of FTO in adipogenesis and body size. Current investigation has also revealed the link of FTO neighbouring genes i.e., RPGRIP1L, IRX3 and IRX5 and epigenetic factors with obesity phenotypes. The motive behind this review is to cite the consequences of FTO on obesity vulnerability.

[Poverty as a determinant of food quality in Argentina. Results of the Argentine Study of Nutrition and Health (EANS)]

Introduction

Introduction: socio-economic differences lead to food and nutritional inequalities. Diet is a modifiable risk factor by public health activities, on the way to the prevention of chronic non-communicable diseases. Objective: to estimate food inequalities in Argentina based on the socioeconomic level of the population, analyzing the consumption of different food groups. Methods: Argentine data from the Latin American Study of Nutrition and Health. Sample: 1,266 individuals stratified by gender, socioeconomic level and geographic region. Intake: 2 24-hour reminders with the multi-step technique. Analysis: with the NDS Software average consumption values of 11 food groups were analyzed by socioeconomic level and country region. Results: the population with lower socioeconomic status consumes significantly less fruits, vegetables and dairy products than the population with medium to high socioeconomic level. Fruits: 59 vs. 79.1 and 106.3 g/d, respectively; p = 0.000. Vegetables: 82.3 g/d vs. 112 and 118 g/d; p = 0.000. Dairy products: 114 g/d vs. 165 and 137 g/d; p = 0.000). On the contrary, it consumes a greater volume of soft drinks and industrial juices (680 mL/d vs. 527 and 590 mL/d, respectively; p = 0.000), infusions with added sugar (568 mL/d vs. 385 and 309 mL/d; p = 0.000), bread (85 g/d vs. 75.5 and 66.7 g/d; p = 0.012) and pastries (159 g/d vs. 147 and 122 g/d; p = 0.008). Conclusions: Social vulnerability is an important determinant for diet quality. Interventions designed to reduce social inequalities as linked to nutrition and health are essential.

A systematic scoping review of the habitual dietary costs in low socioeconomic groups compared to high socioeconomic groups in Australia

Background

Low socioeconomic groups (SEGs) in Australia are less likely to consume diets consistent with the Australian Dietary Guidelines (ADGs) and suffer poorer health than the broader population. The unaffordability, or perceived high cost, of healthy diets may be a factor. Detailed data on the cost of habitually consumed diets is required in order to inform strategies to alleviate socioeconomic impacts on dietary intake.

This systematic scoping review aims to identify the cost of the habitual dietary intake of low SEGs in Australia, in terms of the whole diet and its composite foods, in comparison to the cost in higher SEGs.

Methods

A systematic search of peer-reviewed literature since 2000 and key government and non-government organisation (NGO) websites was undertaken. Data were extracted, synthesised and analysed in relation to study populations, dietary cost assessment measures, socioeconomic measures, and dietary cost and affordability.

Results

The review identified four studies meeting inclusion criteria. Results confirmed that overall, low SEGs spend a lower amount, yet a higher proportion of household income, on food and drinks than higher SEGs. Quantitative comparison of the dietary costs between included studies was not possible due to difference in populations and study metrics. Costs of the habitual diet in these studies were not reported for ADG food groups, so did not allow for assessment of the healthfulness of the dietary intake or comparison with costs of recommended diets at food group level.

Conclusions

Existing research does not provide sufficiently granular data of the costs of habitual diets of low SEGs in comparison to higher SEGs or data in a form that can inform strategies and interventions to improve dietary intake and diet-related health of low SEGs in Australia. Future empirical health research requires more granular measures of habitual spending on ADG food groups across SEGs.

Dietary Approaches to Stop Hypertension (DASH) diet and associated socio-economic inequalities in the UK

The Dietary Approaches to Stop Hypertension (DASH) diet is an effective measure in the prevention and treatment of CVD. We evaluated recent trends in socio-economic differences in the DASH score in the UK population, using education, occupation and income as proxies of socio-economic position (SEP). We analysed data on 6416 subjects aged 18 years and older collected in the National Diet and Nutrition Survey (2008-2016). The DASH score was calculated using sex-specific quintiles of DASH items. Multiple linear regression and quantile regression models were used to evaluate the trend in DASH score according to SEP. The mean DASH score was 24 (sd 5). The estimated mean difference between people with no qualification and those having the highest level of education was -3·61 (95 % CI -4·00, -3·22) points. The mean difference between subjects engaged in routine occupations and those engaged in high managerial and professional occupations was -3·41 (95 % CI -3·89, -2·93) points and for those in the first fifth and last fifth of the household income distribution was -2·71 (95 % CI -3·15, -2·28) points. DASH score improved over time, and no significant differences in the trend were observed across SEP. The widest socio-economic differences emerged for consumption of fruit, vegetables, whole grains, nuts, seeds and legumes. Despite an overall increase in the DASH score, a persisting SEP gap was observed. This is an important limiting factor in reducing the high socio-economic inequality in CVD observed in the UK.

Urban environment and dietary behaviours as perceived by residents living in socioeconomically diverse neighbourhoods: A qualitative study in a Mediterranean context

Scholars have determined that low socioeconomic status (SES) is associated with unhealthy dietary behaviours and that local food environments shape food inequality. Less is known about how residents' perceptions of their food environment affect their dietary behaviours. We conducted 37 semistructured interviews and 29 focus groups in three socioeconomically distinct neighbourhoods in Madrid. We identified the following main categories related to social and physical food environments: (a) perceptions of healthy and unhealthy dietary behaviours, (b) children's relationships with food, (c) precariousness and (d) residential food retailer types. Older adults were perceived as healthier consumers, whereas younger people were identified as fast-food consumers. In the low- and middle-SES neighbourhoods, residents saw home-cooked legume-based stews as healthy food. In the high-SES neighbourhood, television cooking programs were highlighted as a positive influence. In the low- and middle-SES neighbourhoods, grandparents played an essential role in the transmission of healthy eating habits to their grandchildren. In the high-SES neighbourhood, children's diets at home were determined by school menus. In the low- and middle-SES neighbourhoods, participants talked about a black market where food could be purchased. Food retailers with low-quality foods were also highlighted. In all neighbourhoods, residents missed traditional food stores, and in the low- and middle-SES neighbourhoods, immigrant-run food stores were not well accepted. Our study presents the concepts shaping how neighbourhood SES differences affect dietary behaviours according to residents of a large Mediterranean city.

[Quality of diet and daily spending on food by adults with cardiovascular disease in Brazil]

Adherence to a healthy diet depends on factors such as food prices, while studies in developed countries have identified higher costs of more nutritional foods. The current study aimed to assess the direct food expenditures by adults with cardiovascular disease in Brazil, investigating the relationship between cost and quality of diet. The study used data from a randomized clinical trial, the BALANCE Program. The current study is a cross-sectional baseline analysis of participants with high adherence to the trial, conducted in 35 sites in all five major geographic regions of Brazil. Food consumption by 1,160 individuals was collected with a 24-hour dietary recall (24HR), quality of diet was measured with the Diet Quality Index Revised (DQI-R), and direct food costs were estimated from market prices. No significant differences were observed between tertiles of adherence in the direct costs of food or individual characteristics. When all the 24HR were analyzed, there was no correlation between cost and quality of diet (r = 0.38; p = 0.17), while analysis by tertiles showed a weak correlation in the lowest tertile of adherence (r = -0.112; p = 0.03). The study showed absence of differences between direct costs of healthy versus unhealthy foods, a finding that can serve as an incentive for adherence to food recommendations in Brazil, thereby minimizing barriers to the adoption of healthy lifestyles.

The affordability of a healthy and sustainable diet: an Australian case study

BACKGROUND/AIMS

EAT-Lancet Commission's Planetary Health Diet proposed a diet that integrates nutrition and sustainability considerations, however its affordability is unknown in many country-specific contexts, including Australia. The aim of this study is to develop a healthy and sustainable food basket modelled on the Planetary Health Diet to determine the affordability of the Planetary Health Diet basket across various socio-economic groups, and compare this affordability with a food basket modelled on the typical current diet, in an Australian setting.

METHODS

An Australian-specific Planetary Health Diet basket was developed for a reference household (2 adults and 2 children) modelled on the Planetary Health Diet reference diet, and compared to a previously-developed Typical Australian Diet basket. The cost of each food basket was determined by online supermarket shopping surveys in low, medium and high socio-economic areas in each Australian state. Basket affordability was determined for the reference household by comparing the basket cost to disposable income in each socio-economic group in each state. Mann-Whitney U tests then determined if there were significant differences between the median costs and the median affordability of both baskets.

RESULTS

The Planetary Health Diet basket was shown to be less expensive and more affordable than the Typical Australian Diet basket nationally, in all metropolitan areas, in all socio-economic groups across Australia (median cost: Planetary Health Diet = AUD$188.21, Typical Australian Diet = AUD$224.36; median affordability: Planetary Health Diet = 13%, Typical Australian Diet = 16%; p = < 0.05).

CONCLUSIONS

This study showed the Planetary Health Diet to be more affordable than the Typical Australian Diet for metropolitan-dwelling Australians.

IMPLICATIONS

These results can help to inform public health and food policy aimed at achieving a healthy and sustainable future for all Australians, including reductions in overweight/obesity rates and increased food security.

Streamlined data-gathering techniques to estimate the price and affordability of healthy and unhealthy diets under different pricing scenarios

OBJECTIVE

To determine the reliability of streamlined data-gathering techniques for examining the price and affordability of a healthy (recommended) and unhealthy (current) diet. We additionally estimated the price and affordability of diets across socio-economic areas and quantified the influence of different pricing scenarios.

DESIGN

Following the Healthy Diets Australian Standardised Affordability and Pricing (ASAP) protocol, we compared a cross-sectional sample of food and beverage pricing data collected using online data and phone calls (lower-resource streamlined techniques) with data collected in-store from the same retailers.

SETTING

Food and beverage prices were collected from major supermarkets, fast food and alcohol retailers in eight conveniently sampled areas in Victoria, Australia (n 72 stores), stratified by area-level deprivation and remoteness.

PARTICIPANTS

This study did not involve human participants.

RESULTS

The biweekly price of a healthy diet was on average 21 % cheaper ($596) than an unhealthy diet ($721) for a four-person family using the streamlined techniques, which was comparable with estimates using in-store data (healthy: $594, unhealthy: $731). The diet price differential did not vary considerably across geographical areas (range: 18-23 %). Both diets were estimated to be unaffordable for families living on indicative low disposable household incomes and below the poverty line. The inclusion of generic brands notably reduced the prices of healthy and unhealthy diets (≥20 %), rendering both affordable against indicative low disposable household incomes. Inclusion of discounted prices marginally reduced diet prices (3 %).

CONCLUSIONS

Streamlined data-gathering techniques are a reliable method for regular, flexible and widespread monitoring of the price and affordability of population diets in areas where supermarkets have an online presence.

A tale of two cities: the cost, price-differential and affordability of current and healthy diets in Sydney and Canberra, Australia

BACKGROUND

The perception that healthy foods are more expensive than unhealthy foods has been reported widely to be a key barrier to healthy eating. However, assessment of the relative cost of healthy and unhealthy foods and diets is fraught methodologically. Standardised approaches to produce reliable data on the cost of total diets and different dietary patterns, rather than selected foods, are lacking globally to inform policy and practice.

METHODS

This paper reports the first application, in randomly selected statistical areas stratified by socio-economic status in two Australian cities, of the Healthy Diets Australian Standardized Affordability and Pricing (ASAP) method protocols: diet pricing tools based on national nutrition survey data and dietary guidelines; store sampling and location; determination of household incomes; food price data collection; and analysis and reporting. The methods were developed by the International Network on Food and Obesity/NCD Research, Monitoring and Action Support (INFORMAS) as a prototype of an optimum approach to assess, compare and monitor the cost and affordability of diets across different geographical and socio-economic settings and times.

RESULTS

Under current tax policy in Australia, healthy diets would be 15-17% less expensive than current (unhealthy) diets in all locations assessed. Nevertheless, healthy diets are likely to be unaffordable for low income households, costing more than 30% of disposable income in both cities surveyed. Households spent around 58% of their food budget on unhealthy food and drinks. Food costs were on average 4% higher in Canberra than Sydney, and tended to be higher in high socioeconomic locations.

CONCLUSIONS

Health and fiscal policy actions to increase affordability of healthy diets for low income households are required urgently. Also, there is a need to counter perceptions that current, unhealthy diets must be less expensive than healthy diets. The Healthy Diets ASAP methods could be adapted to assess the cost and affordability of healthy and unhealthy diets elsewhere.