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Hejazi J, Aminzare M, Ayatollahi Y, Vakili MM, Hassanzadazar H, Rahimlou M. Effect of a comprehensive nutrition education program on nutritional behavior and food security of female-headed households who receive welfare support in Zanjan Province, Iran. BMC Public Health 2023; 23:1512. [PMID: 37559021 PMCID: PMC10413688 DOI: 10.1186/s12889-023-16478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/08/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND In recent years, the food security and dietary quality of many Iranian families have deteriorated due to unprecedented inflation. Nutrition education programs can be an effective and inexpensive method to improve food quality and security. The present study aimed to investigate the effect of a comprehensive nutrition education program for low-income women who are heads of households and are covered by the Zanjan province's welfare. METHODS The food security of 2600 female-headed households covered by the Welfare of Zanjan province was evaluated using a standard 6-item questionnaire. A total of 600 women with the highest food insecurity scores were selected for the comprehensive nutrition education program. The participants received six sessions of 1.5 h of courses about how to improve the quality of their diets and manage their budgets and be physically active. At the beginning of the study and one month after the completion of the intervention, the participants were asked to complete a questionnaire designed and validated by the investigators. The scores of each section before and after the intervention were compared using paired t-test method and p values of < 0.05 were considered statistically significant. RESULTS The prevalence of severe food insecurity among female-headed households who receive welfare support in Abhar, Khodabandeh, and Zanjan cities was 59.5%, 75%, and 62%, respectively. A total of 505 participants successfully completed the courses. After completion of the educational intervention, diet quality, physical activity, budgeting, and food safety scores of the participants increased by 6%, 4%, 4%, and 5%, respectively, which were statistically significant (p < 0.001). However, no significant difference was observed in the food insecurity scores. CONCLUSION The comprehensive nutrition education program without financial or nutritional support can have a small but significant impact on the improvement of the nutritional behaviors and dietary quality of low-income people.
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Affiliation(s)
- Jalal Hejazi
- Department of Nutrition, School of Medicine, Zanjan University of Medical Sciences, Mahdavi Blvd., Shahrak-E Karmandan, P.O.Box: 4513956111, Zanjan, Iran.
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Majid Aminzare
- Department of Food Safety and Hygiene, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Yasamin Ayatollahi
- Department of Nutrition, School of Medicine, Zanjan University of Medical Sciences, Mahdavi Blvd., Shahrak-E Karmandan, P.O.Box: 4513956111, Zanjan, Iran
| | - Mohammad Masoud Vakili
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
- Department of Health Education & Health Promotion, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hassan Hassanzadazar
- Department of Food Safety and Hygiene, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehran Rahimlou
- Department of Nutrition, School of Medicine, Zanjan University of Medical Sciences, Mahdavi Blvd., Shahrak-E Karmandan, P.O.Box: 4513956111, Zanjan, Iran
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Warren AM, Frongillo EA, Nguyen PH, Menon P. Nutrition Intervention Using Behavioral Change Communication without Additional Material Inputs Increased Expenditures on Key Food Groups in Bangladesh. J Nutr 2020; 150:1284-1290. [PMID: 31943055 PMCID: PMC7198287 DOI: 10.1093/jn/nxz339] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/20/2019] [Accepted: 12/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Behavioral change communication (BCC) promotes skills and knowledge to improve infant and young child feeding, but without additional material inputs, recipients must develop strategies to translate knowledge into action. Using data from the Alive & Thrive initiative in Bangladesh (2010-2014), we aimed to test whether households receiving the intensive intervention (opposed to the nonintensive intervention) increased expenditures on key foods for mothers and children (e.g., foods that were promoted by the intervention and also changed in maternal and child diets). METHODS The intensive intervention provided interpersonal counseling, community mobilization, and mass media campaigns to promote breastfeeding and complementary feeding. A cluster-randomized design compared 20 subdistricts randomly assigned to the intensive (4281 households) or nonintensive (4284 households) intervention. Measures included food and nonfood expenditures, dietary diversity, and women's economic resources. Linear and logistic regression tested difference-in-differences (DD) in expenditures and dietary diversity, accounting for subdistricts as clusters, and the association between maternal and child consumption of specific food groups and corresponding food expenditures. RESULTS Expenditures on eggs and flesh foods increased more in intensive areas than in nonintensive areas by 53 (P < 0.01) and 471 (P < 0.01) taka/mo, respectively. Household food expenditures increased more in intensive areas by 832 taka (P = 0.02), whereas changes in nonfood expenditures did not differ. Women's employment and control of income increased more in intensive areas by 12 (P = 0.03) and 13 (P < 0.01) percentage points, respectively, while jewelry ownership decreased more by 23 percentage points (P < 0.01). Higher expenditures on food groups were reflected in higher consumption by women and children. CONCLUSIONS Recipients in the intensive intervention mobilized additional resources to improve diets, reflected in increased expenditures and consumption of promoted foods. BCC interventions should document how recipients produce desired results without additional material inputs, particularly for behaviors that likely require additional resources. This trial was registered at clinicaltrials.gov as NCT01678716.
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Affiliation(s)
- Andrea M Warren
- University of South Carolina, Columbia, SC, USA,Address correspondence to AMW (e-mail: )
| | | | - Phuong H Nguyen
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Purnima Menon
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
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Richardson AS, Chen C, Sturm R, Azhar G, Miles J, Larkin J, Motala A, Hempel S. Obesity Prevention Interventions and Implications for Energy Balance in the United States and Mexico: A Systematic Review of the Evidence and Meta-Analysis. Obesity (Silver Spring) 2019; 27:1390-1403. [PMID: 31325241 PMCID: PMC6707899 DOI: 10.1002/oby.22540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/11/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Obesity is preventable and yet continues to be a major risk factor for chronic disease. Multiple prevention approaches have been proposed across multiple settings where people live, work, learn, worship, and play. This review searched the vast literature on obesity prevention interventions to assess their effects on daily energy consumed and energy expended. METHODS This systematic review (PROSPERO registration CRD42017077083) searched seven databases for systematic reviews and studies reporting energy intake and expenditure. Two independent reviewers screened 5,977 citations; data abstraction supported an evidence map, comprehensive evidence tables, and meta-analysis; critical appraisal assessed risk of bias; and the quality of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Hundreds of published reviews were identified. However, few studies reported on energy intake and expenditure to determine intervention success. Ninety-nine studies across all intervention domains were identified. Few areas demonstrated statistically significant effects across studies; school-based approaches and health care initiatives reduced energy consumed, education reduced energy consumed and increased energy expended, and social-group approaches increased energy expenditure. CONCLUSIONS Despite the amount of research on obesity prevention interventions, very few studies have provided relevant information on energy intake and expenditure, two factors determining weight gain. Future research needs to fill this gap to identify successful public health policies.
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Affiliation(s)
| | | | - Roland Sturm
- Economics, Sociology, and Statistics RAND CorporationSanta MonicaCaliforniaUSA
- RAND HealthSanta MonicaCaliforniaUSA
| | - Gulrez Azhar
- Pardee RAND Graduate SchoolSanta MonicaCaliforniaUSA
| | | | - Jody Larkin
- Southern California Evidence‐Based Practice CenterRAND Health CareSanta MonicaCaliforniaUSA
- University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Aneesa Motala
- Southern California Evidence‐Based Practice CenterRAND Health CareSanta MonicaCaliforniaUSA
- University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Susanne Hempel
- Southern California Evidence‐Based Practice CenterRAND Health CareSanta MonicaCaliforniaUSA
- University of Southern CaliforniaLos AngelesCaliforniaUSA
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Emami S, Saraf-Bank S, Rouhani MH, Azadbakht L. Diet Quality and Total Daily Price of Foods Consumed among Iranian Diabetic Patients. Int J Prev Med 2019; 10:50. [PMID: 31143424 PMCID: PMC6528422 DOI: 10.4103/ijpvm.ijpvm_334_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 08/26/2017] [Indexed: 12/31/2022] Open
Abstract
Background: The aim is to investigate the association between diet quality and daily price of foods consumed among Iranian diabetic patients. Methods: This cross-sectional study was conducted among 200 patients with type 2 diabetes mellitus (T2DM) aged 30–70 years. General information, socioeconomic status, anthropometric and biochemical characteristics, and food prices were collected by pretested questionnaires. Dietary intakes were assessed using a semi-quantitative reliable and valid food frequency questionnaire. Modified nutritionist IV and SPSS software were used for analyses. Results: The results of the present study indicated a direct relationship between total daily price of diet and nutrient adequacy ratio of Vitamin D, Vitamin B1, selenium, zinc, magnesium, potassium, and mean adequacy ratio of 11 micronutrients (Vitamin C, Vitamin E, Vitamin D, Vitamin B1, Vitamin B6, Vitamin B12, selenium, zinc, calcium, magnesium, and potassium) (P < 0.05). Furthermore, the total daily price of diet had a positive association with dietary intakes of protein, Vitamin D, Vitamin B1, selenium, zinc, magnesium and potassium among type 2 diabetic patients (P < 0.05). However, no significant relationship was observed between the total daily price of diet and anthropometric indices, biochemical characteristics, and socioeconomic status of participants in the present study (P > 0.05). Conclusions: This study showed that dietary quality and dietary intakes of energy, protein, and micronutrients were directly associated with the total daily price of foods among Iranian patients with type 2 diabetes.
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Affiliation(s)
- Shaghayegh Emami
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada, USA
| | - Sahar Saraf-Bank
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Rouhani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Azadbakht
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada, USA.,Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Buscemi J, Odoms-Young A, Stolley MR, Schiffer L, Blumstein L, Clark MH, Berbaum ML, McCaffrey J, Braunschweig C, Fitzgibbon ML. Comparative Effectiveness Trial of an Obesity Prevention Intervention in EFNEP and SNAP-ED: Primary Outcomes. Nutrients 2019; 11:E1012. [PMID: 31060275 PMCID: PMC6566246 DOI: 10.3390/nu11051012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/19/2019] [Accepted: 04/30/2019] [Indexed: 11/17/2022] Open
Abstract
There is a need to disseminate evidence-based childhood obesity prevention interventions on a broader scale to reduce obesity-related disparities among underserved children. The purpose of this study was to test the comparative effectiveness of an evidence-based obesity prevention intervention, Hip-Hop to Health (HH), delivered through Expanded Food and Nutrition Education Program (EFNEP) and the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) versus the standard curriculum delivered by the programs (Standard Nutrition Education (NE)). A nonequivalent control group design was delivered to compare the effectiveness of HH to NE on weight gain prevention and health behavior outcomes at EFNEP and SNAP-Ed sites. One hundred and fifty-three caregiver-child dyads (n = 103 in the HH group; n = 50 in the NE group) participated in the study. HH is an evidence-based dietary and physical activity intervention for low-income preschool children. The NE curriculum provided lessons for children that are consistent with the Dietary Guidelines for Americans 2010. Data were collected on demographics, anthropometrics, and behavioral variables for parent-child dyads at baseline and postintervention. Mixed model methods with random effects for site and participant were utilized. No differences in child or caregiver diet, physical activity, or screen time by group were found. No between-group differences in child BMI z-score were found; however, caregivers in the HH group lost significantly more weight than those in the NE group. Results from this trial can inform future dissemination efforts of evidenced-based programs for underserved families.
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Affiliation(s)
- Joanna Buscemi
- DePaul University, Department of Psychology, 2219 N. Kenmore Ave, Chicago IL 60614, USA.
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 West Roosevelt Road, Chicago, IL 60608, USA.
| | - Angela Odoms-Young
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 1919 West Taylor Street, Chicago, IL 60612, USA.
| | - Melinda R Stolley
- Medical College of Wisconsin, General Internal Medicine, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Linda Schiffer
- Medical College of Wisconsin, General Internal Medicine, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Lara Blumstein
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 West Roosevelt Road, Chicago, IL 60608, USA.
| | - Margaret H Clark
- DePaul University, Department of Psychology, 2219 N. Kenmore Ave, Chicago IL 60614, USA.
| | - Michael L Berbaum
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 West Roosevelt Road, Chicago, IL 60608, USA.
| | - Jennifer McCaffrey
- Family and Consumer Sciences, University of Illinois Cooperative Extension Service, University of Illinois at Urbana-Champaign, 905 S. Goodwin Ave, Urbana, IL 61801, USA.
| | - Carol Braunschweig
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 1919 West Taylor Street, Chicago, IL 60612, USA.
| | - Marian L Fitzgibbon
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 West Roosevelt Road, Chicago, IL 60608, USA.
- Department of Pediatrics, University of Illinois at Chicago, 840 S. Wood Street, Chicago, IL 60612, USA.
- University of Illinois Cancer Center, University of Illinois at Chicago, 818 South Wolcott Avenue, Chicago, IL 60612, USA.
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Frongillo EA, Nguyen PH, Sanghvi T, Mahmud Z, Aktar B, Alayon S, Menon P. Nutrition Interventions Integrated into an Existing Maternal, Neonatal, and Child Health Program Reduce Food Insecurity Among Recently Delivered and Pregnant Women in Bangladesh. J Nutr 2019; 149:159-166. [PMID: 30649523 PMCID: PMC6351142 DOI: 10.1093/jn/nxy249] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/04/2018] [Indexed: 11/13/2022] Open
Abstract
Background Antenatal care may be a means to reduce food insecurity in pregnancy and postpartum periods. Objective With the use of a cluster-randomized design, we tested whether participation in nutrition-focused antenatal care intending to improve household knowledge about the importance of nutrition for pregnant and lactating women and encourage allocation of household resources to ensure sufficient quality and quantity of foods, without providing food assistance, would reduce household food insecurity. Methods Alive & Thrive integrated nutrition interventions into an existing Maternal, Neonatal, and Child Health (MNCH) program in Bangladesh. The nutrition-focused MNCH package was delivered in 10 subdistricts through antenatal care visits with the use of interpersonal communication, community mobilization, and monitoring of weight gain, aiming to improve maternal diet quality, quantity, and micronutrient intake during pregnancy and breastfeeding. The package included components that could reduce food insecurity, measured using the Household Food Insecurity Access Scale. To examine the impact of the nutrition-focused MNCH package compared with the standard MNCH package, we used linear and multinomial logit regression models, adjusted for subdistrict clustering, to test differences at endline in items, domains, and categories of food insecurity, after first confirming no differences at baseline. Results At baseline, nearly half of households were food insecure. At endline, the groups differed in food insecurity, whether expressed as items, domains, or categories, with food insecurity in the nutrition-focused MNCH group 22 percentage points lower than in the standard MNCH group and 20 percentage points lower than at baseline. Conclusions Participation in nutrition-focused antenatal care reduced household food insecurity among recently delivered and pregnant women. Integration of social and behavioral nutrition interventions into antenatal care with components that promote food security provides a potentially effective means to reduce food insecurity, without incurring high costs of providing supplemental food, in populations where limited resources can be directed towards accessing adequate and appropriate foods. Registered at clinicaltrials.gov as NCT02745249.
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Affiliation(s)
- Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC,Address correspondence to EAF (e-mail: )
| | - Phuong H Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC
| | | | | | - Bachera Aktar
- BRAC, James P Grant School of Public Health, BRAC University, Bangladesh
| | | | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC
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Oakley AR, Nikolaus CJ, Ellison B, Nickols-Richardson SM. Food insecurity and food preparation equipment in US households: exploratory results from a cross-sectional questionnaire. J Hum Nutr Diet 2018; 32:143-151. [PMID: 30474895 PMCID: PMC6588011 DOI: 10.1111/jhn.12615] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Food insecurity (FI) impacted 15.7% (5.9 million) of US households with children in 2017. These households often experience issues within one or more of the food security pillars: access, availability, utilisation or stability. An underexplored area within the pillar of utilisation that may impact FI risk is the availability of kitchen equipment in households. This exploratory project aimed to quantify household food preparation equipment ownership and use by household FI status. Methods An online platform (Qualtrics, Provo, UT, USA) was used to administer a questionnaire to a sample of 135 parents of children aged 11–14 years. The instrument queried sociodemographic characteristics, food preparation items owned and frequency of use of 44 items within a 6‐month interval. Household FI was measured using the 18‐item US Department of Agriculture, Household Food Security Survey Module with a 12‐month reference period. Results Households experiencing FI (n = 39; 28.9%) owned an average of five fewer items than their food secure counterparts (n = 96, 71.1%, P < 0.001), reporting lower item ownership within each equipment category subgroup (i.e. large appliances, small appliances, food preparation utensils and cooking utensils; all P < 0.01). There were no differences between FI and food secure households in frequency of use (all P > 0.01). Conclusions Compared to food secure households, the number of food preparation items owned was lower, although frequency of use was the same, in US households that were FI. Future projects should investigate how food equipment ownership impacts cooking behaviours, and whether households experiencing FI display behaviours to compensate for a differing set of equipment.
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Affiliation(s)
- A R Oakley
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - C J Nikolaus
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - B Ellison
- Department of Agricultural and Consumer Economics, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - S M Nickols-Richardson
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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The impact of financial incentives on participants' food purchasing patterns in a supermarket-based randomized controlled trial. Int J Behav Nutr Phys Act 2017; 14:115. [PMID: 28841892 PMCID: PMC5574131 DOI: 10.1186/s12966-017-0573-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/17/2017] [Indexed: 11/20/2022] Open
Abstract
Background The impacts of supermarket-based nutrition promotion interventions might be overestimated if participants shift their proportionate food purchasing away from their usual stores. This study quantified whether participants who received price discounts on fruits and vegetables (FV) in the Supermarket Healthy Eating for Life (SHELf) randomized controlled trial (RCT) shifted their FV purchasing into study supermarkets during the intervention period. Methods Participants were 642 females randomly assigned to a 1) skill-building (n = 160), 2) price reduction (n = 161), 3) combined skill-building and price reduction (n = 160), or 4) control (n = 161) group. Participants self-reported the proportion of FV purchased in study supermarkets at baseline, 3- and 6-months post-intervention. Fisher’s exact and χ2 tests assessed differences among groups in the proportion of FV purchased in study supermarkets at each time point. Multinomial logistic regression assessed differences among groups in the change in proportionate FV purchasing over time. Results Post-intervention, 49% of participants purchased ≥50% of their FV in study supermarkets. Compared to all other groups, the price reduction group was approximately twice as likely (RRR: 1.8-2.2) to have increased proportionate purchasing of FV in study supermarkets from baseline to post-intervention (p< 0.05). Conclusions Participants who received price reductions on FV were approximately twice as likely to shift their FV purchasing from other stores into study supermarkets during the intervention period. Unless food purchasing data are available for all sources, differential changes in purchasing patterns can make it difficult to discern the true impacts of nutrition interventions. Trial registration The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901, Registered 30 June 2010, Retrospectively registered (http://www.isrctn.com/ISRCTN39432901).
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Abstract
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.
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Crouch EL, Dickes LA. Evaluating a Nutrition Education Program in an Era of Food Insecurity. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2016. [DOI: 10.1080/19320248.2016.1227748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Elizabeth L. Crouch
- Department of Health Services Policy & Management, University of South Carolina, South Carolina Rural Health Research Center, Columbia, South Carolina, USA
| | - Lori A. Dickes
- South Carolina Water Resources Center, Strom Thurmond Institute, Clemson University, Clemson, South Carolina, USA
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Auld G, Baker S, Infante N, Inglis-Widrick R, Procter SB, Steger MF, Yerxa K. EFNEP's Impact on Exemplary Educators' Quality of Life. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:647-654.e1. [PMID: 27527907 DOI: 10.1016/j.jneb.2016.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 07/01/2016] [Accepted: 07/10/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine how the Expanded Food and Nutrition Education Program (EFNEP) affects the quality of life (QoL) of its exemplary paraprofessional educators. METHODS Qualitative telephone interviews with EFNEP supervisors (15), educators (28), and agency partners (15). Template analysis based on the University of Toronto's QoL constructs. RESULTS The EFNEP had a positive impact on 6 of 9 a priori categories: physical being, psychological being, social belonging, community belonging, practical becoming, and growth becoming. CONCLUSIONS AND IMPLICATIONS The EFNEP enhances the QoL of its exemplary educators, which suggests that the program's benefits go beyond those documented in participants.
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Affiliation(s)
- Garry Auld
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO.
| | - Susan Baker
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | | | - Ruth Inglis-Widrick
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Sandra B Procter
- Department of Human Nutrition, Kansas State University, Manhattan, KS
| | - Michael F Steger
- Department of Psychology, Colorado State University, Fort Collins, CO; Department of Psychology, North-West University, Vanderbijlpark, South Africa
| | - Kate Yerxa
- University of Maine Cooperative Extension, Orono, ME
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12
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Martin SS. From Poverty to Obesity: Exploration of the Food Choice Constraint Model and the Impact of an Energy-Dense Food Tax. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/056943450504900210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Obesity has reached epidemic proportions in the United States and is disproportionately concentrated in poor populations. This paper explores the role that poverty may play in driving the present obesity epidemic. Current literature supports a food choice constraint model in which one's ability to purchase healthy foods falls with income in a standard budget constraint shift fashion because healthy foods (nonenergydense foods) are relatively costly. This model is reinforced by a biological preference for energy-dense foods. Theoretically, a tax on energy-dense food would reduce the prevalence of obesity, along with obesity-related disease, and therefore should be carefully considered by the American people.
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13
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Le HN, Gold L, Abbott G, Crawford D, McNaughton SA, Mhurchu CN, Pollard C, Ball K. Economic evaluation of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: The SHELf randomized controlled trial. Soc Sci Med 2016; 159:83-91. [DOI: 10.1016/j.socscimed.2016.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 04/05/2016] [Accepted: 04/15/2016] [Indexed: 11/27/2022]
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14
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Community-based fortified dietary intervention improved health outcomes among low-income African-American women. Nutr Res 2016; 36:771-9. [PMID: 27440531 DOI: 10.1016/j.nutres.2016.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/15/2016] [Accepted: 04/18/2016] [Indexed: 01/03/2023]
Abstract
Poor dietary exposure disproportionately affects African-Americans and contributes to the persistence of disparities in health outcomes. In this study, we hypothesized that fortified dietary intervention (FDI) will improve measured dietary and related health outcomes and will be acceptable among low-income African-American women living in Tampa, FL. These objectives were tested using a prospective experimental study using pretest and posttest design with a control group, using a community-based participatory research approach. The intervention (FDI) was designed by the community through structural modification of a preexisting, diet-based program by the addition of a physical and mental health component. Paired sample t tests were used to examine preintervention and postintervention changes in study outcomes. A total of 49 women participated in the study, 26 in the FDI group and 23 controls. Two weeks postintervention, there were significant improvements in waist circumference and health-related quality of life related to physical health (P< .0001), physical fitness subscores (P= .002), and nutritional subscores (P= .001) in the FDI group. Among overweight/obese women, improvement in health-related quality of life related to physical health, a significant decrease in depressive score, and a reduction in waist circumference were noted. In the control group, a decrease in waist circumference was observed. Implementation of the FDI through a community-based participatory research approach is feasible and effective among low-income African-American women in general and overweight/obese women in particular. Social reengineering of a nutritional intervention coupled with community-based approach will enhance health outcomes of low-income women.
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McKinnon RA, Siddiqi SM, Chaloupka FJ, Mancino L, Prasad K. Obesity-Related Policy/Environmental Interventions: A Systematic Review of Economic Analyses. Am J Prev Med 2016; 50:543-549. [PMID: 26707464 DOI: 10.1016/j.amepre.2015.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/12/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT Policy and environmental changes to support and encourage individual-level nutrition and physical activity behavior are underway in many parts of the U.S. and around the world at national, state, and local levels. Yet, to the authors' knowledge, no summary of the cost-benefit or cost-effectiveness studies of obesity-related policy/environmental interventions exists. EVIDENCE ACQUISITION The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines were followed to identify, screen, and describe the protocols used in this systematic review. In 2014, a unique search was conducted of titles and abstracts in MEDLINE, EconLit, SCOPUS, and Web of Science databases that were published from January 2002 through January 2014 in English-language, peer-reviewed journals. The search terms described obesity, physical activity, and diet in combination with economic evaluation. EVIDENCE SYNTHESIS In 2014 and 2015, the results were analyzed. A total of 27 studies met the inclusion criteria, of which 26 described separate interventions. Of the 27 included studies, eight focused on the community and built environment, seven assessed nutrition-related changes, nine reported on the school environment, and three evaluated social marketing and media interventions. The vast majority of included studies reported beneficial economic outcomes of the interventions. CONCLUSIONS Given the large and growing literature on the health and behavioral outcomes of policy and environmental interventions, the relatively low number of located cost-benefit and cost-effectiveness economic assessments appears to indicate a prime opportunity for the research community to address.
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Affiliation(s)
- Robin A McKinnon
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland.
| | - Sameer M Siddiqi
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Frank J Chaloupka
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Lisa Mancino
- U.S. Department of Agriculture, Economic Research Service, Washington, District of Columbia
| | - Kislaya Prasad
- Robert H. Smith School of Business, University of Maryland, College Park, Maryland
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Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev 2015; 73:643-60. [PMID: 26307238 PMCID: PMC4586446 DOI: 10.1093/nutrit/nuv027] [Citation(s) in RCA: 647] [Impact Index Per Article: 71.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
CONTEXT It is well established in the literature that healthier diets cost more than unhealthy diets. OBJECTIVE The aim of this review was to examine the contribution of food prices and diet cost to socioeconomic inequalities in diet quality. DATA SOURCES A systematic literature search of the PubMed, Google Scholar, and Web of Science databases was performed. STUDY SELECTION Publications linking food prices, dietary quality, and socioeconomic status were selected. DATA EXTRACTION Where possible, review conclusions were illustrated using a French national database of commonly consumed foods and their mean retail prices. DATA SYNTHESIS Foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. Food budgets in poverty were insufficient to ensure optimum diets. CONCLUSIONS Socioeconomic disparities in diet quality may be explained by the higher cost of healthy diets. Identifying food patterns that are nutrient rich, affordable, and appealing should be a priority to fight social inequalities in nutrition and health.
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Affiliation(s)
- Nicole Darmon
- N. Darmon is with the Unité Mixte de Recherche "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique 1260, Institut National de la Santé et de la Recherche Médicale 1062, Aix-Marseille Université, Marseille, France. A. Drewnowski is with the Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA.
| | - Adam Drewnowski
- N. Darmon is with the Unité Mixte de Recherche "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique 1260, Institut National de la Santé et de la Recherche Médicale 1062, Aix-Marseille Université, Marseille, France. A. Drewnowski is with the Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
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Abstract
AbstractObjectiveFor more than 20 years, the FOODcents adult nutrition education programme has been delivered to Western Australians. The aim of the programme is to provide disadvantaged individuals with the knowledge, skills and motivation to buy healthy foods on a limited budget. The present study evaluated whether the FOODcents curriculum and the way it is delivered are effective in improving participants’ nutrition-related knowledge and behaviours.DesignEvaluation data were collected via in-session pre–post questionnaires and a post-course online questionnaire.SettingWestern Australia.SubjectsData were collected from participants attending just over one-half (54 %) of the FOODcents courses conducted over the two-year evaluation period. In total, 927 course participants provided usable data.ResultsAfter exposure to the course, respondents demonstrated an improved ability to: (i) categorize foods according to the frequency with which they should be consumed and the proportion of the food budget that should be allocated to them; (ii) correctly interpret nutrition labels on food products; and (iii) appreciate the link between diet/obesity and a range of diseases. Improvements in the latter were especially pronounced among participants of low socio-economic status. In terms of behaviour change, significant improvements in fruit and vegetable consumption were reported, along with reductions in the consumption of fast food. Participants of low socio-economic status reported the greatest changes.ConclusionsThe results indicate that the FOODcents nutrition education programme improves participants’ nutrition-related knowledge and behaviours.
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Fattore G, Ferrè F, Meregaglia M, Fattore E, Agostoni C. Critical review of economic evaluation studies of interventions promoting low-fat diets. Nutr Rev 2014; 72:691-706. [PMID: 25323698 DOI: 10.1111/nure.12142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Various national and local policies encouraging healthy eating have recently been proposed. The present review aims to summarize and critically assess nutrition-economic evaluation studies of direct (e.g., diet counseling) and indirect (e.g., food labeling) interventions aimed at improving dietary habits. A systematic literature review was performed by searching 5 databases (PubMed, Ovid Medline, EconLit, Agricola, and Embase) using a combination of diet-related (fat, diet, intake, nutrition) and economics-related (cost-effectiveness, cost-benefit, cost-utility, health economics, economic evaluation) key words. The search yielded 36 studies that varied in target population, study design, economic evaluation method, and health/economic outcome. In general, all provide limited experimental evidence and adopt the framework of economic evaluations in healthcare. Certain important aspects were not well considered: 1) the non-health-related effects of nutrition interventions on well-being; 2) the private nature of food expenditures; 3) the distributional effects on food expenditures across socioeconomic groups; and 4) the general economic implications (e.g., agrofoods, import/export) of such interventions. Overall, the methodology for the economic evaluation of nutrition interventions requires substantial improvement.
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Affiliation(s)
- Giovanni Fattore
- Centre for Research on Health and Social Care Management (CERGAS), Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
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Buscemi J, Odoms-Young A, Stolley ML, Blumstein L, Schiffer L, Berbaum ML, McCaffrey J, Montoya AM, Braunschweig C, Fitzgibbon ML. Adaptation and dissemination of an evidence-based obesity prevention intervention: design of a comparative effectiveness trial. Contemp Clin Trials 2014; 38:355-60. [PMID: 24952282 PMCID: PMC4115581 DOI: 10.1016/j.cct.2014.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/06/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
Abstract
Low-income youth are at increased risk for excess weight gain. Although evidence-based prevention programs exist, successful adaptation to provide wide dissemination presents a challenge. Hip-Hop to Health (HH) is a school-based obesity prevention intervention that targets primarily preschool children of low-income families. In a large randomized controlled trial, HH was found to be efficacious for prevention of excessive weight gain. The Expanded Food and Nutrition Education Program (EFNEP) and the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) are USDA-funded nutrition education programs offered to low-income families, and may provide an ideal platform for the wide dissemination of evidence-based obesity prevention programs. A research-practice partnership was established in order to conduct formative research to guide the adaptation and implementation of HH through EFNEP and SNAP-Ed. We present the design and method of a comparative effectiveness trial that will determine the efficacy of HH when delivered by peer educators through these programs compared to the standard EFNEP and SNAP-Ed nutrition education (NE) curriculum. Results from this trial will inform larger scale dissemination. The dissemination of HH through government programs has the potential to increase the reach of efficacious obesity prevention programs that target low-income children and families.
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Affiliation(s)
- Joanna Buscemi
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 West Roosevelt Road, Chicago, IL 60608, United States.
| | - Angela Odoms-Young
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 1919 West Taylor Street, Chicago, IL 60612, United States
| | - Melinda L Stolley
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 West Roosevelt Road, Chicago, IL 60608, United States
| | - Lara Blumstein
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 West Roosevelt Road, Chicago, IL 60608, United States
| | - Linda Schiffer
- University of Illinois at Chicago, Department of Medicine, Division of Health Promotion Research, 1747 West Roosevelt Road, Chicago, IL 60608, United States
| | - Michael L Berbaum
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 West Roosevelt Road, Chicago, IL 60608, United States
| | - Jennifer McCaffrey
- University of Illinois at Urbana-Champaign, Family and Consumer Sciences, University of Illinois Cooperative Extension Service, 905 S. Goodwin Avenue, Urbana, IL 61801, United States
| | - Anastasia McGee Montoya
- University of Illinois at Chicago, Chicago Partnership for Health Promotion, Office of Community Engagement and Neighborhood Health Partnerships, 828S. Wolcott, Suite B40, Chicago, IL 60612, United States
| | - Carol Braunschweig
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 1919 West Taylor Street, Chicago, IL 60612, United States
| | - Marian L Fitzgibbon
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 West Roosevelt Road, Chicago, IL 60608, United States; University of Illinois at Chicago, Department of Medicine, Division of Health Promotion Research, 1747 West Roosevelt Road, Chicago, IL 60608, United States; University of Illinois at Chicago, Institute for Health Research and Policy, Health Promotion Research Program, 1747 West Roosevelt Road, Chicago, IL 60608, United States; University of Illinois Cancer Center, Population Health, Behavior and Outcomes Program, 1747 West Roosevelt Road, Chicago, IL 60608, United States
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Providing Nutrition Education to Recently Resettled Refugees: Piloting a Collaborative Model and Evaluation Methods. J Immigr Minor Health 2014; 17:482-8. [DOI: 10.1007/s10903-014-0056-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dollahite JS, Pijai EI, Scott-Pierce M, Parker C, Trochim W. A randomized controlled trial of a community-based nutrition education program for low-income parents. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:102-109. [PMID: 24268300 DOI: 10.1016/j.jneb.2013.09.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/11/2013] [Accepted: 09/18/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Assess effectiveness of the Expanded Food and Nutrition Education Program on nutrition behaviors post-education and longitudinally. DESIGN Switching replications randomized experimental design. Participants randomly assigned to immediate education (IE) or delayed education (DE). Participants in IE received intervention the first 8 weeks, and those in DE the second 8 weeks, with no intervention during alternate periods. Data were collected in 3 repeated measures. PARTICIPANTS Parents (n = 168 randomized; n = 134 completed) of children in 2 Head Start and 6 low-income schools. INTERVENTION Eight weekly workshops, based on Eating Right is Basic-Enhanced adapted to incorporate dialogue approach with experiential learning. MAIN OUTCOME MEASURES Ten-item self-reported behavior checklist on nutrition, food resource management, food safety, and food security; responses on a 5-point scale reporting frequency of behavior. ANALYSIS Chi-square, analysis of variance, and multiple regression. RESULTS Groups were demographically similar. Both groups reported improved behaviors pre- to post-education (P < .05). There was no significant difference between groups at Time 1 (T1) or DE control period (T1 vs T2). Changed IE behavior was retained T2 to T3. A multiple regression model of overall change, controlling for T1 score and educator, showed significant improvement (n = 134, β = 5.72, P < .001). CONCLUSIONS AND IMPLICATIONS Positive outcomes were supported by this experimental study in a usual program context, with reported behavior changes retained at least 2 months.
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Affiliation(s)
| | - Erika I Pijai
- Child Nutrition Division, USDA Food and Nutrition Service, Alexandria, VA
| | | | - Carol Parker
- Cornell Cooperative Extension, Cornell University, Ithaca, NY
| | - William Trochim
- Department of Policy, Analysis, and Management, Cornell University, Ithaca, NY
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Auld G, Baker S, Bauer L, Koszewski W, Procter SB, Steger MF. EFNEP's impact on the quality of life of its participants and educators. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2013; 45:482-489. [PMID: 23981711 DOI: 10.1016/j.jneb.2013.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 06/20/2013] [Accepted: 06/23/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Determine whether the Expanded Food and Nutrition Education Program (EFNEP) affects the quality of life (QOL) of its participants and educators. DESIGN Longitudinal, where QOL was measured 3 times for participants (pre, post, 3-month delayed post) and educators (before and 6 and 12 months after training). SETTING Participants' and educators' QOL was measured in Colorado, Kansas, Missouri, and Nebraska. Georgia and Texas measured educators; Minnesota and Virginia measured participants. PARTICIPANTS English speaking EFNEP participants and educators. MAIN OUTCOME MEASURES The investigators used the QOL Profile to measure QOL in 3 domains: Being (who one is), Belonging (connection with social and physical environment), and Becoming (achieving personal goals). ANALYSIS Chi-square and t tests compared group demographics; repeated-measures ANOVA detected changes over time; ANCOVA examined the influence of demographic variables. RESULTS Both groups had QOL Profile scores above 1.5, which is considered acceptable. Participants improved from pre to post in the Being domains including Overall Being (least square means [standard error of the mean], 3.1 [0.2] to 4.1 [0.3]), and in Social Belonging (3.5 [0.3] to 3.8 [0.3]); most improvements were sustained at 3 months. Educators improved in the Belonging domains, and a number of scores continued to improve at 1 year after training, for example, Social Belonging (4.2 [0.5], 5.0 [0.5], and 5.8 [0.6]); and Community Belonging (3.5 [0.5], 3.8 [0.5], and 4.7 [0.5]) at the 3 time points, respectively. CONCLUSIONS AND IMPLICATIONS EFNEP improved the QOL of participants, primarily in the Being domain, and of educators, primarily in the Belonging domain. The QOL profile has the potential to broaden the assessment of EFNEP impacts.
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Affiliation(s)
- Garry Auld
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
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Feldens CA, Rodrigues PH, Rauber F, Chaffee BW, Vitolo MR. Food expenditures, cariogenic dietary practices and childhood dental caries in southern Brazil. Caries Res 2013; 47:373-81. [PMID: 23571856 DOI: 10.1159/000348518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/30/2013] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- C A Feldens
- Universidade Luterana do Brasil, Canoas, Brazil
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Klatt M, Harpster K, Browne E, White S, Case-Smith J. Feasibility and preliminary outcomes for Move-Into-Learning: An arts-based mindfulness classroom intervention. JOURNAL OF POSITIVE PSYCHOLOGY 2013. [DOI: 10.1080/17439760.2013.779011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Maryanna Klatt
- a College of Medicine, Health and Rehabilitation Sciences, The Ohio State University , 306 G Atwell Hall, 452 W 10th Ave, Columbus , OH , 43210 , USA
| | - Karen Harpster
- b Department of Occupational Therapy and Physical Therapy , Cincinnati Children’s Hospital Medical Center , Cincinnati , OH , USA
| | - Emma Browne
- a College of Medicine, Health and Rehabilitation Sciences, The Ohio State University , 306 G Atwell Hall, 452 W 10th Ave, Columbus , OH , 43210 , USA
| | - Susan White
- a College of Medicine, Health and Rehabilitation Sciences, The Ohio State University , 306 G Atwell Hall, 452 W 10th Ave, Columbus , OH , 43210 , USA
| | - Jane Case-Smith
- c College of Medicine, Occupational Therapy, The Ohio State University , Columbus , OH , USA
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Aaron GJ, Keim NL, Drewnowski A, Townsend MS. Estimating dietary costs of low-income women in California: a comparison of 2 approaches. Am J Clin Nutr 2013; 97:835-41. [PMID: 23388658 PMCID: PMC3607657 DOI: 10.3945/ajcn.112.044453] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Grant J Aaron
- Program in International and Community Nutrition and the Department of Nutrition, University of California, Davis, CA 95616, USA
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Abstract
Food insecurity is a leading public health challenge in the United States today. This is primarily due to the magnitude of the problem, ∼50 million persons are food insecure (i.e., they were uncertain of having, or unable to acquire, enough food because they had insufficient money or other resources), and the serious negative health and other outcomes associated with being food insecure. This paper defines the measure used to delineate whether a household is food insecure. The measure, the Core Food Security Module, is based on 18 questions about a household's food situation. From the responses, a household is defined as food secure, low food secure, or very low food secure, with the latter 2 categories defined as "food insecure." I next discuss the extent of food insecurity in the US across various dimensions and the key determinants of food insecurity. The key policy tool used to address food insecurity is the Supplemental Nutrition Assistance Program (SNAP; formerly known as the Food Stamp Program). During the current economic downturn, >40 million persons are enrolled in SNAP, with total benefits of >$70 billion. This makes it the largest food assistance program and the largest near-cash assistance program in the US. After defining the eligibility criteria, I review the literature, which has demonstrated the effectiveness of SNAP in addressing its key goal, namely the alleviation of food insecurity in the US. I conclude with 4 suggestions for how SNAP can maintain and even improve its effectiveness in alleviating food insecurity.
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Affiliation(s)
- Craig Gundersen
- Department of Agricultural and Consumer Economics, University of Illinois, Urbana, USA.
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Cleary J, Casey S, Hofsteede C, Moses RG, Milosavljevic M, Brand-Miller J. Does a low glycaemic index (GI) diet cost more during pregnancy? Nutrients 2012. [PMID: 23201846 PMCID: PMC3509519 DOI: 10.3390/nu4111759] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
 The aim of this study was to examine the monetary cost of dietary change among pregnant women before and after receiving low glycaemic index (GI) dietary advice. The pregnant women in this study were a subgroup of participants in the Pregnancy and Glycaemic Index Outcomes (PREGGIO) study. Twenty women from the low GI dietary advice group, who had completed their pregnancies, were randomly chosen. All these women had completed three day food records at 12–16 weeks and again around 36 weeks of gestation. Consumer food prices were applied to recorded dietary intake data. The mean ± SD GI of the diet reduced from 55.1 ± 4.3 to 51.6 ± 3.9 (p = 0.003). The daily cost of the diet (AUD) was 9.1 ± 2.7 at enrolment and 9.5 ± 2.1 prior to delivery was not significantly different (p = 0.52). There were also no significant differences in the daily energy intake (p = 0.2) or the daily cost per MJ (p = 0.16). Women were able to follow low GI dietary advice during pregnancy with no significant increase in the daily costs.
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Affiliation(s)
- Jane Cleary
- Department of Nutrition, Wollongong Hospital, Wollongong, NSW 2500, Australia; (S.C.); (M.M.)
- Author to whom correspondence should be addressed; ; Tel.: +61-2-42534547; Fax: +61-2-42534504
| | - Shelly Casey
- Department of Nutrition, Wollongong Hospital, Wollongong, NSW 2500, Australia; (S.C.); (M.M.)
| | - Clare Hofsteede
- School of Health Sciences, University of Wollongong, NSW 2500, Australia;
| | - Robert G. Moses
- Illawarra Diabetes Services, P.O. Box W58, Wollongong, NSW 2500, Australia;
| | - Marianna Milosavljevic
- Department of Nutrition, Wollongong Hospital, Wollongong, NSW 2500, Australia; (S.C.); (M.M.)
| | - Jennie Brand-Miller
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, NSW 2006, Australia;
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Gundersen CG, Garasky SB. Financial management skills are associated with food insecurity in a sample of households with children in the United States. J Nutr 2012; 142:1865-70. [PMID: 22955515 DOI: 10.3945/jn.112.162214] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Food insecurity is one of the leading public health challenges facing children in the United States today. Reducing food insecurity and its attendant consequences requires an understanding of the determinants of food insecurity. Although previous work has greatly advanced our understanding of these determinants, the role of one of the oft-speculated important determinants of food insecurity, household financial management skills, has not been considered. To address this research lacuna, we use a recently conducted survey, the Survey of Household Finances and Childhood Obesity, that has information on specific financial management practices, impressions of financial management skills, and households' food insecurity. The sample included 904 households with children. Within this sample, 19.3% were food insecure and, for our central financial management skill variable, the mean value was 3.55 on a 5-point scale. Probit regression models estimated the probability of a household being food insecure as conditional on financial management skills and other covariates. We found a large and significant inverse relationship between a respondent's use of specific financial management practices and food insecurity and between a respondent's confidence in his or her financial management skills and food insecurity. That is, households with greater financial management abilities are less likely to be food insecure. This finding also holds when the sample is restricted to households with incomes <200% of the poverty line. These results suggest that improving households' financial management skills has the potential to reduce food insecurity in the United States.
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Affiliation(s)
- Craig G Gundersen
- Department of Agricultural and Consumer Economics, University of Illinois, Urbana, IL, USA.
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Abstract
A lack of cooking skills and reduced food preparation knowledge are significant barriers to the production of home cooked meals in the United States. The benefits and barriers to healthful eating in relationship to decreased food preparation ability are summarized in this review. In particular, home food preparation barriers, the consequences that result from eating out frequently, and the benefits of home-produced meals are presented. Strategies for preparing meals at home and specific recommendations for health care professionals are presented in this article.
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Affiliation(s)
- Lu Ann Laurice Soliah
- Department FCS, Baylor University, Waco, Texas (LLS, JMW)
- Department of Exercise Science and Health, Abilene Christian University, Abilene, Texas (SAJ)
| | - Janelle Marshall Walter
- Department FCS, Baylor University, Waco, Texas (LLS, JMW)
- Department of Exercise Science and Health, Abilene Christian University, Abilene, Texas (SAJ)
| | - Sheila Ann Jones
- Department FCS, Baylor University, Waco, Texas (LLS, JMW)
- Department of Exercise Science and Health, Abilene Christian University, Abilene, Texas (SAJ)
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Serrano E, McFerren M, Lambur M, Ellerbock M, Hosig K, Franz N, Townsend M, Baker S, Muennig P, Davis G. Cost-effectiveness model for youth EFNEP programs: what do we measure and how do we do it? JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2011; 43:295-302. [PMID: 21377936 DOI: 10.1016/j.jneb.2010.03.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 03/24/2010] [Accepted: 03/27/2010] [Indexed: 05/30/2023]
Abstract
The Youth Expanded Food and Nutrition Education Program (EFNEP) is one of the United States Department of Agriculture's hallmark nutrition education programs for limited-resource youth. The objective of this study was to gather opinions from experts in EFNEP and related content areas to identify costs, effects (impacts), and related instruments to develop a cost-effectiveness model (instrument) for youth EFNEP, which does not exist. A cost-effectiveness model determines the economic or financial cost of producing an impact. The findings highlight several challenges in identifying inputs through consensus and provide a roadmap for the creation of a model that can be adopted by state EFNEP coordinators.
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Affiliation(s)
- Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061-0430, USA.
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Ghirardelli A, Linares A, Fong A. Usage and recall of the Food Stamp Office Resource Kit (FSORK) by food stamp applicants in 4 California counties. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2011; 43:S86-S95. [PMID: 21683295 DOI: 10.1016/j.jneb.2011.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 02/22/2011] [Accepted: 02/24/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate recall and usage of the Food Stamp Office Resource Kit (FSORK), a set of nutrition education materials designed for use in food stamp offices. DESIGN Client intercept exit surveys, an environmental scan, and individual observations of clients in the food stamp office. SETTING Four food stamp offices in California. PARTICIPANTS People applying for food stamps in community social service offices: exit survey (n = 419), environmental scan (n = 308), individual observations of video (n = 111). INTERVENTION FSORK includes a video, poster, recipe cards, and brochures for the waiting room. MAIN OUTCOME MEASURE(S) Aided and unaided recall of FSORK materials, self-efficacy, video attention (eyes on screen), and observations of materials usage. ANALYSIS Descriptive statistics for recall, usage, and video attention. RESULTS Nearly 70% of clients recalled, unaided, at least 1 FSORK element with the video recalled the most. In the observation study, of clients who initially engaged with the video, 40% of their viewing time was spent "watching" it. CONCLUSIONS AND IMPLICATIONS Food stamp offices are a useful setting for nutrition education in offices that are willing and able to display the materials and show the video.
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Affiliation(s)
- Alyssa Ghirardelli
- Network for a Healthy California, California Department of Public Health and Public Health Institute, Sacramento, CA, USA.
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le Roux IM, le Roux K, Mbeutu K, Comulada WS, Desmond KA, Rotheram-Borus MJ. A randomized controlled trial of home visits by neighborhood mentor mothers to improve children's nutrition in South Africa. VULNERABLE CHILDREN AND YOUTH STUDIES 2011; 6:91-102. [PMID: 22299019 PMCID: PMC3262232 DOI: 10.1080/17450128.2011.564224] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Malnourished children and babies with birth weights under 2500 g are at high risk for negative outcomes over their lifespans. Philani, a paraprofessional home visiting program, was developed to improve nutritional outcomes for young children in South Africa. One "mentor mother" was recruited from each of 37 neighborhoods in Cape Town, South Africa. Mentor mothers were trained to conduct home visits to weigh children under six years old and to support mothers to problem-solve life challenges, especially around nutrition. Households with underweight children were assigned randomly on a 2:1 ratio to the Philani program (n = 500) or to a standard care condition (n = 179); selection effects occurred and children in the intervention households weighed less at recruitment. Children were evaluated over a one-year period (n = 679 at recruitment and n = 638 with at least one follow-up; 94%). Longitudinal random effects models indicated that, over 12 months, the children in the intervention condition gained significantly more weight than children in the control condition. Mentor mothers who are positive peer deviants may be a viable strategy that is efficacious and can build community, and the use of mentor mothers for other problems in South Africa is discussed.
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Affiliation(s)
- Ingrid M. le Roux
- Philani Child Health and Nutrition Project, Khayelitsha, Elonwabeni, Cape Town, South Africa
| | - Karl le Roux
- Zithulele Hospital, Eastern Cape, Zithulele Village, Mqanduli District, South Africa
| | - Kwanie Mbeutu
- Philani Child Health and Nutrition Project, Khayelitsha, Elonwabeni, Cape Town, South Africa
| | - W. Scott Comulada
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Katherine A. Desmond
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Mary Jane Rotheram-Borus
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
- Corresponding author.
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Diet cost, diet quality and socio-economic position: how are they related and what contributes to differences in diet costs? Public Health Nutr 2011; 14:1680-92. [PMID: 21255480 DOI: 10.1017/s1368980010003642] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine diet costs in relation to dietary quality and socio-economic position, and to investigate underlying reasons for differences in diet costs. DESIGN Dietary intake was assessed by a 4 d food diary and evaluated using the 2005 Healthy Eating Index (HEI). National consumer food prices collected by Statistics Sweden and from two online stores/supermarkets were used to estimate diet costs. SETTING Sweden. SUBJECTS A nationally representative sample of 2160 children aged 4, 8 or 11 years. RESULTS Higher scores on the HEI resulted in higher diet costs and, conversely, higher diet costs were linked to increased total HEI scores. Children who consumed the most healthy and/or expensive diets ate a more energy-dilute and varied diet compared with those who ate the least healthy and/or least expensive diets. They also consumed more fish, ready meals and fruit. Regression analysis also linked increased food costs to these food groups. There was a positive, but weak, relationship between HEI score and diet cost, parental education and parental occupation respectively. CONCLUSIONS Healthy eating is associated with higher diet cost in Swedish children, in part because of price differences between healthy and less-healthy foods. The cheapest and most unhealthy diets were found among those children whose parents were the least educated and had manual, low-skill occupations. Our results pose several challenges for public health policy makers, as well as for nutrition professionals, when forming dietary strategies and providing advice for macro- and microlevels in society.
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Thompson D, Cullen KW, Reed DB, Konzelmann K, Smalling AL. Formative assessment in the development of an obesity prevention component for the expanded food and nutrition education program in Texas. FAMILY & COMMUNITY HEALTH 2011; 34:61-71. [PMID: 21135629 DOI: 10.1097/fch.0b013e3181fdeb3f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study conducted formative research (surveys, focus groups) to assess the nutrition education needs of clients in the Texas Expanded Food and Nutrition Education Program prior to curriculum revision. Participants were current Expanded Food and Nutrition Education Program participants in 3 Texas cities (Austin, Houston, San Antonio). Data were used to tailor the curriculum to the target population. This research provides evidence that members of the target audience can provide valuable insights into a particular topic. Formative work prior to intervention development should be conducted to identify key issues regarding a particular topic and to evaluate potential educational approaches.
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Affiliation(s)
- Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA.
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le Roux IM, le Roux K, Comulada WS, Greco EM, Desmond KA, Mbewu N, Rotheram-Borus MJ. Home visits by neighborhood Mentor Mothers provide timely recovery from childhood malnutrition in South Africa: results from a randomized controlled trial. Nutr J 2010; 9:56. [PMID: 21092178 PMCID: PMC3002292 DOI: 10.1186/1475-2891-9-56] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 11/22/2010] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Child and infant malnourishment is a significant and growing problem in the developing world. Malnourished children are at high risk for negative health outcomes over their lifespans. Philani, a paraprofessional home visiting program, was developed to improve childhood nourishment. The objective of this study is to evaluate whether the Philani program can rehabilitate malnourished children in a timely manner. METHODS Mentor Mothers were trained to conduct home visits. Mentor Mothers went from house to house in assigned neighborhoods, weighed children age 5 and younger, and recruited mother-child dyads where there was an underweight child. Participating dyads were assigned in a 2:1 random sequence to the Philani intervention condition (n = 536) or a control condition (n = 252). Mentor Mothers visited dyads in the intervention condition for one year, supporting mothers' problem-solving around nutrition. All children were weighed by Mentor Mothers at baseline and three, six, nine and twelve month follow-ups. RESULTS By three months, children in the intervention condition were five times more likely to rehabilitate (reach a healthy weight for their ages) than children in the control condition. Throughout the course of the study, 43% (n = 233 of 536) of children in the intervention condition were rehabilitated while 31% (n = 78 of 252) of children in the control condition were rehabilitated. CONCLUSIONS Paraprofessional Mentor Mothers are an effective strategy for delivering home visiting programs by providing the knowledge and support necessary to change the behavior of families at risk.
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Affiliation(s)
- Ingrid M le Roux
- Philani Child Health and Nutrition Project, Khayelitsha, PO Box 40188, Elonwabeni, Cape Town, 7791, South Africa
| | - Karl le Roux
- Zithulele Hospital, Eastern Cape Zithulele Village, Mqanduli District, 5080, South Africa
| | - W Scott Comulada
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles 360 Westwood Blvd., Los Angeles, California 90095, USA
| | - Erin M Greco
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles 360 Westwood Blvd., Los Angeles, California 90095, USA
| | - Katherine A Desmond
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles 360 Westwood Blvd., Los Angeles, California 90095, USA
| | - Nokwanele Mbewu
- Philani Child Health and Nutrition Project, Khayelitsha, PO Box 40188, Elonwabeni, Cape Town, 7791, South Africa
| | - Mary Jane Rotheram-Borus
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles 360 Westwood Blvd., Los Angeles, California 90095, USA
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Cullen KW, Thompson DI, Scott AR, Lara-Smalling A, Watson KB, Konzelmann K. The impact of goal attainment on behavioral and mediating variables among low income women participating in an Expanded Food and Nutrition Education Program intervention study. Appetite 2010; 55:305-10. [PMID: 20643172 DOI: 10.1016/j.appet.2010.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 06/18/2010] [Accepted: 06/29/2010] [Indexed: 10/19/2022]
Abstract
This study examined the relationships between participant goal attainment and changes in mediating variables and food choice outcomes from a modified curriculum for the Texas Expanded Food and Nutrition Education Program (EFNEP) promoting healthy home food environments and parenting skills related to obesity prevention. EFNEP participants in 54 intervention classes received a goal sheet after each of 6 classes. Participants recorded goal attainment and returned at the next class, Diet and mediating variables were measured at baseline, immediate post, and 4 months later. Mixed model regression analysis over time assessed whether goal attainment was associated with the outcomes at post or follow-up, controlling for baseline assessment. Participants who reported attaining more goals reported greater self-efficacy for planning/encouraging fruit and vegetable consumption and making fruit and vegetables available, menu planning skills, improvement in the food preparation practices and higher home availability for regular vegetables. At post, those who reported attaining more fiber, vegetable, and water goals reported consuming more of these items. Goal attainment was related to some changes in food choice and mediating variables in an at risk population. Further research into the use and efficacy of goal setting and attainment in this population is warranted.
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Affiliation(s)
- Karen Weber Cullen
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030-2600, USA
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Stang J. Position of the American Dietetic Association: Child and Adolescent Nutrition Assistance Programs. ACTA ACUST UNITED AC 2010; 110:791-99. [DOI: 10.1016/j.jada.2010.02.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Peterson SL, Dodd KM, Kim K, Roth SL. Food Cost Perceptions and Food Purchasing Practices of Uninsured, Low-Income, Rural Adults. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2010. [DOI: 10.1080/19320240903578073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sharon L. Peterson
- Department of Animal Science, Food and Nutrition, Southern Illinois University Carbondale, Carbondale, Illinois, USA
| | - Katie M. Dodd
- Veterans Health Administration, Southern Oregon Rehabilitation Center and Clinics, White City, Oregon, USA
| | - Kyungmi Kim
- Hotel and Restaurant Management, Department of Nutrition and Food Sciences, Auburn University, Auburn, Alabama, USA
| | - Sara Long Roth
- Department of Animal Science, Food and Nutrition, Southern Illinois University Carbondale, Carbondale, Illinois, USA
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Abstract
OBJECTIVE Nutritious yet inexpensive foods do exist. However, many such foods are rejected by the low-income consumer. Is it because their use violates unspoken social norms? The present study was designed to assess the variety and cost of the lowest-cost market basket of foods that simultaneously met required dietary standards and progressively stricter consumption constraints. DESIGN A mathematical optimisation model was used to develop the lowest-cost food plans to meet three levels of nutritional requirements and seven levels of consumption constraints. SUBJECTS The nationally representative INCA (National Individual Survey of Food Consumption) dietary survey study of 1332 adults provided population estimates of food consumption patterns in France. Food plan costs were based on retail food prices. RESULTS The lowest-cost food plans that provided 9204 kJ/d (2200 kcal/d) for men and 7531 kJ/d (1800 kcal/d) for women and met specified dietary standards could be obtained for <1.50 euro/d. The progressive imposition of consumption constraints designed to create more mainstream French diets sharply increased food plan costs, without improving nutritional value. CONCLUSIONS Minimising diet costs, while meeting nutrition standards only, led to food plans that provided little variety and deviated substantially from social norms. Aligning the food plan with mainstream consumption led to higher costs. Food plans designed for low-income groups need to be socially acceptable as well as affordable and nutritious.
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Cullen KW, Lara Smalling A, Thompson D, Watson KB, Reed D, Konzelmann K. Creating healthful home food environments: results of a study with participants in the expanded food and nutrition education program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2009; 41:380-388. [PMID: 19879493 DOI: 10.1016/j.jneb.2008.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 12/16/2008] [Accepted: 12/24/2008] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate a modified curriculum for the 6-session Texas Expanded Food and Nutrition Education Program (EFNEP) promoting healthful home food environments and parenting skills related to obesity prevention. DESIGN Two-group randomized control trial; intervention versus usual EFNEP curriculum. SETTING Texas EFNEP classes. PARTICIPANTS 1,104 EFNEP clients in 100 classes. INTERVENTION Six short videos, with goal setting, problem solving, guided discussion, and handouts, incorporated into existing EFNEP classes. MAIN OUTCOME MEASURES Body mass index (BMI), diet, psychosocial variables with baseline measurements, immediately post, and 4 months later. ANALYSIS Mixed-model repeated measures analysis of variance. RESULTS 100 classes were randomized (54 intervention/46 comparison), with 1,006 participants at baseline (582 intervention, 424 comparison, 97% women, 89% Hispanic). Significant improvements over time were found for both groups' consumption of most food items and nutrients, and nearly all psychosocial variables, regardless of study group. Only the intervention group had a significant BMI decrease at post. Fidelity to the intervention class session structure was high, and comments from intervention staff and clients were positive. CONCLUSION AND IMPLICATIONS Existing EFNEP programs in local communities could have a significant impact on family dietary behaviors for populations at risk of obesity. Replication with similar populations is warranted.
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Affiliation(s)
- Karen Weber Cullen
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030-2600, USA.
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Monetary cost of self-reported diet in relation to biomarker-based estimates of nutrient intake in young Japanese women. Public Health Nutr 2009; 12:1290-7. [DOI: 10.1017/s1368980008003923] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveAll previous studies on monetary diet cost have examined the relationship of monetary cost of self-reported diet to self-reported, rather than biomarker-based, estimates of dietary intake. The present cross-sectional study examined the association between monetary costs of self-reported diet and biomarker-based estimates of nutrient intake.DesignMonetary diet cost (Japanese yen/1000 kJ) was calculated based on dietary intake information from a self-administered, comprehensive diet history questionnaire using retail food prices. Biomarker-based estimates of nutrient intake (percentage of energy for protein and mg/1000 kJ for K and Na) were estimated based on 24 h urinary excretion and estimated energy expenditure.SettingA total of fifteen universities and colleges in Japan.SubjectsA total of 1046 female Japanese dietetic students aged 18–22 years.ResultsTotal monetary diet cost showed a significant positive association with biomarker-based estimates of protein, K and Na. Vegetables and fish were not only the main contributors to total monetary diet cost (16·4 % and 15·5 %, respectively) but also were relatively strongly correlated with total monetary diet cost (Pearson’s correlation coefficient: 0·70 and 0·68, respectively). Monetary cost of vegetables was significantly positively associated with all three nutrients, while that of fish showed a significant and positive association only with protein.ConclusionsTotal monetary cost of self-reported diet was positively associated with biomarker-based estimates of protein, K and Na intake in young Japanese women, and appeared mainly to be explained by the monetary costs of vegetables and fish.
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Zagorsky JL, Smith PK. Does the U.S. Food Stamp Program contribute to adult weight gain? ECONOMICS AND HUMAN BIOLOGY 2009; 7:246-258. [PMID: 19540176 DOI: 10.1016/j.ehb.2009.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2007] [Revised: 05/13/2009] [Accepted: 05/16/2009] [Indexed: 05/27/2023]
Abstract
Obesity poses substantial costs both to the individual and society, mainly through its impact on health and labor productivity. Because obesity is more prevalent among the poor some have raised concerns that food assistance programs may encourage excess weight. This paper investigates whether the U.S. Food Stamp Program contributes to adult participants' weight as measured by body mass index (BMI). Results suggest that the typical female food stamp participant's BMI is indeed more than 1 unit higher than someone with the same socioeconomic characteristics who is not in the program. For the average American woman, who is 5 ft 4 in. (1.63 m) tall, this means an increase in weight of 5.8 pounds (2.6 kg). While this association does not prove that the Food Stamp Program causes weight gain, it does suggest that program changes to encourage the consumption of high-nutrient, low-calorie foods should be considered.
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Affiliation(s)
- Jay L Zagorsky
- Center for Human Resource Research, Ohio State University, 921 Chatham Lane, Suite 100, Columbus, OH 43221, USA.
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Townsend MS, Aaron GJ, Monsivais P, Keim NL, Drewnowski A. Less-energy-dense diets of low-income women in California are associated with higher energy-adjusted diet costs. Am J Clin Nutr 2009; 89:1220-6. [PMID: 19225114 DOI: 10.3945/ajcn.2008.26916] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND US-based studies are needed to estimate the relation, if any, between diet quality and estimated diet costs. OBJECTIVE We hypothesized that lower cost diets among low-income women in California would be energy dense but nutrient poor. DESIGN Energy and nutrient intakes for 112 women aged 18-45 y living in California were obtained with a food-frequency instrument. Dietary energy density (in MJ/kg or kcal/g) and energy-adjusted diet costs (in $/10 MJ or $/2000 kcal) were calculated with local food prices. Tertile splits of energy density and energy cost were analyzed with one-factor analysis of variance. RESULTS Mean daily energy intake excluding all beverages was 7.1 MJ (1699 kcal), and mean dietary energy density was 6.5 kJ/kg (1.54 kcal/g). Lower dietary energy density was associated with significantly higher intakes of dietary fiber (P = 0.004), vitamin A (P < 0.001), and vitamin C (P < 0.001) and with significantly lower intakes of total fat (P = 0.003) and saturated fat (P < 0.001). Higher diet cost was associated with significantly lower dietary energy density (P < 0.001), total fat (P = 0.024), and saturated fat (P = 0.025) and with significantly higher intakes of vitamins A (P = 0.003) and C (P < 0.001). Each additional dollar in estimated diet costs was associated with a drop in energy density of 0.94 MJ/kg (0.225 kcal/g). CONCLUSIONS The finding that higher quality diets were more costly for these low-income women has implications for the food assistance and education programs of the US Department of Agriculture. Policy interventions may be required to allow low-income families in the United States to improve the quality of their diets given their food budget constraints.
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Murakami K, Sasaki S, Takahashi Y, Okubo H, Hirota N, Notsu A, Fukui M, Date C. Comparability of weighed dietary records and a self-administered diet history questionnaire for estimating monetary cost of dietary energy. ENVIRONMENTAL HEALTH INSIGHTS 2008; 1:35-43. [PMID: 21572846 PMCID: PMC3091351 DOI: 10.4137/ehi.s1036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
An increasing number of studies have estimated monetary diet cost using various dietary assessment methods, based on databases on retail food prices, for investigating its association with dietary intake and health outcomes. However, information regarding the comparability of monetary diet cost across dietary assessment methods is absolutely lacking. This study compared monetary cost of dietary energy estimated from weighed dietary records (DRs) with that estimated from a self-administered diet history questionnaire (DHQ). The subjects were 92 Japanese women aged 31-69 years and 92 Japanese men aged 32-76 years. The DHQ (assessing diet during the preceding month) and 4-day DRs (one weekend day and three weekdays) were completed in each season over a 1-year period (DHQs1-4 and DRs1-4, respectively). An additional DHQ was completed at one year after completing DHQ1 (DHQ5). Monetary cost of dietary energy (Japanese yen/4184 kJ) was calculated using food intake information derived from each dietary assessment method, based on retail food prices. Pearson correlation between the mean of DRs1-4 and mean of DHQs1-4 was 0.64 for women and 0.69 for men. Pearson correlation between the mean of DRs1-4 and DHQ1 was 0.60 for women and 0.52 for men, while intraclass correlation between DHQ1 and DHQ5 was 0.64 for women and 0.51 for men. These data indicate reasonable comparability of monetary cost of dietary energy across DR and a DHQ as well as usefulness of a single administration of the DHQ for estimating monetary cost of dietary energy.
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Affiliation(s)
- Kentaro Murakami
- Department of Social and Preventive Epidemiology, School of Public Health, the University of Tokyo, Tokyo, Japan
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Pérez-Escamilla R, Hromi-Fiedler A, Vega-López S, Bermúdez-Millán A, Segura-Pérez S. Impact of peer nutrition education on dietary behaviors and health outcomes among Latinos: a systematic literature review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2008; 40:208-25. [PMID: 18565462 PMCID: PMC2746903 DOI: 10.1016/j.jneb.2008.03.011] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 03/13/2008] [Accepted: 03/19/2008] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This systematic review assesses the impact of peer education/counseling on nutrition and health outcomes among Latinos and identifies future research needs. DESIGN A systematic literature search was conducted by: (1) searching Internet databases; (2) conducting backward searches from reference lists of articles of interest; (3) manually reviewing the archives of the Center for Eliminating Health Disparities among Latinos; (4) searching the Journal of Nutrition Education and Behavior; and (5) directly contacting researchers in the field. The authors reviewed 22 articles derived from experimental or quasi-experimental studies. OUTCOME MEASURES Type 2 diabetes behavioral and metabolic outcomes, breastfeeding, nutrition knowledge, attitudes and behaviors. RESULTS Peer nutrition education has a positive influence on diabetes self-management and breastfeeding outcomes, as well as on general nutrition knowledge and dietary intake behaviors among Latinos. CONCLUSIONS AND IMPLICATIONS There is a need for longitudinal randomized trials testing the impact of peer nutrition education interventions grounded on goal setting and culturally appropriate behavioral change theories. Inclusion of reliable scales and the construct of acculturation are needed to further advance knowledge in this promising field. Operational research is also needed to identify the optimal peer educator characteristics, the type of training that they should receive, the client loads and dosage (ie, frequency and amount of contact needed between peer educator and client), and the best educational approaches and delivery settings.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT
- Connecticut Center for Eliminating Health Disparities among Latinos
| | - Amber Hromi-Fiedler
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT
- Connecticut Center for Eliminating Health Disparities among Latinos
| | - Sonia Vega-López
- Hispanic Health Council, Hartford CT
- Connecticut Center for Eliminating Health Disparities among Latinos
| | - Angela Bermúdez-Millán
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT
- Hispanic Health Council, Hartford CT
- Connecticut Center for Eliminating Health Disparities among Latinos
| | - Sofia Segura-Pérez
- Hispanic Health Council, Hartford CT
- Connecticut Center for Eliminating Health Disparities among Latinos
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Maillot M, Ferguson EL, Drewnowski A, Darmon N. Nutrient profiling can help identify foods of good nutritional quality for their price: a validation study with linear programming. J Nutr 2008; 138:1107-13. [PMID: 18492842 DOI: 10.1093/jn/138.6.1107] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Nutrient profiling ranks foods based on their nutrient content. They may help identify foods with a good nutritional quality for their price. This hypothesis was tested using diet modeling with linear programming. Analyses were undertaken using food intake data from the nationally representative French INCA (enquête Individuelle et Nationale sur les Consommations Alimentaires) survey and its associated food composition and price database. For each food, a nutrient profile score was defined as the ratio between the previously published nutrient density score (NDS) and the limited nutrient score (LIM); a nutritional quality for price indicator was developed and calculated from the relationship between its NDS:LIM and energy cost (in euro/100 kcal). We developed linear programming models to design diets that fulfilled increasing levels of nutritional constraints at a minimal cost. The median NDS:LIM values of foods selected in modeled diets increased as the levels of nutritional constraints increased (P = 0.005). In addition, the proportion of foods with a good nutritional quality for price indicator was higher (P < 0.0001) among foods selected (81%) than among foods not selected (39%) in modeled diets. This agreement between the linear programming and the nutrient profiling approaches indicates that nutrient profiling can help identify foods of good nutritional quality for their price. Linear programming is a useful tool for testing nutrient profiling systems and validating the concept of nutrient profiling.
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Affiliation(s)
- Matthieu Maillot
- INRA, UMR1260 Nutriments Lipidiques et Prévention des Maladies Métaboliques, Marseille, F-13385 France
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Dollahite J, Kenkel D, Thompson CS. An economic evaluation of the expanded food and nutrition education program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2008; 40:134-143. [PMID: 18457781 DOI: 10.1016/j.jneb.2007.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 08/19/2007] [Accepted: 08/21/2007] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To evaluate the New York State Expanded Food and Nutrition Education Program using economic methodology. DESIGN Data were collected by nutrition educators in a pretest, posttest design with an epidemiological modeling approach to assess costs and estimate potential health benefits of the state program. SETTING Cooperative Extension, 35 counties. PARTICIPANTS 5730 low-income participants. INTERVENTION Series of 6 or more food and nutrition lessons. MAIN OUTCOME MEASURES Cost (program and participant); health benefits in quality adjusted life years (QALYs); and monetized benefits: society's willingness to pay for QALYs, and benefits of avoiding or delaying health care costs and loss of productivity. ANALYSIS Cost-effectiveness estimated from behavior change and QALY weights. Cost-benefit ratios estimated from costs and monetized benefits. Sensitivity analyses provided ranges where lack of agreement exists around parameters' values. RESULTS Cost was $892/graduate. Cost-effectiveness was 245 QALYs saved, at $20863/QALY (sensitivity 42-935 QALYs, $5467-$130311 per QALY). Societal willingness to pay benefit-to-cost ratio was $9.58:$1.00 (sensitivity $1.44-$41.92:$1:00); narrow governmental benefit-to-cost ratio was $0.82:$1.00 (sensitivity $0.08-$4.33:$1:00). CONCLUSIONS AND IMPLICATIONS Outcome data indicate that food and nutrition behavior changes resulting from the Program are likely to improve future health and reduce health care costs. Cost-effectiveness is estimated to be as great as for many current health interventions.
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Affiliation(s)
- Jamie Dollahite
- Division of Nutritional Sciences, Cornell University, Ithaca, New York 14853, USA.
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Murakami K, Sasaki S, Okubo H, Takahashi Y, Hosoi Y, Itabashi M. Monetary costs of dietary energy reported by young Japanese women: association with food and nutrient intake and body mass index. Public Health Nutr 2007; 10:1430-9. [PMID: 17572935 DOI: 10.1017/s1368980007000213] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveLittle is known about the relationship of monetary diet costs to dietary intake and obesity, particularly in non-Western populations. This study examined monetary cost of dietary energy in relation to diet quality and body mass index (BMI) among young Japanese women.DesignDietary intake was assessed by a validated, self-administered, diet history questionnaire. Diet costs were estimated using retail food prices. Monetary cost of dietary energy (Japanese yen 1000 kcal−1) was then calculated. BMI was computed from self-reported body weight and height.SubjectsA total of 3931 female Japanese dietetic students aged 18–20 years.ResultsMonetary cost of dietary energy was positively associated with intakes of fruits, vegetables, fish and shellfish, and pulses; however, higher monetary cost of dietary energy was also associated with higher consumption of fat and oil, meat and energy-containing beverages, and lower consumption of cereals (rice, bread and noodles) (all P for trend <0.01). At the nutrient level, monetary cost of dietary energy was positively associated with intakes of dietary fibre and key vitamins and minerals, but also associated positively with intakes of fat, saturated fatty acids, cholesterol and sodium, and negatively with carbohydrate intake (all P for trend <0.0001). After adjustment for possible confounders, monetary cost of dietary energy was quite weakly but significantly negatively associated with BMI (P for trend = 0.0197).ConclusionsIncreasing monetary cost of dietary energy was associated with both favourable and unfavourable dietary intake patterns and a quite small decrease in BMI in young Japanese women.
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Affiliation(s)
- Kentaro Murakami
- Nutritional Epidemiology Program, National Institute of Health and Nutrition, Toyama 1-23-1, Shinjuku-ku, Tokyo 162-8636, Japan
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Drewnowski A, Monsivais P, Maillot M, Darmon N. Low-energy-density diets are associated with higher diet quality and higher diet costs in French adults. ACTA ACUST UNITED AC 2007; 107:1028-32. [PMID: 17524726 DOI: 10.1016/j.jada.2007.03.013] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Indexed: 01/12/2023]
Abstract
Low-energy-density diets are often recommended for weight control. Such diets have a higher nutrient content than do high-energy-density diets. This study tested the hypothesis that energy-dense diets have a relatively low monetary cost, whereas less energy-dense diets are more expensive. In this cross-sectional study, dietary intakes of 1,474 French adults (672 men, 802 women), aged 15 to 92 years, were assessed using 7-day diet records. Dietary energy density (kcal/g) was calculated by dividing total dietary energy by the edible weight of foods and caloric beverages consumed. Diet cost ($/7 days or $/2,000 kcal) was estimated using mean national food prices for 895 foods. The relationship between dietary energy density and diet cost was examined in a linear regression model. Within each quintile of energy intakes, the more energy-dense diets were associated with lower diet quality and with lower diet costs (r(2)=0.38 to 0.44). In a regression model, the more energy-dense diets cost less, whereas low-energy-density diets cost substantially more, adjusting for energy intakes, sex, and age. The finding that energy-dense diets cost less per 2,000 kcal may help explain why the highest rates of obesity are observed among groups of limited economic means. The finding that low-energy-density diets are associated with higher diet costs suggests that lasting improvements in diet quality may require economic as well as behavioral interventions.
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Affiliation(s)
- Adam Drewnowski
- School of Public Health and Community Medicine, University of Washington, Seattle, WA 98195, USA.
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Maillot M, Darmon N, Darmon M, Lafay L, Drewnowski A. Nutrient-dense food groups have high energy costs: an econometric approach to nutrient profiling. J Nutr 2007; 137:1815-20. [PMID: 17585036 DOI: 10.1093/jn/137.7.1815] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Consumers wishing to replace some of the foods in their diets with more nutrient-dense options need to be able to identify such foods on the basis of nutrient profiling. The present study used nutrient profiling to rank 7 major food groups and 25 subgroups in terms of their contribution to dietary energy, diet quality, and diet cost for 1332 adult participants in the French National INCA1 Study. Nutrient profiles were based on the presence of 23 qualifying nutrients, expressed as the percentage of nutrient adequacy per 8 MJ, and 3 negative or disqualifying nutrients, expressed as the percentage of the maximal recommended values for saturated fatty acids, added sugar, and sodium per 1.4 kg. Calculated cost of energy (euro/8 MJ) was based on the mean retail price of 619 foods in the nutrient composition database. The meat and the fruit and vegetables food groups had the highest nutritional quality but were associated with highest energy costs. Sweets and salted snacks had the lowest nutritional quality but were also one of the least expensive sources of dietary energy. Starches and grains were unique because they were low in disqualifying nutrients yet provided low-cost dietary energy. Within each major food group, some subgroups had a higher nutritient-to-price ratio than others. However, the fact that food groups with the more favorable nutrient profiles were also associated with higher energy costs suggests that the present structure of food prices may be a barrier to the adoption of food-based dietary guidelines, at least by low-income households.
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Affiliation(s)
- Matthieu Maillot
- INSERM, U476 Nutrition Humaine et Lipides, Marseille, F-13385 France
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