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Sood S, Feehan J, Itsiopoulos C, Wilson K, Plebanski M, Scott D, Hebert JR, Shivappa N, Mousa A, George ES, de Courten B. Higher Adherence to a Mediterranean Diet Is Associated with Improved Insulin Sensitivity and Selected Markers of Inflammation in Individuals Who Are Overweight and Obese without Diabetes. Nutrients 2022; 14:nu14204437. [PMID: 36297122 PMCID: PMC9608711 DOI: 10.3390/nu14204437] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
Abstract
Insulin resistance (IR) and chronic low-grade inflammation are risk factors for chronic diseases including type 2 diabetes (T2D) and cardiovascular disease. This study aimed to investigate two dietary indices: Mediterranean Diet Score (MDS) and Dietary Inflammatory Index (DII®), and their associations with direct measures of glucose metabolism and adiposity, and biochemical measures including lipids, cytokines and adipokines in overweight/obese adults. This cross-sectional study included 65 participants (males = 63%; age 31.3 ± 8.5 years). Dietary intake via 3-day food diaries was used to measure adherence to MDS (0-45 points); higher scores indicating adherence. Energy-adjusted DII (E-DII) scores were calculated with higher scores indicating a pro-inflammatory diet. IR was assessed using hyperinsulinemic euglycemic clamps, insulin secretion by intravenous glucose tolerance test, adiposity by dual-energy X-ray absorptiometry, and circulating cytokine and adipokine concentrations by multiplex assays. Higher MDS was associated with greater insulin sensitivity (β = 0.179; 95%CI: 0.39, 0.318) after adjusting for age, sex and % body fat, and lower NF-κB, higher adiponectin and adipsin in unadjusted and adjusted models. Higher E-DII score was associated with increased total cholesterol (β = 0.364; 95%CI: 0.066, 0.390) and LDL-cholesterol (β = 0.305; 95%CI: 0.019, 0.287) but not with adiposity, glucose metabolism, cytokines or adipokines. Greater MDS appears to be associated with decreased IR and inflammatory markers in overweight/obese adults.
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Affiliation(s)
- Surbhi Sood
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, VIC 3216, Australia
| | - Jack Feehan
- Institute for Health and Sport, Victoria University, Footscray, VIC 3011, Australia
| | - Catherine Itsiopoulos
- Department of Medicine, Nursing and Health Sciences, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
| | - Kirsty Wilson
- Department of Medicine, Nursing and Health Sciences, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
| | - Magdalena Plebanski
- Department of Medicine, Nursing and Health Sciences, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
| | - David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, VIC 3216, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia
| | - James R. Hebert
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29208, USA
| | - Nitin Shivappa
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29208, USA
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia
| | - Elena S. George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, VIC 3216, Australia
| | - Barbora de Courten
- Department of Medicine, Nursing and Health Sciences, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia
- Correspondence: ; Tel.: +61-3-9925-6474
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Bôto JM, Rocha A, Miguéis V, Meireles M, Neto B. Sustainability Dimensions of the Mediterranean Diet: A Systematic Review of the Indicators Used and Its Results. Adv Nutr 2022; 13:2015-2038. [PMID: 35679078 PMCID: PMC9526822 DOI: 10.1093/advances/nmac066] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/28/2022] [Accepted: 06/02/2022] [Indexed: 01/28/2023] Open
Abstract
The concern about sustainability is growing and the Mediterranean diet has been extensively identified as a promising model, with benefits for human and environmental health. This systematic review aims to identify and describe the indicators that have been used to evaluate the sustainability of the Mediterranean diet and the results from their application. A methodology using PRISMA guidelines was followed, and searches were performed in Web of Science, PubMed, Scopus, and GreenFile. A total of 32 studies assessing the sustainability of the Mediterranean diet were identified. Twenty-five of these studies quantified the environmental impact, 7 studies evaluated the nutritional quality, and 12 studies assessed the daily cost of this dietary pattern. A total of 33 distinct indicators were identified, of which 10 were used to assess the environmental dimension (mainly, carbon, water, and ecological footprint), 8 were used to assess the nutritional dimension (mainly Health score and Nutrient Rich Food Index), 1 was used to assess the economic dimension (dietary cost), and 8 used combined indicators. The remaining 6 indicators for the assessment of sociocultural dimension were only identified in 1 study but were not measured. The Mediterranean diet had a lower environmental impact than Western diets and showed a carbon footprint between 0.9 and 6.88 kg CO2/d per capita, a water footprint between 600 and 5280 m3/d per capita, and an ecological footprint between 2.8 and 53.42 m2/d per capita. With regard to the nutritional dimension, the Mediterranean diet had a high nutritional quality and obtained 122 points on the Health score and ranged between 12.95 and 90.6 points on the Nutrient Rich Food Index. The cost of the Mediterranean diet is similar to other diets and varied between 3.33 and 14.42€/d per capita. These findings show that no uniformity in assessing the MDiet's sustainability exists.
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Affiliation(s)
- Joana Margarida Bôto
- GreenUPorto—Sustainable Agrifood Production Research Centre/Inov4Agro, Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal,Faculty of Sciences, University of Porto, Porto, Portugal,LEPABE (Laboratory for Process Engineering, Environment, Biotechnology and Energy), Faculty of Engineering, University of Porto, Porto, Portugal,InescTec (Institute of Systems and Computer Engineering, Technology and Science), Faculty of Engineering, University of Porto, Porto, Portugal
| | - Ada Rocha
- GreenUPorto—Sustainable Agrifood Production Research Centre/Inov4Agro, Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Vera Miguéis
- InescTec (Institute of Systems and Computer Engineering, Technology and Science), Faculty of Engineering, University of Porto, Porto, Portugal
| | - Manuela Meireles
- Centro de Investigação de Montanha (CIMO), Instituto Politécnico de Bragança, Campus Santa Apolónia, Bragança, Portugal
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Echeverría G, Tiboni O, Berkowitz L, Pinto V, Samith B, von Schultzendorff A, Pedrals N, Bitran M, Ruini C, Ryff CD, Del Rio D, Rigotti A. Mediterranean Lifestyle to Promote Physical, Mental, and Environmental Health: The Case of Chile. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8482. [PMID: 33207718 PMCID: PMC7696560 DOI: 10.3390/ijerph17228482] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/26/2020] [Accepted: 10/31/2020] [Indexed: 12/12/2022]
Abstract
Chile is currently experiencing a progressive epidemiological transition towards chronic diseases. In this country, >50% of annual deaths are attributed to cardiovascular disease and cancer. Moreover, health surveys have shown high prevalence of obesity, diabetes, hypertension, and elevated cardiovascular disease risk. In addition, mental health issues are also frequent among Chilean adults. On the other hand, the agri-food system contributes to 21-37% of greenhouse gases emissions worldwide. Overall, current health and food chain situation calls out for design and implementation of evidence-based feasible and effective nutritional interventions needed to promote physical and mental health along with addressing food sustainability in Chile. Nowadays, the Mediterranean diet is recognized as one of the healthiest dietary patterns based on observational and interventional studies linked to a wide variety of health outcomes. However, a Mediterranean lifestyle goes well beyond food intake: it includes promotion of psychosocial resources, community life as well as cultural traditions. Indeed, Mediterranean lifestyle is a true modus vivendi that integrally promotes physical, mental, and social well-being. In addition, the Mediterranean diet stands out for its environmental sustainability because it is characterized mainly as a plant-based dietary pattern with low carbon and water footprints. Remarkably, Central Chile has a Mediterranean-like setting with plant and animal food production and availability patterns comparable to those present in countries located around the Mediterranean Sea. Therefore, this article reviews how promotion of Mediterranean lifestyle adherence in Chile offers great potential for management of the ongoing epidemiological transition to chronic diseases as well to promote psychological well-being within a unique food system and dietary sustainability vision for this Latin American country.
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Affiliation(s)
- Guadalupe Echeverría
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago CP 83300024, Chile; (G.E.); (L.B.); (B.S.); (N.P.)
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago CP 83300024, Chile; (O.T.); (V.P.); (A.v.S.); (M.B.)
| | - Ornella Tiboni
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago CP 83300024, Chile; (O.T.); (V.P.); (A.v.S.); (M.B.)
| | - Loni Berkowitz
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago CP 83300024, Chile; (G.E.); (L.B.); (B.S.); (N.P.)
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago CP 83300024, Chile; (O.T.); (V.P.); (A.v.S.); (M.B.)
| | - Victoria Pinto
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago CP 83300024, Chile; (O.T.); (V.P.); (A.v.S.); (M.B.)
| | - Bárbara Samith
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago CP 83300024, Chile; (G.E.); (L.B.); (B.S.); (N.P.)
| | - Andrea von Schultzendorff
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago CP 83300024, Chile; (O.T.); (V.P.); (A.v.S.); (M.B.)
| | - Nuria Pedrals
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago CP 83300024, Chile; (G.E.); (L.B.); (B.S.); (N.P.)
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago CP 83300024, Chile; (O.T.); (V.P.); (A.v.S.); (M.B.)
| | - Marcela Bitran
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago CP 83300024, Chile; (O.T.); (V.P.); (A.v.S.); (M.B.)
- Centro de Educación Médica y de Ciencias de la Salud, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago CP 83300024, Chile
| | - Chiara Ruini
- Department of Psychology, University of Bologna, 40126 Bologna, Italy;
| | - Carol D. Ryff
- Institute on Aging and Department of Psychology, University of Wisconsin-Madison, Madison, WI 53706-1611, USA;
| | - Daniele Del Rio
- Department of Food and Drugs, University of Parma, 43121 Parma, Italy;
| | - Attilio Rigotti
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago CP 83300024, Chile; (G.E.); (L.B.); (B.S.); (N.P.)
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago CP 83300024, Chile; (O.T.); (V.P.); (A.v.S.); (M.B.)
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Dietary cost associated with adherence to the Mediterranean diet, and its variation by socio-economic factors in the UK Fenland Study. Br J Nutr 2019; 119:685-694. [PMID: 29553031 DOI: 10.1017/s0007114517003993] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
High cost of healthy foods could be a barrier to healthy eating. We aimed to examine the association between dietary cost and adherence to the Mediterranean diet in a non-Mediterranean country. We evaluated cross-sectional data from 12 417 adults in the UK Fenland Study. Responses to 130-item FFQ were used to calculate a Mediterranean diet score (MDS). Dietary cost was estimated by matching food consumption data with retail prices of five major supermarkets. Using multivariable-adjusted linear regression, we examined the association of MDS and individual foods with dietary cost in absolute and relative scales. Subsequently, we assessed how much the association was explained by education, income, marital status and occupation, by conducting mediation analysis and testing interaction by these variables. High compared with low MDS (top to bottom third) was associated with marginally higher cost by 5·4 % (95 % CI 4·4, 6·4) or £0·20/d (95 % CI 0·16, 0·25). Participants with high adherence had higher cost associated with the healthier components (e.g. vegetables, fruits and fish), and lower cost associated with the unhealthy components (e.g. red meat, processed meat and sweets) (P for trend<0·001 each). In total, 20·7 % (95 % CI 14·3, 27·0) of the MDS-cost association was explained by the selected socio-economic factors, and the MDS-cost association was of greater magnitude in lower socio-economic groups (P interaction<0·005). Overall, greater adherence to the Mediterranean diet was associated with marginally higher dietary cost, partly modified and explained by socio-economic status, but the potential economic barriers of high adherence might be offset by cost saving from reducing unhealthy food consumption.
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Robinson SM, Jameson KA, Bloom I, Ntani G, Crozier SR, Syddall H, Dennison EM, Cooper CR, Sayer AA. Development of a Short Questionnaire to Assess Diet Quality among Older Community-Dwelling Adults. J Nutr Health Aging 2017; 21:247-253. [PMID: 28244562 DOI: 10.1007/s12603-016-0758-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the use of a short questionnaire to assess diet quality in older adults. DESIGN Cross-sectional study. SETTING Hertfordshire, UK. PARTICIPANTS 3217 community-dwelling older adults (59-73 years). MEASUREMENTS Diet was assessed using an administered food frequency questionnaire (FFQ); two measures of diet quality were defined by calculating participants' 'prudent diet' scores, firstly from a principal component analysis of the data from the full FFQ (129 items) and, secondly, from a short version of the FFQ (including 24 indicator foods). Scores calculated from the full and short FFQ were compared with nutrient intake and blood concentrations of vitamin C and lipids. RESULTS Prudent diet scores calculated from the full FFQ and short FFQ were highly correlated (0.912 in men, 0.904 in women). The pattern of associations between nutrient intake (full FFQ) and diet scores calculated using the short and full FFQs were very similar, both for men and women. Prudent diet scores calculated from the full and short FFQs also showed comparable patterns of association with blood measurements: in men and women, both scores were positively associated with plasma vitamin C concentration and serum HDL; in women, an inverse association with serum triglycerides was also observed. CONCLUSIONS A short food-based questionnaire provides useful information about the diet quality of older adults. This simple tool does not require nutrient analysis, and has the potential to be of value to non-specialist researchers.
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Affiliation(s)
- S M Robinson
- SM Robinson; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton. SO16 6YD; Telephone: +44 (0)23 8077 7624; Fax: +44 (0)23 8070 4021; e-mail:
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Bonaccio M, Bes-Rastrollo M, de Gaetano G, Iacoviello L. Challenges to the Mediterranean diet at a time of economic crisis. Nutr Metab Cardiovasc Dis 2016; 26:1057-1063. [PMID: 27524802 DOI: 10.1016/j.numecd.2016.07.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 12/29/2022]
Abstract
AIMS The traditional Mediterranean diet (MD) is reportedly associated with lower risk of major chronic diseases and long considered to contribute to the reduced rates of cardiovascular and cerebrovascular events and to the highest life expectancy in adults who lived near the Mediterranean Sea. But despite its widely documented health benefits, adherence to this dietary pattern has been rapidly declining over the last decades due to a clear socioeconomic influence. The present review provides an overview of the evidence on the current major determinants of adherence to the Mediterranean diet, with a particular emphasis on Mediterranean Countries at a time of economic crisis; second it explores emerging socioeconomic inequalities in other domains of healthy dietary behaviours such as dietary variety, access to organic foods and food purchasing behaviour. DATA SYNTHESIS According to ecological evidence, the Mediterranean Countries that used to have the highest adherence to the Mediterranean pattern in the Sixties, more recently experienced the greatest decrease, while Countries in Northern Europe and some other Countries around the world are currently embracing a Mediterranean-like dietary pattern. A potential cause of this downward trend could be the increasing prices of some food items of the Mediterranean diet pyramid. Recent evidence has shown a possible involvement of the economic crisis, material resources becoming strong determinants of the adherence to the MD just after the recession started in 2007-2008. Beyond intake, the MD also encourages increasing dietary diversity, while international dietary recommendations suggest replacing regular foods with healthier ones. CONCLUSIONS Socioeconomic factors appear to be major determinants of the adherence to MD and disparities also hold for other indices of diet quality closely related to this dietary pattern.
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Affiliation(s)
- M Bonaccio
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - M Bes-Rastrollo
- Dept. Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; CIBERobn, Instituto de Salud Carlos III, Madrid, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - G de Gaetano
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - L Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy.
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Dalma A, Kastorini CM, Zota D, Veloudaki A, Petralias A, Yannakoulia M, Linos A. Perceptions of parents and children, participating in a school-based feeding programme in disadvantaged areas in Greece: a qualitative study. Child Care Health Dev 2016; 42:267-77. [PMID: 26757263 DOI: 10.1111/cch.12315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 11/09/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
Abstract
AIM The aim of this work was to explore parents' and children's attitudes towards healthy eating and the free provision of a daily school meal in underprivileged areas of Greece. METHODS Twenty focus groups were conducted in 14 schools. Eligible participants were children/adolescents and their parents, who were recipients of a food aid, healthy nutrition school-based programme. Their perceptions towards healthy eating and related barriers, experience of a school feeding programme, other nutrition intervention initiatives were qualitatively evaluated. RESULTS Most of the parents referred to the Mediterranean diet as a healthy dietary pattern. Nearly all parents were aware of their effect as role models and commented on the benefits of eating together as a family, as well as on the importance of improving their own dietary habits. Parents reported using various methods to promote a healthy diet, as part of their parenting role. They perceived their role as difficult, as they have to deal with children's resistance, financial constraints arising from the current economic crisis in Greece and busy work schedules. All students perceived the school feeding programme as health-promoting, reflecting their parents' perceptions. CONCLUSION The present findings indicate that although the traditional Mediterranean diet was perceived by the majority of the adults as a health and traditional dietary pattern, parents reported several barriers related to its adoption. In particular, the most common barriers included financial difficulties, limited time for food preparation and children's resistance to consume healthy foods.
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Affiliation(s)
- A Dalma
- Institute of Preventive Medicine, Environmental and Occupational Health, Athens, Greece.,Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - C M Kastorini
- Institute of Preventive Medicine, Environmental and Occupational Health, Athens, Greece
| | - D Zota
- Institute of Preventive Medicine, Environmental and Occupational Health, Athens, Greece
| | - A Veloudaki
- Institute of Preventive Medicine, Environmental and Occupational Health, Athens, Greece
| | - A Petralias
- Institute of Preventive Medicine, Environmental and Occupational Health, Athens, Greece.,Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - M Yannakoulia
- Institute of Preventive Medicine, Environmental and Occupational Health, Athens, Greece.,Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - A Linos
- Institute of Preventive Medicine, Environmental and Occupational Health, Athens, Greece.,Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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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: 655] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
CONTEXT It is well established in the literature that healthier diets cost more than unhealthy diets. OBJECTIVE The aim of this review was to examine the contribution of food prices and diet cost to socioeconomic inequalities in diet quality. DATA SOURCES A systematic literature search of the PubMed, Google Scholar, and Web of Science databases was performed. STUDY SELECTION Publications linking food prices, dietary quality, and socioeconomic status were selected. DATA EXTRACTION Where possible, review conclusions were illustrated using a French national database of commonly consumed foods and their mean retail prices. DATA SYNTHESIS Foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. Food budgets in poverty were insufficient to ensure optimum diets. CONCLUSIONS Socioeconomic disparities in diet quality may be explained by the higher cost of healthy diets. Identifying food patterns that are nutrient rich, affordable, and appealing should be a priority to fight social inequalities in nutrition and health.
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Affiliation(s)
- Nicole Darmon
- N. Darmon is with the Unité Mixte de Recherche "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique 1260, Institut National de la Santé et de la Recherche Médicale 1062, Aix-Marseille Université, Marseille, France. A. Drewnowski is with the Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA.
| | - Adam Drewnowski
- N. Darmon is with the Unité Mixte de Recherche "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique 1260, Institut National de la Santé et de la Recherche Médicale 1062, Aix-Marseille Université, Marseille, France. A. Drewnowski is with the Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
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Cost and cost-effectiveness of the Mediterranean diet: results of a systematic review. Nutrients 2013; 5:4566-86. [PMID: 24253053 PMCID: PMC3847749 DOI: 10.3390/nu5114566] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 11/03/2013] [Accepted: 11/04/2013] [Indexed: 11/28/2022] Open
Abstract
The growing impact of chronic degenerative pathologies (such as cardiovascular disease, type 2 diabetes and Alzheimer’s disease) requires and pushes towards the development of new preventive strategies to reduce the incidence and prevalence of these diseases. Lifestyle changes, especially related to the Mediterranean diet, have the potential to modify disease outcomes and ultimately costs related to their management. The objective of the study was to perform a systematic review of the scientific literature, to gauge the economic performance and the cost-effectiveness of the adherence to the Mediterranean diet as a prevention strategy against degenerative pathologies. We investigated the monetary costs of adopting Mediterranean dietary patterns by determining cost differences between low and high adherence. Research was conducted using the PubMed and Scopus databases. Eight articles met the pre-determined inclusion criteria and were reviewed. Quality assessment and data extraction was performed. The adherence to the Mediterranean diet has been extensively reported to be associated with a favorable health outcome and a better quality of life. The implementation of a Mediterranean dietary pattern may lead to the prevention of degenerative pathologies and to an improvement in life expectancy, a net gain in health and a reduction in total lifetime costs.
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Vandevijvere S, Monteiro C, Krebs-Smith SM, Lee A, Swinburn B, Kelly B, Neal B, Snowdon W, Sacks G. Monitoring and benchmarking population diet quality globally: a step-wise approach. Obes Rev 2013; 14 Suppl 1:135-49. [PMID: 24074217 DOI: 10.1111/obr.12082] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support) aims to monitor and benchmark the healthiness of food environments globally. In order to assess the impact of food environments on population diets, it is necessary to monitor population diet quality between countries and over time. This paper reviews existing data sources suitable for monitoring population diet quality, and assesses their strengths and limitations. A step-wise framework is then proposed for monitoring population diet quality. Food balance sheets (FBaS), household budget and expenditure surveys (HBES) and food intake surveys are all suitable methods for assessing population diet quality. In the proposed 'minimal' approach, national trends of food and energy availability can be explored using FBaS. In the 'expanded' and 'optimal' approaches, the dietary share of ultra-processed products is measured as an indicator of energy-dense, nutrient-poor diets using HBES and food intake surveys, respectively. In addition, it is proposed that pre-defined diet quality indices are used to score diets, and some of those have been designed for application within all three monitoring approaches. However, in order to enhance the value of global efforts to monitor diet quality, data collection methods and diet quality indicators need further development work.
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Affiliation(s)
- S Vandevijvere
- School of Population Health, University of Auckland, Auckland, New Zealand
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