Diet cost and quality using the Healthy Eating Index-2015 in adults from urban and rural areas of Mexico

Diet quality indices are associated with breast cancer by molecular subtypes in Mexican women

BACKGROUND

Inconclusive epidemiological evidence suggests that diet quality indices may influence breast cancer (BC) risk; however, the evidence does not consider the molecular expression of this cancer.

PURPOSE

We aimed to evaluate if diet quality is related to molecular subtypes of BC, in women residing in Northern Mexico.

METHODS

This is a secondary analysis of 1,045 incident cases and 1,030 population controls from a previous case-control study, conducted between 2007 and 2011 in Northern Mexico. Information about the expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) was obtained from medical records to classify BC as luminal (ER + and/or PR+/HER2-), HER2+ (ER+/-and/or PR+/-/HER2+), or triple-negative (TN) (ER- and PR-/HER2-) cases. Food consumption was assessed with a semi-quantitative food frequency questionnaire. Diet quality was evaluated using the Mexican Diet Quality Index (MxDQI) and the Mexican Alternative Healthy Eating Index (MxAHEI). We used unconditional logistic regression models to estimate the association between Mexican diet quality indices and BC molecular subtypes.

RESULTS

The MxDQI was related to lower odds of BC (ORT3vsT1=0.24; 95%CI: 0.18, 0.31). Similarly, MxAHEI was negatively associated with BC (ORT3vsT1=0.43; 95%CI: 0.34, 0.54). The associations of both indices remained significant in the ER + and ER- tumors, and in the BC luminal and HER2 + molecular subtypes, except in the TN molecular subtype for MxAHEI, which was not statistically significant.

CONCLUSIONS

Our findings showed that MxDQI and MxAHEI were negatively associated with BC risk regardless of its molecular subtype.

Adherence to the EAT-Lancet index is associated with lower diet costs in the Mexican population

BACKGROUND

Poor diet quality contributes to morbidity and mortality and affects environmental sustainability. The EAT-Lancet reference diet offers a healthy and sustainable solution. This study aimed to estimate the association between diet cost and dietary quality, measured with an EAT-Lancet Index.

METHODS

An EAT-Lancet index was adapted to assess adherence to this dietary pattern from 24-h recalls data from the 2012 and 2016 Mexican National Health and Nutrition Surveys (n = 14,242). Prices were obtained from the Consumer Price Index. We dichotomized cost at the median (into low- and high-cost) and compared the EAT-Lancet index scores. We also used multivariate linear regression models to explore the association between diet cost and diet quality.

RESULTS

Individuals consuming a low-cost diet had a higher EAT-Lancet score than those consuming a high-cost diet (20.3 vs. 19.4 from a possible scale of 0 to 42; p < 0.001) due to a lower intake of beef and lamb, pork, poultry, dairy, and added sugars. We found that for each one-point increase in the EAT-Lancet score, there was an average decrease of MXN$0.4 in the diet cost (p < 0.001). This association was only significant among low- and middle-SES individuals.

CONCLUSIONS

Contrary to evidence from high-income countries, this study shows that in Mexico, adhering to the EAT-Lancet reference diet is associated with lower dietar costs, particularly in lower SES groups. These findings suggest the potential for broader implementation of healthier diets without increasing the financial burden.

Cost of a Healthy Diet: A Population-Representative Comparison of 3 Diet Cost Methods in Canada

BACKGROUND

Different food price sources and dietary assessment tools may impact the estimation of diet costs and hamper our understanding of the relationship between diet costs and dietary intakes.

OBJECTIVES

We aimed to investigate the effect of 3 diet cost derivation methods, with increasing numbers of food prices and geographic specificity, holding consistent dietary assessment, on the estimation of diet costs overall and by food group.

METHODS

We matched 24-h dietary recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS-N) to food price data from 3 Canadian Consumer Price Index (CPI) food price lists; national short list, national long list, and provincial long list. We compared the daily ($/day) and energy-adjusted ($/2000 kcal) diet costs overall and by food groups for the overall population (4+), children (4-18), and adults (19+).

RESULTS

The proportion of dietary intakes (grams) that were covered by CPI prices significantly increased from the national short list to the national long list but did not significantly differ from the national long list to the provincial long list. The national short list resulted in the highest daily and energy-adjusted diet costs overall. No difference in diet costs was noted between the national and provincial long lists. Diet costs for 4 food groups-additions, sweets, fruits, and vegetables, which were poorly covered by the national short list-significantly differed using the national and provincial long lists. All 3 diet cost methods were significantly correlated with energy intakes; however, a strong/very strong correlation was detected for children, and a weak/moderate correlation for adults.

CONCLUSIONS

The choice of food price data may introduce bias in the diet cost estimate, as well as limiting our understanding of how individuals allocate their diet costs. Refinement of diet cost estimation methodology and measures can strengthen future studies of how consumers allocate their purchases to their diets.

The Role of Environmental and Nutritional Factors in the Development of Inflammatory Bowel Diseases: A Case-Control Study

BACKGROUND

The incidence and prevalence of inflammatory bowel diseases (IBD) are increasing around the world, especially in Western countries. The objective of this study was to evaluate the health habits of healthy controls and individuals with IBDs to identify possible risk factors for IBD development.

METHODS

A case-control study was conducted among Spanish participants over 18 years of age. A self-administered questionnaire was completed by subjects to collect information on several sociodemographic variables and habits, such as the consumption of tobacco, alcohol, antibiotics, nonsteroidal anti-inflammatory agents and macronutrients; anxiety and depression; and quality of life.

RESULTS

The main risk factors identified were age; living in an urban environment; anxiety; and excessive consumption of proteins, carbohydrates and fats. In addition, the consumption of fibre had a preventive effect against IBD development.

CONCLUSIONS

Age, anxiety and living in urban areas pose a risk of suffering from IBD, as does the excessive consumption of certain macronutrients. However, the consumption of fibre has a protective effect on the development of some IBD types.

Association Between the Nutritional Quality of Food Purchases and Household Food at Home Expenditures in Mexico

BACKGROUND

Poor-quality diets are a major risk factor for noncommunicable diseases. Few studies in Mexico have tested whether higher expenditures are needed to purchase high-quality food.

OBJECTIVE

The objective of the study was to assess how dietary quality of food purchases was associated with household food at home expenditures.

DESIGN

This study was a secondary analysis of cross-sectional data from the National Household Income and Expenditure Survey (EncuestaNacional de Ingresos y Gastos de los Hogares [ENIGH] 2018).

PARTICIPANTS/SETTING

The study included 74 469 households with information on food and beverage purchases in Mexico in 2018.

MAIN OUTCOME MEASURES

Quarterly household food at home expenditures by adult equivalent (AE) for all food groups that were scored with the Global Dietary Quality Score (GDQS) for food purchases expressed in dollars/quarterly/AE.

STATISTICAL ANALYSES PERFORMED

Adjusted generalized linear models were used to evaluate the association between GDQS for food purchases (expressed in tertiles: low, mid, and high) and quarterly food expenditures. The analyses were performed at the national level by place of residence and income quintile.

RESULTS

At the national level, the difference in food expenditures between the high- and the low-GDQS groups was +$13.85/AE. By place of residence, the difference between the high- and the low-GDQS groups was +$17.31/AE in urban and +$5.12/AE in rural areas. For income quintile 1 (lowest), there was a statistical difference of -$4.79/AE and +$43.25 for quintile 5 (highest).

CONCLUSIONS

Quality of food purchases can be associated with higher or lower expenditures depending on the specific food purchased. High GDQS is associated with lower expenditures among the lowest-income households as they purchase less expensive options compared with high-income households.

Association between Diet Quality and Eating Behavior in Type 2 Diabetes Adults: A Cross-Sectional Study

Type 2 diabetes mellitus (T2DM) has become a global epidemic. To effectively control T2DM, individuals must adhere to a high-quality diet that encompasses not only healthy dietary patterns but also promotes positive eating behaviors. We conducted a cross-sectional study on 314 patients with T2DM, and we evaluated the diet quality and also examined the associations between eating behavior, diet quality, and anthropometric and clinical factors in T2DM patients. We used the Diet Quality Index-International and Dutch Eating Behavior Questionnaire to assess dietary characteristics. We found that women had a significantly higher diet quality than men (61.40 vs. 58.68, p = 0.002) but were also more prone to emotional eating (2.00 vs. 1.53, p < 0.001) and restrained eating (2.39 vs. 2.05, p = 0.002). Restrained eating correlated with duration of diabetes (r = -0.169, p = 0.003), body mass index (r = 0.182, p = 0.001), and external eating with glycated hemoglobin (r = 0.114, p = 0.044). Patients with emotional eating had a higher vitamin C adequacy score (β = 0.117, p = 0.045). External eating was positively associated with grain adequacy (β = 0.208, p < 0.001) and negatively associated with empty-calorie food moderation score (β = -0.125, p = 0.032). For restrained eating, we found associations with vitamin C adequacy (β = -0.138, p = 0.017) and fruit adequacy (β = 0.125, p = 0.033). In conclusion, the results of this study provide valuable insight into dietary behavior and emphasize the importance of promoting healthy eating habits for T2DM patients.

Association between total available nutritional quality and food expenditure in Peruvian households, 2019-2020

Evidence points to a direct relationship between nutritional quality and food expenditure. However, food expenditure is highly susceptible to changes, and nutritional quality of household food presents limited evidence. The aim of this study was to assess the relationship between nutritional quality available and total food expenditure in Peruvian households, and whether there were differences by area (urban and rural) and between years of the COVID-19 pandemic. For this, we used Peru's National Household Survey (ENAHO) from 2019 and 2020. We assessed total food expenditure in US dollars per day, whereas household nutritional quality available was assessed based on dietary diversity and compliance with the household calorie requirements, percentage of food expenditure, and potential confounders. We used the Student's t-test, analysis of variance (ANOVA), linear regression, and the Wald test to assess the interaction effect. Households with adequate total/partial nutritional quality available by area were found to spend, on average, USD 2.00 more in urban than in rural areas and, by year, they presented 7.1% more percentage of food expenditure in 2020 than in 2019. Despite associations existing between nutritional quality available and total food expenditure by year and study area, the effect modification was only present by study area. In multivariable model, households with adequate total/partial nutritional quality available consistently presented a lower total food expenditure by year, with a lower total food expenditure in urban areas. An inverse relationship was found between nutritional quality available and total food expenditure, in contrast to the direct relationship of studies assessing dietary cost and nutritional quality. Our results reflect the nutritional deficit in the food purchases of Peruvian households.

Sustainability of Diets in Mexico: Diet Quality, Environmental Footprint, Diet Cost, and Sociodemographic Factors

Background

Little is known about the current intake of sustainable diets globally and specifically in middle-income countries, considering nutritional, environmental and economic factors.

Objective

To assess and characterize the sustainability of Mexican diets and their association with sociodemographic factors.

Design

Dietary data of 2,438 adults within the National Health and Nutrition Survey 2012 by integrating diet quality measured by the Healthy Eating Index (HEI-2015), diet cost, and four environmental indicators were analyzed: land use (LU), biodiversity loss (BDL), carbon footprint (CFP), and blue water footprint (BWFP). We defined healthier more sustainable diets (MSD) as those with HEI-2015 above the overall median, and diet cost and environmental indicators below the median. Logistic regression was used to evaluate the association of sociodemographic factors with MSD.

Results

MSD were consumed by 10.2% of adults (4% of urban and 22% of rural), who had lower intake of animal-source foods, unhealthy foods (refined grains, added sugar and fats, mixed processed dishes and sweetened beverages), fruits, and vegetables, and higher intake of whole grains than non-MSD subjects. Characteristics of MSD vs. non-MSD (urban; rural) were: HEI-2015 (62.6 vs. 51.9; 66.8 vs. 57.6), diet-cost (1.9 vs. 2.8; 1.9 vs. 2.5 USD), LU (3.3 vs. 6.6; 3.2 vs. 5.9 m2), BDL (105 vs. 780; 87 vs. 586 species × 10-10), BWFP (244 vs. 403; 244 vs. 391 L), and CFP (1.6 vs. 4.4; 1.6 vs. 3.7 kg CO2eq). Adults from rural vs. urban (OR 2.7; 95% CI: 1.7, 4.1), or from the South (OR 2.1; 95% CI: 1.1, 3.9), Center (OR 2.3; 95% CI: 1.3, 4.4) vs. the North were more likely to consume MSD, while adults with high vs. low socioeconomic status were less likely (OR 0.17; 95% CI: 0.09, 0.3).

Conclusions

The MSD is a realistic diet pattern mainly found in disadvantaged populations, but diet quality is still sub-optimal. Increased consumption of legumes, fruits, and vegetables, and a reduction in unhealthy foods, is required to improve nutritional quality of diets while ensuring their environmental sustainability.