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Alaofè H, Mahdavimanshadi M, Mizéhoun-Adissoda C, Okechukwu A, Hounkpatin WA, Bedrick EJ, Gninkoun J, Fan N, Ehiri J. Precision nutrition for type 2 diabetes in Benin: leveraging linear goal programming to optimize diets with emphasis on adequacy, affordability, accessibility, and culture. Front Nutr 2024; 11:1400594. [PMID: 39176027 PMCID: PMC11338894 DOI: 10.3389/fnut.2024.1400594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/18/2024] [Indexed: 08/24/2024] Open
Abstract
Background Nutrition and diet are critical to managing Type 2 diabetes (T2D). Low-income households often face challenges maintaining a healthy and balanced diet due to food insecurity, availability, and cost. To address this issue, we used a linear goal programming (LGP) model to develop nutritionally adequate, affordable, accessible, and culturally acceptable diets for persons with T2D in Benin, a French-speaking sub-Saharan country. The goal was to help persons with T2D manage their condition more effectively. Methods We compiled a robust list of local commonly consumed foods in Benin, and calculated their nutritional value using West African food composition tables and food costs per serving from a market survey. Using mathematical optimization techniques, we designed dietary plans that meet the daily nutrient intake recommended by the World Health Organization (WHO) to prevent chronic diseases in normal adults. While adhering to dietary constraints of T2D, we developed optimized diet plans with varying energy levels that meet all nutrient requirements while considering availability, acceptability, and budgetary constraints. Results Fifty-two food items and recipes were evaluated to create six low-cost daily menus. Menu 1 was the most affordable at CFA 1,127 (USD 1.88), providing 1890 kcal of energy, while Menu 6 was the most expensive at CFA 1,227 (USD 2.05), providing 1749 kcal. All the menus met the daily WHO minimum requirements for carbohydrates, fat, cholesterol, and fiber content, while other nutrients such as protein, vitamin C, and iron reached the upper limits of the acceptable value range. Conclusion Linear goal programming can be an effective tool in helping to obtain optimized adequate, accessible, and culturally acceptable diets at minimal cost by interpreting and translating dietary recommendations into a nutritional model, based on local market prices.
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Affiliation(s)
- Halimatou Alaofè
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Mahdi Mahdavimanshadi
- Department of Systems and Industrial Engineering, University of Arizona, Tucson, AZ, United States
| | - Carmelle Mizéhoun-Adissoda
- School of Nutrition and Dietetics, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Abidemi Okechukwu
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Waliou Amoussa Hounkpatin
- School of Nutrition and Food Science and Technology, Faculty of Agricultural Sciences of the University of Abomey-Calavi, Calavi, Benin
| | - Edward John Bedrick
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jules Gninkoun
- Faculty of Health Sciences, University of Abomey Calavi, Cotonou, Benin
| | - Neng Fan
- Department of Systems and Industrial Engineering, University of Arizona, Tucson, AZ, United States
| | - John Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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Verdeau B, Monnery-Patris S. When food is uncertain, how much does sustainability matter? A qualitative exploration of food values and behaviours among users of a social grocery store. Appetite 2024; 194:107175. [PMID: 38128764 DOI: 10.1016/j.appet.2023.107175] [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: 09/04/2023] [Revised: 11/23/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
A transition towards sustainable diets ensuring food security while preserving ecosystems is necessary, but remains challenging. Low-income consumers, particularly those experiencing food insecurity, require specific consideration since they face financial constraints when making food choices, leading to poorer diets. However, little is known about the place given to sustainability in their choices. This study thus aims to identify the role played by sustainability in the food values of food-insecure consumers in France. Twenty-nine semi-structured interviews with users of a social grocery store were conducted to investigate food values and actual behaviours, with a focus on the four dimensions of sustainable diets - health, economic, sociocultural and environmental. Verbatims were analysed through thematic analysis. Five core values were identified, namely health and nutrition, naturalness, trust and control, solidarity and frugality, and preferences. Participants valued all dimensions of food sustainability but notably valued less the environmental dimension. Despite various strategies, participants felt unable to adhere to their values in practice, mainly because of their socioeconomic vulnerability. They insisted on their lack of control over their food behaviour. These findings provide insights into the disempowerment experienced by consumers with low financial resources regarding more sustainable food choices. Our study calls for interventions addressing affordability issues and considering consumers' food values, while providing opportunities to make consumers feel involved in the transition of the food system.
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Affiliation(s)
- Basile Verdeau
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne, F-21000, Dijon, France.
| | - Sandrine Monnery-Patris
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne, F-21000, Dijon, France
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Baudry J, Neves F, Lairon D, Allès B, Langevin B, Brunin J, Berthy F, Danquah I, Touvier M, Hercberg S, Amiot MJ, Pointereau P, Kesse-Guyot E. Sustainability analysis of the Mediterranean diet: results from the French NutriNet-Santé study. Br J Nutr 2023; 130:2182-2197. [PMID: 37357796 DOI: 10.1017/s0007114523001411] [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] [Indexed: 06/27/2023]
Abstract
The Mediterranean diet is often proposed as a sustainable diet model. This study aimed to evaluate the associations between adherence to the Mediterranean diet and sustainability domains in a cohort of French adults, using multiple criteria including nutritional quality, environmental pressures, monetary cost and dietary pesticide exposure. Food intakes of 29 210 NutriNet-Santé volunteers were assessed in 2014 using a semi-quantitative FFQ. Adherence to the Mediterranean diet was evaluated using the validated literature-based adherence score (MEDI-LITE). The associations between the MEDI-LITE and various sustainability indicators were examined using ANCOVA models, adjusted for sex, age and energy intake. Higher adherence to the MEDI-LITE was associated with higher nutritional quality scores, better overall nutrient profile as well as reduced environmental impact (land occupation: Q5 v. Q1: -35 %, greenhouse gas emissions: -40 % and cumulative energy demand: -17 %). In turn, monetary cost increased with increasing adherence to the Mediterranean diet (Q5 v. Q1: +15 %), while higher adherents to the Mediterranean diet had overall higher pesticide exposure due to their high plant-based food consumption. In this large cohort of French adults, greater adherence to the Mediterranean diet was associated with nutritional and environmental benefits, but also with higher monetary cost and greater exposure to pesticides, illustrating the necessity to develop large-scale strategies for healthy, safe (pesticide- and contaminant-free) and environmentally sustainable diets for all.
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Affiliation(s)
- Julia Baudry
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
| | - Floriane Neves
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
| | - Denis Lairon
- Aix Marseille Université, Inserm, INRAE, C2VN, Marseille, France
| | - Benjamin Allès
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
| | | | - Joséphine Brunin
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
| | - Florine Berthy
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
| | - Ina Danquah
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
| | - Serge Hercberg
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
- Département de Santé Publique, Hôpital Avicenne, Bobigny, France
| | - Marie-Josèphe Amiot
- MoISA, Univ Montpellier, CIHEAM-IAMM, CIRAD, INRAE, Institut Agro, IRD, Montpellier, France
| | | | - Emmanuelle Kesse-Guyot
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
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Cole A, Pethan J, Evans J. The Role of Agricultural Systems in Teaching Kitchens: An Integrative Review and Thoughts for the Future. Nutrients 2023; 15:4045. [PMID: 37764827 PMCID: PMC10537800 DOI: 10.3390/nu15184045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Diet-related chronic disease is a public health epidemic in the United States. Concurrently, conventional agricultural and food production methods deplete the nutritional content of many foods, sever connections between people and the origin of their food, and play a significant role in climate change. Paradoxically, despite an abundance of available food in the US, many households are unable to afford or attain a healthful diet. The linkages between agriculture, health, and nutrition are undeniable, yet conventional agriculture and healthcare systems tend to operate in silos, compounding these pressing challenges. Operating teaching kitchens in collaboration with local agriculture, including farms, community gardens, vertical farms, and urban agriculture, has the potential to catalyze a movement that emphasizes the role of the food system in promoting human and planetary health, building resilient communities, and encouraging cross-disciplinary collaboration. This paper reviews the current state of agricultural systems, food is medicine, consumer behavior, and the roles within these sectors. This is followed by a series of case studies that fill the gaps between TKs and agriculture. The authors summarize opportunities to combine the knowledge and resources of teaching kitchens and agriculture programs, as well as challenges that may arise along the way.
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Affiliation(s)
- Alexis Cole
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA;
| | - Jennifer Pethan
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA;
| | - Jason Evans
- College of Food Innovation and Technology, Johnson and Wales University, Providence, RI 02903, USA;
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Shahi PV, Shrestha RM, Schreinemachers P, Shibanuma A, Kiriya J, Ong KIC, Jimba M. Identifying positive and negative deviants and factors associated with healthy dietary practices among young schoolchildren in Nepal: a mixed methods study. BMC Nutr 2023; 9:42. [PMID: 36890574 PMCID: PMC9993389 DOI: 10.1186/s40795-023-00700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/03/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND School-based interventions have been implemented in resource-limited settings to promote healthy dietary habits, but their sustainability remains a challenge. This study identified positive deviants (PDs) and negative deviants (NDs) from the control and treatment groups in a nutrition-sensitive agricultural intervention in Nepal to identify factors associated with healthy dietary practices. METHODS This is an explanatory mixed methods study. Quantitative data come from the endline survey of a cluster randomized controlled trial of a school and home garden intervention in Nepal. Data were analyzed from 332 and 317 schoolchildren (grades 4 and 5) in the control and treatment group, respectively. From the control group, PDs were identified as schoolchildren with a minimum dietary diversity score (DDS) ≥ 4 and coming from low wealth index households. From the treatment group, NDs were identified as schoolchildren with a DDS < 4 and coming from high wealth index households. Logistic regression analyses were conducted to identify factors associated with PDs and NDs. Qualitative data were collected through in-depth phone interviews with nine pairs of parents and schoolchildren in each PD and ND group. Qualitative data were analyzed thematically and integrated with quantitative data in the analysis. RESULTS Twenty-three schoolchildren were identified as PDs, and 73 schoolchildren as NDs. Schoolchildren eating more frequently a day (AOR = 2.25; 95% CI:1.07-5.68) and whose parents had a higher agricultural knowledge level (AOR = 1.62; 95% CI:1.11-2.34) were more likely to be PDs. On the other hand, schoolchildren who consumed diverse types of vegetables (AOR = 0.56; 95% CI: 0.38-0.81), whose parents had higher vegetable preference (AOR = 0.72; 95% CI: 0.53-0.97) and bought food more often (AOR = 0.71; 95% CI: 0.56-0.88) were less likely to be NDs. Yet, schoolchildren from households with a grandmother (AOR = 1.98; 95% CI: 1.03-3.81) were more likely to be NDs. Integrated results identified four themes that influenced schoolchildren's DDS: the availability of diverse food, the involvement of children in meal preparation, parental procedural knowledge, and the grandmother's presence. CONCLUSION Healthy dietary habit can be promoted among schoolchildren in Nepal by encouraging parents to involve their children in meal preparation and increasing the awareness of family members.
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Affiliation(s)
- Prasant Vikram Shahi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Rachana Manandhar Shrestha
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | | | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Junko Kiriya
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ken Ing Cherng Ong
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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The revised Healthy Purchase Index (r-HPI): a validated tool for exploring the nutritional quality of household food purchases. Eur J Nutr 2023; 62:363-377. [PMID: 36029328 PMCID: PMC9899728 DOI: 10.1007/s00394-022-02962-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 07/08/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Healthy Purchase Index (HPI) assesses the nutritional quality of food purchases (FP) from food group expenditure shares only. However, it was developed from the FP of a disadvantaged population. OBJECTIVE To adapt and validate the HPI for a general population. METHODS FP were obtained from a representative sample of French households (Kantar WorldPanel) subdivided into two subsamples. The first sample (n = 4375) was used to adapt and validate the score; the second sample (n = 2188) was used to test external validity. The revised-HPI (r-HPI) includes 2 subscores: the diversity subscore and the quality subscore. Diversity subscore points were awarded when expenditure shares were above the 25th percentile for 5 food groups ("Fruits", "Vegetables", "Starches", "Dairy", "Meat, Fish and Eggs"). Regression models between the expenditure shares of each food group and the Mean Adequacy Ratio (MAR) and the Mean Excess Ratio (MER) of FP were used to select quality subscore components and define cut-offs for point allocation. Construct validity was assessed on the first sample using Spearman's correlations between the r-HPI and the four nutritional quality indicators (NRF9.3, MAR, MER, energy density), and also by comparing the r-HPI of monthly FP of sub-populations defined by criteria known to influence diet quality (age, gender, income, education) and between households having a monthly food basket of higher (MAR > median and MER and energy density < median) vs. lower nutritional quality within the population, using Wilcoxon tests or pairwise comparisons of contrasts. External validity was tested by performing the same analyses on the 2nd sample of 2188 households. RESULTS The adaptation led to include new components (e.g. red meat) and define new cut-offs (e.g. - 1 point when budget share for red meat > 21%). The r-HPI (mean = 6.50 ± 3.58) was strongly correlated with NRF9.3, MAR, MER and energy density (0.59, 0.52, - 0.41 and - 0.65, respectively, p < 0.01) and poorly correlated with total energy content (- 0.096, p < 0.001). The r-HPI was significantly higher in women (β = 1.41 [0.20], p < 0.01), households having a food basket of higher nutritional quality (β = 4.15 [0.11], p < 0.001), and increased significantly with age, income and education levels. Similar results were obtained in the 2nd sample. CONCLUSION We showed the validity of the r-HPI in a large sample of French households. As it does not require food quantity or nutrient content, it can be used as a valuable tool to explore FP behaviours. Cut-offs can be used in health promotion to provide nutri-economic counselling.
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Foster BA, Seeley K, Davis M, Boone-Heinonen J. Positive deviance in health and medical research on individual level outcomes - a review of methodology. Ann Epidemiol 2022; 69:48-56. [PMID: 34915122 PMCID: PMC9081135 DOI: 10.1016/j.annepidem.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Positive deviance as a methodology is increasing in application yet there is high variability in how this approach is applied in health services research. METHODS We conducted a scoping review of the literature for positive deviance applied to health outcomes informed by PRISMA-ScR. We searched the literature from 1945 to 2020, including articles on positive deviance or positive outliers, and restricted to examining individual rather than organizational outcomes. We analyzed the methodology applied including the process of identifying deviants, the use of control groups, and the degree of community engagement. RESULTS Our initial search identified 1140 manuscripts; we included 104 papers describing 98 studies, 11 topical and one miscellaneous category. Most studies used objective measures of health or survey-based responses to identify deviants from a sub-set of the population at risk. The use of controls was less common in some topics (hospital infections), whereas controls were universally applied in other topics (malnutrition). The degree of community engagement varied widely. CONCLUSIONS Positive deviance would benefit from improvements in reporting and standardized approaches to defining deviance. Studies could be improved through clarified definitions of deviance/risk, explicit descriptions of community engagement, and more consistent use of controls.
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Affiliation(s)
- Byron A Foster
- Department of Pediatrics, Oregon Health & Science University, Portland, OR; School of Public Health, Portland State University and Oregon Health & Science University.
| | - Kylie Seeley
- Department of Pediatrics, Stanford University, Stanford School of Medicine, Palo Alto, CA
| | - Melinda Davis
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Janne Boone-Heinonen
- School of Public Health, Portland State University and Oregon Health & Science University
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Farapti F, Buanasita A, Atmaka DR, Setyaningtyas SW, Adriani M, Rejeki PS, Yamaoka Y, Miftahussurur M. Potassium intake is associated with nutritional quality and actual diet cost: a study at formulating a low sodium high potassium (LSHP) healthy diet. J Nutr Sci 2022; 11:e11. [PMID: 35291270 PMCID: PMC8889219 DOI: 10.1017/jns.2021.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022] Open
Abstract
Increasing potassium and reducing sodium intake have been identified as a priority intervention to reduce non-communicable diseases. A low sodium high potassium (LSHP) healthy diet can be a predictor of overall dietary quality and is associated with higher diet costs. The present study was a randomised controlled-feeding trial, formulating menus of low sodium and potassium-rich healthy diet and comparing with usual diet (a control diet based on typical Indonesian diet) to assess the association of potassium intake in the menus with other nutritional contents and diet cost. Totally seventy menus, which consisted of LSHP diets and the usual diets for a 7-d cycle, were composed from the analysis of the Indonesian food composition database. The correlation coefficient of the potassium content of all menus with nutritional quality and diet cost was analysed using the Pearson test. Multiple linear regression analysis was performed to determine the most important nutrient in determining diet cost. A comparison of nutrition quality and diet cost from the two menus was analysed using the independent t-test. LSHP diet had significantly higher carbohydrate, protein, fibre, magnesium, calcium, vitamin C, potassium density and diet cost but lower total fat, saturated fat and energy density than the usual diet (P < 0⋅05). Furthermore, there was a strong positive correlation between fibre, potassium and diet cost (coefficient correlation of >0⋅8). Potassium is a nutrient that is closely related to diet quality although the cost of the diet often may inhibit its intake. A targeted and effective strategy is required to provide affordable food for achieving a sustainable nutrient-rich diet.
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Affiliation(s)
- Farapti Farapti
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya60115, Indonesia
- Post Graduate Doctoral Program, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Annas Buanasita
- Nutrition Department, Surabaya Health Polytechnic, Surabaya60282, Indonesia
| | - Dominikus R. Atmaka
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya60115, Indonesia
| | | | - Merryana Adriani
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya60115, Indonesia
| | - Purwo S. Rejeki
- Department of Physiology, Faculty of Medicine, Universitas Airlangga, Surabaya60132, Indonesia
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu879-5593, Japan
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX, USA
- Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya60286, Indonesia
| | - Muhammad Miftahussurur
- Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya60286, Indonesia
- Institute of Tropical Disease, Universitas Airlangga, Surabaya60115, Indonesia
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Russell C, Whelan J, Love P. Assessing the Cost of Healthy and Unhealthy Diets: A Systematic Review of Methods. Curr Nutr Rep 2022; 11:600-617. [PMID: 36083573 PMCID: PMC9461400 DOI: 10.1007/s13668-022-00428-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Poor diets are a leading risk factor for chronic disease globally. Research suggests healthy foods are often harder to access, more expensive, and of a lower quality in rural/remote or low-income/high minority areas. Food pricing studies are frequently undertaken to explore food affordability. We aimed to capture and summarise food environment costing methodologies used in both urban and rural settings. RECENT FINDINGS Our systematic review of high-income countries between 2006 and 2021 found 100 relevant food pricing studies. Most were conducted in the USA (n = 47) and Australia (n = 24), predominantly in urban areas (n = 74) and cross-sectional in design (n = 76). All described a data collection methodology, with just over half (n = 57) using a named instrument. The main purpose for studies was to monitor food pricing, predominantly using the 'food basket', followed by the Nutrition Environment Measures Survey for Stores (NEMS-S). Comparatively, the Healthy Diets Australian Standardised Affordability and Price (ASAP) instrument supplied data on relative affordability to household incomes. Future research would benefit from a universal instrument reflecting geographic and socio-cultural context and collecting longitudinal data to inform and evaluate initiatives targeting food affordability, availability, and accessibility.
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Affiliation(s)
- Cherie Russell
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jillian Whelan
- School of Medicine, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Penelope Love
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia ,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Batal M, Kenny TA, Johnson-Down L, Ing A, Fediuk K, Sadik T, Chan HM, Willows N. Development of an optimal grocery list based on actual intake from a cross-sectional study of First Nations adults in Ontario, Canada. Appl Physiol Nutr Metab 2021; 47:379-394. [PMID: 34826224 DOI: 10.1139/apnm-2020-0950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A multi-stage sampling strategy selected 1387 on-reserve First Nations adults in Ontario. Foods from a 24-hour dietary recall were assigned to the 100 most common food groups for men and women. Nutrients from market foods (MF) and traditional foods (TF) harvested from the wild as well as MF costs were assigned based on the proportions of total grams consumed. Linear programming was performed imposing various constraints to determine whether it was possible to develop diets that included the most popular foods while meeting Institute of Medicine guidelines. Final models were obtained for both sexes with the top 100 food groups consumed while limiting the nutrient-poor foods to no more than the actual observed intake. These models met all nutrient constraints for men but those for dietary fibre, linoleic acid, phosphorus, and potassium were removed for women. MF costs were obtained from community retailers and online resources. A grocery list was then developed and MF were costed for a family of four. The grocery list underestimated the actual weekly food cost because TF was not included. Contemporary observed diets deviated from healthier historic First Nations diets. A culturally appropriate diet would include more traditional First Nations foods and fewer MF. Novelty ● Linear programming is a mathematical approach to evaluating the diets of First Nations ● The grocery list is representative of food patterns within Ontario First Nations and can be used as an alternative to the nutritious food basket used for public health food costing.
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Affiliation(s)
- Malek Batal
- CP 6128 succ Centre-Ville, Département de nutrition, Montréal, Quebec, Canada.,Centre de recherche en santé publique [CReSP], Département de nutrition, Montréal, Quebec, Canada;
| | - Tiff-Annie Kenny
- Université Laval, 4440, Département de médecine sociale et préventive, Quebec, Quebec, Canada;
| | - Louise Johnson-Down
- CP 6128 succ Centre-Ville, Département de nutrition, Montréal, Quebec, Canada;
| | - Amy Ing
- CP 6128 succ Centre-Ville, Département de nutrition, Montréal, Quebec, Canada;
| | - Karen Fediuk
- University of Ottawa, 6363, Ottawa, Canada, K1N 6N5;
| | - Tonio Sadik
- Assembly of First Nations, Ottawa, Ontario, Canada;
| | - Hing Man Chan
- University of Ottawa, 6363, Department of Biology, Ottawa, Canada, K1N 6N5;
| | - Noreen Willows
- University of Alberta, 3158, Food & Nutri Sci Dept, Edmonton, Canada, T6G 2R3;
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Clark P, Mendoza-Gutiérrez CF, Montiel-Ojeda D, Denova-Gutiérrez E, López-González D, Moreno-Altamirano L, Reyes A. A Healthy Diet Is Not More Expensive than Less Healthy Options: Cost-Analysis of Different Dietary Patterns in Mexican Children and Adolescents. Nutrients 2021; 13:3871. [PMID: 34836126 PMCID: PMC8624608 DOI: 10.3390/nu13113871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 01/10/2023] Open
Abstract
Unhealthy diets are recognized as a major risk factor for many diseases. The decrease in costs of industrialized products, as well as the possible misinformation about a healthy diet, has led to new behaviors in the dietary patterns of the pediatric population. The costs of dietary patterns have not been estimated in our population, so the objective of this study was to determine the cost associated with dietary patterns in Mexican children and adolescents, hypothesizing that a healthy diet is not necessarily more economically expensive. This study analyzed data from a population-based cross-sectional study of healthy children and adolescents in Mexico City. Data were collected from a food frequency questionnaire and the meal cost of habitual food shopping. Eating patterns were obtained by using principal component analysis. A micro-costing technique was performed to obtain the direct costs of each pattern. When comparing the healthy pattern with the transition and non-healthy patterns, it was observed that there were no statistically significant differences between the dietary patterns (p = 0.8293). The cost of the healthy pattern only takes up 16.6% of the total biweekly income of a salaried Mexican. In this study, no differences were observed between the costs of a healthy and a less healthy diet.
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Affiliation(s)
- Patricia Clark
- Clinical Epidemiology Research Unit, Children’s Hospital of Mexico Federico Gomez-Faculty of Medicine, National Autonomous University of Mexico UNAM, Mexico City 06720, Mexico; (P.C.); (D.M.-O.); (D.L.-G.)
| | - Carlos F. Mendoza-Gutiérrez
- Clinical Epidemiology Research Unit, Children’s Hospital of Mexico Federico Gomez-Faculty of Medicine, National Autonomous University of Mexico UNAM, Mexico City 06720, Mexico; (P.C.); (D.M.-O.); (D.L.-G.)
| | - Diana Montiel-Ojeda
- Clinical Epidemiology Research Unit, Children’s Hospital of Mexico Federico Gomez-Faculty of Medicine, National Autonomous University of Mexico UNAM, Mexico City 06720, Mexico; (P.C.); (D.M.-O.); (D.L.-G.)
| | - Edgar Denova-Gutiérrez
- Nutrition and Health Research Center, Public Health National Institute, Cuernavaca 62000, Mexico;
| | - Desirée López-González
- Clinical Epidemiology Research Unit, Children’s Hospital of Mexico Federico Gomez-Faculty of Medicine, National Autonomous University of Mexico UNAM, Mexico City 06720, Mexico; (P.C.); (D.M.-O.); (D.L.-G.)
| | - Laura Moreno-Altamirano
- Department of Public Health, Faculty of Medicine, National Autonomous University of Mexico UNAM, Mexico City 04510, Mexico;
| | - Alfonso Reyes
- Center for Economic and Social Studies in Health, Children’s Hospital of Mexico Federico Gomez, Mexico City 06720, Mexico;
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Marty L, de Lauzon-Guillain B, Labesse M, Nicklaus S. Food choice motives and the nutritional quality of diet during the COVID-19 lockdown in France. Appetite 2021; 157:105005. [PMID: 33068666 PMCID: PMC7558232 DOI: 10.1016/j.appet.2020.105005] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/02/2020] [Accepted: 10/11/2020] [Indexed: 02/08/2023]
Abstract
To limit the transmission of COVID-19, nationwide lockdown was imposed in France between March, 17th and May 10th, 2020. This disruption in individuals' daily routines likely altered food consumption habits. We examined how changes in food choice motives related to changes in nutritional quality during the lockdown compared to before. A convenience sample of 938 French adults completed online questionnaires on the Qualtrics platform at the end of April 2020. Participants were retrospectively asked about their food choice motives and food consumption during the month before and in the first month of the lockdown. The importance of nine food choice motives was assessed: health, convenience, sensory appeal, natural content, ethical concern, weight control, mood, familiarity, and price, scoring from 1 to 4. Food intakes were recorded using a food frequency questionnaire including 110 foods, 12 non-alcoholic beverages and 4 alcoholic beverages. Adherence to the French dietary recommendations before and during the lockdown was estimated using the simplified PNNS-GS2, scoring from -17 to 11.5. The nutritional quality of diet was lower during the lockdown compared to before (-0.32, SD 2.28, p < 0.001). Food choice motives significantly changed and an increase in the importance of weight control was associated with increased nutritional quality (β = 0.89, p < 0.001, partial η2 = 0.032), whereas an increase in the importance of mood was associated with decreased nutritional quality (β = -0.43, p = 0.021, partial η2 = 0.006). The lockdown period in France was related to a decrease in nutritional quality of diet on average, which could be partly explained by changes in food choice motives. The lockdown was indeed related to modification of food choice motives, notably with an increase of mood as a food choice motive for 48% of the participants, but also with an increase of health (26%), ethical concern (21%) and natural content (19%) suggesting a growing awareness of the importance of sustainable food choices in some participants.
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Affiliation(s)
- Lucile Marty
- Department of Psychological Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK; Centre des Sciences Du Goût et de l'Alimentation, Agrosup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, 17 Rue Sully, 21065, Dijon Cedex, France.
| | - Blandine de Lauzon-Guillain
- Université de Paris, CRESS, INSERM, INRAE, 16 Avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France
| | - Maë Labesse
- Centre des Sciences Du Goût et de l'Alimentation, Agrosup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, 17 Rue Sully, 21065, Dijon Cedex, France
| | - Sophie Nicklaus
- Centre des Sciences Du Goût et de l'Alimentation, Agrosup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, 17 Rue Sully, 21065, Dijon Cedex, France
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13
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Koehn JZ, Quinn EL, Otten JJ, Allison EH, Anderson CM. Making seafood accessible to low-income and nutritionally vulnerable populations on the U.S. West Coast. JOURNAL OF AGRICULTURE, FOOD SYSTEMS, AND COMMUNITY DEVELOPMENT 2020; 10:171-189. [PMID: 33996191 PMCID: PMC8121265 DOI: 10.5304/jafscd.2020.101.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Along the U.S. West Coast, sustainable management has rebuilt fish stocks, providing an opportunity to supply nutrient-rich food to adjacent coastal communities where food insecurity and diet-based diseases are common. However, the market has not successfully supplied locally sourced seafood to nutritionally vulnerable people. Rather, a few organizations make this connection on a limited scale. We used a "positive deviant" approach to learn how these organizations' efforts developed, how they overcame challenges, and what conditions enabled their interventions. We found that organizations in these positive deviant cases provided fish from a wide variety of species and sources, and distributed them through different channels to a diversity of end consumers. A key factor facilitating success was the ability to negotiate a price point that was both profitable and reasonable for organizations supplying nutritionally vulnerable or low-income consumers. Further-more, securing access to grants overcame initial costs of establishing new supply channels. All cases highlighted the importance of individual champions who encouraged development and cultural connections between the initiative and the nearby community. Organizations overcame key challenges by establishing regulations governing these new channels and either using partnerships or vertically integrating to reduce costs associated with processing and transport. Oftentimes training and education were also critical to instruct workers on how to process unfamiliar fish and to increase consumer awareness of local fish and how to prepare them. These lessons illuminate pathways to improve the contribution of local seafood to the healthy food system.
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Affiliation(s)
- J. Zachary Koehn
- School of Aquatic & Fishery Sciences, College of the Environment, University of Washington; 1122 NE Boat Street, Box 355020; Seattle, WA 98195 USA
- Center for Ocean Solutions, Stanford University; 473 Via Ortega; Stanford, CA USA
| | - Emilee L. Quinn
- Center for Public Health Nutrition, Department of Health Services, School of Public Health, University of Washington; Raitt Hall; Seattle, WA 98105 USA
| | - Jennifer J. Otten
- Nutritional Sciences Program, Center for Public Health Nutrition, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington; Raitt Hall; Seattle, WA 98105 USA
| | - Edward H. Allison
- Nippon Foundation Ocean Nexus Program, Earthlab, University of Washington; 3707 Brooklyn Ave. NE; Seattle, WA 98105 USA
- WorldFish, Jalan Batu Maung, Batu Maung, Bayan Lepas, Penang, Malaysia
| | - Christopher M. Anderson
- School of Aquatic & Fishery Sciences, College of the Environment, University of Washington; 1122 NE Boat Street, Box 355020; Seattle, WA 98195 USA
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Nutrient density, but not cost of diet, is associated with anemia and iron deficiency in school-age children in South Africa. Nutrition 2020; 84:111096. [PMID: 33453623 DOI: 10.1016/j.nut.2020.111096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aimed to investigate the relationship of nutrient density and diet cost with anemia and iron deficiency (ID) in children. METHODS Dietary intake data of 5- to 12-y-old children (n = 578) from three independent studies in low-income communities were pooled. Nutrient densities were calculated using the Nutrient Rich Foods index and Nutrient Rich Diet index, with higher scores indicating more nutrient-dense foods and diets. Food prices and food intake data were used to calculate ratios of nutrient density to price for foods and diets. Descriptive and correlation analyses examined associations of nutrient density and diet cost with anemia and ID. RESULTS Most children (>50%) consumed starchy staples (100%), vegetables that are not vitamin A rich (63.9%), and legumes (58.1%), with mean NRF9.3 scores ranging from 31.9 to 56.3. Cheese, eggs, organ meat, fish, dark-green leafy vegetables, and vitamin A-rich vegetables and fruits had mean NRF9.3 scores ranging from 112.6 to 184.7, but each was consumed by less than a third of the children. Children with anemia or ID had lower NRD9.3 scores than children without (P < 0.001 and P = 0.039, respectively). Diet cost did not differ according to anemia and iron status, but nutrient-density-to-price ratio was lower in children with anemia than without (P = 0.001). CONCLUSIONS Careful selection of nutrient-dense foods as substitutes for foods with lower nutrient density could make it possible for children to consume a diet richer in specific nutrients and help prevent anemia and ID without affecting diet cost.
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Rose CM, Gupta S, Buszkiewicz J, Ko LK, Mou J, Cook A, Moudon AV, Aggarwal A, Drewnowski A. Small increments in diet cost can improve compliance with the Dietary Guidelines for Americans. Soc Sci Med 2020; 266:113359. [PMID: 32949981 DOI: 10.1016/j.socscimed.2020.113359] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]
Abstract
Adherence to the Dietary Guidelines for Americans (DGA) may involve higher diet costs. This study assessed the relation between two measures of food spending and diet quality among adult participants (N = 768) in the Seattle Obesity Study (SOS III). All participants completed socio-demographic and food expenditure surveys and the Fred Hutch food frequency questionnaire. Dietary intakes were joined with local supermarket prices to estimate individual-level diet costs. Healthy Eating Index (HEI- 2015) scores measured compliance with DGA. Multiple linear regressions using Generalized Estimating Equations with robust standard errors showed that lower food spending was associated with younger age, Hispanic ethnicity, and lower socioeconomic status. Even though higher HEI-2015 scores were associated with higher diet costs per 2000 kcal, much individual variability was observed. A positive curvilinear relationship was observed in adjusted models. At lower cost diets, a $100/month increase in cost (from $150 to $250) was associated with a 20.6% increase in HEI-2015. For higher levels of diet cost (from $350 to $450) there were diminishing returns (2.8% increase in HEI- 2015). These findings indicate that increases in food spending at the lower end of the range have the most potential to improve diet quality.
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Affiliation(s)
- Chelsea M Rose
- Center for Public Health Nutrition, University of Washington, Seattle, WA, 98105, USA.
| | - Shilpi Gupta
- Center for Public Health Nutrition, University of Washington, Seattle, WA, 98105, USA.
| | - James Buszkiewicz
- Center for Public Health Nutrition, University of Washington, Seattle, WA, 98105, USA.
| | - Linda K Ko
- Division of Public Health Sciences Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA; Department of Health Services, University of Washington, Seattle, WA, 98105, USA.
| | - Jin Mou
- MultiCare Institute for Research & Innovation, Tacoma, WA, USA.
| | - Andrea Cook
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Dept of Biostatistics, University of Washington, Seattle, WA, USA.
| | | | - Anju Aggarwal
- Center for Public Health Nutrition, University of Washington, Seattle, WA, 98105, USA.
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, 98105, USA.
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16
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UK residents with low incomes and healthy diets: in search of exemplars. Proc Nutr Soc 2020. [DOI: 10.1017/s0029665120007284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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17
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Beydoun MA, Nkodo A, Fanelli-Kuczmarski MT, Maldonado AI, Beydoun HA, Popkin BM, Evans MK, Zonderman AB. Longitudinal Associations between Monetary Value of the Diet, DASH Diet Score and the Allostatic Load among Middle-Aged Urban Adults. Nutrients 2019; 11:E2360. [PMID: 31623373 PMCID: PMC6835231 DOI: 10.3390/nu11102360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022] Open
Abstract
Lower cost can lead to poorer-quality diets, potentially worsening metabolic profiles. We explored these pathways among urban adults. Longitudinal data were extracted from 1224-1479 participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. DASH(mean) (Dietary Approaches to Stop Hypertension) score was computed using four 24 h recalls (v1/v2: 2004-2013) linked with a national food price database to estimate monetary value of the diet [MVD(mean)]. Allostatic load (AL) was measured at visits 2 (v2) and 3 (v3) in 2009-2018. Mixed-effects regression and structural equation modeling (SEM) were conducted, linking MVD(mean)/DASH(mean) to AL [v2 and annual change(v3-v2)] and exploring mediating pathways between MVD(mean) and AL(v3) through DASH(mean), stratifying by sex, race and poverty status. MVD(mean) tertiles were linearly associated with contemporaneous DASH(mean), after energy adjustment. In mixed-effects regression models, DASH(mean) was consistently linked to lower AL(v2). DASH(mean) and MVD(mean) were positively associated with higher serum albumin(v2). In SEM, MVD(mean) was linked to AL(v3) through DASH(mean), mainly among Whites and specifically for the cholesterol and Waist-Hip-Ratio AL components. In summary, energy and other covariate-adjusted increase in MVD may have a sizeable impact on DASH which can reduce follow-up AL among urban White middle-aged adults. More studies are needed to replicate findings in comparable samples of urban adults.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD 21224, USA.
| | - Amelie Nkodo
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD 21224, USA.
| | | | - Ana I Maldonado
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD 21224, USA.
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA.
| | - Barry M Popkin
- Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27517, USA.
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD 21224, USA.
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD 21224, USA.
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Johnson-Down L, Willows N, Kenny TA, Ing A, Fediuk K, Sadik T, Chan HM, Batal M. Optimisation modelling to improve the diets of First Nations individuals. J Nutr Sci 2019; 8:e31. [PMID: 31595187 PMCID: PMC6764187 DOI: 10.1017/jns.2019.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 01/19/2023] Open
Abstract
We examined the feasibility of linear programming (LP) to develop diets that were economical, included traditional (cultural, non-market) foods and met the dietary reference intakes (DRI) in a Canadian Indigenous population. Diet optimisation using LP is a mathematical technique that can develop food-based dietary guidelines for healthy eating in Indigenous populations where food insecurity, availability and cost are important considerations. It is a means of developing nutritionally optimal food combinations that are based on economical and culture-specific foods. Observed food consumption data were derived using 24-h food recalls from the First Nations Food, Nutrition and Environment Study. The LP models were constructed to develop diets meeting DRI, cost and food constraints. Achieving the recommended food intake was not feasible in a model meeting all nutrient requirements. Models that met most nutrient requirements at reduced cost were designed for men and women, separately. In women, it was necessary to increase energy intake to meet most nutrient requirements. Nutrient requirements could not be met for fibre, linoleic and linolenic acids, vitamin D, Ca and K in both sexes, P in women, and Mg and vitamin A in men. Using LP to develop optimal diets for First Nations people, we found simultaneous achievement of all DRI was difficult, suggesting that supplementation might be necessary which goes against recommendations for individuals to meet their nutrient needs through healthy eating patterns. Additionally, to make diets feasible, programmes to reduce market food costs and to support First Nations people in traditional food harvesting are recommended.
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Affiliation(s)
- Louise Johnson-Down
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, CanadaH3T 1A8
| | - Noreen Willows
- Department of Agricultural, Food and Nutritional Science, University of Alberta, 410 Agriculture/Forestry Centre, Edmonton, AB, CanadaT6G 2P5
| | - Tiff-Annie Kenny
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, CanadaK1N 6N5
| | - Amy Ing
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, CanadaH3T 1A8
| | - Karen Fediuk
- First Nations Food, Nutrition and Environment Study, University of Ottawa, Ottawa, ON, CanadaK1N 6N5
| | - Tonio Sadik
- Assembly of First Nations, Ottawa, ON, CanadaK1P 6L5
| | - Hing Man Chan
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, CanadaK1N 6N5
| | - Malek Batal
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, CanadaH3T 1A8
- WHO Collaborating Centre on Nutrition Changes and Development, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, CanadaH3T 1A8
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Impact of a front-of-pack nutritional traffic-light label on the nutritional quality and the hedonic value of mid-afternoon snacks chosen by mother-child dyads. Appetite 2019; 143:104425. [PMID: 31465810 DOI: 10.1016/j.appet.2019.104425] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/23/2019] [Accepted: 08/24/2019] [Indexed: 11/22/2022]
Abstract
The aim of this study was to assess the impact of a nutritional traffic-light label, the Nutri-Score, on snack choices in mother-child dyads and to assess a potential hedonic cost associated with a change in favour of healthier choices. French mothers and children (n = 95; children's age: 7-11 years) who participated were asked to choose, for themselves and for the other dyad member, a snack composed of one beverage and two food items selected among several products with different nutritional quality. In the first step, the products were presented without any information. In the second step, the products were labelled with the Nutri-Score. Mothers and children were asked to rate their liking for all proposed products before being informed of their nutritional quality. The nutritional quality, the hedonic score, and the estimated budget of the selected snacks were compared before and after labelling. As hypothesized, the Nutri-Score label led to a significant increase in the nutritional quality of the chosen snacks. The budget for the chosen snacks was unchanged or decreased after the nutritional labelling was applied. Children and mothers had significantly lower liking for the snacks after nutritional labelling than before nutritional labelling, suggesting a hedonic cost associated with a change in favour of healthier snack choices. This raises the question of the sustainability of the behavioural change induced by the Nutri-Score label.
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Buscail C, Gendreau J, Daval P, Lombrail P, Hercberg S, Latino-Martel P, Julia C. Impact of fruits and vegetables vouchers on food insecurity in disadvantaged families from a Paris suburb. BMC Nutr 2019; 5:26. [PMID: 32153939 PMCID: PMC7050857 DOI: 10.1186/s40795-019-0289-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social inequalities in nutrition lead a high number of families to struggle with food insecurity, even in developed countries. We aimed to assess the impact of fruits and vegetables vouchers on food security among disadvantaged households from a Paris suburb. METHODS We used a pre-post assessment design. Families answered face-to-face questionnaires on food consumption and food security status before and after a randomly assigned intervention. Households in the intervention group received vouchers to buy exclusively fruits and vegetables over one year. Both intervention and control groups benefitted from nutritional education through workshops performed by dieticians during the study period. The Household Food Security Module (HFSM) was used to assess food security status of households at inclusion. Food Insufficiency Indicator (FSI) was used to assess food security at inclusion and follow-up. Evolution of FSI on both groups was evaluated using McNemar test. RESULTS Among the 91 families included between May 2015 and May 2016, 64 completed the post assessment questionnaire. At inclusion, 68.3% of families were experiencing food insecurity and 78.1% were experiencing food insufficiency. No association was found between food consumptions and food security status. After one-year follow-up, the prevalence of food insufficiency was significantly decreased in the intervention group (61.8%, with p value = 0.03), and unchanged in the control group. CONCLUSION In this pilot study, food insufficiency was significantly decreased in families receiving vouchers for fruits and vegetables over a one-year period. TRIAL REGISTRATION NCT02461238, registered 3 June 2015 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02461238.
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Affiliation(s)
- Camille Buscail
- Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Université Paris 13, Inserm U1153, Inra U1125, Cnam, Centre de Recherche en Epidémiologie et Biostatistiques (CRESS) Sorbonne Paris Cité, Bâtiment SMBH -74 rue Marcel Cachin, 93017 Bobigny cedex, France
- Département de Santé Publique, Hôpital Avicenne (AP-HP), 125 rue de Stalingrad, 93000 Bobigny, France
| | - Judith Gendreau
- Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Université Paris 13, Inserm U1153, Inra U1125, Cnam, Centre de Recherche en Epidémiologie et Biostatistiques (CRESS) Sorbonne Paris Cité, Bâtiment SMBH -74 rue Marcel Cachin, 93017 Bobigny cedex, France
- Département de Santé Publique, Hôpital Avicenne (AP-HP), 125 rue de Stalingrad, 93000 Bobigny, France
| | - Paul Daval
- Maison de la Santé de Saint-Denis, 6 rue des Boucheries, 93200 Saint-Denis, France
| | - Pierre Lombrail
- Département de Santé Publique, Hôpital Avicenne (AP-HP), 125 rue de Stalingrad, 93000 Bobigny, France
- Laboratoire Educations et Pratiques de Santé, Campus Condorcet, Université Paris, 13, 74 rue Marcel Cachin, Bobigny, France
| | - Serge Hercberg
- Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Université Paris 13, Inserm U1153, Inra U1125, Cnam, Centre de Recherche en Epidémiologie et Biostatistiques (CRESS) Sorbonne Paris Cité, Bâtiment SMBH -74 rue Marcel Cachin, 93017 Bobigny cedex, France
- Département de Santé Publique, Hôpital Avicenne (AP-HP), 125 rue de Stalingrad, 93000 Bobigny, France
| | - Paule Latino-Martel
- Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Université Paris 13, Inserm U1153, Inra U1125, Cnam, Centre de Recherche en Epidémiologie et Biostatistiques (CRESS) Sorbonne Paris Cité, Bâtiment SMBH -74 rue Marcel Cachin, 93017 Bobigny cedex, France
| | - Chantal Julia
- Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Université Paris 13, Inserm U1153, Inra U1125, Cnam, Centre de Recherche en Epidémiologie et Biostatistiques (CRESS) Sorbonne Paris Cité, Bâtiment SMBH -74 rue Marcel Cachin, 93017 Bobigny cedex, France
- Département de Santé Publique, Hôpital Avicenne (AP-HP), 125 rue de Stalingrad, 93000 Bobigny, France
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French SA, Tangney CC, Crane MM, Wang Y, Appelhans BM. Nutrition quality of food purchases varies by household income: the SHoPPER study. BMC Public Health 2019; 19:231. [PMID: 30808311 PMCID: PMC6390355 DOI: 10.1186/s12889-019-6546-2] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 02/14/2019] [Indexed: 11/23/2022] Open
Abstract
Background Lower household income has been consistently associated with poorer diet quality. Household food purchases may be an important intervention target to improve diet quality among low income populations. Associations between household income and the diet quality of household food purchases were examined. Methods Food purchase receipt data were collected for 14 days from 202 urban households participating in a study about food shopping. Purchase data were analyzed using NDS-R software and scored using the Healthy Eating Index 2010 (HEI 2010). HEI total and subscores, and proportion of grocery dollars spent on food categories (e.g. fruits, vegetables, sugar sweetened beverages) were examined by household income-to-poverty ratio. Results Compared to lower income households, after adjusting for education, marital status and race, higher income households had significantly higher HEI total scores (mean [sd] = 68.2 [13.3] versus 51.6 [13.9], respectively, adjusted p = 0.05), higher total vegetable scores (mean [sd] = 3.6 [1.4] versus 2.3 [1.6], respectively, adjusted p < .01), higher dairy scores (mean [sd] = 5.6 [3.0] versus 5.0 [3.3], p = .05) and lower proportion of grocery dollars spent on frozen desserts (1% [.02] versus 3% [.07], respectively, p = .02). Conclusions Lower income households purchase less healthful foods compared with higher income households. Food purchasing patterns may mediate income differences in dietary intake quality. Trial registration ClinicalTrials.gov identifier: NCT02073643.
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Affiliation(s)
- Simone A French
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, USA.
| | - Christy C Tangney
- Department of Clinical Nutrition, College of Health Sciences, Rush University Medical Center, 600 Paulina Street, Room 716, Chicago, IL, 60612, USA
| | - Melissa M Crane
- Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren Street, Suite 470, Chicago, IL, 60612, USA
| | - Yamin Wang
- Department of Internal Medicine, Rush University Medical Center, 1645 W. Jackson, Suite 675, Chicago, IL, 60612, USA
| | - Bradley M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren Street, Suite 470, Chicago, IL, 60612, USA
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Development of the Healthy Purchase Index (HPI): a scoring system to assess the nutritional quality of household food purchases. Public Health Nutr 2018; 22:765-775. [PMID: 30472975 DOI: 10.1017/s1368980018003154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To develop an index to assess the nutritional quality of household food purchases based on food expenditures only. DESIGN A database of monthly food purchases of a convenience sample of low-income households was used to develop the Healthy Purchase Index (HPI). The HPI is the sum of two sub-scores based on expenditure shares of food categories in total household food expenditure: the purchase diversity sub-score and the purchase quality sub-score. The first was adapted from an existing diversity score. The second integrated those food categories identified as the best predictors of the nutritional quality of purchases based on associations between expenditure shares of food categories and two nutritional quality indicators: the mean adequacy ratio (MAR) and the mean excess ratio (MER). Correlation between the HPI and a score assessing adherence to French dietary guidelines (PNNS-GSmod) was performed as a first validation.Setting/ParticpantsFood purchases of 112 households from deprived neighbourhoods of Marseille (France), participating in the Opticourses and Jassur projects (2012-2015). RESULTS The purchase diversity sub-score reflects the presence in food purchases of five food categories: fruits, vegetables, starches, dairy products, and meat, fish & eggs. The purchase quality sub-score is based on expenditure shares for fruit & vegetables, added fats & seasonings, sweet snacks, cheese, sugary drinks, refined grains and fish, as these were identified as predictors of the nutritional quality of purchases. The HPI was positively associated with the PNNS-GSmod (r s=0·378; P<0·001). CONCLUSIONS The HPI helps assess the healthiness of household food purchases.
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Beydoun MA, Fanelli-Kuczmarski MT, Poti J, Allen A, Beydoun HA, Evans MK, Zonderman AB. Longitudinal change in the diet's monetary value is associated with its change in quality and micronutrient adequacy among urban adults. PLoS One 2018; 13:e0204141. [PMID: 30312298 PMCID: PMC6193582 DOI: 10.1371/journal.pone.0204141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/03/2018] [Indexed: 11/22/2022] Open
Abstract
Background Reducing diet costs may lead to the selection of energy-dense foods, such as refined grains or foods high in added sugars and/or fats, which can lower overall dietary quality. We examined the longitudinal association between the monetary value of the diet (MVD) and the overall dietary quality across sex, race and income groups. Methods and findings Longitudinal data from 1,466 adult urban participants from Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used. Healthy Eating Index–2010 (HEI–2010) and Mean Adequacy Ratio (MAR) were computed and a national food price database was used to estimate MVD. Multiple linear regression analyses were conducted linking annual rates of change (Δ) in MVD to ΔHEI-2010 and ΔMAR, stratifying by sex, race and income groups. Among key findings, ΔHEI-2010 was comparable across socio-demographic groups, while ΔMAR was higher among women and individuals above poverty. Adjusting for key covariates, ΔMVD was positively associated with both ΔHEI-2010 and ΔMAR, and with a consistently stronger association among individuals above poverty, specifically for the total proteins and empty calories components of HEI-2010 and several nutrient adequacy ratios (NARs: vitamins C, E, B-6 and Zinc). ΔMVD-ΔMAR association was stronger in women, mainly influenced by ΔMVD’s positive associations with B-vitamins, copper, calcium, magnesium and phosphorus NARs. ΔMVD-Δvitamin D NAR’s positive relationship was stronger among Whites, while ΔMVD-Δvitamin B-12 NAR’s association was stronger among African-Americans. Conclusions In sum, a potential increase in MVD may have a stronger impact on dietary quality among urban adult women and above-poverty individuals.
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Affiliation(s)
- May A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, United States of America
- * E-mail:
| | | | - Jennifer Poti
- Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Allyssa Allen
- Centers for Medicare and Medicaid Services (CMS), Woodlawn, Maryland, United States of America
| | - Hind A. Beydoun
- Department of Medicine, Johns Hopkins Medical Institutions, Johns Hopkins University, Baltimore, MD, United States of America
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, United States of America
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, United States of America
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Perignon M, Dubois C, Gazan R, Maillot M, Muller L, Ruffieux B, Gaigi H, Darmon N. Co-construction and Evaluation of a Prevention Program for Improving the Nutritional Quality of Food Purchases at No Additional Cost in a Socioeconomically Disadvantaged Population. Curr Dev Nutr 2017; 1:e001107. [PMID: 29955680 PMCID: PMC5998781 DOI: 10.3945/cdn.117.001107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/21/2017] [Accepted: 09/13/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Food prices influence food choices. Purchasing foods with higher nutritional quality for their price may help improve the diet quality of socioeconomically disadvantaged individuals. Objective: This study aimed to describe the co-construction and evaluation of the Opticourses prevention program, which promotes healthy eating among participants in socioeconomically deprived situations by improving the nutritional quality of their household food purchases with no additional cost. Methods: Individuals were recruited in poor districts of Marseille, France. The intervention and evaluation tools and protocols were co-constructed with 96 individuals. Then, 93 adults willing to participate in a standardized intervention comprising 5 participative workshops on diet and budget were enrolled. Impact on food purchases was estimated with experimental economics: 2-d experimental food purchase intents were observed at baseline and endline for workshop participants (WPs, n = 35) and controls (n = 23), with the use of monetary incentives to limit social-desirability bias. Changes in food and nutrient content and energy cost (expressed in €/2000 kcal) of experimental purchases were assessed. Results: The co-constructed participative workshops included playful activities around food purchase practices and the nutritional quality, taste, and price of foods. Experimental purchases contained a large amount of energy at baseline for both WPs and controls (5114 and 4523 kcal ⋅ d-1 ⋅ person-1, respectively). For WPs only, the mean energy content decreased between baseline and endline (-1729 kcal ⋅ d-1 ⋅ person-1; P < 0.01; medium effect size: Cohen's d = 0.5), and the percentage of energy from free sugars and from foods high in fat, sugar, and salt also decreased (both P < 0.05 and medium effect sizes), whereas energy cost remained unchanged. No significant changes between baseline and endline were observed for the controls. Conclusions: After the intervention, the energy content of participants' experimental purchases was closer to their needs, suggesting that the workshops helped them plan and rationalize their food purchases better. The nutritional quality of the experimental purchases increased but energy cost did not, showing that the co-constructed Opticourses prevention program can favorably change food purchasing behaviors of socioeconomically disadvantaged individuals with no additional cost. This trial was registered at clinicaltrials.gov as NCT02383875.
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Affiliation(s)
- Marlène Perignon
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
- Marchés, Organisations, Institutions et Stratégies d'Acteurs (MOISA) Joint Research Unit, Institut National de la Recherche Agronomique (INRA), Centre International de Hautes Etudes Agronomiques Méditerranéennes-Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD), Montpellier Supagro, Univ Montpellier, Montpellier, France
| | - Christophe Dubois
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
| | - Rozenn Gazan
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
- MS-Nutrition, Marseille, France
| | | | - Laurent Muller
- Grenoble Applied Economics Laboratory (GAEL) Joint Research Unit, Institut National de la Recherche Agronomique (INRA), Grenoble, France
| | - Bernard Ruffieux
- Grenoble Applied Economics Laboratory (GAEL) Joint Research Unit, Institut National de la Recherche Agronomique (INRA), Grenoble, France
| | - Hind Gaigi
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
| | - Nicole Darmon
- Aix Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Nutrition Obésité et Risque Thrombotique (NORT) Joint Research Unit, Marseille, France
- Marchés, Organisations, Institutions et Stratégies d'Acteurs (MOISA) Joint Research Unit, Institut National de la Recherche Agronomique (INRA), Centre International de Hautes Etudes Agronomiques Méditerranéennes-Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD), Montpellier Supagro, Univ Montpellier, Montpellier, France
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Identifying foods with good nutritional quality and price for the Opticourses intervention research project. Public Health Nutr 2017; 20:3051-3059. [DOI: 10.1017/s1368980017002282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivePeople on a limited budget want to know the ‘good price’ of foods. Here we report the methodology used to produce an educational tool designed to help recognize foods with good nutritional quality and price, and assess the validity and relevancy of the tool.DesignA ‘Good Price Booklet’ presenting a list of foods with good nutritional quality and price was constructed. The validity of the in-booklet prices was assessed by comparing them with prices actually paid by households from the Opticourses project. The relevancy of the booklet tool was assessed by semi-structured interviews with Opticourses participants.SettingSocio-economically disadvantaged neighbourhoods of Marseille, France.SubjectsNinety-one participants collected household food-purchase receipts over a 1-month period.ResultsBased on the French food database, foods with higher-than-median nutritional quality were identified. After grouping similar foods, 100 foods were selected and their corresponding in-booklet prices were derived based on the distribution of average national prices by food group. Household food purchases data revealed that of the 2386 purchases of foods listed in the booklet, 67·1 % were bought at prices lower than the in-booklet prices. Nineteen semi-structured interviews showed that participants understood the tool and most continued using it more than a month after the intervention.ConclusionsA method was developed to ease the identification of foods with good nutritional quality and price. The Good Price Booklet is an effective tool to help guide people shopping on a low budget.
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Martin P, Consalès JN, Scheromm P, Marchand P, Ghestem F, Darmon N. Community gardening in poor neighborhoods in France: A way to re-think food practices? Appetite 2017; 116:589-598. [DOI: 10.1016/j.appet.2017.05.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/27/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
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Abstract
Studies in many Western countries have consistently shown that monetary diet cost is positively associated with diet quality, but this may not necessarily be the case in Japan. This cross-sectional study examined the nutritional correlates of monetary diet cost among 3963 young (all 18 years old), 3800 middle-aged (mean age 48 years) and 2211 older (mean age 74 years) Japanese women. Dietary intakes were assessed using a comprehensive self-administered diet history questionnaire for young and middle-aged women and a brief self-administered diet history questionnaire for older women. Monetary diet cost was estimated using retail food prices. Total vegetables, fish and shellfish, green and black tea, white rice, meat, fruit and alcoholic beverages contributed most (79–89 %) to inter-individual variation in monetary diet cost. Multiple regression analyses showed that monetary diet cost was negatively associated with carbohydrate intake, but positively with intakes of all other nutrients examined (including not only dietary fibre and key vitamins and minerals but also saturated fat and Na) in all generations. For food group intakes, irrespective of age, monetary diet cost was associated inversely with white rice and bread but positively with pulses, potatoes, fruit, total vegetables, fruit and vegetable juice, green and black tea, fish and shellfish, and meat. In conclusion, in all three generations of Japanese women and contrary to Western populations, monetary diet cost was positively associated with not only healthy dietary components (including fruits, vegetables, fish and shellfish, dietary fibre, and key vitamins and minerals), but also less healthy components (including saturated fat and Na).
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Maillot M, Vieux F, Delaere F, Lluch A, Darmon N. Dietary changes needed to reach nutritional adequacy without increasing diet cost according to income: An analysis among French adults. PLoS One 2017; 12:e0174679. [PMID: 28358837 PMCID: PMC5373615 DOI: 10.1371/journal.pone.0174679] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/12/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore the dietary changes needed to achieve nutritional adequacy across income levels at constant energy and diet cost. MATERIALS AND METHODS Individual diet modelling was used to design iso-caloric, nutritionally adequate optimised diets for each observed diet in a sample of adult normo-reporters aged ≥20 years (n = 1,719) from the Individual and National Dietary Survey (INCA2), 2006-2007. Diet cost was estimated from mean national food prices (2006-2007). A first set of free-cost models explored the impact of optimisation on the variation of diet cost. A second set of iso-cost models explored the dietary changes induced by the optimisation with cost set equal to the observed one. Analyses of dietary changes were conducted by income quintiles, adjusting for energy intake, sociodemographic and socioeconomic variables, and smoking status. RESULTS The cost of observed diets increased with increasing income quintiles. In free-cost models, the optimisation increased diet cost on average (+0.22 ± 1.03 euros/d) and within each income quintile, with no significant difference between quintiles, but with systematic increases for observed costs lower than 3.85 euros/d. In iso-cost models, it was possible to design nutritionally adequate diets whatever the initial observed cost. On average, the optimisation at iso-cost increased fruits and vegetables (+171 g/day), starchy foods (+121 g/d), water and beverages (+91 g/d), and dairy products (+20 g/d), and decreased the other food groups (e.g. mixed dishes and salted snacks), leading to increased total diet weight (+300 g/d). Those changes were mostly similar across income quintiles, but lower-income individuals needed to introduce significantly more fruit and vegetables than higher-income ones. CONCLUSIONS In France, the dietary changes needed to reach nutritional adequacy without increasing cost are similar regardless of income, but may be more difficult to implement when the budget for food is lower than 3.85 euros/d.
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Affiliation(s)
| | - Florent Vieux
- MS-Nutrition, Faculté de Médecine La Timone, Marseille, France
| | - Fabien Delaere
- Danone Nutricia Research, Centre Daniel Carasso, Palaiseau, France
| | - Anne Lluch
- Danone Nutricia Research, Centre Daniel Carasso, Palaiseau, France
| | - Nicole Darmon
- NORT, Aix-Marseille Université, INRA, INSERM, Marseille, France
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Nutritional adequacy of diets for adolescents with overweight and obesity: considerations for dietetic practice. Eur J Clin Nutr 2017; 71:646-651. [DOI: 10.1038/ejcn.2016.268] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/03/2016] [Accepted: 12/05/2016] [Indexed: 02/07/2023]
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Gamburzew A, Darcel N, Gazan R, Dubois C, Maillot M, Tomé D, Raffin S, Darmon N. In-store marketing of inexpensive foods with good nutritional quality in disadvantaged neighborhoods: increased awareness, understanding, and purchasing. Int J Behav Nutr Phys Act 2016; 13:104. [PMID: 27677446 PMCID: PMC5039802 DOI: 10.1186/s12966-016-0427-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Consumers often do not understand nutrition labels or do not perceive their usefulness. In addition, price can be a barrier to healthy food choices, especially for socio-economically disadvantaged individuals. METHOD A 6-month intervention combined shelf labeling and marketing strategies (signage, prime placement, taste testing) to draw attention to inexpensive foods with good nutritional quality in two stores located in a disadvantaged neighborhood in Marseille (France). The inexpensive foods with good nutritional quality were identified based on their nutrient profile and their price. Their contribution to customers' spending on food was assessed in the two intervention stores and in two control stores during the intervention, as well as in the year preceding the intervention (n = 6625). Exit survey (n = 259) and in-depth survey (n = 116) were used to assess customers' awareness of and perceived usefulness of the program, knowledge of nutrition, understanding of the labeling system, as well as placement-, taste- and preparation-related attractiveness of promoted products. Matched purchasing data were used to assess the contribution of promoted products to total food spending for each customer who participated in the in-depth survey. RESULTS The contribution of inexpensive foods with good nutritional quality to customers' total food spending increased between 2013 and 2014 for both the control stores and the intervention stores. This increase was significantly higher in the intervention stores than in the control stores for fruits and vegetables (p = 0.001) and for starches (p = 0.011). The exit survey revealed that 31 % of customers had seen the intervention materials; this percentage increased significantly at the end of the intervention (p < 0.001). The in-depth survey showed that customers who had seen the intervention materials scored significantly higher on quizzes assessing nutrition knowledge (p < 0.001) and understanding of the labeling system (p = 0.024). CONCLUSION A social marketing intervention aimed at increasing the visibility and attractiveness of inexpensive foods with good nutritional quality may improve food purchasing behaviors in disadvantaged neighborhoods.
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Affiliation(s)
- Axel Gamburzew
- UMR "Nutrition Physiology and Ingestive Behavior", AgroParisTech, INRA, Université Paris-Saclay, F-75005, Paris, France.
| | - Nicolas Darcel
- UMR "Nutrition Physiology and Ingestive Behavior", AgroParisTech, INRA, Université Paris-Saclay, F-75005, Paris, France
| | - Rozenn Gazan
- MS-Nutrition, Aix-Marseille Université, Marseille, France
| | - Christophe Dubois
- UMR "Nutrition, Obesity and Risk of Thrombosis", INRA, INSERM, Aix-Marseille Université, 13385, Marseille, France
| | | | - Daniel Tomé
- UMR "Nutrition Physiology and Ingestive Behavior", AgroParisTech, INRA, Université Paris-Saclay, F-75005, Paris, France
| | | | - Nicole Darmon
- UMR "Nutrition, Obesity and Risk of Thrombosis", INRA, INSERM, Aix-Marseille Université, 13385, Marseille, France
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Schwenke DC. Improving dietary quality by increasing plant foods when income is limited. Curr Opin Lipidol 2015; 26:465-7. [PMID: 26339768 DOI: 10.1097/mol.0000000000000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Dawn C Schwenke
- Research Service, Phoenix VA Healthcare System College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
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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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Troesch B, Biesalski HK, Bos R, Buskens E, Calder PC, Saris WHM, Spieldenner J, Verkade HJ, Weber P, Eggersdorfer M. Increased Intake of Foods with High Nutrient Density Can Help to Break the Intergenerational Cycle of Malnutrition and Obesity. Nutrients 2015; 7:6016-37. [PMID: 26197337 PMCID: PMC4517043 DOI: 10.3390/nu7075266] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 12/15/2022] Open
Abstract
A workshop held at the University Medical Center in Groningen, The Netherlands, aimed at discussing the nutritional situation of the population in general and the role diet plays during critical windows in the life course, during which the body is programmed for the development of non-communicable diseases (NCDs). NCDs are increasingly prevalent as our society ages, and nutrition is well known to play an important role in determining the risk and the time of onset of many common NCDs. Even in affluent countries, people have difficulties to achieve adequate intakes for a range of nutrients: Economic constraints as well as modern lifestyles lead people to consume diets with a positive energy balance, but low in micronutrients, resulting in increasing prevalence of obesity and suboptimal nutritional status. Information about nutrient density, which refers to the content of micronutrients relative to energy in food or diets, can help identify foods that have a low calorie to nutrient ratio. It thus allows the consumption of diets that cover nutritional needs without increasing the risk of becoming obese. Given the impact a nutrient dense, low energy diet can have on health, researchers, food industry and governments jointly should develop options for affordable, appealing nutrient-rich food products, which, in combination with physical activity, allow for optimal health throughout the life-course.
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Affiliation(s)
- Barbara Troesch
- DSM Nutritional Products Ltd., Wurmisweg 576, Kaiseraugst 4303, Switzerland.
| | - Hans K Biesalski
- Institut für Biologische Chemie und Ernährungswissenschaft, Universität Hohenheim, Stuttgart 70599, Germany.
| | - Rolf Bos
- FrieslandCampina, Bronland 20, Wageningen 6708 WH, The Netherlands.
| | - Erik Buskens
- Department of Pediatrics, Beatrix Children's Hospital/University Medical Center Groningen, University of Groningen, P.O. Box 30001, Groningen 9700 RB, The Netherlands.
| | - Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
| | - Wim H M Saris
- Department of Human Biology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht 6200MD, The Netherlands.
| | - Jörg Spieldenner
- Nestlé Research Center, Vers-chez-les Blanc, Lausanne 26 1000, Switzerland.
| | - Henkjan J Verkade
- Department of Pediatrics, Beatrix Children's Hospital/University Medical Center Groningen, University of Groningen, P.O. Box 30001, Groningen 9700 RB, The Netherlands.
| | - Peter Weber
- DSM Nutritional Products Ltd., Wurmisweg 576, Kaiseraugst 4303, Switzerland.
| | - Manfred Eggersdorfer
- DSM Nutritional Products Ltd., Wurmisweg 576, Kaiseraugst 4303, Switzerland.
- Department of Pediatrics, Beatrix Children's Hospital/University Medical Center Groningen, University of Groningen, P.O. Box 30001, Groningen 9700 RB, The Netherlands.
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