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

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

Does Climate Change Cause an Upsurge in Food Prices?

Climate change is the reason behind most contemporary economic problems. The rising inflationary pressures in the food sector are one of these problems, and stable food prices are a necessity for economic development and social cohesion in societies. Therefore, this study analyzes the relationship between food prices and climate change in Nigeria by using various non-linear and quantile-based methods and data from 2008m5 to 2020m12. The empirical findings indicate that (i) there is a time- and frequency-based dependence between food prices and some explanatory variables, including climate change (i.e., temperature). (ii) At higher quantiles, temperature, oil prices, food exports, monetary expansion, global food prices, agricultural prices, and fertilizer prices stimulate food prices. (iii) The increase in food prices due to the rise in temperature and the difficulties in agriculture indicate that the heatflation phenomenon is present in Nigeria. The evidence outlines that Nigerian decisionmakers should adopt a national food security policy that considers environmental, agricultural, and monetary factors to stabilize food prices.

Visualizing Data Interoperability for Food Systems Sustainability Research-From Spider Webs to Neural Networks

Food systems represent all elements and activities needed to feed the growing global population. Research on sustainable food systems is transdisciplinary, relying on the interconnected domains of health, nutrition, economics, society, and environment. The current lack of interoperability across databases poses a challenge to advancing research on food systems transformation. Crosswalks among largely siloed data on climate change, soils, agricultural practices, nutrient composition of foods, food processing, prices, dietary intakes, and population health are not fully developed. Starting with US Department of Agriculture FoodData Central, we assessed the interoperability of databases from multiple disciplines by identifying existing crosswalks and corresponding visualizations. Our visual demonstration serves as proof of concept, identifying databases in need of expansion, integration, and harmonization for use by researchers, policymakers, and the private sector. Interoperability is the key: ontologies and well-defined crosswalks are necessary to connect siloed data, transcend organizational barriers, and draw pathways from agriculture to nutrition and health.

Habitual Diets Are More Expensive than Recommended Healthy Diets

Understanding food prices and affordability is crucial for promoting healthy dietary habits and informing policy actions. We assessed changes in the cost and affordability of habitual and recommended healthy diets in Northwest Tasmania from 2021 to 2023. The recommended diet was 16-22% less expensive than the habitual diet during the period. Notably, 60% of the total cost of the habitual diet was spent on discretionary items. The cost of the habitual diet increased by 9% in this period, whereas the cost of the recommended diet increased by only 2%. The habitual diet was unaffordable for households with median gross, minimum wage disposable or welfare-dependent incomes. The recommended diet, however, was affordable for some groups but posed a risk of food stress for those with median gross and minimum wage disposable income and remained unaffordable for those who were welfare dependent. Our findings reveal that adhering to a healthy Australian Dietary Guidelines-recommended diet can be more cost-effective than following a habitual unhealthy diet. However, adopting a healthy diet can be challenging for low-income families. Interventions such as financial support, nutrition education, community gardens and food hubs, as well as price regulation and subsidies for farmers, can help address food insecurity in Northwest Tasmania.

A Proposed Strategy against Obesity: How Government Policy Can Counter the Obesogenic Environment

An epidemic of obesity emerged in the USA in 1976-1980. The epidemic then spread to many other Westernized nations. Many interventions have been carried out with the goal of lowering the prevalence of obesity. These have mostly taken the form of various types of health promotion (i.e., providing people with education, advice, and encouragement). These actions have achieved, at most, only limited success. A strategy with a better chance of success starts with the recognition that the fundamental cause of obesity is that we live in an obesogenic environment. It is therefore necessary to change the environment so that it fosters a generally healthy lifestyle, thereby leading to enhanced health for the population, including improved weight control. A major goal is to increase the intake of healthy foods (especially fruit, vegetables, and whole grains), while decreasing intake of unhealthy foods (especially ultra-processed foods such as sugar). This will require major changes of many government policies. Some of the required policies are as follows. Schools should implement policies that create a healthy environment for children. For example, they should adopt a policy that only foods of high nutritional quality are sold in vending machines or given to students within school meals. Policies need to go well beyond the school setting; a broad strategy is needed that creates a healthy environment for children. Another important policy is the manipulation of food prices in order to shift the diet toward healthy foods. This requires using subsidies to lower the price of healthy foods, while adding a tax to less healthy foods to increase the price. This policy has been implemented in many cities and countries in the form of a tax on sugar-sweetened beverages (SSBs). The advertising of unhealthy foods (including fast-food restaurants) should be banned, especially where children and adolescents are the major target. Such a ban could be extended to a complete ban on all advertising for unhealthy foods, including that directed at adults. The proposed policy measures are likely to be strongly opposed by food corporations.

Healthy Eating for All? The Challenge of Adhering to Dietary Guidelines for Low-Income Groups in China

The Chinese Dietary Guidelines propose a balanced diet for healthy living, but the affordability of this diet needs to be considered, especially for low-income households. To investigate the affordability of a healthy diet, this study analyzes the daily retail prices of 46 food items in 36 Chinese cities from 2016 to 2021. This study compares expenditure, diet composition, and nutritional status in two scenarios aligned with the guidelines. The results show that the mean minimum cost of a balanced diet exceeds the current per capita food expenditure for at least 182.85 million urban households. This suggests that low-income people would need to increase their expenditure by at least 20-121% to achieve the recommended diets. This study also identifies affordable and nutrient-dense foods such as standard flour, eggs, black beans, and cabbage, which policymakers should focus on when monitoring food prices. The findings recommend a combination of social and food system policies to reduce prices and make healthy diets accessible. This study identifies the gaps in the Chinese Dietary Guidelines for ensuring accessibility for vulnerable groups and provides a template for policymakers and researchers to track diet affordability using available food price data in China, contributing to China's 2030 Health Plan and the UN's Sustainable Development Goals.

The Nutrient Rich Food Price Index: a nutrition-relevant adaptation of the Laspeyres price index to track the cost of affordable nutrient density

Background

The Laspeyres price index is the ratio of the current cost of a market basket of commodities or food groups relative to base period prices.

Objective

To develop a nutrition-relevant version of the Laspeyres price index, using market baskets based on tertiles of the nutrient rich food (NRF9.3) nutrient density metric.

Methods

Nutrient composition data for 151 foods from the 2012 Mexico national health and nutrition survey (ENSANUT) were merged with food prices and price indices from the national institute of geography and statistics (INEGI). Nutrient Rich Food Index (NRF9.3) was the measure of nutrient density. May 2012 was the base period. Nutrient rich food price index (NRFPI) values were calculated for each tertile of NRF nutrient density scores for each month between June 2011 and March 2022.

Results

The market basket of foods in the top tertile of NRF nutrient density scores cost more per 100 kcal and had higher NRFPI values compared to foods in the bottom tertile. Higher NRF9.3 scores were correlated with greater monthly inflation. The NRFPI for foods in the top tertile of NRF9.3 scores was marked by seasonal price spikes, and greater volatility compared to foods in the bottom tertile.

Conclusion

The present adaptation of the Laspeyres Index used market baskets defined by nutrient density tertiles instead of commodity groups. This approach allows for easier tracking of the cost of nutrient dense foods and healthful diets across geographic regions and over time. Applied to Mexico food prices prior to and during the Covid-19 pandemic, the NRFPI was sensitive to time trends, seasonality, and price fluctuations. The new tool may be useful in monitoring the rising cost of healthy foods worldwide.

Captive Market Pricing and Lack of Transportation: A Survey of Undergraduate Food Insecurity at a Public University in New England

PURPOSE

The purpose of this study is to describe the prevalence of food insecurity among college students and its relationship to on-campus food purchasing patterns and barriers to eating a healthy and sufficient diet, including the relative cost of food items on campus compared to national chain grocery stores.

DESIGN

A campus-wide survey using stratified sampling among undergraduates and food audit.

SETTING

An urban public university in New England.

SUBJECTS

A total of 951 surveys completed by undergraduates.

MEASURES

Demographic characteristics, behavioral factors and food security status (measured using the USDA 6-item short form) were collected.

METHOD

Descriptive and multivariable analyses were conducted to describe differences between food insecure and food secure undergraduates.

RESULTS

Overall, 35% of undergraduates experienced food insecurity in the past year (response rate = 92%). Food insecure undergraduates had different on-campus purchasing patterns than their food secure counterparts. Food insecure students were more likely to report barriers to healthy eating on all measures, including prices (AOR= 8.12, P < .0001), to experience housing insecurity (AOR= 2.64, P = .001) and to report that transportation is a barrier to buying groceries (AOR= 1.63, P = .01). After multivariable adjustment, food insecure undergraduates had higher odds of being African American (AOR= 1.57, P = .031) or other races (more than 1 race) (AOR= 3.35, P = .002) compared to white undergraduates.

CONCLUSIONS

Food insecure college students face a variety of barriers to healthy eating on campus, including high food pricing on campus and limited transportation options. Further research is needed to inform campus resource development, policies and programming focused on food insecurity prevention for college students.

Economic surplus implications of Mexico's decision to phaseout genetically modified maize imports

The Mexican government has decided to ban imports of genetically modified (GM) maize, to rely on agroecology for maize production to satisfy domestic yellow maize requirements. No economic impact assessment of this policy decision was made public, and the implications of this decision for users of yellow maize and consumers are significant. This article measures the economic surplus generated from Mexican GM yellow maize imports and domestic conventional yellow maize production over the last 20 years, and projects the economic surplus generated over five years from adopting agroecology for yellow maize production. We explore three likely scenarios and find that in all of them, yellow maize processors lose almost twice as much economic surplus as producers. In the most conservative loss estimate (Scenario 1), the surplus loss in five years is equivalent to 35% of the economic surplus generated over the last 21 years from GM maize imports and domestic Mexican conventional production. In all simulated Scenarios, between 2024 and 2025 the price of a metric ton of yellow maize will increase 81percent because of the change in production systems (from conventional to agroecology). These financial losses will ultimately factor into the prices consumers pay for poultry and red meat products, resulting in higher domestic retail food prices.

The Role of Income and Food Prices in Diet-Related Greenhouse Gas Emissions in China: A Path towards a Sustainable Diet

China has undergone rapid economic growth and diet transition over the past decades, along with environmental challenges. To help to achieve carbon peaking by 2030, this study investigates the time-variable diet-related greenhouse gas emissions (GHGEs) from 2000 to 2020 and examines the responses of food demands and diet-related GHGEs to an increase in per capita income and animal-based food prices. Based on the Almost Ideal Demand System model, addressing the problem of the endogeneity of food expenditure, we estimate the demand elasticities for six food groups and analyze their changing trends with time. Then, we perform two projections. One is to project the impacts of income growth on food demands and diet-related GHGEs, taking into consideration dynamic income elasticities as per capita income increases; the other is to project the effects of an increase in prices of different animal-based foods on food demands and diet-related GHGEs. Our results reveal that diet-related agricultural GHGEs show a continued increase in the short term, but the increased effect tends to decline gradually. The dominant driver of increased diet-related GHGEs is the increased consumption of beef, mutton, and pork. However, an increase in prices of beef and mutton; pork; and poultry and eggs can reduce diet-related GHGEs, while a decrease in the prices of aquatic products can also deliver a significant decrease in GHGEs. The results imply that policymakers should take an interest in the environmental impacts of diet transition and promote a more sustainable diet structure.

Food-Level Analysis to Identify Dietary Choices With the Highest Nutritional Quality and Lowest Greenhouse Gas Emissions and Price

Introduction

Food systems are challenged to provide healthy, sustainable and affordable foods. From a consumer perspective, identifying healthy, sustainable and affordable choices based on individual food products rather than diets could promote better shopping choices.

Objective

To identify foods and drinks with the highest nutritional quality and lowest greenhouse gas emissions (GHGE) and price. We also assessed how a combination of these indicators (e.g., nutritional quality, GHGE and price) for food categories aligned with current United Kingdom dietary recommendations.

Materials and Methods

We performed a secondary analysis of the National Diet and Nutrition Survey (NDNS) nutrient databank year 11 (2018/2019). Spearman correlation coefficients were used to assess the strength of relationships between nutritional quality, environmental impact and/or prices per 100 kcal. In addition, we developed an optimized nutritional quality, GHGE and price score for each food or drink item based on the overall medians for each of these indicators.

Results

Median nutritional value was highest for fruit and vegetables, whilst median GHGE and price was lower for starchy carbohydrates, fats and items of which consumption should be limited. The relative proportions of foods considered the most nutritious and with a low GHGE and price in each of the food categories, on a per 100 kcal basis, were comparable to the proportions in the Eatwell Guide, except for the proportion of fruits and vegetables being smaller and the proportion of potatoes, bread, rice, pasta, and other starchy carbohydrates being larger in our analysis.

Conclusion

Public health efforts should consider the impact of dietary choices not only in terms of nutritional quality but also in terms of environmental and economic impact. Our food-based analysis shows a large variation in nutritional quality, GHGE and price within and across food categories, which provides consumers with opportunities for “food swaps” that are more nutritious and have lower GHGE and price.

Access to Healthy Wheat and Maize Processed Foods in Mexico City: Comparisons across Socioeconomic Areas and Store Types

The contributions of processed foods to the overweight and obesity problem in Latin America are well known. Engagement with the private and public sectors on possible solutions requires deeper insights into where and how these products are sold and the related implications for diet quality. This article characterizes the diversity of wheat and maize processed foods (WMPFs) available to consumers in Mexico City. Data were gathered across nine product categories at different points of sale (supermarkets, small grocery stores, convenience stores) in high and low socioeconomic (SE) areas. We assessed WMPFs based on Nutri-Score profile, price, and health and nutrition claims. Roughly 17.4% of the WMPFs were considered healthy, of which 62.2% were pastas and breads. Availability of healthy WMPFs was scarce in most stores, particularly in convenience stores Compared to supermarkets in the low SE area, those in the high SE area exhibited greater variety in access to healthy WMPFs across all product categories. In the low SE area, healthy WMPFs were priced 16–69% lower than unhealthy WMPFs across product categories. The extensive variety of unhealthy WMPFs, the limited stock of healthy WMPFs in most retail outlets, and the confusing health and nutrition claims on packaging make it difficult for urban consumers to find and choose healthy WMPFs.

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

OBJECTIVE

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

METHODS

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

SETTING

Canada.

PARTICIPANTS

20,487 Canadians ages one and older.

RESULTS

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

CONCLUSIONS

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

Cost and accessibility of empiric food elimination diets for treatment of eosinophilic oesophagitis

AIM

This study aimed to investigate and compare the cost, affordability, and accessibility of three elimination diet approaches for the treatment of patients with eosinophilic esophagitis: the two-, four- and six-food elimination diets and with comparison to a standard diet.

METHODS

An evidence-based modelling process was undertaken for costing and accessibility, including the development of three hypothetical reference families; four food baskets were modified from an established benchmark for each diet. Baskets were costed across eastern Melbourne, Australia. Affordability was modelled using two incomes: the equivalised disposable household income and welfare payments for reference families. Affordability was defined as <30% of the median weekly household income and food stress defined as >25% of a median weekly household income.

RESULTS

All elimination diets were significantly more expensive than a standard diet and may be unaffordable for those receiving welfare. Prices significantly increased as the number of food allergens eliminated increased. Most items for a two-food elimination diet were available at major supermarkets; however, items for nutritionally complete four- and six-food elimination diets required a visit to a second store.

CONCLUSION

A step-up approach, commencing with a two-food elimination diet, instead of starting with a six-food elimination diet, may alleviate affordability barriers for most family types, which may enhance compliance. Clinicians should consider family type, financial situation, as well as accessibility of allergen-free foods in the patient's residential area when deciding on the most appropriate dietary or therapeutic treatment approach for eosinophilic oesophagitis.

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

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

COVID-19's First Wave: Examination of Impact on Food Purchasing Behaviour in the Eurozone

COVID-19 has had a negative impact on the living conditions of people in all countries worldwide. With a devastating economic crisis where many families are finding it difficult to pay bills and make ends meet, increases in prices of food basket staples can be very worrying. This study examines the relationship between the incidence of the pandemic during the first wave in 16 Eurozone countries with the variation experienced in food prices. We analysed the harmonised index of consumer food prices (included in HICP) and the classification of the degree of pandemic impact by country, the latter established with the index of deaths provided by the Johns Hopkins Center. The procedure used compared actual food prices during the first wave (March to June 2020) with those foreseeable in the absence of the pandemic. Time series analysis was used, dividing the research period into two phases. In both phases, the Holt-Winters model was applied for estimation and subsequent prediction. After a contrast using Kendall's tau correlation index, it was concluded that in the countries with the highest death rates during the first wave, there was a higher increase in food prices than in the least affected countries of the Eurozone.

The New Hybrid Nutrient Density Score NRFh 4:3:3 Tested in Relation to Affordable Nutrient Density and Healthy Eating Index 2015: Analyses of NHANES Data 2013-16

Background: Hybrid nutrient density scores are based on both nutrients and selected food groups. Objective: To compare the new hybrid nutrient-rich food NRFh 4:3:3 score to other nutrient-rich food (NRF) scores, energy density, and energy cost and to model the impact on the Healthy Eating Index (HEI-2015) of partially replacing less nutrient-rich with more nutrient-rich foods. Methods: Analyses were based on 5870 foods and beverages in the Food and Nutrient Database for Dietary Studies and on 24 h dietary recalls from the National Health and Nutrition Examination Survey (NHANES 2013–16). The NRFh 4:3:3 model was based on four nutrients to encourage (protein fiber, potassium, MUFA + PUFA); three food groups to encourage (dairy, fruit, whole grains); and three nutrients to limit (saturated fat, added sugar, sodium). Ratings generated by NRFh 4:3:3 and by other NRF models were correlated with score components, energy density (kcal/100 g), and energy cost (USD/100 kcal). The impact on HEI-2015 of replacing foods in the lowest nutrient density tertile (T1) with top tertile (T3) foods at 10%, 20%, 30%, and 100% equicaloric replacement was modeled using NHANES 2013–16 dietary data by population subgroups. Results: The NRFh 4:3:3 model awarded higher scores to foods containing dairy, fruit, and whole grains and proportionately lower scores to vegetables when compared to the NRF 9.3 model. Higher NRF and NRFh nutrient density scores were linked to lower energy density and higher energy cost; however, both correlations were lower for the NRFh 4:3:3. Isocaloric replacement of bottom tertile with top tertile foods as rated by both models led to significantly higher HEI-2105 values, based on complete (100%) and on partial (10–30%) replacement. Conclusion: The new NRFh 4:3:3 model provides the basis for developing new metrics of affordable nutrient density. The model identified “best value” food categories that were both affordable and nutrient-rich. Total and partial replacement of low nutrient density with high nutrient density foods was associated with higher HEI-2015 scores, suggesting that even partial inclusion of more nutrient dense foods in the diet may have an important impact on total diet quality.

Food Price Volatility and Asymmetries in Rural Areas of South Mediterranean Countries: A Copula-Based GARCH Model

Many discussions following the 2007/08 food price crisis have revolved around the magnitude of the negative impacts that it may have had on food security worldwide. In South-Eastern Mediterranean countries (SEMC), food security is strongly interrelated with several key economic and political issues. Many of these countries are becoming increasingly import-dependent, particularly on cereals, which are the essential raw material for human and animal food and feed. Due to both their economic system structure and consumption, the SEMC are responsible for a third of world cereals imports, whereas they account for only 5% of the world population. Given the set of constraints and this dependence on global markets, SEMC will be probably more exposed to severe swings in agricultural commodity prices in the coming years. In this view, this study examines the dependence structure among global food grain markets and Morocco and provides flexible models for dependency and the conditional volatility GARCH. A copula-based GARCH model has been carried out to estimate the marginal distributions of Morocco and world cereals commodity price changes. The results revealed that the joint co-movement between agricultural commodity price changes around the world and in Morocco, are generally considerable and there exists asymmetric tail dependence.

Anticipated impacts of Brexit scenarios on UK food prices and implications for policies on poverty and health: a structured expert judgement approach

INTRODUCTION

Food insecurity is associated with increased risk for several health conditions and with poor chronic disease management. Key determinants for household food insecurity are income and food costs. Whereas short-term household incomes are likely to remain static, increased food prices would be a significant driver of food insecurity.

OBJECTIVES

To investigate food price drivers for household food security and its health consequences in the UK under scenarios of Deal and No-deal for Britain's exit from the European Union. To estimate the 5% and 95% quantiles of the projected price distributions.

DESIGN

Structured expert judgement elicitation, a well-established method for quantifying uncertainty, using experts. In July 2018, each expert estimated the median, 5% and 95% quantiles of changes in price for 10 food categories under Brexit Deal and No-deal to June 2020 assuming Brexit had taken place on 29 March 2019. These were aggregated based on the accuracy and informativeness of the experts on calibration questions.

PARTICIPANTS

Ten specialists with expertise in food procurement, retail, agriculture, economics, statistics and household food security.

RESULTS

When combined in proportions used to calculate Consumer Price Index food basket costs, median food price change for Brexit with a Deal is expected to be +6.1% (90% credible interval -3% to +17%) and with No-deal +22.5% (90% credible interval +1% to +52%).

CONCLUSIONS

The number of households experiencing food insecurity and its severity is likely to increase because of expected sizeable increases in median food prices after Brexit. Higher increases are more likely than lower rises and towards the upper limits, these would entail severe impacts. Research showing a low food budget leads to increasingly poor diet suggests that demand for health services in both the short and longer terms is likely to increase due to the effects of food insecurity on the incidence and management of diet-sensitive conditions.

The Relative Caloric Prices of Healthy and Unhealthy Foods Differ Systematically across Income Levels and Continents

BACKGROUND

Relative prices of healthy/unhealthy foods have been implicated in the obesity epidemic, but never extensively quantified across countries or empirically linked to undernutrition.

OBJECTIVES

This study compared relative caloric prices (RCPs) for different food categories across 176 countries and ascertained their associations with dietary indicators and nutrition outcomes.

METHODS

We converted prices for 657 standardized food products from the 2011 International Comparison Program into caloric prices using USDA Food Composition tables. We classified products into 21 specific food groups. We constructed RCPs as the ratio of the 3 cheapest products in each food group, relative to the weighted cost of a basket of starchy staples. We analyzed RCP differences across World Bank income levels and regions and used cross-country regressions to explore associations with Demographic Health Survey dietary indicators for women 15-49 y old and children 12-23 mo old and with WHO indicators of the under-5 stunting prevalence and adult overweight prevalence.

RESULTS

Most noncereal foods were relatively cheap in high-income countries, including sugar- and fat-rich foods. In lower-income countries, healthy foods were generally expensive, especially most animal-sourced foods and fortified infant cereals (FICs). Higher RCPs for a food predict lower consumption among children for 7 of 9 food groups. Higher milk and FIC prices were positively associated with international child stunting patterns: a 1-SD increase in milk prices was associated with a 2.8 percentage point increase in the stunting prevalence. Similarly, a 1-SD increase in soft drink prices was associated with a reduction in the overweight prevalence of ∼3.6 percentage points.

CONCLUSIONS

Relative food prices vary systematically across countries and partially explain international differences in the prevalences of undernutrition and overweight adults. Future research should focus on how to alter relative prices to achieve better dietary and nutrition outcomes.

A Systematic Review on Socioeconomic Differences in the Association between the Food Environment and Dietary Behaviors

Little is known about socioeconomic differences in the association between the food environment and dietary behavior. We systematically reviewed four databases for original studies conducted in adolescents and adults. Food environments were defined as all objective and perceived aspects of the physical and economic food environment outside the home. The 43 included studies were diverse in the measures used to define the food environment, socioeconomic position (SEP) and dietary behavior, as well as in their results. Based on studies investigating the economic (n = 6) and school food environment (n = 4), somewhat consistent evidence suggests that low SEP individuals are more responsive to changes in food prices and benefit more from healthy options in the school food environment. Evidence for different effects of availability of foods and objectively measured access, proximity and quality of food stores on dietary behavior across SEP groups was inconsistent. In conclusion, there was no clear evidence for socioeconomic differences in the association between food environments and dietary behavior, although a limited number of studies focusing on economic and school food environments generally observed stronger associations in low SEP populations. (Prospero registration: CRD42017073587)

An Economic Gap Between the Recommended Healthy Food Patterns and Existing Diets of Minority Groups in the US National Health and Nutrition Examination Survey 2013-14

The US Department of Agriculture (USDA) has identified three Healthy Food Patterns as ways to implement the 2015–2020 Dietary Guidelines for Americans. We estimated the daily cost of the Healthy Vegetarian, US-Style, and Mediterranean Food Patterns (at 2,000 kcal/d) using national food prices adjusted for inflation. We also estimated the cost of existing dietary intakes in $/2,000 kcal/d for persons ≥2 years in the National Health and Nutrition Examination Survey (NHANES 2013–2014) using the same national food prices. The Nutrient Rich Food index (NRF9.3) was used as a measure of diet quality. Compared to existing diets, the USDA Healthy Food Patterns were higher in protein, fiber, vitamins, and minerals; were lower in solid fats, sugars, and sodium, and had higher diet quality scores. However, they also cost more. The cost of existing diets in NHANES was $5.47/d for Hispanics, $5.48/d for African-Americans, $5.94/d for Whites and $6.57/d for Asians. By contrast, the recommended US-Style Pattern cost $8.27/d, the Vegetarian Pattern cost $5.90/d, and the Mediterranean Pattern cost $8.73/d. Further, the Healthy Food Patterns featured some of the recommended food groups in unrealistic amounts. To ensure that the US Dietary Guidelines are both feasible and relevant to minority health, economic modeling studies should accompany government-issued dietary advice.

The Relative Costs of High- vs. Low-Energy-Density Foods and More vs. Less Healthful Beverages Consumed by Children

Objective

To compare grocery costs between relatively high energy density foods and sugar-sweetened/high-fat beverages and lower energy density foods and more healthful beverages in children's diets.

Methods

Sixty foods were divided into high and low energy density baskets. Fourteen beverages were designated to either basket based on fat and added-sugar content. Prices were collected at 60 grocery stores and composite costs compared between baskets using Wilcoxon tests.

Results

The cost per kilogram of high energy density foods was greater, but the cost per quart of sugar-sweetened/high-fat beverages was lower than more healthful beverages. The cost per 1000 calories and the cost per serving of the high energy density basket were lower.

Conclusions

The relative cost of high and low energy density foods in children's diets depends on how cost is quantified. "Pound-for-pound," lower energy density foods and more healthful beverages are generally less expensive, but high energy density foods and less healthful beverages are cheaper per serving. Cost metrics including other factors (e.g. time cost) may further clarify the role of grocery prices in children's diets.

Healthy Diets in Rural Victoria-Cheaper than Unhealthy Alternatives, Yet Unaffordable

Rural communities experience higher rates of obesity and reduced food security compared with urban communities. The perception that healthy foods are expensive contributes to poor dietary choices. Providing an accessible, available, affordable healthy food supply is an equitable way to improve the nutritional quality of the diet for a community, however, local food supply data are rarely available for small rural towns. This study used the Healthy Diets ASAP tool to assess price, price differential and affordability of recommended (healthy) and current diets in a rural Local Government Area (LGA) (pop ≈ 7000; 10 towns) in Victoria, Australia. All retail food outlets were surveyed (n = 40). The four most populous towns had supermarkets; remaining towns had one general store each. Seven towns had café/take-away outlets, and all towns had at least one hotel/pub. For all towns the current unhealthy diet was more expensive than the recommended healthy diet, with 59.5% of the current food budget spent on discretionary items. Affordability of the healthy diet accounted for 30⁻32% of disposable income. This study confirms that while a healthy diet is less expensive than the current unhealthier diet, affordability is a challenge for rural communities. Food security is reduced further with restricted geographical access, a limited healthy food supply, and higher food prices.

Ten-year trends in the price differential between healthier and less healthy foods in New Zealand

AIM

To measure the relative change in price of healthier and less healthy foods over 10 years in New Zealand.

METHODS

Foods in the New Zealand food price index were classified as healthy and less healthy (WHO Europe Nutrient Profile Model) and by degree of processing (according to the NOVA classification). The change in price from February 2007 to January 2017 was analysed using a mixed model for repeated measures with healthiness (or level of processing), season and time added as covariates.

RESULTS

Eighty-eight (of 155) relevant items had sufficient information on weight and healthiness. The trend of increasing food prices over time was similar for healthier and less healthy foods and between the three categories of processing. There was a statistically significant interaction (P = 0.014) between seasons and healthiness of foods, and seasons and degrees of processing (P < 0.001). The price of healthy foods and minimally processed foods fluctuated more by season compared to less healthy foods and processed foods.

CONCLUSIONS

Food prices increased over time with no significant difference in the rate of change for healthier and less healthy foods, and between foods of different degrees of processing. This method can be used to routinely monitor relative changes in food prices according to healthiness.

Neighborhood Prices of Healthier and Unhealthier Foods and Associations with Diet Quality: Evidence from the Multi-Ethnic Study of Atherosclerosis

It is known that the price of food influences the purchasing and consumption decisions of individuals; however, little work has examined if the price of healthier food relative to unhealthier food in an individual’s neighborhood is associated with overall dietary quality while using data from multiple regions in the United States. Cross-sectional person-level data came from The Multi-Ethnic Study of Atherosclerosis (exam 5, 2010–2012, n = 2765); a food frequency questionnaire assessed diet. Supermarket food/beverage prices came from Information Resources Inc. (n = 794 supermarkets). For each individual, the average price of select indicators of healthier foods (vegetables, fruits, dairy) and unhealthier foods (soda, sweets, salty snacks), as well as their ratio, was computed for supermarkets within three miles of the person’s residential address. Logistic regression estimated odds ratios of a high-quality diet (top quintile of Healthy Eating Index 2010) associated with healthy-to-unhealthy price ratio, adjusted for individual and neighborhood characteristics. Sensitivity analyses used an instrumental variable (IV) approach. Healthier foods cost nearly twice as much as unhealthier foods per serving on average (mean healthy-to-unhealthy ratio = 1.97 [SD 0.14]). A larger healthy-to-unhealthy price ratio was associated with lower odds of a high-quality diet (OR = 0.76 per SD increase in the ratio, 95% CI = [0.64–0.9]). IV analyses largely confirmed these findings although—as expected with IV adjustment—confidence intervals were wide (OR = 0.82 [0.57–1.19]). Policies to address the large price differences between healthier and unhealthy foods may help improve diet quality in the United States.

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

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.

Higher Dietary Cost Is Associated with Higher Diet Quality: A Cross-Sectional Study among Selected Malaysian Adults

Food price is a determining factor of food choices; however its relationship with diet quality is unclear in Malaysia. This study aimed to examine socio-economic characteristics and daily dietary cost (DDC) in relation to diet quality in the state of Selangor, Malaysia. Dietary intake was assessed using a Food Frequency Questionnaire (FFQ) and diet quality was estimated using a Malaysian Healthy Eating Index (M-HEI). DDC in Malaysian Ringgit (RM) was calculated from dietary intake and national food prices. Linear regression models were fitted to determine associations between DDC and M-HEI scores and predictors of diet quality. The mean M-HEI score of respondents was 61.31 ± 10.88 and energy adjusted DDC was RM10.71/2000 kcal (USD 2.49). The highest quintile of adjusted DDC had higher M-HEI scores for all respondents (Q1: 57.14 ± 10.07 versus Q5: 63.26 ± 11.54, p = 0.001). There were also positive associations between DDC and M-HEI scores for fruits (p < 0.001) and vegetables (p = 0.017) for all respondents. Predictors of diet quality included carbohydrate (β = 0290; p < 0.001) and fat intakes (β = −0.242; p < 0.001) and energy adjusted DDC (β= 0.196; p < 0.001). Higher dietary cost is associated with healthy eating among Malaysian adults.

Minimum Dietary Diversity Scores for Women Indicate Micronutrient Adequacy and Food Insecurity Status in South African Towns

The lack of dietary diversity is a severe problem experienced by most poor households globally. In particular; women of reproductive age (WRA) are at high risk of inadequate intake of micronutrients resulting from diets dominated by starchy staples. The present study considered the diets, dietary diversity, and food security of women aged 15–49 years along the rural-urban continuum in three South African towns situated along an agro-ecological gradient. A 48 h dietary recall was conducted across two seasons with 554 women from rural, peri-urban, and urban locations of Richards Bay, Dundee, and Harrismith. Minimum Dietary Diversity for WRA (MDD-W) were calculated and a dichotomous indicator based on a set of ten food groups was used to determine if women had consumed at least five food groups the previous 48 h to achieve minimum dietary intake for women. The mean (±sd) MDD-W for Richards Bay (3.78 ± 0.07) was significantly higher than at Dundee (3.21 ± 0.08) and Harrismith (3.36 ± 0.07). Food security and MDD-W were significantly higher in urban locations than in peri-urban or rural ones. There was lower dependence on food purchasing in Richards Bay compared to Dundee and Harrismith. The majority of women in Richards Bay practiced subsistence agriculture, produced a surplus for sale, and collected wild foods which improved dietary intake and food security. The peri-urban populations had limited dietary intake and were more food insecure because of high levels of poverty, unemployment, and lack of land. Peri-urban dwellers are therefore more sensitive to changes in incomes and food prices because they lack safety nets to absorb income or price shocks as they purchase more, rather than growing their own food. This compromises dietary diversity as they have limited access to diverse foods.

Quantifying the impact of rising food prices on child mortality in India: a cross-district statistical analysis of the District Level Household Survey

BACKGROUND

Rates of child malnutrition and mortality in India remain high. We tested the hypothesis that rising food prices are contributing to India's slow progress in improving childhood survival.

METHODS

Using rounds 2 and 3 (2002-08) of the Indian District Level Household Survey, we calculated neonatal, infant and under-five mortality rates in 364 districts, and merged these with district-level food price data from the National Sample Survey Office. Multivariate models were estimated, stratified into 27 less deprived states and territories and 8 deprived states ('Empowered Action Groups').

RESULTS

Between 2002 and 2008, the real price of food in India rose by 11.7%. A 1% increase in total food prices was associated with a 0.49% increase in neonatal (95% confidence interval (CI): 0.13% to 0.85%), but not infant or under-five mortality rates. Disaggregating by type of food and level of deprivation, in the eight deprived states, we found an elevation in neonatal mortality rates of 0.33% for each 1% increase in the price of meat (95% CI: 0.06% to 0.60%) and 0.10% for a 1% increase in dairy (95% CI: 0.01% to 0.20%). We also detected an adverse association of the price of dairy with infant (b = 0.09%; 95% CI: 0.01% to 0.16%) and under-five mortality rates (b = 0.10%; 95% CI: 0.03% to 0.17%). These associations were not detected in less deprived states and territories.

CONCLUSIONS

Rising food prices, particularly of high-protein meat and dairy products, were associated with worse child mortality outcomes. These adverse associations were concentrated in the most deprived states.

What Happens to Patterns of Food Consumption when Food Prices Change? Evidence from A Systematic Review and Meta-Analysis of Food Price Elasticities Globally

Recent years have seen considerable interest in examining the impact of food prices on food consumption and subsequent health consequences. Fiscal policies targeting the relative price of unhealthy foods are frequently put forward as ways to address the obesity epidemic. Conversely, various food subsidy interventions are used in attempts to reduce levels of under-nutrition. Information on price elasticities is essential for understanding how such changes in food prices affect food consumption. It is crucial to know not only own-price elasticities but also cross-price elasticities, as food substitution patterns may have significant implications for policy recommendations. While own-price elasticities are common in analyses of the impact of food price changes on health, cross-price effects, even though generally acknowledged, are much less frequently included in analyses, especially in the public health literature. This article systematically reviews the global evidence on cross-price elasticities and provides combined estimates for seven food groups in low-income, middle-income and high-income countries alongside previously estimated own-price elasticities. Changes in food prices had the largest own-price effects in low-income countries. Cross-price effects were more varied and depending on country income level were found to be reinforcing, undermining or alleviating own-price effects.

What Happens to Patterns of Food Consumption when Food Prices Change? Evidence from A Systematic Review and Meta-Analysis of Food Price Elasticities Globally

Recent years have seen considerable interest in examining the impact of food prices on food consumption and subsequent health consequences. Fiscal policies targeting the relative price of unhealthy foods are frequently put forward as ways to address the obesity epidemic. Conversely, various food subsidy interventions are used in attempts to reduce levels of under-nutrition. Information on price elasticities is essential for understanding how such changes in food prices affect food consumption. It is crucial to know not only own-price elasticities but also cross-price elasticities, as food substitution patterns may have significant implications for policy recommendations. While own-price elasticities are common in analyses of the impact of food price changes on health, cross-price effects, even though generally acknowledged, are much less frequently included in analyses, especially in the public health literature. This article systematically reviews the global evidence on cross-price elasticities and provides combined estimates for seven food groups in low-income, middle-income and high-income countries alongside previously estimated own-price elasticities. Changes in food prices had the largest own-price effects in low-income countries. Cross-price effects were more varied and depending on country income level were found to be reinforcing, undermining or alleviating own-price effects.

Accurate market price formation model with both supply-demand and trend-following for global food prices providing policy recommendations

Recent increases in basic food prices are severely affecting vulnerable populations worldwide. Proposed causes such as shortages of grain due to adverse weather, increasing meat consumption in China and India, conversion of corn to ethanol in the United States, and investor speculation on commodity markets lead to widely differing implications for policy. A lack of clarity about which factors are responsible reinforces policy inaction. Here, for the first time to our knowledge, we construct a dynamic model that quantitatively agrees with food prices. The results show that the dominant causes of price increases are investor speculation and ethanol conversion. Models that just treat supply and demand are not consistent with the actual price dynamics. The two sharp peaks in 2007/2008 and 2010/2011 are specifically due to investor speculation, whereas an underlying upward trend is due to increasing demand from ethanol conversion. The model includes investor trend following as well as shifting between commodities, equities, and bonds to take advantage of increased expected returns. Claims that speculators cannot influence grain prices are shown to be invalid by direct analysis of price-setting practices of granaries. Both causes of price increase, speculative investment and ethanol conversion, are promoted by recent regulatory changes-deregulation of the commodity markets, and policies promoting the conversion of corn to ethanol. Rapid action is needed to reduce the impacts of the price increases on global hunger.

Accurate market price formation model with both supply-demand and trend-following for global food prices providing policy recommendations

Recent increases in basic food prices are severely affecting vulnerable populations worldwide. Proposed causes such as shortages of grain due to adverse weather, increasing meat consumption in China and India, conversion of corn to ethanol in the United States, and investor speculation on commodity markets lead to widely differing implications for policy. A lack of clarity about which factors are responsible reinforces policy inaction. Here, for the first time to our knowledge, we construct a dynamic model that quantitatively agrees with food prices. The results show that the dominant causes of price increases are investor speculation and ethanol conversion. Models that just treat supply and demand are not consistent with the actual price dynamics. The two sharp peaks in 2007/2008 and 2010/2011 are specifically due to investor speculation, whereas an underlying upward trend is due to increasing demand from ethanol conversion. The model includes investor trend following as well as shifting between commodities, equities, and bonds to take advantage of increased expected returns. Claims that speculators cannot influence grain prices are shown to be invalid by direct analysis of price-setting practices of granaries. Both causes of price increase, speculative investment and ethanol conversion, are promoted by recent regulatory changes-deregulation of the commodity markets, and policies promoting the conversion of corn to ethanol. Rapid action is needed to reduce the impacts of the price increases on global hunger.

Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis

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.

Greater accordance with the Dietary Approaches to Stop Hypertension dietary pattern is associated with lower diet-related greenhouse gas production but higher dietary costs in the United Kingdom

BACKGROUND

The Dietary Approaches to Stop Hypertension (DASH) diet is a proven way to prevent and control hypertension and other chronic disease. Because the DASH diet emphasizes plant-based foods, including vegetables and grains, adhering to this diet might also bring about environmental benefits, including lower associated production of greenhouse gases (GHGs).

OBJECTIVE

The objective was to examine the interrelation between dietary accordance with the DASH diet and associated GHGs. A secondary aim was to examine the retail cost of diets by level of DASH accordance.

DESIGN

In this cross-sectional study of adults aged 39-79 y from the European Prospective Investigation into Cancer and Nutrition-Norfolk, United Kingdom cohort (n = 24,293), dietary intakes estimated from food-frequency questionnaires were analyzed for their accordance with the 8 DASH food and nutrient-based targets. Associations between DASH accordance, GHGs, and dietary costs were evaluated in regression analyses. Dietary GHGs were estimated with United Kingdom-specific data on carbon dioxide equivalents associated with commodities and foods. Dietary costs were estimated by using national food prices from a United Kingdom-based supermarket comparison website.

RESULTS

Greater accordance with the DASH dietary targets was associated with lower GHGs. Diets in the highest quintile of accordance had a GHG impact of 5.60 compared with 6.71 kg carbon dioxide equivalents/d for least-accordant diets (P < 0.0001). Among the DASH food groups, GHGs were most strongly and positively associated with meat consumption and negatively with whole-grain consumption. In addition, higher accordance with the DASH diet was associated with higher dietary costs, with the mean cost of diets in the top quintile of DASH scores 18% higher than that of diets in the lowest quintile (P < 0.0001).

CONCLUSIONS

Promoting wider uptake of the DASH diet in the United Kingdom may improve population health and reduce diet-related GHGs. However, to make the DASH diet more accessible, food affordability, particularly for lower income groups, will have to be addressed.

The carbohydrate-fat problem: can we construct a healthy diet based on dietary guidelines?

The inclusion of nutrition economics in dietary guidance would help ensure that the Dietary Guidelines for Americans benefit equally all segments of the US population. The present review outlines some novel metrics of food affordability that assess nutrient density of foods and beverages in relation to cost. Socioeconomic disparities in diet quality in the United States are readily apparent. In general, groups of lower socioeconomic status consume cheaper, lower-quality diets and suffer from higher rates of noncommunicable diseases. Nutrient profiling models, initially developed to assess the nutrient density of foods, can be turned into econometric models that assess both calories and nutrients per reference amount and per unit cost. These novel metrics have been used to identify individual foods that were affordable, palatable, culturally acceptable, and nutrient rich. Not all nutrient-rich foods were expensive. In dietary surveys, both local and national, some high-quality diets were associated with relatively low cost. Those population subgroups that successfully adopted dietary guidelines at an unexpectedly low monetary cost were identified as "positive deviants." Constructing a healthy diet based on dietary guidelines can be done, provided that nutrient density of foods, their affordability, as well as taste and social norms are all taken into account.

Local food prices and their associations with children's weight and food security

OBJECTIVES

Both obesity and food insecurity are important public health problems facing young children in the United States. A lack of affordable, healthy foods is one of the neighborhood factors presumed to underlie both food insecurity and obesity among children. We examine associations between local food prices and children's BMI, weight, and food security outcomes.

METHODS

We linked data from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative study of children from infancy to age 5, to local food price data from the Council for Community and Economic Research (C2ER) Cost-of-Living Index (n = 11,700 observations). Using ordinary least squares (OLS), linear probability, and within-child fixed effects (FE) models, we exploit the variability in food price data over time and among children who move residences focusing on a subsample of households under 300% of the Federal Poverty Level.

RESULTS

Results from ordinary least squares and FE models indicate that higher-priced fruits and vegetables are associated with higher child BMI, and this relationship is driven by the prices of fresh (versus frozen or canned) fruits and vegetables. In the FE models, higher-priced soft drinks are associated with a lower likelihood of being overweight, and surprisingly, higher fast food prices are associated with a greater likelihood of being overweight.

CONCLUSIONS

Policies that reduce the costs of fresh fruits and vegetables may be effective in promoting healthy weight outcomes among young children.

Four issues in undernutrition-related health impact modeling

Undernutrition modeling makes it possible to evaluate the potential impact of such events as a food-price shock or harvest failure on the prevalence and severity of undernutrition. There are, however, uncertainties in such modeling. In this paper we discuss four methodological issues pertinent to impact estimation: (1) the conventional emphasis on energy intake rather than dietary quality; (2) the importance of the distribution of nutrient intakes; (3) the timing of both the 'food shock' and when the response is assessed; and (4) catch-up growth and risk accumulation.

Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes

Taxes and subsidies are increasingly being considered as potential policy instruments to incentivize consumers to improve their food and beverage consumption patterns and related health outcomes. This study provided a systematic review of recent U.S. studies on the price elasticity of demand for sugar-sweetened beverages (SSBs), fast food, and fruits and vegetables, as well as the direct associations of prices/taxes with body weight outcomes. Based on the recent literature, the price elasticity of demand for SSBs, fast food, fruits and vegetables was estimated to be -1.21, -0.52, -0.49 and -0.48, respectively. The studies that linked soda taxes to weight outcomes showed minimal impacts on weight; however, they were based on existing state-level sales taxes that were relatively low. Higher fast-food prices were associated with lower weight outcomes particularly among adolescents, suggesting that raising prices would potentially impact weight outcomes. Lower fruit and vegetable prices were generally found to be associated with lower body weight outcomes among both low-income children and adults, suggesting that subsidies that would reduce the cost of fruits and vegetables for lower-socioeconomic populations may be effective in reducing obesity. Pricing instruments should continue to be considered and evaluated as potential policy instruments to address public health risks.

Improving nutrition in home child care: are food costs a barrier?

OBJECTIVE

Child-care providers have a key role to play in promoting child nutrition, but the higher cost of nutritious foods may pose a barrier. The present study tested the hypothesis that higher nutritional quality of foods served was associated with higher food expenditures in child care homes participating in the Child and Adult Care Food Program (CACFP).

DESIGN

In this cross-sectional study, nutritional quality of foods served to children and food expenditures were analysed based on 5 d menus and food shopping receipts. Nutritional quality was based on servings of whole grains, fresh whole fruits and vegetables, energy density (kJ/g) and mean nutrient adequacy (mean percentage of dietary reference intake) for seven nutrients of concern for child health. Food expenditures were calculated by linking receipt and menu data. Associations between food expenditures and menu quality were examined using bivariate statistics and multiple linear regression models.

SETTING

USA in 2008-2009.

SUBJECTS

Sixty child-care providers participating in CACFP in King County, Washington State.

RESULTS

In bivariate analyses, higher daily food expenditures were associated with higher total food energy and higher nutritional quality of menus. Controlling for energy and other covariates, higher food expenditures were strongly and positively associated with number of portions of whole grains and fresh produce served (P = 0·001 and 0·005, respectively), with lower energy density and with higher mean nutrient adequacy of menus overall (P = 0·003 and 0·032, respectively).

CONCLUSIONS

The results indicate that improving the nutritional quality of foods in child care may require higher food spending.

Multiple crises and global health: new and necessary frontiers of health politics

The world economy is entering an era of multiple crises, involving finance, food security and global environmental change. This article assesses the implications for global public health, describes the contours of post-2007 crises in food security and finance, and then briefly indicates the probable health impacts. There follows a discussion of the crisis of climate change, one that will unfold over a longer time frame but with manifestations that may already be upon us. The article then discusses the political economy of responses to these crises, noting the formidable obstacles that exist to equitable resolution. The article concludes by noting the threat that such crises present to recent progress in global health, arguing that global health researchers and practitioners must become more familiar with the relevant social processes, and that proposed solutions that neglect the continuing importance of the nation-state are misdirected.

Prices of unhealthy foods, Food Stamp Program participation, and body weight status among U.S. low-income women

This paper examines the interactive effect between the price of unhealthy foods and Food Stamp Program participation on body weight status among low-income women in the United States. We merged the panel data of the National Longitudinal Survey of Youth 1979 cohort in 1985-2002 and the Cost of Living Index data compiled by the American Chamber of Commerce Researchers Association by using geographic identifiers. Using the merged data, we used panel econometric models to examine the impact of unhealthy food prices on the food stamp-eligible U.S. population. Our results indicate that higher prices for unhealthy food can partially offset the positive association between Food Stamp Program participation and bodyweight among low-income women.

The Mediterranean diet: does it have to cost more?

OBJECTIVE

To test the viability of the Mediterranean diet as an affordable low-energy-density model for dietary change.

DESIGN

Foods characteristic of the Mediterranean diet were identified using previously published criteria. For these foods, energy density (kJ/100 g) and nutrient density in relation to both energy ($/MJ) and nutrient cost were examined.

RESULTS

Some nutrient-rich low-energy-density foods associated with the Mediterranean diet were expensive, however, others that also fit within the Mediterranean dietary pattern were not.

CONCLUSIONS

The Mediterranean diet provides a socially acceptable framework for the inclusion of grains, pulses, legumes, nuts, vegetables and both fresh and dried fruit into a nutrient-rich everyday diet. The precise balance between good nutrition, affordability and acceptable social norms is an area that deserves further study. The new Mediterranean diet can be a valuable tool in helping to stem the global obesity epidemic.

The impact of food price increases on caloric intake in China

World food prices have increased dramatically in recent years. We use panel data from 2006 to examine the impact of these increases on the consumption and nutrition of poor households in two Chinese provinces. We find that households in Hunan suffered no nutrition declines. Households in Gansu experienced a small decline in calories, though the decline is on par with usual seasonal effects. The overall nutritional impact of the world price increase was small because households were able to substitute to cheaper foods and because the domestic prices of staple foods remained low due to government intervention in grain markets.