Global food expenditure patterns diverge between low-income and high-income countries.

Globalization, income growth and changing cultural trends are believed to prompt consumers in low-income countries to adopt the more affluent diet of high-income countries. This study investigates the convergence of food expenditure patterns worldwide, focusing on total food expenditure, raw food categories and ultra-processed foods and beverages across more than 90 countries over the past decades. Contrary to prior belief, we find that food expenditure patterns of lower-income countries do not universally align with those of higher-income nations. This trend is evident across most raw food categories and ultra-processed foods and beverages, as the income level of a country continues to play a crucial role in determining its food expenditure patterns. Importantly, expenditure patterns offer estimates rather than a precise idea of dietary intake, reflecting consumer choices shaped by economic constraints rather than exact dietary consumption.

Differences in the cost and environmental impact between the current diet in Brazil and healthy and sustainable diets: a modeling study.

BACKGROUND: While healthy and sustainable diets benefit human and planetary health, their monetary cost has a direct impact on consumer food choices. This study aimed to identify the cost and environmental impact of the current Brazilian diet (CBD) and compare it with healthy and sustainable diets. METHODS: Data from the Brazilian Household Budget Survey 2017/18 and the Footprints of Foods and Culinary Preparations Consumed in Brazil database were used for a modeling study comparing the cost of healthy and sustainable diets (based on the Brazilian Dietary Guidelines (BDG) diet and the EAT-Lancet diet) versus the CBD. The DIETCOST program generated multiple food baskets for each scenario (Montecarlo simulations). Nutritional quality, cost, and environmental impact measures (carbon footprint (CF) and water footprint (WF)) were estimated for all diets and compared by ANOVA. Simple linear regressions used standardized environmental impacts measures to estimate differentials in costs and environmental impacts among diets scenarios. RESULTS: We observed significant differences in costs/1000 kcal. The BDG diet was cheaper (BRL$4.9 (95%IC:4.8;4.9) ≈ USD$1.5) than the CBD (BRL$5.6 (95%IC:5.6;5.7) ≈ USD$1.8) and the EAT-Lancet diet (BRL$6.1 (95%IC:6.0;6.1) ≈ USD$1.9). Ultra-processed foods (UPF) and red meat contributed the most to the CBD cost/1000 kcal, while fruits and vegetables made the lowest contribution to CBD. Red meat, sugary drinks, and UPF were the main contributors to the environmental impacts of the CBD. The environmental impact/1000 kcal of the CBD was nearly double (CF:3.1 kg(95%IC: 3.0;3.1); WF:2,705 L 95%IC:2,671;2,739)) the cost of the BDG diet (CF:1.4 kg (95%IC:1.4;1.4); WF:1,542 L (95%IC:1,524;1,561)) and EAT-Lancet diet (CF:1.1 kg (95%IC:1.0;1.1); WF:1,448 L (95%IC:1,428;1,469)). A one standard deviation increase in standardized CF corresponded to an increase of BRL$0.48 in the cost of the CBD, similar to standardized WF (BRL$0.56). A similar relationship between the environmental impact and the cost of the BDG (CF: BRL$0.20; WF: BRL$0.33) and EAT-Lancet (CF: BRL$0.04; WF: BRL$0.18) was found, but with a less pronounced effect. CONCLUSIONS: The BDG diet was cost-effective, while the EAT-Lancet diet was slightly pricier than the CBD. The CBD presented almost double the CF and WF compared to the BDG and EAT-Lancet diets. The lower cost in each diet was associated with lower environmental impact, particularly for the BDG and EAT-Lancet diets. Multisectoral public policies must be applied to guide individuals and societies towards healthier and more sustainable eating patterns.

Trends in Complementary Feeding Indicators in Children Aged 6-23 Months According to Participation in a Conditional Cash Transfer Program: Data from the Brazilian Food and Nutrition Surveillance System, 2015-2019.

Inadequate practices during complementary feeding are associated with malnutrition, especially in children experiencing vulnerable conditions and social inequality. The aim of this study was to evaluate the trends in complementary feeding indicators (CFIs) according to participation in a Brazilian cash transferu program-the Bolsa Família Program (BFP). This was a time-series study with secondary data from 600,138 children assisted from 2015 to 2019 and registered within the Brazilian Food and Nutrition Surveillance System. The CFIs assessed were food introduction, minimum meal frequency and appropriate consistency, minimum dietary diversity, iron-rich food, vitamin A-rich food, ultra-processed food consumption, and zero vegetable or fruit consumption. Prevalence and 95% confidence intervals were calculated for the CFIs according to BFP, the region of residence, and the child's age. The Prais-Winsten regression method was used to analyze the temporal trend. There was a steady trend for all CFIs of a healthy diet. A decrease in ultra-processed food consumption for both BFP (-10.02%) and non-BFP children (-9.34%) was observed over the years. Children residing in the North and Northeast regions and those enrolled in the BFP were more distant from the recommended feeding practices when compared to the other regions and non-BFP children. The results highlight the relevance of nutritional surveillance and the need to improve food and nutrition public policies for children aged 6-23 months, particularly for those experiencing greater social vulnerability.

Geographical patterns of implementing a government subsidy program: implications for health outcomes and nutrient intake in Iran.

Introduction: The lack of access to a diverse and nutritious diet has significant health consequences worldwide. Governments have employed various policy mechanisms to ensure access, but their success varies. Method: In this study, the impact of changes in food assistance policy on food prices and nutrient security in different provinces of Iran, a sanctioned country, was investigated using statistical and econometric models. Results: Both the old and new policies were broad in scope, providing subsidized food or cash payments to the entire population. However, the implementation of these policies led to an increase in the market price of food items, resulting in a decline in the intake of essential nutrients. Particularly, the policy that shifted food assistance from commodity subsidies to direct cash payments reduced the price sensitivity of consumers. Consequently, the intake of key nutrients such as Vitamin C and Vitamin A, which are often constrained by their high prices, decreased. To improve the diets of marginalized populations, it is more effective to target subsidies towards specific nutrient groups and disadvantaged populations, with a particular focus on food groups that provide essential nutrients like Vitamin A and Vitamin C in rural areas of Iran. Discussion: More targeted food assistance policies, tailored to the specific context of each province and income level, are more likely to yield positive nutritional outcomes with minimal impact on food prices.

The association between COVID-19 related income loss and diet quality: The mediating role of distress.

The COVID-19 lockdowns saw many individuals lose income, experience distress and increase intake of foods that would typically be considered less 'healthy' (more processed and less fresh produce). Establishing whether there are direct and indirect links between these variables would be of benefit in preparing for similar future events but also has implications for the current global financial climate, where many are experiencing relative decreases in income. Adults in two locations (UK and Australia) (N = 917) completed online questionnaires to explore the impact of the first COVID-19 lockdown on their change in income, emotional wellbeing (depression, anxiety, stress, loneliness), resilience and diet quality. A structural equation model revealed that income loss was indirectly associated with diet quality via distress. As such, the greater the loss of income experienced, the more distress reported; distress was then directly associated with a less nutritious diet. This pattern of results existed when data from both countries were combined but also when they were modelled individually. Our findings indicate that where individuals experience a sudden reduction of income there are likely to be negative consequences for both mental and physical health. It is plausible that these findings would extend to other circumstances in which sudden loss of income may be experienced such as reductions in state social care, rising inflation and interest rates and sudden increases to the general cost of living.

Effects of discounting fruits, vegetables, and noncaloric beverages in New York City supermarkets on purchasing, intake, and weight.

OBJECTIVE: The objective of this study was to assess purchasing, intake, and weight after discounting fruits and vegetables (F&V) and noncaloric beverages in New York City supermarkets. METHODS: A 16-week randomized controlled trial was conducted with a 4-week baseline, an 8-week intervention with 50% discounts on F&V and noncaloric beverages, and a 4-week follow-up. Purchasing was tracked via loyalty cards, and intake was tracked via 24-h dietary recalls. Weights were measured at five in-person visits. RESULTS: Data from 67 participants were analyzed (38 in the experimental group; 29 in the control group). F&V and noncaloric beverage weekly purchasing was greater in the experimental than the control group (mean difference [SD], $4.64 [$1.44], p < 0.0001; $0.53 [$0.39], p = 0.008) during intervention, with F&V purchasing remaining greater in the experimental versus control group during follow-up (p = 0.005). F&V intake was greater for the experimental than the control group during intervention (142 [105] g/day; p = 0.009) and follow-up (p = 0.001). Although no difference in noncaloric beverage consumption was observed between groups, there was lower alcohol intake in the experimental than the control group during follow-up (-85.8 [60.2] g/day; p = 0.004). The experimental group lost weight compared with the control group (-1.33 [0.92] kg; p = 0.006 intervention and p = 0.106 follow-up). No differences in nutrient composition or high energy-dense product consumption were found. CONCLUSIONS: A 50% discount on F&V and noncaloric beverages promoted increased purchasing and intake of F&V and induced weight loss.

Share of food group expenditure in Mexican households according to the gender of the head of household and size of the locality.

OBJECTIVE: To evaluate differences in the percentage of expenditure on food groups in Mexican households according to the gender of the household head and the size of the locality. DESIGN: Analysis of secondary data from the National Household Income and Expenditure Survey (ENIGH) 2018. We estimated the percentage of expenditure on fifteen food groups according to the gender of the head of household and locality size and evaluated the differences using a two-part model approach. SETTING: Mexico, 2018. PARTICIPANTS: A nationally representative sample of 74 647 Mexican households. RESULTS: Female-headed households allocated a lower share of expenditure to the purchase of sweetened beverages and alcoholic beverages and higher percentages to milk and dairy, fruits and water. In comparison with metropolitan households, households in rural and urban localities spent more on cereals and tubers, sugar and honey, oil and fat and less on food away from home. CONCLUSIONS: Households allocate different percentages of expenditure to diverse food groups according to the gender of the head of the household and the size of the locality where they are located. Future research should focus on understanding the economic and social disparities related to differences in food expenditure, including the gender perspective.

Dietary diversity moderates household economic inequalities in the double burden of malnutrition in Tanzania.

OBJECTIVE: Improved food availability and a growing economy in Tanzania may insufficiently decrease pre-existing nutritional deficiencies and simultaneously increase overweight within the same individual, household or population, causing a double burden of malnutrition (DBM). We investigated economic inequalities in DBM at the household level, expressed as a stunted child with a mother with overweight/obesity, and the moderating role of dietary diversity in these inequalities. DESIGN: We used cross-sectional data from the 2015-2016 Tanzania Demographic and Health Survey. SETTING: A nationally representative survey. PARTICIPANTS: Totally, 2867 children (aged 6-23 months) and their mothers (aged 15-49 years). The mother-child pairs were categorised into two groups based on dietary diversity score: achieving and not achieving minimum dietary diversity. RESULTS: The prevalence of DBM was 5·6 % (sd = 0·6) and significantly varied by region (ranging from 0·6 % to 12·2 %). Significant interaction was observed between dietary diversity and household wealth index (Pfor interaction < 0·001). The prevalence of DBM monotonically increased with greater household wealth among mother-child pairs who did not achieve minimum dietary diversity (Pfor trend < 0·001; however, this association was attenuated in those who achieved minimum dietary diversity (Pfor trend = 0·16), particularly for the richest households (P = 0·44). Analysing household wealth index score as a continuous variable yielded similar results (OR (95 % CI): 2·10 (1·36, 3·25) for non-achievers of minimum dietary diversity, 1·38 (0·76, 2·54) for achievers). CONCLUSIONS: Greater household wealth was associated with higher odds of DBM in Tanzania; however, the negative impact of household economic status on DBM was mitigated by minimum dietary diversity.

Food diversity: its relation to children's health and consequent economic burden.

BACKGROUND: This study investigates the impact of low food diversity on the health status of children using the Dietary Diversity Score (DDS) and Dietary Serving Score (DSS) in a sub-district with the highest percentage of poor households. The economic burden of low food diversity was observed by analysing the cost of illness in the children with low food diversity. METHODS: Data from 329 children were collected. We determined the impact of DDS and DSS and other factors on the health status of children aged 2-14 years, using a probit model. The cost of illness (e.g., typhus, stomach ulcers, coughs, flu, and fever) due to low food diversity was calculated from medical registration fees, medical action costs, transportation costs, and other costs. RESULTS: The results shows that a 1% point increase in DDS or DSS potentially decreases children's health complaints by 10% and 8%, respectively. Given the current 26% prevalence of health complaints among children with low DDS, the annual economic burden reaches US$75.72 per child per household. In addition, the current 41% prevalence of children with low DDS resulted in an annual cost to the government of US$153.45 per child. CONCLUSIONS: The effect of inadequate dietary diversity on children's health is potentially high and contributes to the economic burden on households and the government.

Does an antihypertensive diet cost more? Analysis from the Chinese Heart-Healthy diet trial.

OBJECTIVE: To determine whether the Chinese heart-healthy diet (Sichuan cuisine version) (CHH diet-SC) was more expensive than the conventional Sichuan diet and explore the food groups and nutrients that mainly affected the cost of CHH diet-SC. DESIGN: Cost analysis of 4-week intervention diets in the Sichuan center representing southwestern China in the CHH diet study. SETTING: A multicentre, parallel-group, single-blind, randomised feeding trial evaluating the efficacy of lowering blood pressure with the cuisine-based CHH diet. PARTICIPANTS: Totally, fifty-three participants with hypertension aged 25-75 years in the Sichuan center were randomised into the control group (n 26) or the CHH diet-SC group (n 27). RESULTS: The CHH diet-SC was more expensive than the control diet (¥27·87 ± 2·41 v. ¥25·18 ± 2·79 equals $3·90 ± 0·34 v. $3·52 ± 0·39, P < 0·001), and the incremental cost-effectiveness ratio for a 1-mm Hg systolic blood pressure reduction was ¥9·12 ($1·28). Intakes and the cost of seafood, dairy products, fruits, soybeans and nuts, whole grains and mixed beans were higher for the CHH diet-SC than for the control diet (P < 0·001). Intakes of vitamin B1, vitamin B6, vitamin C, Mg and phosphorus were positively correlated with the cost (P < 0·05). CONCLUSIONS: The CHH diet-SC costs more than the conventional Sichuan diet, partly due to the high cost of specific food groups. Positive correlations between the intakes of vitamin B1, vitamin B6, vitamin C, Mg, phosphorus and the dietary cost could be a direction to adjust the composition within the food groups to reduce the cost of the CHH diet-SC.

Nutritional, environmental and economic implications of children plate waste at school: a comparison between two Italian case studies.

OBJECTIVE: This study aims at comparing two Italian case studies in relation to schoolchildren's plate waste and its implications, in terms of nutritional loss, economic cost and carbon footprint. DESIGN: Plate waste was collected through an aggregate selective weighting method for 39 d. SETTING: Children from the first to the fifth grade from four primary schools, two in each case study (Parma and Lucca), were involved. RESULTS: With respect to the served food, in Parma, the plate waste percentage was lower than in Lucca (P < 0·001). Fruit and side dishes were highly wasted, mostly in Lucca (>50 %). The energy loss of the lunch meals accounted for 26 % (Parma) and 36 % (Lucca). Among nutrients, dietary fibre, folate and vitamin C, Ca and K were lost at most (26-45 %). Overall, after adjusting for plate waste data, most of the lunch menus fell below the national recommendations for energy (50 %, Parma; 79 %, Lucca) and nutrients, particularly for fat (85 %, Parma; 89 %, Lucca). Plate waste was responsible for 19 % (Parma) and 28 % (Lucca) of the carbon footprint associated with the food supplied by the catering service, with starchy food being the most important contributor (52 %, Parma; 47 %, Lucca). Overall, the average cost of plate waste was 1·8 €/kg (Parma) and 2·7 €/kg (Lucca), accounting respectively for 4 % and 10 % of the meal full price. CONCLUSION: A re-planning of the school meals service organisation and priorities is needed to decrease the inefficiency of the current system and reduce food waste and its negative consequences.

Relationship between Bone Mineral Density and Selected Parameters of Calcium-Phosphate Economy with Dietary Management and Metabolic Control in Polish Pediatric Patients with Classical Homocystinuria-A Preliminary Study.

BACKGROUND: Classical homocystinuria (HCU) is an inborn defect of methionine metabolism caused by a deficiency of the enzyme cystathionine ß-synthase (CBS). The main symptoms of classical homocystinuria are lens subluxation, bone lesions, vascular disease and developmental delay/intellectual disability. The treatment method for HCU is a methionine-poor diet supplemented with amino acid preparations. The aim of the study was to examine the relationship of dietary factors, metabolic compensation and selected skeletal parameters in patients with HCU. METHODS: Bone mineral density measurements (DXA) were performed in pediatric patients with HCU, and blood levels of selected amino acids, minerals and vitamins, as well as dietary nutritional value, were analyzed. RESULTS: A total of 11 patients with HCU whose median age was 9.3 years were enrolled in the study. The median DXA total body less head of HCU patients was -0.4 z-score, and the lumbar spine was -1.4 z-score. Despite supplementation, calcium intake was below the age norm. Average vitamin D3 intake was in line with recommendations, but 36% of patients had reduced blood levels. Bone mineral density depended on blood levels of 25-hydroxyvitamin D, homocysteine and methionine, as well as on BMI, age and intake of natural protein (R2 = 98.5%, p = 0.015; R2 = 86.7%, p = 0.0049) and protein from an amino acid preparation (r = 0.69, p = 0.026). CONCLUSION: The results of the study indicate the need for regular densitometry in patients with HCU and also the use of additional calcium and vitamin D3 supplementation. It is also necessary to perform a comprehensive analysis of the diet and metabolic controls.

Wealth and Sedentary Time Are Associated With Dietary Patterns Among Preadolescents in Nairobi City, Kenya.

OBJECTIVE: The study aimed to compare dietary patterns in preadolescents in urban areas with different physical activity and socioeconomic profiles in Nairobi, Kenya. DESIGN: Cross-sectional. PARTICIPANTS: Preadolescents aged 9-14 years (n = 149) living in low- or middle-income areas in Nairobi. VARIABLES MEASURED: Sociodemographic characteristics were collected using a validated questionnaire. Weight and height were measured. Diet was assessed using a food frequency questionnaire and physical activity by accelerometer. ANALYSIS: Dietary patterns (DP) were formed through principal component analysis. Associations of age, sex, parental education, wealth, body mass index, physical activity, and sedentary time with DPs were analyzed with linear regression. RESULTS: Three DPs explained 36% of the total variance in food consumption: (1) snacks, fast food, and meat; (2) dairy products and plant protein; and (3) vegetables and refined grains. Higher wealth was associated with higher scores of the first DP (P < 0.05). CONCLUSIONS AND IMPLICATIONS: Consumption of foods often deemed unhealthy (eg, snacks and fast food) was more frequent among preadolescents whose families were wealthier. Interventions that seek ways to promote healthy lifestyles among families residing in urban areas of Kenya are warranted.

Using household economic survey data to assess food expenditure patterns and trends in a high-income country with notable health inequities.

This study aimed to identify dietary trends in Aotearoa New Zealand (NZ) and whether inequities in dietary patterns are changing. We extracted data from the Household Economic Survey (HES), which was designed to provide information on impacts of policy-making in NZ, and performed descriptive analyses on food expenditures. Overall, total household food expenditure per capita increased by 0.38% annually over this period. Low-income households spent around three quarters of what high-income households spent on food per capita. High-income households experienced a greater increase in expenditure on nuts and seeds and a greater reduction in expenditure on processed meat. There was increased expenditure over time on fruit and vegetables nuts and seeds, and healthy foods in Maori (Indigenous) households with little variations in non-Maori households. But there was little change in processed meat expenditure for Maori households and expenditure on less healthy foods also increased over time. Routinely collected HES data were useful and cost-effective for understanding trends in food expenditure patterns to inform public health interventions, in the absence of nutrition survey data. Potentially positive expenditure trends for Maori were identified, however, food expenditure inequities in processed meat and less healthy foods by ethnicity and income continue to be substantial.

Custo da alimentação em São Paulo, Brasil: um estudo de base populacional (2003-2015) / Diet costs in São Paulo, Brazil: populational-based study (2003-2015)

Introdução: Ter uma alimentação adequada e saudável envolve diferentes aspectos, entre os quais o custo é um dos principais determinantes. Objetivo: Investigar os custos da alimentação em amostra representativa da população residente no município de São Paulo em 2003, 2008 e 2015. Métodos: Foram utilizados dados do estudo transversal, base populacional, ISA-Nutrição, com residentes no município de São Paulo. Dados socioeconômicos e estilo de vida foram coletados em visitas domiciliares e inquérito telefônico e, consumo alimentar, por dois recordatórios de 24 horas. Para avaliação da qualidade e classificação da dieta foram utilizados: Índice de Qualidade da Dieta Revisado - IQD-R, grupos de alimentos de proteção ou de risco para doenças cardiometabólicas baseados na classificação What we eat in América? (WEEIA), adaptada para América Latina e análise da aderência às recomendações da Organização Mundial da Saúde (OMS) quanto ao consumo de frutas, verduras e legumes, açúcar, sódio e gordura saturada. A estimativa de custos da alimentação foi baseada em preços dos alimentos das Pesquisas de Orçamento Familiar (POF) do Instituto Brasileiro de Geografia e Estatística (IBGE), sendo adotados critérios definidos de pareamento para linkage (ano de estudo, renda familiar per capita, perfil familiar), incluindo, aplicação de fatores de cocção e conversão, assim como uso de deflatores para comparação entre diferentes períodos. Elasticidades da demanda por alimentos foram analisadas utilizando-se regressão log-linear (endogeneidade/teste Durbin-Wu-Hausman). Associação entre custo e qualidade da dieta foi avaliada por meio de custo-efetividade/incremental. Resultados: De 2003 a 2015, houve aumento nos preços por caloria de cereais integrais e carne vermelha. Por outro lado, queda para frutas, verduras/legumes, feijão, leguminosas, oleaginosas/sementes e peixes/frutos do mar. Elasticidades-preço destes grupos de alimentos apresentaram coeficientes negativos, mostrando tendência de redução do consumo devido ao aumento dos preços. Cereais integrais mostraram complementaridade com oleaginosas e sementes, enquanto verduras/legumes, complementaridade com carnes processadas em 2003 e 2015, e oleaginosas/sementes em 2008 e 2015. Frutas e bebidas açucaradas apresentaram relação de substituição. Em 2015, dietas que apresentaram maior aderência às recomendações dietéticas (IQD-R - maiores pontuações) possuíam maior custo. No entanto, maior aderência às recomendações da Organização Mundial da Saúde (OMS) quanto ao consumo de frutas, verduras/legumes, sódio, açúcares e gordura saturada representou menor custo. Indivíduos que compraram alimentos em feiras livres tiveram menor custo da dieta e aqueles com renda inferior a um salário-mínimo comprometem quase totalidade do orçamento familiar com alimentação (99,49%). Verifica-se maior participação no custo da dieta, do grupo das carnes, independente da qualidade da dieta. Conclusões: O método linkage constituiu-se um recurso importante para avaliação do custo das dietas em estudos em que estas informações estão ausentes. Devido à alta elasticidade-preço no período avaliado (12 anos), consumidores do município de São Paulo responderam ao aumento dos preços com redução do consumo. Grandes mudanças nos preços relativos de bebidas açucaradas deveriam ser necessárias para reduzir seu consumo, com possibilidade de substituição às frutas. Impostos para carnes ou subsídios para legumes e verduras devem considerar potenciais efeitos cruzados. Por outro lado, subsídios, aos cereais integrais, beneficiaria o consumo de oleaginosas e sementes. Maior custo de dietas apresentou maior aderência às recomendações dietéticas e local de compra de alimentos (feiras livres) melhoria na qualidade nutricional da dieta com menor custo.

Introduction: Having an adequate and healthy diet involves different aspects, among which cost is one of the main determinants. Objective: To investigate the costs of food in a representative sample of the population living in São Paulo in samples from the years 2003, 2008 and 2015. Methods: We used data from the cross-sectional, population-based study, ISA-Nutrition, with residents in the municipality of São Paulo in 2003, 2008, and 2015. Socioeconomic and lifestyle data were collected in home visits and telephone survey and, food intake, by two 24-hour recall. To evaluate the quality and classification of diet, we used: the Brazilian Health Eating Index - Revised (BHEI-R); protection or risk groups for cardiometabolic diseases based on the "What we eat in America?" (WEEIA) classification, adapted for Latin America and analysis of adherence to World Health Organization (WHO) recommendations for fruit and vegetable consumption, sugar, sodium, and saturated fat. The estimation of food costs was based on food prices from the Household Budget Surveys (HBS) of the Brazilian Institute of Geography and Statistics (IBGE), adopting well-defined pairing criteria for linkage (year of study, per capita family income, family profile), including the application of cooking and conversion factors, as well as the use of deflators for comparison between different periods. Food demand elasticities were analyzed using log-linear regression (endogeneity/Durbin-Wu-Hausman test). Association between cost and diet quality was assessed using cost-effectiveness/incremental. Results: From 2003 to 2015, there was an increase in prices per calorie for whole grains and red meat. On the other hand, declines for fruits, vegetables/legumes, beans, legumes, oilseeds/seeds, and fish/seafood. The price elasticities of these food groups showed negative coefficients, showing a tendency of consumption to decrease due to price increases. Whole grains showed complementarity with oilseeds and seeds, while vegetables/legumes, complementarity with processed meats in 2003 and 2015, and oilseeds/seeds in 2008 and 2015. Fruits and sugar-sweetened beverages showed a substitution relationship. In 2015, diets that showed higher adherence to dietary recommendations (BHEI-R - higher scores) had higher cost. However, higher adherence to World Health Organization (WHO) recommendations for fruit, vegetable intake, sodium, sugars, and saturated fat represented lower cost. Individuals who bought food at street markets had lower dietary costs and those with incomes below one minimum wage spent almost the entire family budget on food (99.49%). There was a greater participation of the meat group in the cost of the diet, regardless of the quality of the diet. Conclusions: The linkage method can be an important resource for evaluating the cost of diets in studies where this information is absent. Due to the high price elasticity over the evaluated period (12 years), consumers in São Paulo responded to price increases by reducing consumption. Large changes in the relative prices of sugar-sweetened beverages would be necessary to reduce their consumption, with the possibility of substitution to fruit. Taxes for meat or subsidies for vegetables should consider potential cross effects. Subsidies, to whole grains, would benefit the consumption of oilseeds and seeds. Higher cost of diets showed greater adherence to dietary recommendations and location of food purchase (street markets) improved nutritional diet quality at lower cost.

Factors Influencing Changes in Food Preparation during the COVID-19 Pandemic and Associations with Food Intake among Japanese Adults.

The primary aim of this study was to evaluate factors associated with changes in food-preparation practices during the Coronavirus Disease 2019 (COVID-19) pandemic in Japan and its associations to food-group intake. To examine this, a cross-sectional online survey was conducted in July 2020. Participants were 2285 adults aged 20-69 years who resided in any of 13 prefectures in Japan where specific COVID-19 regulations had been implemented. Self-reported changes in food-preparation practices when compared to the pre-COVID-19 pandemic period were measured as "increased" (24.6%), "decreased" (7.3%), and "no change" (68.1%), respectively. Stepwise logistic regression analyses indicated that participants who increased the time and effort for food preparation were younger in age, partially working remotely, experiencing reduced household income due to COVID-19, but highly concerned the importance of diet. On the other hand, participants whose household income decreased, and household economic status worsened, as well as those whose importance of diet deteriorated due to COVID-19 were more likely to decrease time and effort for cooking. Although the increased group were more likely to prepare meals with raw ingredients, the decreased group showed higher frequency of using takeout. These results indicated major determinants of changes in time spending on food preparation in consequence of COVID-19, and highlighted essential targets for future nutrition education.

Pulses Twice a Week in Replacement of Meat Modestly Increases Diet Sustainability.

The French food-based dietary guidelines recommend eating pulses at least twice a week and to reduce meat consumption. This study assessed the impact on the sustainability characteristics (nutrition, cost, environment) of individual diets of meeting the pulse guideline. Dietary data of 2028 adults from the Esteban survey were completed with the nutritional content (considering bioavailability on iron, zinc and protein), price and environmental impacts of foods. When the pulse guideline (i.e., 57 g/day) was not met, two substitution scenarios raised the quantity of pulses to the recommended level, in replacement of an equivalent portion of (i) starches or (ii) meat. Only 9.6% of the participants reached the pulse guideline. Diet sustainability characteristics improved with the meat scenario (nutritional indicators improved; diet cost, greenhouse gas emissions and acidification decreased), while several indicators deteriorated with the starches scenario. Zinc available for absorption slightly decreased in both scenarios while iron available for absorption decreased in the meat scenario only. Increasing pulse consumption to two portions/week could modestly improve the sustainability of diets when pulses replace meat but not starches. Cultural acceptability of that substitution still needs to be proven, and iron and zinc status of individuals at risk of deficiency should be monitored.

Impact of decreasing the proportion of higher energy foods and reducing portion sizes on food purchased in worksite cafeterias: A stepped-wedge randomised controlled trial.

BACKGROUND: Overconsumption of energy from food is a major contributor to the high rates of overweight and obesity in many populations. There is growing evidence that interventions that target the food environment may be effective at reducing energy intake. The current study aimed to estimate the effect of decreasing the proportion of higher energy (kcal) foods, with and without reducing portion size, on energy purchased in worksite cafeterias. METHODS AND FINDINGS: This stepped-wedge randomised controlled trial (RCT) evaluated 2 interventions: (i) availability: replacing higher energy products with lower energy products; and (ii) size: reducing the portion size of higher energy products. A total of 19 cafeterias were randomised to the order in which they introduced the 2 interventions. Availability was implemented first and maintained. Size was added to the availability intervention. Intervention categories included main meals, sides, cold drinks, snacks, and desserts. The study setting was worksite cafeterias located in distribution centres for a major United Kingdom supermarket and lasted for 25 weeks (May to November 2019). These cafeterias were used by 20,327 employees, mainly (96%) in manual occupations. The primary outcome was total energy (kcal) purchased from intervention categories per day. The secondary outcomes were energy (kcal) purchased from nonintervention categories per day, total energy purchased per day, and revenue. Regression models showed an overall reduction in energy purchased from intervention categories of -4.8% (95% CI -7.0% to -2.7%), p < 0.001 during the availability intervention period and a reduction of -11.5% (95% CI -13.7% to -9.3%), p < 0.001 during the availability plus size intervention period, relative to the baseline. There was a reduction in energy purchased of -6.6% (95% CI -7.9% to -5.4%), p < 0.001 during the availability plus size period, relative to availability alone. Study limitations include using energy purchased as the primary outcome (and not energy consumed) and the availability only of transaction-level sales data per site (and not individual-level data). CONCLUSIONS: Decreasing the proportion of higher energy foods in cafeterias reduced the energy purchased. Decreasing portion sizes reduced this further. These interventions, particularly in combination, may be effective as part of broader strategies to reduce overconsumption of energy from food in out-of-home settings. TRIAL REGISTRATION: ISRCTN registry ISRCTN87225572.