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.

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.

Stable isotopes in hair reveal dietary protein sources with links to socioeconomic status and health.

Carbon and nitrogen isotope ratios in hair sampled from 65 communities across the central and intermountain regions of the United States and more intensively throughout 29 ZIP codes in the Salt Lake Valley, Utah, revealed a dietary divergence related to socioeconomic status as measured by cost of living, household income, and adjusted gross income. Corn-fed, animal-derived proteins were more common in the diets of lower socioeconomic status populations than were plant-derived proteins, with individual estimates of animal-derived protein diets as high as 75%; United States towns and cities averaged 57%. Similar patterns were seen across the socioeconomic status spectrum in the Salt Lake Valley. It is likely that corn-fed animal proteins were associated with concentrated animal-feeding operations, a common practice for industrial animal production in the United States today. Given recent studies highlighting the negative impacts of animal-derived proteins in our diets, hair carbon isotope ratios could provide an approach for scaling assessments of animal-sourced foods and health risks in communities across the United States.

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.

The impact of financial incentives on SNAP transactions at mobile produce markets.

BACKGROUND: Offering financial incentives promotes increases in fruit and vegetable purchases in farmers' markets and supermarkets. Yet, little is understood about whether food-insecure adults purchase more fruits and vegetables as a result of receiving financial incentives in mobile produce market settings. METHODS: In 2018-2019, Food on the Move provided a 50% discount to customers using Supplemental Nutrition Assistance Program (SNAP) benefits to purchase fruit and vegetables from 16 market locations in Rhode Island (n = 412 market occasions). We used mixed multivariable linear regression to estimate the difference in total dollar sales per transaction per month between SNAP transactions and non-SNAP transactions. We also estimated the difference in out-of-pocket dollar sales per transaction per month between SNAP and non-SNAP transactions, less the 50% discount. This reflects the actual amount spent on fresh fruits and vegetables purchased per visit. In both models, we controlled for the number of market sites per month, with fixed effects for quarter and year. We estimated random intercept variance for date of transaction and market site to adjust for clustering. RESULTS: In 2018-2019, the majority of market transactions (total n = 13,165) were SNAP transactions [n = 7.988 (63.0%)]. On average, customers spent $17.38 (SD = 16.69) on fruits and vegetables per transaction per month. However, customers using SNAP benefits spent significantly more on FVs per transaction per month [$22.01 (SD = 17.97)] compared to those who did not use SNAP benefits [9.81 (SD = 10.68)] (ß = $10.88; 95% CI: 10.18, 11.58). Similarly, out-of-pocket dollar sales per SNAP transaction per month (i.e., less the 50% discount) were significantly higher [$11.42 (SD = 9.44)] relative to non-SNAP transactions [$9.40 (SD = 9.33)] (ß = $1.85; 95% CI: 1.44, 2.27). CONCLUSIONS: Financial incentives contributed to higher fruit and vegetable purchases among low-income customers who shop at mobile produce markets by making produce more affordable. Higher spending on fruits and vegetables may promote healthy diet behaviors and reduce chronic disease risk among food-insecure adults.

Characterising percentage energy from ultra-processed foods by participant demographics, diet quality and diet cost: findings from the Seattle Obesity Study (SOS) III.

Higher consumption of 'ultra-processed' (UP) foods has been linked to adverse health outcomes. The present paper aims to characterise percentage energy from UP foods by participant socio-economic status (SES), diet quality, self-reported food expenditure and energy-adjusted diet cost. Participants in the population-based Seattle Obesity Study III (n 755) conducted in WA in 2016-2017 completed socio-demographic and food expenditure surveys and the FFQ. Education and residential property values were measures of SES. Retail prices of FFQ component foods (n 378) were used to estimate individual-level diet cost. Healthy Eating Index (HEI-2015) and Nutrient Rich Food Index 9.3 (NRF9.3) were measures of diet quality. UP foods were identified following NOVA classification. Multivariable linear regressions were used to test associations between UP foods energy, socio-demographics, two estimates of food spending and diet quality measures. Higher percentage energy from UP foods was associated with higher energy density, lower HEI-2015 and NRF9.3 scores. The bottom decile of diet cost ($216·4/month) was associated with 67·5 % energy from UP foods; the top decile ($369·9/month) was associated with only 48·7 % energy from UP foods. Percentage energy from UP foods was inversely linked to lower food expenditures and diet cost. In multivariate analysis, percentage energy from UP foods was predicted by lower food expenditures, diet cost and education, adjusting for covariates. Percentage energy from UP foods was linked to lower food spending and lower SES. Efforts to reduce UP foods consumption, an increasingly common policy measure, need to take affordability, food expenditures and diet costs into account.

Affordability of current, and healthy, more equitable, sustainable diets by area of socioeconomic disadvantage and remoteness in Queensland: insights into food choice.

BACKGROUND: Poor diet is the leading preventable risk factor contributing to the burden of disease globally and in Australia, and is inequitably distributed. As the price of healthy foods is a perceived barrier to improved diets, evidence on the cost and affordability of current (unhealthy) and recommended (healthy, more equitable and sustainable) diets is required to support policy action. METHODS: This study applied the Healthy Diets ASAP (Australian Standardised Affordability and Pricing) methods protocol to measure the cost, cost differential and affordability of current and recommended diets for a reference household in Queensland, Australia. Food prices were collected in 18 randomly selected locations stratified by area of socioeconomic disadvantage and remoteness. Diet affordability was calculated for three income categories. RESULTS: Surprisingly, recommended diets would cost 20% less than the current diet in Queensland as a whole. Households spent around 60% of their food budget on discretionary choices (that is, those not required for health that are high in saturated fat, added sugar, salt and/or alcohol). Queensland families would need to spend around 23% of their income on recommended diets. However, recommended diets would not be affordable in low socioeconomic or very remote areas, costing 30 and 35% of median household income respectively. The government supplements due to the SARS-CoV-2 pandemic would improve affordability of recommended diets by 29%. CONCLUSIONS: Study findings highlight that while price is one factor affecting consumer food choice, other drivers such as taste, convenience, advertising and availability are important. Nevertheless, the study found that recommended diets would be unaffordable in very remote areas, and that low-income families are likely experiencing food stress, irrespective of where they live in Queensland. Policy actions, such as increasing to 20% the current 10% tax differential between basic healthy, and unhealthy foods in Australia, and supplementing incomes of vulnerable households, especially in remote areas, are recommended to help improve diet equity and sustainability, and health and wellbeing for all.

Effects of different feeding regimens with protease supplementation on growth, amino acid digestibility, economic efficiency, blood biochemical parameters, and intestinal histology in broiler chickens.

BACKGROUND: This study was conducted to estimate the impacts of using varied feeding regimens with or without protease supplementation on the growth performance, apparent amino acid ileal digestibility (AID%), economic efficiency, intestinal histology, and blood biochemical parameters of broiler chickens. Three hundred one-day-old chicks (Ross 308 broiler) were randomly allotted to a 3 × 2 factorial design. The experimental design consisted of three feeding regimens; FR1: a recommended protein SBM diet, FR2: a low-protein SBM diet, and FR3: a low-protein diet with the inclusion of 5% DDGS and 5% SFM, with or without protease supplementation (250 mg/kg). RESULTS: Increased feed intake and feed conversion ratio were observed in the FR3 treatment during the starter stage and decreased body weight and body weight gain during the grower stage. However, there was no significant effect of the different feeding regimens, protease supplementation, or interaction on the overall performance. The economic value of diets also remained unaffected by the different feeding regimens, protease supplementation, or interaction. Protease supplementation resulted in lowering the AID% of tryptophan and leucine. Reduced AID% of methionine was evident in the FR2 + VE and FR3 - VE treatments. Histological findings substantiated the FR3 treatment mediated a decrease in the duodenal and jejunal villous height (VH), jejunal villous width (VW), and ileal VW, whereas, increase in the ileal crypt depth (CD). The FR2 + VE treatment reduced the VH:CD ratio in the duodenum. The duodenal CD and the jejunal goblet cell count were reduced as a consequence of protease supplementation. The FR3 + VE treatment documented a rise in duodenal CD, while an increase in the jejunal goblet cell count was observed in the FR3 - VE treatment. The FR3 treatment enhanced the IgM serum levels compared to the FR1 and FR2 treatments. IgM serum levels were also elevated following protease supplementation. FR3 + VE treatment increased IgM serum levels. The highest serum ALP was found in the FR3 treatment, whereas the lowest level was obtained in the FR2 treatment. CONCLUSION: Low-protein SBM-based diets could be used without affecting the birds' growth. Altered morphometric measures of the intestine and increased IgM and ALP levels indicated the low-protein SBM/DDGS-SFM diet-induced damage of the intestinal histoarchitecture and immune system of birds. These different diets and protease supplementation failed to affect economic efficiency positively.

Beyond faith: Biomolecular evidence for changing urban economies in multi-faith medieval Portugal.

OBJECTIVES: During the Middle Ages, Portugal witnessed unprecedented socioeconomic and religious changes under transitioning religious political rule. The implications of changing ruling powers for urban food systems and individual diets in medieval Portugal is poorly understood. This study aimed to elucidate the dietary impact of the Islamic and Christian conquests. MATERIALS AND METHODS: Radiocarbon dating, peptide mass fingerprinting (ZooMS) and stable isotope analysis (δ13 C, δ15 N) of animal (n = 59) and human skeletal remains (n = 205) from Muslim and Christian burials were used to characterize the diet of a large historical sample from Portugal. A Bayesian stable isotope mixing model (BSIMM) was used to estimate the contribution of marine protein to human diet. RESULTS: Early medieval (8-12th century), preconquest urban Muslim populations had mean (±1SD) values of -18.8 ± 0.4 ‰ for δ13 C 10.4 ± 1 ‰ for δ15 N, indicating a predominantly terrestrial diet, while late medieval (12-14th century) postconquest Muslim and Christian populations showed a greater reliance on marine resources with mean (±1SD) values of -17.9 ± 1.3‰ for δ13 C and 11.1 ± 1.1‰ for δ15 N. BSIMM estimation supported a significant increase in the contribution of marine resources to human diet. DISCUSSION: The results provide the first biomolecular evidence for a dietary revolution that is not evidenced in contemporaneous historical accounts. We find that society transitioned from a largely agro-pastoral economy under Islamic rule to one characterized by a new focus on marine resources under later Christian rule. This economic change led to the naissance of the marine economy that went on to characterize the early-modern period in Portugal and its global expansion.

Replacement of grain maize with spineless cactus in the diet of dairy goats.

Spineless cactus (Nopalea cochenillifera) is widely used in animal feed in semi-arid regions, due to the adaptive characteristics to such conditions and for having high levels of soluble carbohydrates. This research article describes the effect of replacing grain maize with spineless cactus in the diet of dairy goats on dry matter intake, water intake, milk yield, milk physicochemical characteristics and diet production costs. Eight multiparous Anglo Nubian goats were fed diets in which grain maize was replaced with spineless cactus at four levels (0, 33, 66, and 100%) in a double 4 × 4 Latin square design. Milk yield was measured and samples collected in the last three days of each period for physicochemical analysis and for determining nutrient intake. Diet production costs were also determined. Replacing maize with spineless cactus did not influence dry matter intake. Water intake via the drinker decreased linearly in response to the increasing levels of spineless cactus in the diet. The replacement of maize with spineless cactus did not change milk yield or physicochemical parameters. Total feed cost and the percentage of revenue losses from feed decreased with the replacement. Therefore, spineless cactus can fully replace grain maize in the diet of dairy goats, as it does not change dry matter intake or milk yield, but rather reduces feed costs and the drinking-water intake of goats.

[Change in dietary consciousness and its related factors among Japanese adults under the COVID-19 pandemic: Analysis using Dietary Consciousness Scale].

Objectives　This study aims to develop a dietary consciousness scale and examine its reliability and validity, as well as investigate the changes in psychological aspects that influence diet among Japanese adults during the COVID-19 pandemic and clarify its related factors.Methods　An online survey was conducted from July 1, 2020 to July 3, 2020. Participants were adults aged between 20 and 69 years selected from 13 prefectures where the government declared the state of emergency from April to May 2020. All selected participants were shopping or cooking foods for more than 2 days a week at the time of the survey. A total of 2,299 participants were included in the analysis. Dietary consciousness was measured using 12 items, and the construct was examined using factor analysis. Cronbach's alpha was examined as an indicator of internal validity, and the criterion-referenced validity was confirmed using the Kruskal-Wallis test. To determine changes in dietary consciousness, we calculated total scores based on changes in each item of the Dietary Consciousness Scale as follows: no change (0 points), improved (+1 point), and worsening (-1 point). The associations between the changes in dietary consciousness and characteristics or socioeconomic factors of the participants were examined using the chi-squared test and residual analysis.Results　Exploratory and confirmatory factor analyses demonstrated that a model consisting of two factors fitted the data (GFI = 0.958, AGFI = 0.938, CFI = 0.931, RMSEA = 0.066). Cronbach's alpha of the first factor (importance of diet) was 0.838 and 0.734 for the second factor (precedence of diet), and the reliability was confirmed at 0.828 for the entire scale. In the examination of criterion-related validity, the higher the stage of change, the higher the total score of the scale, and a significant difference was observed (P<0.001). The percentage of participants whose precedence worsened was higher than the importance. Significant differences were observed regarding gender, age group, marital status, employment status, household annual income, and income change during the COVID-19 pandemic considering changes in both the importance and precedence of diet. Those who were in the "worsening tendency" group in both the importance and precedence were men, 20-29 years old, unmarried, full-time employees, with a household income of 4-6 million yen during the past year.Conclusion　During the COVID-19 pandemic, the precedence of diet worsened, compared to its importance, and men, young, or unmarried persons show a worsening of dietary consciousness.

Flavonoid Intakes in the US Diet Are Linked to Higher Socioeconomic Status and to Tea Consumption: Analyses of NHANES 2011-16 Data.

BACKGROUND: Many of the health benefits of tea have been attributed to its flavonoid content. Tea consumption in US adults varies by socioeconomic status (SES). OBJECTIVES: The present objective was to explore intakes of total flavonoids and flavonoid subclasses by participant sociodemographics and by patterns of tea consumption. METHODS: The present analyses were based on 2 d of dietary recalls for 17,506 persons aged >9 y in the 2011-2016 NHANES. The What We Eat in America nutrient composition database was merged with the USDA Expanded Flavonoid database, which included total flavonoids and flavan-3-ols (including catechins), flavanones, flavonols, anthocyanidins, flavones, and isoflavones. Flavonoid intakes were compared by sex, age, race/ethnicity, education, and income-to-poverty ratio (IPR) in univariate analyses. Flavonoid intakes of children and adults were also compared by tea consumption status. Time trends in flavonoid intakes were also examined. RESULTS: Mean total flavonoid intake was 219 mg/d, of which flavan-3-ols provided 174 mg/d, or 79%. The highest total flavonoid intakes were found in adults aged 51-70 y (293 mg/d), non-Hispanic whites (251 mg/d) and in groups with college education (251 mg/d) and higher income (IPR >3.5: 249 mg/d) (P < 0.001 for all). The socioeconomic gradient was significant for anthocyanidins, flavonols, and flavones (P < 0.001 for all) but not for flavan-3-ols, and persisted across 3 cycles of NHANES. Adult tea consumers had higher intakes of total flavonoids (610 mg/d compared with 141 mg/d) and flavan-3-ols (542 mg/d compared with 97.8 mg/d) than did nonconsumers (P < 0.001). Time trend analyses showed that both tea consumption and flavonoid intakes were unchanged from 2011 to 2016. CONCLUSIONS: Flavonoid intakes in children and adults in the NHANES 2011-16 sample were associated with higher SES and were largely determined by tea consumption. Studies of diet and disease risk need to take sociodemographic gradients and eating and drinking habits into account.

Manufacturing personalized food for people uniqueness. An overview from traditional to emerging technologies.

Personalized nutrition means that we are unique in the way to absorb and to metabolize nutrients as a consequence of our genetic profile and the microbiome that we host in the gut. With the terminology of Personalized Food Manufacturing we want not only to stress the idea of the capability to manufacture food meeting our unique nutritional needs but - based on the idea that eating is a global experience - also to broad this to meet additional personal requirements and expectations, i.e. taste, texture, color, aspect, etc. To address this aim, traditional and advances technologies will have to be employed in new ways and new technological solutions will have to be implemented. All these considerations motivated our paper by which we want to explore and to discuss the technological options having the potential to produce personalized food. After pointing out the main diet styles, firstly we have analyzed the modern approaches of agricultural and animal nutrition in use to manufacture food for narrow group of consumers. Secondly, we have explored emerging technologies at disposal employable to manufacture customized food that meet our uniqueness. Finally the most important market products belonging in the sector of personalized food production have been considered.

Diets containing the highest levels of dairy products are associated with greater eutrophication potential but higher nutrient intakes and lower financial cost in the United Kingdom.

PURPOSE: Previously, the nutritional contribution, environmental and financial costs of dairy products have been examined independently. Our aim was to determine the nutritional adequacy, financial cost and environmental impact of UK diets according to dairy content. METHODS: In this cross-sectional study of adults (19-64 years) from the UK National Diet and Nutrition Survey years 1-4 (n = 1655), dietary intakes assessed from 4-day estimated food diaries were organized into quartiles (Q) total grams of dairy (milk, cheese, yogurt, dairy desserts) and analyzed using ANCOVA controlling for age, sex and energy intake with Bonferroni post hoc test for nutritional adequacy, Alternative Healthy Eating Index (AHEI-2010), environmental impact [greenhouse gas emissions (GHGE), eutrophication and acidification potentials], financial cost, markers of health and cardio-metabolic diseases. RESULTS: Nutritional adequacy, particularly for protein, calcium and iodine (+ 18 g, + 533 mg, + 95 g, respectively, all P < 0.0001) and AHEI-2010 (P < 0.0001) were significantly higher and systolic BP (- 2 mmHg, P = 0.019) was significantly lower for the higher-dairy diets (Q4, 274-1429 g/day dairy), compared with diets containing lower dairy (Q1, 0-96 g/day dairy). Diets in Q4 had lower financial cost (- 19%, P < 0.0001) and the greatest eutrophication potential, compared with Q1 (+ 29%, P < 0.0001). Yet the environmental (GHGE) and financial costs per unit nutrient (riboflavin, zinc, iodine, magnesium, calcium, potassium) were lower in Q4 than Q1 (all P < 0.0001). CONCLUSION: Diets with the highest dairy content had higher nutrient composition, better diet quality, were associated with lower BP and financial cost, but with higher eutrophication potential. Robust environmental data for many of food groups are limited and this needs an urgent addressing. TRIAL REGISTRATION: This trial was registered on clinicaltrials.gov as NCT03407248.

Industrially processed v. home-prepared dishes: what economic benefit for the consumer?

OBJECTIVE: To cope with the pressure of modern life, consumer demand for convenience foods has increased in the last decades. The current study set out to compare the costs of buying industrially processed dishes and of preparing them at home. DESIGN: Direct purchase costs of industrially processed dishes frequently consumed in France (n 19) and of the ingredients needed for their home-prepared counterparts (n 86) were collected from four major food retailers' websites in Montpellier, France. Mean prices and energy density were calculated for four portions. Costs related to energy used by cooking appliances and time spent preparing dishes were further estimated. SETTING: Montpellier, France. PARTICIPANTS: Not applicable. RESULTS: Based on the costs of ingredients and energy used for cooking, dishes prepared at home cost less (-0·60 € per four portions, P < 0.001) than industrially processed dishes, but when the cost of time was taken into account, the industrially processed dishes were much cheaper (-5·34 € per four portions, P < 0.001) than their home-prepared counterparts. There was no difference in energy density between industrially processed and home-prepared dishes. CONCLUSIONS: Our findings suggest that industrially processed dishes are more profitable to consumers when the cost of time for preparing dishes at home is valued. Given the ever greater demands of everyday life, more account should be taken of the additional cost to consumers of the time they spend preparing meals at home.

Diet quality of Japanese adults with respect to age, sex, and income level in the National Health and Nutrition Survey, Japan.

OBJECTIVE: Although several studies in Western countries show that higher socioeconomic status is associated with higher diet quality, no study has observed this association in Japan. In the current study, we examined the association between diet quality and the combinations of age, sex, and household income, and also compared the dietary intake between diet quality levels according to household income. DESIGN: Cross-sectional study. SETTING: National Health and Nutrition Survey, Japan in 2014. PARTICIPANTS: 2785 men and 3215 women. RESULTS: Higher Japanese Food Guide Spinning Top scores (better diet quality) were observed in older women, especially those with higher household income, whereas lower scores were observed in younger men with lower household income. Those having low quality diet, especially in low income households, had higher odds of not meeting the recommended amounts of the Japanese dietary guidelines, than those having high quality diet. CONCLUSIONS: Diet quality in Japanese adults differed by age and sex as well as by household income level. A different approach to diet quality improvement is needed according to population characteristics including not only age and sex but also social economic status.

The effect of time use and food cost on dietary quality.

OBJECTIVE: To develop a questionnaire to measure food nutrition, food expenditures and time spent in food-related activities; and to assess the association between diet quality, time spent in food-related activities and food expenditures using data from a pilot study. DESIGN: Cross-sectional study. Multiple linear regression models were used to analyse participants' survey response behaviours and the relationship between food nutritional quality and time and money expenditures. SETTING: Online survey using Qualtrics software in a public university located in West Texas, USA. PARTICIPANTS: Faculty and staff aged 18 years and older from a public university located in West Texas, USA. RESULTS: Combining questions from three survey instruments that collect data on food nutrition, food expenditures and time spent in food-related activities resulted in a thirty-page survey instrument. The median completion time of the survey instrument was about 30 min. Preliminary results suggest that time and money expenditures are associated with food quality but that their role is small relative to sociodemographic characteristics such as race and gender. CONCLUSIONS: Time and money expenditures are associated with food quality but their role is small relative to sociodemographic characteristics such as race and gender.