Affordable Nutrient Density in Brazil: Nutrient Profiling in Relation to Food Cost and NOVA Category Assignments.

Affordable nutrient density is provided by low-cost and nutrient-rich foods. We explored nutrient density, cost, and NOVA category assignments within and across food groups in Brazil. The nutrient density of the foods (n = 591) was assessed using the Nutrient Rich Food Index (NRF9.3) based on protein, fiber, vitamin A (RAE), vitamin C, vitamin E (mg), Ca, Fe, K and Mg; and NRF6.3 score for priority nutrients: Ca, Fe, Zn, vitamin A, vitamin B12, and folate. Nutrients to limit (LIM) were saturated fat, added sugar, and sodium. Affordability was defined as the ratio of energy and/or nutrient density of foods and retail price per 100 kcal. Foods were classified as minimally processed (n = 106), processed (n = 188), ultra-processed (n = 286), and culinary ingredients (n = 11). Nutrient density was positively linked to per 100 kcal food cost. Ultra-processed foods (UPF) contained more energy, fat, sugar, and salt and had lower NRF scores compared to minimally processed (MPF) foods. UPF was also less expensive than MPF foods. Nutrient-rich foods below the median per 100 kcal costs included MPF foods, but also processed foods (PF) and UPF. Affordable nutrient-rich foods can be found in the different categories of the NOVA classification.

Nutrient density and affordability of foods in Brazil by food group and degree of processing.

OBJECTIVE: Affordable nutrition refers to the relation between nutrient density of foods and their monetary cost. There are limited data on affordable nutrition in low- and middle-income countries. The present study aimed to develop a nutrient density score and nutrient affordability metrics for 377 most consumed foods in Brazil. DESIGN: The foods were aggregated into seven major food groups and four NOVA food categories. Nutrient composition data were obtained from the Brazilian Institute of Geography and Statistics. Food prices were obtained from retailer websites and were converted to prices per 100 g and 418 kJ. The Nutrient Rich Food (NRF8.2) score was based on protein, fiber, vitamins A, C and E, Ca, Fe and K. Nutrients to limit were sugar and Na. Affordability was measured as kcal/R$ and nutrients/R$. RESULTS: Grains, fats and sweets were more energy dense and had lower NRF8.2 scores than dairy, vegetables and fruits. Grains, fats and sweets were the lowest cost sources of energy. Vegetables and fruits, beans, nuts and seeds and eggs and dairy were the lowest cost sources of multiple nutrients. Ultra-processed foods (48 % of total) had higher energy density and lower NRF8.2 scores than did unprocessed foods. In Brazil, fruits, vegetables and dairy products offered the most nutrients per real. CONCLUSIONS: Analysis of the relationship between nutrient density of foods and their cost can help identify locally available foods that are nutrient rich, affordable and culturally acceptable. Achieving high nutrient density at an affordable cost should be the goal of Brazil's food systems.

Energy density of foods and diets in Mexico and their monetary cost by socioeconomic strata: analyses of ENSANUT data 2012.

BACKGROUND: In January 2014, Mexico implemented an 8% tax on non-essential foods with energy density ≥275 kcal/100 g, with a view to prevent obesity. This study explored energy density of foods and diets in Mexico and their monetary cost across population subgroups. METHODS: Dietary intakes for 3057 adults (ages ≥19 years) were obtained from the nationally representative Encuesta Nacional de Salud y Nutrición (ENSANUT 2012). Energy density (kcal/g) was calculated for foods, food groups and total diets. The mean national retail prices for 153 foods were obtained from the National Institute for Geography and Statistics (INEGI). The monetary cost of total diets (MXN/day) was estimated by attaching food prices to dietary intakes from the ENSANUT food frequency questionnaire. A series of descriptive analyses and regression models examined associations among dietary energy density and diet cost by age, gender, rural or urban residence and socioeconomic status (SES). RESULTS: Energy-dense grains, fats and sweets cost less per calorie than did milk and dairy, meat, vegetables and fruit. Lower cost diets derived more calories from tortillas, tamales, beans and sugar, whereas higher cost diets contained more non-essential energy-dense processed foods and more sugar sweetened beverages, and fruits and vegetables. At each quintile of energy intake, higher dietary energy density was associated with lower energy-adjusted diet costs. Traditional energy-dense tortillas and tamales, also characterised by lower cost, were consumed more by the rural poor. Urban dwellers had more 'western-style' diets. CONCLUSIONS: Food patterns in Mexico appear to be driven by monetary cost and SES.

The feasibility of meeting the WHO guidelines for sodium and potassium: a cross-national comparison study.

OBJECTIVE: To determine joint compliance with the WHO sodium-potassium goals in four different countries, using data from nationally representative dietary surveys. SETTING: Compared to national and international recommendations and guidelines, the world's population consumes too much sodium and inadequate amounts of potassium. The WHO recommends consuming less than 2000 mg sodium (86 mmol) and at least 3510 mg potassium (90 mmol) per person per day. PARTICIPANTS: Dietary surveillance data were obtained from the National Health and Nutrition Examination Survey (NHANES 2007-2010) for the USA; the Encuesta Nacional de Salud y Nutrición 2012 for Mexico; the Individual and National Study on Food Consumption (INCA2) for France; and the National Diet and Nutrition Survey (NDNS) for the UK. PRIMARY OUTCOME MEASURES: We estimated the proportion of adults meeting the joint WHO sodium-potassium goals in the USA, the UK, France and Mexico. RESULTS: The upper bounds of joint compliance with the WHO sodium-potassium goals were estimated at 0.3% in the USA, 0.15% in Mexico, 0.5% in France and 0.1% in the UK. CONCLUSIONS: Given prevailing food consumption patterns and the current food supply, implementing WHO guidelines will be an enormous challenge for global public health.