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Diet cost, diet quality and socio-economic position: how are they related and what contributes to differences in diet costs?
Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
2011 (English)In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 14, no 9, 1680-1692 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To examine diet costs in relation to dietary quality and socio-economic position, and to investigate underlying reasons for differences in diet costs.

Design: Dietary intake was assessed by a 4 d food diary and evaluated using the 2005 Healthy Eating Index (HEI). National consumer food prices collected by Statistics Sweden and from two online stores/supermarkets were used to estimate diet costs.

Setting: Sweden.

Subjects: A nationally representative sample of 2160 children aged 4, 8 or 11 years.

Results: Higher scores on the HEI resulted in higher diet costs and, conversely, higher diet costs were linked to increased total HEI scores. Children who consumed the most healthy and/or expensive diets ate a more energy-dilute and varied diet compared with those who ate the least healthy and/or least expensive diets. They also consumed more fish, ready meals and fruit. Regression analysis also linked increased food costs to these food groups. There was a positive, but weak, relationship between HEI score and diet cost, parental education and parental occupation respectively.

Conclusions: Healthy eating is associated with higher diet cost in Swedish children, in part because of price differences between healthy and less-healthy foods. The cheapest and most unhealthy diets were found among those children whose parents were the least educated and had manual, low-skill occupations. Our results pose several challenges for public health policy makers, as well as for nutrition professionals, when forming dietary strategies and providing advice for macro- and microlevels in society.

Place, publisher, year, edition, pages
Cambridge University Press , 2011. Vol. 14, no 9, 1680-1692 p.
Keyword [en]
Diet cost, Food prices, Diet quality, Healthy eating index, Socio-economic position
National Category
Nutrition and Dietetics Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Food and Nutrition
URN: urn:nbn:se:umu:diva-39359DOI: 10.1017/S1368980010003642OAI: diva2:393796
FirstView Article,Published online: 24 January 2011 Available from: 2011-02-01 Created: 2011-01-25 Last updated: 2012-02-28Bibliographically approved
In thesis
1. Toward an understanding of the barriers to and facilitators of dietary change:
Open this publication in new window or tab >>Toward an understanding of the barriers to and facilitators of dietary change:
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Faktorer som underlättar respektive försvårar kostförändring :
Abstract [en]

Healthy dietary changes would be beneficial for society, as the economic burden of diet-related diseases is massive, and for the individual, who would reduce their risk of ill health. However, it is not easy to change dietary habits. Therefore, the aim of this thesis was to better understand dietary change, focusing on the barriers to and facilitators of healthy dietary change by i) examining changes in food choices when dietary change is imposed by a medical diagnosis, ii) examining experiences related to dietary change and its sustainability after participation in a study where healthy dietary changes were required, and iii) examining diet cost in relation to healthiness of the diet.

Methods Eighty children aged 13 who were diagnosed with celiac disease (CD) by a screening study reported their food intake in a food frequency questionnaire before and 1,5 years after commencing a gluten-free diet. Changes in food intake and the healthiness of the diet were examined, controlling for societal changes through the use of an age- and sex-matched control group. Diet healthiness was assessed using the National Food Administration’s (NFA) food index and the Diet Quality Index-Swedish Nutritional Recommendations. Qualitative interviews were conducted with 14 individuals who participated in an intervention study five years earlier where they had been randomly selected to adhere to a Mediterranean-like diet for three months. Analyses of the transcribed interviews focused on their experiences of barriers to and facilitators of dietary change and its sustainability. The costs related to healthy diets were examined by comparing consumer food prices with dietary intake data collected in two separate studies. The first study collected dietary intake data through a diet history interview with participants who had been randomized to either a Mediterranean-like diet or to continue their normal diet. The second study collected dietary intake data from 4-, 8-, and 11-year-old children by means of food diaries and was conducted by the NFA. Diet healthiness was assessed using the Healthy Eating Index 2005.

Results The screened CD group made relatively few changes to their diets. They decreased their intake of certain gluten-containing products, including pizza, chicken nuggets, fish sticks, and pastries. There were no changes in the healthiness of their diet. The narratives of the individuals changing their diets showed that social relationships were the main barrier to sustainability. Social relationships within the household were especially troublesome, and various coping strategies were required on an everyday basis. Dietary change also increased the burden of food work (e.g., planning, shopping, cooking), which was another major barrier to dietary change. Comparisons between consumer costs of healthy and less healthy diets showed that those consuming the healthier diets also had consumed more expensive diets.

Conclusion More barriers to healthy dietary changes were found than facilitators of these transitions. For instance, the impact of social relationships on sustainability of dietary change was found to be high, indicating the importance of participation of other household members when dietary changes are implemented. The higher cost of the healthier diets may be another barrier for healthy dietary changes, especially for those with limited resources. Even though it is possible to eat healthily at a lower cost, such a diet would likely require both cooking skills and time, thus making the task more difficult. However, the finding that children diagnosed with CD only made minor changes in their consumption of, for instance, bread and pasta, indicates that one way of increasing the healthiness of a diet is to substitute healthier alternatives within the same food group for less healthy food items.

Place, publisher, year, edition, pages
Umeå: Kostvetenskap, 2011. 89 p.
Dietary change, Healthy eating, Barriers, Facilitators, Dietary indexes, Diet cost, Food prices, Social relationships, Qualitative interviews, Mediterranean diet, Celiac disease, Children
National Category
Food Science
Research subject
Food and Nutrition
urn:nbn:se:umu:diva-43769 (URN)978-91-7459-189-7 (ISBN)
Public defence
2011-06-03, Hörsal C, Samhällsvetarhuset, Umeå Universitet, Umeå, 13:00 (Swedish)
Available from: 2011-05-13 Created: 2011-05-09 Last updated: 2011-05-11Bibliographically approved

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Rydén, PetraHagfors, Linda
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