Abstract
Although low socioeconomic groups have the highest risk of noncommunicable diseases in Estonia, national dietary guidelines and nutrition recommendations do not consider affordability. This study aims to help develop nutritionally adequate, health-promoting, and culturally acceptable dietary guidelines at an affordable price. Three food baskets (FBs) were optimised using linear programming to meet recommended nutrient intakes (RNIs), or Estonian dietary guidelines, or both. In total, 6255 prices of 422 foods were collected. The Estonian National Dietary Survey (ENDS) provided a proxy for cultural acceptability. Food baskets for a family of four, earning minimum wage, contain between 73 and 96 foods and cost between 10.66 and 10.92 EUR per day. The nutritionally adequate FB that does not follow Estonian dietary guidelines deviates the least (26% on average) from ENDS but contains twice the sugar, sweets, and savoury snacks recommended. The health-promoting FB (40% deviation) contains a limited amount of sugar, sweets, and savoury snacks. However, values for vitamin D, iodine, iron, and folate are low compared with RNIs, as is calcium for women of reproductive age. When both the RNIs and dietary guidelines are enforced, the average deviation (73%) and cost (10.92 EUR) are highest. The composition of these FBs can help guide the development of dietary guidelines for low income families in Estonia.
Highlights
In Estonia in 2018, the top three causes of mortality were the preventable noncommunicable diseases (NCD): ischemic heart disease, hypertensive heart disease, and stroke [1]
In Europe, Estonia has among the lowest proportion of adolescents consuming vegetables (24%) and fruits (35%) daily and their consumption decreases with increasing age from 11 to 15 years of age [7]
The Nutritionally Adequate Food Basket (NFB) contains double the amount of sugar, sweets, and savoury snacks recommended in the Estonian food-based dietary guidelines (FBDG)
Summary
In Estonia in 2018, the top three causes of mortality were the preventable noncommunicable diseases (NCD): ischemic heart disease, hypertensive heart disease, and stroke [1]. Among the most important behavioural risk factors for cardiovascular diseases is an unhealthy diet [2], which includes a high consumption of saturated fats, salt, and refined carbohydrates, as well as low consumption of fruits and vegetables [3]. The median vegetable and fruit intake is less than half (400 g and less than half the population (48%) reported consuming vegetables daily [6]. In Europe, Estonia has among the lowest proportion of adolescents consuming vegetables (24%) and fruits (35%) daily and their consumption decreases with increasing age from 11 to 15 years of age [7]. The intake of salt, sugar-sweetened beverages, and trans-fats is around double
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