Abstract
To assess the association between diet cost and quality by place of residence. We analysed cross-sectional data of the National Health and Nutrition Survey-2012. Diet cost was estimated by linking dietary data, obtained from a 7-d SFFQ, with municipality food prices, which were derived from a national expenditure survey. Diet quality was assessed using the Healthy Eating Index-2015 (HEI-2015). Association between quintiles of diet cost and HEI-2015 was assessed using linear regression analysis. Mexico. 2438 adults (18-59 years). Diet cost was positively associated with diet quality (HEI-2015) in urban but not in rural areas. Compared with quintile (Q1) of cost, the increment in diet quality score was 1·17 (95 % CI -0·06, 4·33) for Q2, 2·14 (95 % CI -0·06, 4·33) for Q3, 4·70 (95 % CI 2·62, 6·79) for Q4 and 6·34 (95 % CI 4·20, 8·49) for Q5 (P-trend < 0·001). Individuals in rural v. urban areas on average have higher quality diets at lower cost with higher intakes of whole grains and beans and lower intakes of Na, added sugars and saturated fats. Living in the South, being indigenous and having low socio-economic status were also associated with higher quality diets. Diet cost was positively associated with diet quality, but only in urban areas. Further studies are needed to understand the relation between diet cost and quality in rural areas. To improve overall diet quality in Mexico, strategies that aim to reduce the cost of high-quality diets should consider the heterogeneity by place of residence.
Highlights
No association between diet cost and quality was observed in rural areas, while in urban areas, there was a positive association with stronger magnitude in the North, Centre and Mexico City compared with the Southern region
We found that the association between diet cost and diet quality in urban areas varies by region, showing a stronger association in the most urbanised and wealthier regions (North and Mexico City), compared with the South, which is the poorest region of the country
Our findings showed no significant association between diet cost and diet quality in rural areas, which could be due to less variability in food prices in comparison to urban areas or due to a greater measurement error in prices in rural areas using the ENIGH
Summary
Assessment of food prices and diet cost Our estimation of food prices considered differences between rural and urban areas and was made at the municipal level using data from the National Survey of Household Income and Expenditure 2012 (Encuesta Nacional de Ingresos y Gastos de los Hogares or ENIGH 2012 by its Spanish acronym). This survey has a stratified probabilistic design with national representativeness for urban and rural areas and provides information on the quantity of food and beverages purchased and expenditures per household during the last week. We calculated the adjusted diet quality means using the margin command in Stata
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