Abstract
ObjectiveTo explore the dietary changes needed to achieve nutritional adequacy across income levels at constant energy and diet cost.Materials and methodsIndividual diet modelling was used to design iso-caloric, nutritionally adequate optimised diets for each observed diet in a sample of adult normo-reporters aged ≥20 years (n = 1,719) from the Individual and National Dietary Survey (INCA2), 2006–2007. Diet cost was estimated from mean national food prices (2006–2007). A first set of free-cost models explored the impact of optimisation on the variation of diet cost. A second set of iso-cost models explored the dietary changes induced by the optimisation with cost set equal to the observed one. Analyses of dietary changes were conducted by income quintiles, adjusting for energy intake, sociodemographic and socioeconomic variables, and smoking status.ResultsThe cost of observed diets increased with increasing income quintiles. In free-cost models, the optimisation increased diet cost on average (+0.22 ± 1.03 euros/d) and within each income quintile, with no significant difference between quintiles, but with systematic increases for observed costs lower than 3.85 euros/d. In iso-cost models, it was possible to design nutritionally adequate diets whatever the initial observed cost. On average, the optimisation at iso-cost increased fruits and vegetables (+171 g/day), starchy foods (+121 g/d), water and beverages (+91 g/d), and dairy products (+20 g/d), and decreased the other food groups (e.g. mixed dishes and salted snacks), leading to increased total diet weight (+300 g/d). Those changes were mostly similar across income quintiles, but lower-income individuals needed to introduce significantly more fruit and vegetables than higher-income ones.ConclusionsIn France, the dietary changes needed to reach nutritional adequacy without increasing cost are similar regardless of income, but may be more difficult to implement when the budget for food is lower than 3.85 euros/d.
Highlights
In spite of a global improvement in living conditions, Europe still shows social inequalities in health, with differences in morbidity and mortality according to socioeconomic position (SEP) [1,2,3]
The optimisation at iso-cost increased fruits and vegetables (+171 g/day), starchy foods (+121 g/d), water and beverages (+91 g/d), and dairy products (+20 g/d), and decreased the other food groups, leading to increased total diet weight (+300 g/d). Those changes were mostly similar across income quintiles, but lower-income individuals needed to introduce significantly more fruit and vegetables than higher-income ones
In France, the dietary changes needed to reach nutritional adequacy without increasing cost are similar regardless of income, but may be more difficult to implement when the budget for food is lower than 3.85 euros/d
Summary
In spite of a global improvement in living conditions, Europe still shows social inequalities in health, with differences in morbidity and mortality according to socioeconomic position (SEP) [1,2,3]. These inequalities are significant in France, and have been widening [4]. Foods of lower nutritional value and lower-quality diets generally cost less per calorie They are more often consumed by groups of lower SEP[15], probably because individuals with limited resources are more strongly influenced by prices when they purchase food[16,17,18,19]. Given that food expenditure accounts for a larger share of a low-income household’s budget[20,21], and that cost constraints orient food choices towards less healthy foods[22,23], economic constraints are held to contribute to the higher prevalence of unhealthy eating among individuals with low SEP[15]
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