Diet Cost Research Articles

P17-028-23 Developing a Standard for Global Monitoring of the Cost and Affordability of Healthy Diets

P17-028-23 Developing a Standard for Global Monitoring of the Cost and Affordability of Healthy Diets

Healthy Eating for All? The Challenge of Adhering to Dietary Guidelines for Low-Income Groups in China.

The Chinese Dietary Guidelines propose a balanced diet for healthy living, but the affordability of this diet needs to be considered, especially for low-income households. To investigate the affordability of a healthy diet, this study analyzes the daily retail prices of 46 food items in 36 Chinese cities from 2016 to 2021. This study compares expenditure, diet composition, and nutritional status in two scenarios aligned with the guidelines. The results show that the mean minimum cost of a balanced diet exceeds the current per capita food expenditure for at least 182.85 million urban households. This suggests that low-income people would need to increase their expenditure by at least 20-121% to achieve the recommended diets. This study also identifies affordable and nutrient-dense foods such as standard flour, eggs, black beans, and cabbage, which policymakers should focus on when monitoring food prices. The findings recommend a combination of social and food system policies to reduce prices and make healthy diets accessible. This study identifies the gaps in the Chinese Dietary Guidelines for ensuring accessibility for vulnerable groups and provides a template for policymakers and researchers to track diet affordability using available food price data in China, contributing to China's 2030 Health Plan and the UN's Sustainable Development Goals.

Current Trends with Enzymes Applications in Industrial Broilers Production

Background: This study was conducted to analyse the effect of different enzymes and selenium on production performance and slaughter parameters of Ross (308) broilers production. Method: There were four groups in this experiment, two of them were control and the two test groups. All groups had the same number of one-day-old chickens (20250), moved in the same day. 100 chickens were selected randomly for future analyses. The chickens in the control group were fed with the standard commercial diet which contained crude protein (22.04%, 18.55%, 17.89%) and metabolic energy including selenium (11.99 MJ/kg, 12.64 MJ/kg, 12.79 MJ/kg) for starter, grower and finisher phases respectively. The basal diet was supplemented with: HiPhos - 6 phytase, WX - endo-1,4- betaxylanase, VP-endo-1,3(4)- beta-glucanase and ProAct - serine protease. The experimental group also used organic selenium. Results: Production performance and carcass parameters were not statistically different among treatment groups. Only mortality was decreased in one of the experimental groups (p less than 0.004). Whereas, the use of enzymes and selenium did no effect on the production performance and carcass parameters. The results indicate reduced feed cost of broilers diet with the use of enzymes as feed components. Result from presented work can be considered as complementary contribution in in broiler production.

Food insecurity is associated with glycemic markers, and socioeconomic status and low-cost diets are associated with lipid metabolism in Mexican mothers

The association between socioeconomic status (SES) and chronic disease has recently become more evident in middle- and low-income countries. We hypothesized that poor socioeconomic conditions, such as food insecurity, low educational level, or low SES, may restrict access to a healthy diet and may be associated with cardiometabolic risk independently of body fat. This study examined the relation between socioeconomic indicators, body fat, and cardiometabolic disease risk markers in a random sample of mothers living in Queretaro, Mexico. Young and middle-aged mothers (n = 321) answered validated questionnaires to determine SES, food insecurity, and educational level and a semiquantitative food frequency questionnaire to determine dietary patterns and the cost of individual diet. Clinical measurements included anthropometry, blood pressure, lipids profile, glucose, and insulin. Obesity was present in 29% of the participants. Women with moderate food insecurity had higher waist circumference, glucose, insulin, and homeostasis model assessment of insulin resistance than women with food security. High triglyceride concentration and lower levels of high-density lipoprotein and low-density lipoprotein cholesterol were associated with lower SES and lower educational level. Women who consumed a lower carbohydrate diet had higher SES, higher education, and better cardiovascular risk markers. The higher carbohydrate diet profile was the least expensive diet. There was an inverse association between the cost and energy-density of foods. In conclusion, food insecurity was associated with glycemic control markers, and lower SES and education were related to a low-cost, higher carbohydrate diet and to a greater cardiovascular risk. The influence of the social environment on obesity and cardiovascular diseases needs to be further explored.

The Nutrient Rich Food Price Index: a nutrition-relevant adaptation of the Laspeyres price index to track the cost of affordable nutrient density.

The Laspeyres price index is the ratio of the current cost of a market basket of commodities or food groups relative to base period prices. To develop a nutrition-relevant version of the Laspeyres price index, using market baskets based on tertiles of the nutrient rich food (NRF9.3) nutrient density metric. Nutrient composition data for 151 foods from the 2012 Mexico national health and nutrition survey (ENSANUT) were merged with food prices and price indices from the national institute of geography and statistics (INEGI). Nutrient Rich Food Index (NRF9.3) was the measure of nutrient density. May 2012 was the base period. Nutrient rich food price index (NRFPI) values were calculated for each tertile of NRF nutrient density scores for each month between June 2011 and March 2022. The market basket of foods in the top tertile of NRF nutrient density scores cost more per 100 kcal and had higher NRFPI values compared to foods in the bottom tertile. Higher NRF9.3 scores were correlated with greater monthly inflation. The NRFPI for foods in the top tertile of NRF9.3 scores was marked by seasonal price spikes, and greater volatility compared to foods in the bottom tertile. The present adaptation of the Laspeyres Index used market baskets defined by nutrient density tertiles instead of commodity groups. This approach allows for easier tracking of the cost of nutrient dense foods and healthful diets across geographic regions and over time. Applied to Mexico food prices prior to and during the Covid-19 pandemic, the NRFPI was sensitive to time trends, seasonality, and price fluctuations. The new tool may be useful in monitoring the rising cost of healthy foods worldwide.

A step toward a biofloc system with no‐carbon addition: Increasing dietary lipid level enhances the water quality and body chemical composition without affecting tilapia health status

AbstractA 70‐day experiment was carried out to evaluate biofloc system operation with no carbon addition by manipulating dietary protein and lipid levels for Nile tilapia (Oreochromis niloticus) cultivation. Three treatments were conducted; Control treatment (C; fed on a 30% crude protein [CP] diet supplemented with 3% vegetable oil [VO] + addition of external carbon source [ECS] in rearing tank), low protein–low lipid treatment (LPLL; fed on 23% CP diet supplemented with 3% (VO) + no addition of ECS) and low protein–high lipid treatment (LPHL; fed on 23% CP diet supplemented with 9% VO + no addition of ECS). The C treatment recorded the highest values (p < 0.05) in terms of final body weight (FBW), specific growth rate, floc volume, total suspended solids, and ammonia nitrogen. No significant differences were observed between C and LPHL treatments regarding FBW and protein efficiency ratio. The liver sections of LPHL treatment showed better values for histological alteration index compared to the control. It could be concluded that applying a biofloc system with no carbon addition using LPHL diets may afford better water quality conditions, limit the environmental impact and decrease dietary costs with limited effect on fish performance.

Measuring changes in diet deprivation: New indicators and methods

Improving diet quality is an emerging development policy priority. Existing indicators emphasize the cost and affordability of healthy diets but have not attempted to measure how far households are from ideal diets or how policies may nudge them closer to them. We propose a new Reference Diet Deprivation (ReDD) index, estimated from household consumption survey data, that measures the incidence, breadth, and depth of diet deprivation across multiple food groups. While informative as a standalone measure, we demonstrate how the ReDD index can be integrated into an economic model to examine changes in diet quality under different policy or external shocks. Our Nigerian case study shows that productivity growth in the dairy, pulse & nut, fruit, and red meat value chains have more potential than staple crops to reduce diet deprivation. While these findings have implications for food and agricultural policy prioritization in Nigeria, the study more importantly demonstrates the usefulness of the ReDD index for assessing diet quality and examining the drivers of dietary change when used in conjunction with a simulation model.

Inclusive diets within planetary boundaries

Inclusive diets within planetary boundaries

Changes in milk production and estimated income over feed cost of group-housed dairy cows when moved between pens

Several studies have shown advantages of feeding cows in groups according to their nutrient requirements. However, there are concerns about losing milk when cows change from a high- to a low-nutrient diet. Data from 1,960 cows from 3 herds were analyzed to assess the impact on milk yield and estimated income over feed cost (IOFC) when moving cows between pens and rations. Pen feed intake and individual body weight and milk yield were recorded daily for 21 d before and 21 d after every pen movement. The data included 2,142 pen movements, and for each movement, milk production was recorded for 21 d before and 21 d after the change. Within farm, group, and cow, milk yield during the 21 d preceding a pen movement was used to predict milk yield for the subsequent 21 d using linear regression. Individual dry matter intake was estimated based on cow performance and diet composition, and then individual IOFC was calculated. Differences between actual and predicted milk yield and IOFC during the 21 d following a movement were determined and contrasted against zero using t-tests. In all 3 farms, every pen movement involved a change from a more expensive ration with more energy and protein than the one fed after the movement. On average, in all cases but one, observed milk yield was lower than the forecasted milk yield had cows not been moved. However, IOFC, on average, was positive in all cases except for 2 pen movements on 2 farms. Reasons for the improved IOFC with lower milk yield were due to a nutrient cost advantage, whereas, when IOFC decreased, differences in nutrient supply and dietary cost were not able to offset differences in milk yield. Moving cows according to milk production level does not result in economic advantages when the unit cost of nutrients is greater in the original than in the receiving ration. However, when the cost and nutrient difference between the diets offset potential losses in milk, forming groups according to production is advantageous.

Greenhouse gas emissions, cost, and diet quality of specific diet patterns in the United States

BackgroundMajor policy agendas are calling for accelerated investment in research that addresses the impact of diet patterns on multiple domains of sustainability. ObjectivesTo evaluate the comparative greenhouse gas emissions, diet cost, and diet quality of plant-based, low-grain, restricted carbohydrate, low-fat, and time-restricted diet patterns on a daily per capita basis. MethodsDietary data from the National Health and Nutrition Examination Survey (2013–2016, n = 4025) were merged with data on greenhouse gas emissions (GHGEs) and food prices from multiple databases. The Healthy Eating Index-2015 was used to measure diet quality. ResultsThe plant-based diet pattern had the lowest GHGEs [3.5 kg carbon dioxide equivalent (CO2eq); 95% confidence interval (CI): 3.3, 3.8 kg CO2eq] and among the lowest diet cost ($11.51; 95% CI: $10.67, $12.41), but diet quality (45.8; 95% CI: 43.3, 48.5) was similar (P > 0.005) to most other diet patterns. All of the sustainability impacts of the low-grain diet pattern were intermediate. The restricted carbohydrate diet pattern had the highest diet cost ($18.46; 95% CI: $17.80, $19.13) but intermediate diet quality (46.8; 95% CI: 45.7, 47.9) and moderate-to-high GHGEs (5.7 kg CO2eq; 95% CI: 5.4, 5.9 kg CO2eq). The low-fat diet pattern had the highest diet quality (52.0; 95% CI: 50.8, 53.1) and intermediate GHGEs (4.4 kg CO2eq; 95% CI: 4.1, 4.6 kg CO2eq) and diet cost ($14.53; 95% CI: $13.73, $15.38). The time-restricted diet pattern had among the lowest diet quality score (42.6; 95% CI: 40.8, 44.6), had GHGEs similar to most other diet patterns (4.6 kg CO2eq; 95% CI: 4.2, 5.0 kg CO2eq), and low-to-moderate diet cost ($12.34; 95% CI: $11.38, $13.40). ConclusionsMost diet patterns are associated with sustainability trade-offs. The nature of these trade-offs can help inform discussions on food and nutrition policy in the United States, including the National Strategy on Hunger, Nutrition, and Health, and future Dietary Guidelines for Americans.

Interpreting alignment to the EAT-Lancet diet using dietary intakes of lactating mothers in rural Western Kenya.

The EAT-Lancet reference diet intends to be good for planetary and human health. We compared single multiple pass method 24-h dietary intake of mothers (n = 242) from a cross-sectional study in Western Kenya to the recommended range of intake of 11 EAT-Lancet food groups (e.g., 0-100 g/day legumes; maximum score 11), defining alignment two ways: daily intake among food groups where a minimum intake of 0 g was either acceptable or unacceptable. Ordinal logistic regression models assessed associations between alignment and body mass index (BMI). Cost of mothers' diets and hypothetical diets within recommended ranges (lower bounds >0 g) were estimated using food price data from markets within the mothers' locality. Mean energy intake was 1827 (95% confidence interval [CI]: 1731-1924) kcal/day. Relative to the EAT-Lancet diet, mothers' diets were on average higher for grains; within recommendations for tubers, fish, beef and dairy; closer to lower bounds for chicken, eggs, legumes and nuts; and lower for fruits and vegetables. Mean (95% CI) alignment scores were 8.2 (8.0-8.3) when 0 g intakes were acceptable and 1.7 (1.6-1.9) otherwise. No significant associations were found between alignment and BMI. Mothers' diets and hypothetical diets within recommended ranges averaged 184.6 KES (1.6 USD) and 357.5 KES (3.0 USD)/person/day, respectively. Lactating mothers' diets were not diverse and diverged from the reference diet when an intake of 0 g was considered unacceptable. Lower bound intakes of 0 g for micronutrient-dense food groups are inappropriate in food-insecure populations. It would likely cost more than mothers currently spend to tailor their diets to the EAT-Lancet reference diet.

Impact of phase-feeding programs on performance of broiler chickens in Nigeria

Phase-feeding is the feeding of several diets for a relatively short period of time to specifically meet an animal’s nutrient requirements. The study evaluated the effect of different phase feeding methods on growth and carcass characteristics of broiler chickens. A total of 120-day-old chicks of the FIDAN strain were assigned to four dietary treatments of 30 birds each, 15 birds per replicate. Birds were fed at different phases: Phase 1 were fed broiler starter diet alone for 8 weeks; Phase 2 birds were fed starter diet from 0-4 weeks and 1st finisher diet from 5-8 weeks. Phase 3 birds were fed starter diet from 0-3 weeks, 1st finisher diet from 4-6 weeks and 2nd finisher diet from 6-8 weeks. Phase 4 birds were fed starter diet from 0-2 weeks, 1st finisher diet from 2-4 weeks, 2nd finisher diet from 4-6 weeks and 3rd finisher diet from 6-8 weeks of age. Result no significant differences (p>0.05) between the groups in body weight gain (2.91–2.47 kg/bird) and feed conversion ratio (2.03–2.34). Total feed intake was highest in phase 1 (6.70 kg/bird) followed by phase 2 birds (6.41 kg). Dressed weight in Phase 1 was significantly (p<0.05) higher than others, followed by Phase 2. Dressing percentage did not differ significantly (p>0.05) between the groups. Feed cost between treatments was however significantly (p<0.05) different, Phase 1 diet being costliest. Phase-feeding using phase 4 regime elicited reduced dietary cost without compromising optimal performance of the birds.

Context Specific Complementary Feeding Recommendations for Children in Pakistan Based on Secondary Analysis of National Complementary Feeding Assessment and Pakistan Demographic Health Survey 2018

Background In Low Middle-Income Countries (LIMCs), malnutrition, especially undernutrition is one of the leading causes of childhood mortality and morbidity. Poor complementary feeding practices are among the most notable contributors to poor nutritional indicators in children under five. This article provides an output of secondary data analysis of the Cost of Diet (CoD) and Optifood component of National Complementary Feeding Assessment conducted by UNICEF Pakistan along with Pakistan Demographic Health Survey (PDHS) 2018. Methods For correlation of Optifood data and CoD data with PDHS data of CF, GraphPad software, MS Excel was used along with manual quantifications. The analysis of DHS-2018 data was conducted using STATA software. Univariate analysis included comparison of categorical variables i.e. various individual, household and community level parameters with that of outcome variables of minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum dietary diversity (MAD) using chi-square test. Findings The overall rate of MMF was 56.6% among children of 6-23 months of age with MDD in 18.6% and MAD in 13.8% of children. Percentage of annual cost spent on nutritious diet for MDD, MMF and MAD varies from 27.86% to 43.08% across all the provinces. Children aged 6–8 months and 9–11 months often consumed infant milk and cereals, while children aged 12–23 months often consumed eggs and grain products. Consumption of dairy products was highest in Punjab, Sindh, AJK, and Islamabad, that of grains roots and tubers was highest in KPK, FATA and GB. Conclusion Considering CF practices in Pakistan are inadequate as indicated by poor MDD, MMF, and MAD, therefore it is imperative that a holistic approach using both communication and non-communication based interventions is to be employed through active stakeholder engagement.

Socioeconomic Level and the Relationship in Glycemic Behavior in the Mexican Population. A Nutritional Alternative Focused on Vulnerable Populations.

In this study, numerical approximations were generated to analyze the behavior of glycemic variations in the non-diabetic population of the Mexican republic. The main objective of this work is to obtain an overview of the glycemic variations in the non-diabetic population from different socioeconomic statuses in Mexico (Medium-high, medium, and low). Thus, evaluating the effect on the glucose level under a healthy diet considering the socioeconomic capabilities of the population. Through the national health and nutrition survey of Mexico 2020 and the Mexican food base, 1420 virtual patients were proposed (522 low status, 485 medium status and 413 Medium-High status) focused on simulating the glycemic behavior in each of the survey participants. Considering that the average food expenditure of the Mexican population is $107.00 MXN, and the cost of a healthy diet is $66.50 MXN, the economic sustainability of the Mexican population to adopt a healthy diet is revealed. The particularity of this work is focused on obtaining diverse data that are difficult to access in the development of population analyses. Such is the case of the approach proposed for different socioeconomic statuses. In this way, the proposed methodology provides a framework for complementary research contributions to the subject.

Assessing the diet quality, environmental impact, and monetary costs of the dietary transition in China (1997–2011): Impact of urbanization

BackgroundIncreased urbanization has been linked to transitions in dietary patterns. However, evidence on the impacts of urbanization on diet quality, and environmental impact, and diet cost is limited. The aim of this study was to investigate the time trends of these three dietary sustainability in China over the period 1997–2011 and to examine their associations with urbanization.MethodsFood consumption of 8,330 participants (18–64y) of the China Health and Nutrition Survey cohort (1997, 2000, 2004, 2006, 2009, and 2011) were examined and diet quality was assessed using the Chinese Healthy Eating Index 2016 (CHEI2016). Dietary related environmental impacts on Greenhouse Gas Emissions (GHGE), Total Water Use (TWU), and Land Use (LU) were estimated using the Chinese Food Life Cycle Assessment Database. Monetary cost of diet was calculated using the community market prices of food items. Multilevel mixed-effects models were used to estimate associations between the time trend of dietary sustainability indicators and degree of urbanization.ResultsFrom 1997 to 2011, the CHEI2016 score increased by 10.6%, GHGE by 23.8%, LU by 29.1%, and the inflation-corrected cost of diet by 80%. Urbanization was positively associated with these time trends, which remained after adjustment for sociodemographic and lifestyle factors (all P < 0·05).ConclusionThe rapid urbanization in China over the past two decades has been followed by an improvement in the overall dietary quality, but this has been accompanied by an increase in the environmental impacts and higher cost of the diet, especially in communities with lower urbanization index.

Decrypting the Effect of COVID-19 Pandemic on Food and Nutrition Security in Kenya

Globally, there has been tremendous effort towards ending hunger and malnutrition in all its forms by the year 2030. These efforts have not realized the desired results due to conflicts within and without countries, climate variability and extremes, and economic slowdowns and downturns. In Kenya, food and nutrition insecurity existed even before the emergence of COVID-19 pandemic. With the occurrence of the pandemic, food systems and food supply chains relied upon by the population to access sufficient and affordable food of high nutritional value further worsened the already unfavorable situation. The gradual shocks and interruptions on food systems and food supply chains by the climate change, high poverty levels, income inequality, high cost of healthy diets, labor shortages coupled with global recession and pandemic containment measures required urgent attention and timely interventions to protect the vulnerable population. This view point paper provides an insight of the effect of COVID-19 pandemic on food and nutrition security, and the trends affecting food systems. The paper adopted descriptive approach which utilized an array of contemporary scholarly views and their research outputs on food and nutrition security which resonated with the Kenyan situation. The study findings emphasized on the need to adopt a multidisciplinary and multifaceted approach when addressing food and nutrition security even at the time of a pandemic in order to achieve the intent for the realization of the right to food of high nutritional value. The study revealed that Kenya should adopt diverse strategies for enhancing food and nutrition security, thus including crop diversification, crop bio-fortification, research on genomics and precision breeding, agroecology technique application, capacity building of extension workers, investing in climate smart agriculture and adoption of human centered design model to enhance resilient food systems. The findings will be vital to policy and decision-makers responsible for food and nutrition security.

The Cost of a Nutritious Diet for Households Including People Living with HIV/AIDS in Nova Scotia: Findings and Lessons Learned by FoodNOW 2020 to 2022.

Purpose: FoodNOW (Food to eNhance Our Wellness) engaged in assessment of simulated households that include a person living with HIV/AIDS (PLWHA) in Nova Scotia to determine if a basic nutritious diet is affordable.Methods: We used supermarket websites to cost food and beverage items listed in the National Nutritious Food Basket (NNFB) for simulated households, each with a PLWHA. Food costing methodologies were co-developed and adapted with community members in response to barriers presented by the COVID-19 pandemic.Results: We found that simulated households, each with one PLWHA, that had a potential deficit after monthly expenses were a household of four on Income Assistance (-$1,058.70), a lone mother with two children on Income Assistance (-$973.65), a lone man on Income Assistance (-$677.40), and a household of four with one minimum-wage earner (-$383.45).Conclusions: Nova Scotia households with a PLWHA living on Income Assistance or with a minimum-wage earner cannot reasonably afford a nutritious diet in addition to basic household expenses. Using these food costing data can allow dietitians to efficiently inform government action and policy change to improve the health and wellness of individuals and families.

Silages of agro-industrial by-products in lamb diets – Effect on growth performance, carcass, meat quality and in vitro methane emissions

The use of agro-industrial by-products in animal feed is an opportunity to reduce imports, food waste and promote a clean and circular economy, turning worthless raw materials into high-quality and low-cost animal feeds, which does not compete with human food. This study aims to produce silages with by-products of carrot, sweet potato, potato, and tomato pomace and integrate them in lamb diets, replacing 50% of dry matter (DM) of a concentrate-based diet. Effects on growth performance, meat quality and methane production were evaluated. Three silages were produced using 350 g/kg tomato pomace, 200 g/kg wheat bran, 150 g/kg alfalfa hay and 300 g/kg potato (Psil) or 300 g/kg sweet potato (SPsil) or 300 g/kg carrot (Csil). Thirty-two lambs were housed individually and divided into four groups (8 animals/group) on the following diets: Control - 850 g/kg concentrate and 150 g/kg hay; P - 500 g/kg concentrate and 500 g/kg Psil in DM; SP – 500 g/kg concentrate and 500 g/kg SPsil in DM; C – 500 g/kg concentrate and 500 g/kg Csil in DM. The trial lasted 6 weeks after 1 week of adaptation. Methane production was assessed in vitro by the Ankom system, using as inoculum rumen content samples collected individually from 6 lambs on each diet at slaughter. Diet had no effect on DM intake, average daily gain and DM conversion ratio, averaging 1055 ± 248 g, 320 ± 61.1 g and 3.35 ± 0.600, respectively. Also, carcass characteristics were not affected by the diet except for the lightness of subcutaneous fat which was increased by the silage diets (L* value, P = 0.016). The meat parameters, pH, intramuscular fat, shear force, cooking losses and sensory attributes, were not affected by the diet. In meat color, the parameters a* and Chroma were highest in animals fed diet C, have an intermediate value with Control diet and are lowest with diets P and SP (P = 0.027 and P = 0.012, respectively). Diets had no impact on total methane emissions. The costs of the silage diets per kg live weight gain were lower than those of Control diet (P = 0.018). In summary, by-product silage can be a good option to replace concentrated feed in lamb diets without altering the growth performance and meat quality or methane production and thus contributing to the sustainability of livestock farms and the environment.

Cost of Recommended Diet (CoRD) and Its Affordability in Bangladesh.

The cost of diet has been recognized as a major determinant of overall diet quality and nutritional outcomes. We aimed to estimate the minimum cost and affordability of the recommended diet based on the updated food-based dietary guidelines (FBDG) in Bangladesh. To compute the cost of the recommended diet (CoRD), we collected retail prices of foods corresponding to each of the food groups in the latest Bangladeshi FBDG. For affordability, the household size and daily food expenditure data were used from the most recent Household Income and Expenditure survey (HIES). The CoRD was calculated based on the average number of servings recommended for each food group; the CoRD was adjusted by a deflation factor and divided by the household's daily food expenditure to estimate affordability. We found that the CoRD was $0.87 (83 BDT) per person per day at the national level. Nationally, about 43% of households could not afford the CoRD, with rural areas bearing a disproportionate share of the burden. We also found households to overspend on starchy staples while underspending on protein-rich foods, fruits, and dairy. These findings highlight the need for immediate implementation of interventions to improve the affordability of the CoRD and redesign policy instruments to create a sustainable food system.

Healthy Food Prices Increased More Than the Prices of Unhealthy Options during the COVID-19 Pandemic and Concurrent Challenges to the Food System.

Food prices have escalated due to impacts of the COVID-19 pandemic on global food systems, and other regional shocks and stressors including climate change and war. Few studies have applied a health lens to identify the most affected foods. This study aimed to assess costs and affordability of habitual (unhealthy) diets and recommended (healthy, equitable and more sustainable) diets and their components in Greater Brisbane, Queensland, Australia from 2019 to 2022 using the Healthy Diets Australian Standardised Affordability and Pricing protocol. Affordability was determined for reference households at three levels of income: median, minimum wage, and welfare-dependent. The recommended diet cost increased 17.9%; mostly in the last year when the prices of healthy foods, such as fruit, vegetables and legumes, healthy fats/oils, grains, and meats/alternatives, increased by 12.8%. In contrast, the cost of the unhealthy foods and drinks in the habitual diet 'only' increased 9.0% from 2019 to 2022, and 7.0% from 2021 to 2022. An exception was the cost of unhealthy take-away foods which increased by 14.7% over 2019-2022. With government COVID-19-related payments, for the first time recommended diets were affordable for all and food security and diets improved in 2020. However, the special payments were withdrawn in 2021, and recommended diets became 11.5% less affordable. Permanently increasing welfare support and providing an adequate minimum wage, while keeping basic, healthy foods GST-free and increasing GST to 20% on unhealthy foods, would improve food security and diet-related health inequities. Development of a Consumer Price Index specifically for healthy food would help highlight health risks during economic downturns.