Little Variation in Diet Cost Across Wide Ranges of Overall Dietary Quality among Youth with Type 1 Diabetes

Published:September 27, 2014DOI:


      We examined the association of diet quality with diet cost in a sample of youth with type 1 diabetes, for whom diet is an important component of medical management. Differences in food group spending by diet quality were also examined to identify potential budgetary reallocation to improve overall diet quality. Families of 252 youth with type 1 diabetes aged 8 to 18 years completed 3-day youth diet records. Cost of each food reported was calculated based on the average price obtained from two online grocery stores. Diet cost was estimated as average daily cost of foods consumed. The Healthy Eating Index 2005 (HEI2005), Nutrient Rich Foods Index version 9.3, and Whole Plant Food Density scores were evaluated. Differences in mean daily diet cost across tertiles of HEI2005, Nutrient Rich Foods Index version 9.3, and Whole Plant Food Density were modest, with none reaching statistical significance. Those in the upper tertile of HEI2005 spent more on whole fruit, whole grains, lean meat, and low-fat dairy, and less on high-fat meat and high-fat dairy compared with those in the lower tertiles. Higher-quality diets can be obtained at comparable costs to lesser-quality diets, suggesting that cost need not be an insurmountable barrier to more healthful eating. Reallocation of spending may increase overall quality without substantially increasing overall spending. Findings suggest potential strategies for assisting families of youth with type 1 diabetes in identifying cost-effective ways to achieve a more healthful diet.


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      T. Nansel is a senior investigator, Health Behavior Branch, Division in Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.


      D. Haynie is a staff scientist, Health Behavior Branch, Division in Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.


      L. Lipsky is a staff scientist, Health Behavior Branch, Division in Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.


      S. Mehta is an assistant investigator, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA.


      L. Laffel is chief, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA.