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

Published:September 27, 2014DOI:https://doi.org/10.1016/j.jand.2014.07.035

      Abstract

      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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      References

        • Overby N.C.
        • Margeirsdottir H.D.
        • Brunborg C.
        • Andersen L.F.
        • Dahl-Jorgensen K.
        The influence of dietary intake and meal pattern on blood glucose control in children and adolescents using intensive insulin treatment.
        Diabetologia. 2007; 50: 2044-2051
        • Liese A.D.
        • Bortsov A.
        • Gunther A.L.B.
        • et al.
        Association of DASH diet with cardiovascular risk factors in youth with diabetes mellitus: The SEARCH for Diabetes in Youth Study.
        Circulation. 2011; 123: 1410-1417
        • American Diabetes Association
        Nutrition recommendations and interventions for diabetes: A position statement of the American Diabetes Association.
        Diabetes Care. 2008; 31: S61-S78
        • Smart C.
        • Slander-van Vliet E.
        • Waldron S.
        Nutritional management in children and adolescents with diabetes.
        Pediatr Diabetes. 2009; 10: 100-117
        • Nansel T.R.
        • Haynie D.L.
        • Lipsky L.M.
        • Laffel L.M.B.
        • Mehta S.M.
        Multiple indicators of poor diet quality in children and adolescents with type 1 diabetes are associated with higher body mass index percentile but not glycemic control.
        J Am Acad Nutr Diet. 2012; 112: 1728-1735
        • Kershnar A.K.
        • Daniels S.R.
        • Imperatore G.
        • et al.
        Lipid abnormalities are prevalent in youth with type 1 and type 2 diabetes: The SEARCH for diabetes in youth study.
        J Pediatr. 2006; 149: 314-319
        • Mayer-Davis E.J.
        • Nichols M.
        • Liese A.D.
        • et al.
        Dietary intake among youth with diabetes: The SEARCH for Diabetes in Youth Study.
        J Am Diet Assoc. 2006; 106: 689-697
        • Lucan S.C.
        • Barg F.K.
        • Long J.A.
        Promoters and barriers to fruit, vegetable, and fast-food consumption among Urban, low-income African Americans—A qualitative approach.
        Am J Public Health. 2010; 100: 631-635
        • Hargreaves M.K.
        • Schlundt D.G.
        • Buchowski M.S.
        Contextual factors influencing the eating behaviours of African American women: A focus group investigation.
        Ethn Health. 2002; 7: 133-147
        • Cunningham-Sabo L.
        • Bauer M.
        • Pareo S.
        • Phillips-Benally S.
        • Roanhorse J.
        • Garcia L.
        Qualitative investigation of factors contributing to effective nutrition education for Navajo families.
        Matern Child Health J. 2008; 12: S68-S75
        • Hampson S.E.
        • Martin J.
        • Jorgensen J.
        • Barker M.
        A social marketing approach to improving the nutrition of low-income women and children: An initial focus group study.
        Public Health Nutr. 2009; 12: 1563-1568
        • Glanz K.
        • Basil M.
        • Maibach E.
        • Goldberg J.
        • Snyder D.
        Why Americans eat what they do: Taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption.
        J Am Diet Assoc. 1998; 98: 1118-1126
        • Young C.M.
        • Batch B.C.
        • Svetkey L.P.
        Effect of socioeconomic status on food availability and cost of the dietary approaches to stop hypertension (DASH) dietary pattern.
        J Clin Hypertens. 2008; 10: 603-611
        • French S.A.
        Pricing effects on food choices.
        J Nutr. 2003; 133: 841S-843S
        • Hammond G.K.
        • Chapman G.E.
        Decision-making in the dairy aisle: Maximizing taste, health, cost and family considerations.
        Can J Diet Pract Res. 2008; 69: 66-70
        • Drewnowski A.
        The cost of US foods as related to their nutritive value.
        Am J Clin Nutr. 2010; 92: 1181-1188
        • Maillot M.
        • Darmon N.
        • Vieux F.
        • Drewnowski A.
        Low energy density and high nutritional quality are each associated with higher diet costs in French adults.
        Am J Clin Nutr. 2007; 86: 690-696
        • Monsivais P.
        • Drewnowski A.
        Lower-energy-density diets are associated with higher monetary costs per kilocalorie and are consumed by women of higher socioeconomic status.
        J Am Diet Assoc. 2009; 109: 814-822
        • Waterlander W.E.
        • de Haas W.E.
        • van Amstel I.
        • et al.
        Energy density, energy costs and income—How are they related?.
        Public Health Nutr. 2010; 13: 1599-1608
        • Townsend M.S.
        • Aaron G.J.
        • Monsivais P.
        • Keim N.L.
        • Drewnowski A.
        Less-energy-dense diets of low-income women in California are associated with higher energy-adjusted diet costs.
        Am J Clin Nutr. 2009; 89: 1220-1226
        • Lipsky L.
        Are energy-dense foods really cheaper? Reexamining the relation between food price and energy density.
        Am J Clin Nutr. 2009; 90: 1397-1401
        • Carlson A.
        • Frazao E.
        Are Healthy Foods Really More Expensive? It Depends on How You Measure the Price.
        US Department of Agriculture, Economic Research Service, Washington, DC2012 (ERS Report No. 96)
        • Frazao E.
        • Carlson A.
        • Stewart H.
        Energy-adjusted food costs make little economic sense.
        Am J Clin Nutr. 2011; 93: 861
        • Frazao E.
        Less-energy-dense diets of low-income women in California are associated with higher energy-adjusted costs but not with higher daily diet costs.
        Am J Clin Nutr. 2009; 90: 701
        • Goulet J.
        • Lamarche B.
        • Lemieux S.
        A nutritional intervention promoting a Mediterranean food pattern does not affect total daily dietary cost in North American Women in free-living conditions.
        J Nutr. 2008; 138: 54-59
        • Ottelin A.-M.
        • Lindstrom J.
        • Peltonen M.
        • et al.
        Costs of a self-selected, health-promoting diet among the participants of the Finnish Diabetes Prevention Study.
        Diabetes Care. 2007; 30: 1275-1277
        • Raynor H.A.
        • Kilanowski C.K.
        • Esterlis I.
        • Epstein L.H.
        A cost-analysis of adopting a healthful diet in a family-based obesity treatment program.
        J Am Diet Assoc. 2002; 102: 645-656
        • Banks J.
        • Williams J.
        • Cumberlidge T.
        • Cimonetti T.
        • Sharp D.J.
        • Shield J.P.H.
        Is healthy eating for obese children necessarily more costly for families?.
        Br J Gen Pract. 2012; 63: e1-e5
        • Drewnowski A.
        • Eichelsdoerfer P.
        The Mediterranean diet: Does it have to cost more?.
        Public Health Nutr. 2009; 12: 1621-1628
        • Stewart H.
        • Hyman J.
        • Frazao E.
        • Buzby J.C.
        • Carlson A.
        Can low-income Americans afford to satisfy MyPyramid fruit and vegetable guidelines?.
        J Nutr Educ Behav. 2011; 43: 173-179
        • Kirkpatrick S.I.
        • Tarasuk V.
        The relationship between low income and household food expenditure patterns in Canada.
        Public Health Nutr. 2003; 6: 589-597
        • Katz M.L.
        • Laffel L.M.
        • Perrin J.M.
        • Kuhlthau K.
        Impact of type 1 diabetes mellitus on the family is reduced with the medical home, care coordination, and family-centered care.
        J Pediatr. 2012; 160: 861-867
        • Schakel S.F.
        Maintaining a nutrient database in a changing marketplace: Keeping pace with changing food products—A research perspective.
        J Food Comp Anal. 2001; 14: 315-322
      1. Schakel SSYBI. Sources of data for developing and maintaining a nutrient database. J Am Diet Assoc. 1988;88(10):1268-1271.

      2. Guenther PM, Reedy J, Krebs-Smith SM, Reeve BB, Basiotis PP. Development and evaluation of the Healthy Eating Index-2005: Technical report. 2007. http://www.cnpp.usda.gov/HealthyEatingIndex.htm. Accessed August 18, 2014.

      3. Nutrition and Your Health: Dietary Guidelines for Americans, 2005. US Department of Agriculture, Washington, DC2005
        • Miller P.E.
        • Mitchell D.C.
        • Harala P.L.
        • Pettit J.M.
        • Smiciklas-Wright H.
        • Hartman T.J.
        Development and evaluation of a method for calculating the Healthy Eating Index-2005 using the Nutrition Data System for Research.
        Public Health Nutr. 2011; 14: 306-313
        • Fulgoni V.L.
        • Keast D.R.
        • Drewnowski A.
        Development and validation of the nutrient-rich foods index: A tool to measure nutritional quality of foods.
        J Nutr. 2009; 139: 1549-1554
        • Lipsky L.
        • Cheon K.
        • Nansel T.R.
        • Albert P.
        Candidate measures of whole plant food intake are related to biomarkers of nutrition and health in the US population (NHANES 1999-2002).
        Nutr Res. 2012; 32: 251-259
      4. Behavioral Risk Factor Surveillance System Survey Questionnaire. US Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GA2002
        • Adabonyan I.
        • Loustalot F.
        • Kruger J.
        • Carlson S.A.
        • Fulton J.E.
        Prevalence of highly active adults—Behavioral Risk Factor Surveillance System, 2007.
        Prev Med. 2010; 51: 139-143
      5. Poverty thresholds 2008. 2010. http://www.census.gov/hhes/www/poverty/data/threshld/thresh08.html. Accessed August 18, 2014.

      6. Consumer Expenditure Surveys. US Bureau of Labor Statistics, Washington, DC2010
      7. Carlson A, Lino M, Juan WY, Hanson K, Basiotis P. Thrifty food plan, 2006 http://www.cnpp.usda.gov/sites/default/files/usda_food_plans_cost_of_food/TFP2006Report.pdf. Accessed September 4, 2014.

      8. Carlson A, Lino M, Fungwe T. The low-cost, moderate-cost, and liberal food plans, 2007. http://www.cnpp.usda.gov/Publications/FoodPlans/MiscPubs/TFP2006Report.pdf. Accessed June 11, 2011.

        • Rehm C.D.
        • Monsivais P.
        • Drewnowski A.
        The quality and monetary value of diets consumed by adults in the United States.
        Am J Clin Nutr. 2011; 94: 1333-1339
        • Frazao E.
        • Andrews M.
        • Smallwood D.
        • Prell M.
        Food Spending Patterns of Low-Income Households.
        US Department of Agriculture Economic Research Service, Washington, DC2007 (Economic Information Bulletin No. 29-4)
        • Connors M.
        • Bisogni C.A.
        • Sobal J.
        • Devine C.M.
        Managing values in personal food systems.
        Appetite. 2001; 36: 189-200
        • Furst T.
        • Connors M.
        • Bisogni C.A.
        • Sobal J.
        • Falk L.W.
        Food choice: A conceptual model of the process.
        Appetite. 1996; 26: 247-265
        • Webber C.B.
        • Sobal J.
        • Dollahite J.S.
        Shopping for fruits and vegetables. Food and retail qualities of importance to low-income households at the grocery store.
        Appetite. 2010; 54: 297-303
        • Jabs J.
        • Devine C.M.
        Time scarcity and food choices: An overview.
        Appetite. 2006; 47: 204
        • Hoelscher D.M.
        • Evans A.
        • Parcel G.S.
        • Kelder S.H.
        Designing effective nutrition interventions for adolescents.
        J Am Diet Assoc. 2002; 102: S52-S63
        • Reed J.
        • Frazao E.
        • Itskowitz R.
        How Much Do Americans Pay for Fruits and Vegetables?.
        US Department of Agriculture Economic Research Service, Washington, DC2004 (Agriculture Information Bulletin No. 790)
        • Rovner A.J.
        • Nansel T.R.
        Are children with type 1 diabetes consuming a healthful diet? A review of the current evidence and strategies for behavior change.
        Diabet Educ. 2009; 35: 97-107
        • Fungwe T.
        • Guenther P.M.
        • Juan W.Y.
        • Hiza H.
        • Lino M.
        The Quality of Children's Diets in 2003-04 as Measured by the Healthy Eating Index-2005.
        US Department of Agriculture, Center for Nutrition Policy and Promotion, Washington, DC2009 (Nutrition Insight No. 43)
      9. US Census Bureau. Mean income in the past 12 months (in 2007 inflation-adjusted dollars) 2005-2007 American community survey 3-year estimates. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_07_3YR_S1902&prodType=table. Accessed September 4, 2014.

      Biography

      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.

      Biography

      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.

      Biography

      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.

      Biography

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

      Biography

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