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Can Families Eat Better Without Spending More? Improving Diet Quality Does Not Increase Diet Cost in a Randomized Clinical Trial among Youth with Type 1 Diabetes and Their Parents

Published:August 31, 2016DOI:https://doi.org/10.1016/j.jand.2016.07.005

      Abstract

      Background

      Although cost is a frequently cited barrier to healthful eating, limited prospective data exist.

      Objective

      To examine the association of diet cost with diet quality change.

      Design

      An 18-month randomized clinical trial evaluated a dietary intervention.

      Participants and setting

      Youth with type 1 diabetes duration ≥1 year, age 8.0 to 16.9 years, receiving care at an outpatient tertiary diabetes center in Boston, MA, participated along with a parent from 2010 to 2013 (N=136). Eighty-two percent of participants were from middle- to upper-income households.

      Intervention

      The family-based behavioral intervention targeted intake of whole plant foods.

      Main outcome measures

      Diet quality as indicated by the Healthy Eating Index 2005 (HEI-2005) (which measures conformance to the 2005 Dietary Guidelines for Americans) and whole plant food density (cup or ounce equivalents per 1,000 kcal target food groups) were calculated from 3-day food records of youth and parent dietary intake at six and four time points, respectively. Food prices were obtained from two online supermarkets common to the study location. Daily diet cost was calculated by summing prices of reported foods.

      Statistical analyses performed

      Random effects models estimated treatment group differences in time-varying diet cost. Separate models for youth and parent adjusted for covariates examined associations of time-varying change in diet quality with change in diet cost.

      Results

      There was no treatment effect on time-varying diet cost for either youth (β –.49, 95% CI –1.07 to 0.08; P=0.10) or parents (β .24, 95% CI –1.61 to 2.08; P=0.80). In addition, time-varying change in diet quality indicators was not associated with time-varying change in diet cost for youth. Among parents, a 1-cup or 1-oz equivalent increase in whole plant food density was associated with a $0.63/day lower diet cost (β –.63, 95% CI –1.20 to –0.05; P=0.03).

      Conclusions

      Improved diet quality was not accompanied by greater cost for youth with type 1 diabetes and their parents participating in a randomized clinical trial. Findings challenge the prevailing assumption that improving diet quality necessitates greater cost.

      Keywords

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      Biography

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

      Biography

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

      Biography

      M. H. Eisenberg is a postdoctoral fellow, Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.

      Biography

      A. Liu is a senior investigator, Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.

      Biography

      S. N. Mehta is an assistant investigator, Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA.

      Biography

      L. M. B. Laffel is chief, Pediatric, Adolescent, and Young Adult Section, and an investigator, Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA.