Date Published: March 30, 2017
Publisher: Public Library of Science
Author(s): Matthieu Maillot, Florent Vieux, Fabien Delaere, Anne Lluch, Nicole Darmon, Jean Adams.
To explore the dietary changes needed to achieve nutritional adequacy across income levels at constant energy and diet cost.
Individual 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.
The 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.
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.
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)[1–3]. These inequalities are particularly significant in France, and have been widening . Nutrition, a major determinant of health, greatly contributes to these inequalities with unhealthy eating increasing the risk not only of obesity, but also of nutritional deficiencies and chronic diseases such as diabetes, hypertension and cardiovascular diseases.
In this sample of French adults, a lower income was associated with less adequate diets that were also less costly. Reaching nutritional adequacy did increase diet cost for most individuals, but by introducing an equality cost constraint, it was possible to model optimal diets without increasing diet cost, irrespective of the initial observed cost. The dietary changes induced by the optimisation were mostly similar across quintiles, although a greater fruit and vegetable increase was needed for low-income individuals to meet nutritional recommendations. Greater departure from observed diets was also needed when the budget for food was lower than 3.85 euros/d.