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      Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis

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          Abstract

          Context: It is well established in the literature that healthier diets cost more than unhealthy diets. Objective: The aim of this review was to examine the contribution of food prices and diet cost to socioeconomic inequalities in diet quality. Data Sources: A systematic literature search of the PubMed, Google Scholar, and Web of Science databases was performed. Study Selection: Publications linking food prices, dietary quality, and socioeconomic status were selected. Data Extraction: Where possible, review conclusions were illustrated using a French national database of commonly consumed foods and their mean retail prices. Data Synthesis: Foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. Food budgets in poverty were insufficient to ensure optimum diets. Conclusions: Socioeconomic disparities in diet quality may be explained by the higher cost of healthy diets. Identifying food patterns that are nutrient rich, affordable, and appealing should be a priority to fight social inequalities in nutrition and health.

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          Trends in dietary quality among adults in the United States, 1999 through 2010.

          Many changes in the economy, policies related to nutrition, and food processing have occurred within the United States since 2000, and the net effect on dietary quality is not clear. These changes may have affected various socioeconomic groups differentially.
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            Development and validation of the nutrient-rich foods index: a tool to measure nutritional quality of foods.

            Ranking and/or classifying foods based on their nutrient composition is known as nutrient profiling. Nutrition quality indices need to be tested and validated against quality of the total diet. A family of nutrient-rich foods (NRF) indices were validated against the Healthy Eating Index (HEI), an accepted measure of diet quality. All foods consumed by participants in NHANES 1999-2002 studies were scored using NRFn.3 (where n = 6-15) indices based on unweighted sums, means, and ratios of percent daily values (DV) for nutrients to encourage (n) and for nutrients to limit (LIM) (3). Individual food scores were calculated based on 100 kcal (418 kJ) and FDA serving sizes [reference amounts customarily consumed (RACC)]. Energy-weighted food-based scores per person were then regressed against HEI, adjusting for gender, age, and ethnicity. The measure of index performance was the percentage of variation in HEI (R2) explained by each NRF score. NRF indices based on both nutrients to encourage and LIM performed better than indices based on LIM only. Maximum variance in HEI was explained using 6 or 9 nutrients to encourage; index performance actually declined with the inclusion of additional vitamins and minerals. NRF indices based on 100 kcal (418 kJ) performed similarly to indices based on RACC. Algorithms based on sums or means of nutrient DV performed better than ratio-based scores. The NRF9.3 index, based on 9 nutrients to encourage and 3 LIM per RACC and per 100 kcal, explained the highest percentage of variation from HEI and could be readily expected to rank foods based on nutrient density.
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              The Nutrient Rich Foods Index helps to identify healthy, affordable foods.

              The Nutrient Rich Foods (NRF) Index is a formal scoring system that ranks foods on the basis of their nutrient content. When used in conjunction with a food prices database, it can help identify foods that are both nutritious and affordable. Our aim was to identify healthy, affordable foods and food groups by using the NRF index and US Department of Agriculture (USDA) nutrient composition and food prices data sets. Foods in the USDA Food and Nutrition Database for Dietary Studies 1.0 were scored by using the NRF index. This NRF algorithm was represented by the sum of the percentage of the daily values of 9 nutrients to encourage (protein, fiber, vitamin A, vitamin C, vitamin E, calcium, iron, magnesium, and potassium) minus the sum of the percentage of the maximum recommended values for 3 nutrients to limit (saturated fat, added sugar, and sodium). NRF scores and mean national food prices were calculated per calorie and per US Food and Drug Administration-defined serving. Each of the 9 USDA food groups offered foods of diverse nutritive value and cost. Eggs, dry beans and legumes, and meat and milk products were the lowest-cost sources of protein. Milk and milk products were the lowest-cost sources of calcium, whereas vegetables and fruit were the lowest-cost sources of vitamin C. Milk, potatoes, citrus juices, cereals, and beans had more favorable overall nutrient-to-price ratios than did many vegetables and fruit. Energy-dense grains, sweets, and fats provided most of the calories but fewer nutrients per dollar. One important application of nutrient profile models is to help consumers identify foods that provide optimal nutrition at an affordable cost.
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                Author and article information

                Journal
                Nutr Rev
                Nutr. Rev
                nutritionreviews
                nutritionreviews
                Nutrition Reviews
                Oxford University Press
                0029-6643
                1753-4887
                October 2015
                25 August 2015
                25 August 2015
                : 73
                : 10
                : 643-660
                Affiliations
                N. Darmon is with the Unité Mixte de Recherche “Nutrition, Obesity and Risk of Thrombosis,” Institut National de la Recherche Agronomique 1260, Institut National de la Santé et de la Recherche Médicale 1062, Aix-Marseille Université, Marseille, France. A. Drewnowski is with the Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA.
                Author notes
                N. Darmon, UMR NORT, Faculté de Médecine de la Timone, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France. Tel +33-491294090. E-mail: nicole.darmon@ 123456univ-amu.fr .
                Article
                nuv027
                10.1093/nutrit/nuv027
                4586446
                26307238
                632cbc45-f2a2-4205-ae18-e38b5ccb0f7b
                © The Author(s) 2015. Published by Oxford University Press on behalf of the International Life Sciences Institute.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work properly cited. For commercial re-use, please contact journals.permissions@oup.com

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                Page count
                Pages: 18
                Categories
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                Nutrition & Dietetics
                diet cost,energy density,food prices,nutrient density,nutrition economics,socioeconomic status

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