Abstract
Background
/Objectives:Socioeconomic disparities in diet quality are well established. This study tested the hypothesis that such disparities are mediated, in part, by diet cost.
Subjects/Methods:
The Seattle Obesity Study (S.O.S) was a cross-sectional study based on a representative sample of 1266 adults of King County, WA, conducted in 2008–09. Demographic and socioeconomic variables were obtained through telephone survey. Income and education were used as indicators of socioeconomic position. Dietary intake data were obtained using a food frequency questionnaire (FFQ). Diet cost was calculated based on retail prices for FFQ component foods. Energy density (KJ/g) and mean adequacy ratio (MAR) were used as two indices of overall diet quality.
Results:
Higher income and education were each associated with lower energy density and higher MAR scores, adjusting for covariates. Higher income and education were also associated with higher energy adjusted diet cost. Higher quality diets were in turn associated with higher diet costs. All these associations were significant (P<0.0001). In formal mediation analyses, diet cost significantly mediated the pathway between income and diet quality measures, adjusting for covariates (P<0.05 each). Further, income–diet cost–diet quality pathway was found to be moderated by education level.
Conclusions:
The social gradient in diet quality may be explained by diet cost. Strategies to improve diet quality among lower socioeconomic strata may need to take food prices and diet cost along with nutrition education into account.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Andrieu E, Darmon N, Drewnowski A (2006). Low-cost diets: more energy, fewer nutrients. Eur J Clin Nutr 60, 434–436.
Baron RM, Kenny DA (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51, 1173–1182.
Bernstein AM, Bloom DE, Rosner BA, Franz M, Willett WC (2010). Relation of food cost to healthfulness of diet among US women. Am J Clin Nutr 92, 1197–1203.
Darmon N, Darmon M, Maillot M, Drewnowski A (2005). A nutrient density standard for vegetables and fruits: nutrients per calorie and nutrients per unit cost. J Am Diet Assoc 105, 1881–1887.
Darmon N, Drewnowski A (2008). Does social class predict diet quality? Am J Clin Nutr 87, 1107–1117.
Drewnowski A (2001). Diet image: a new perspective on the food-frequency questionnaire. Nutr Rev 59, 370–372.
Drewnowski A, Monsivais P, Maillot M, Darmon N (2007). Low-energy-density diets are associated with higher diet quality and higher diet costs in French adults. J Am Diet Assoc 107, 1028–1032.
Dynesen AW, Haraldsdottir J, Holm L, Astrup A (2003). Sociodemographic differences in dietary habits described by food frequency questions—results from Denmark. Eur J Clin Nutr 57, 1586–1597.
Food and Nutrition Board, Institute of Medicine (2004). Dietary Reference Intakes: Recommended intakes for individuals. National Academy Press: Washington, DC.
Galobardes B, Morabia A, Bernstein MS (2001). Diet and socioeconomic position: does the use of different indicators matter? Int J Epidemiol 30, 334–340.
Giskes K, Turrell G, Patterson C, Newman B (2002). Socio-economic differences in fruit and vegetable consumption among Australian adolescents and adults. Public Health Nutr 5, 663–669.
Groth MV, Fagt S, Brondsted L (2001). Social determinants of dietary habits in Denmark. Eur J Clin Nutr 55, 959–966.
Hatloy A, Hallund J, Diarra MM, Oshaug A (2000). Food variety, socioeconomic status and nutritional status in urban and rural areas in Koutiala (Mali). Public Health Nutr 3, 57–65.
Kant AK (1996). Indexes of overall diet quality: a review. J Am Diet Assoc 96, 785.
Kant AK, Graubard BI (2007). Secular trends in the association of socio-economic position with self-reported dietary attributes and biomarkers in the US population: National Health and Nutrition Examination Survey (NHANES) 1971–1975 to NHANES 1999–2002. Public Health Nutr 10, 158–167.
Keller HH, Ostbye T, Bright-See E (1997). Predictors of dietary intake in Ontario seniors. Can J Public Health 88, 305–309.
Lallukka T, Laaksonen M, Rahkonen O, Roos E, Lahelma E (2007). Multiple socio-economic circumstances and healthy food habits. Eur J Clin Nutr 61, 701–710.
Ledikwe JH, Blanck HM, Khan LK, Serdula MK, Seymour JD, Tohill BC et al. (2005). Dietary energy density determined by eight calculation methods in a nationally representative United States population. J Nutr 135, 273–278.
Ledikwe JH, Blanck HM, Khan LK, Serdula MK, Seymour JD, Tohill BC et al. (2006). Low-energy-density diets are associated with high diet quality in adults in the United States. J Am Diet Assoc 106, 1172–1180.
MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V (2002). A comparison of methods to test mediation and other intervening variable effects. Psychol Methods 7, 83–104.
Madden JP, Goodman SJ, Guthrie HA (1976). Validity of the 24-h recall. Analysis of data obtained from elderly subjects. J Am Diet Assoc 68, 143–147.
Maillot M, Darmon N, Darmon M, Lafay L, Drewnowski A (2007a). Nutrient-dense food groups have high energy costs: an econometric approach to nutrient profiling. J Nutr 137, 1815–1820.
Maillot M, Darmon N, Vieux F, Drewnowski A (2007b). Low energy density and high nutritional quality are each associated with higher diet costs in French adults. Am J Clin Nutr 86, 690–696.
Marmot MG, Shipley MJ, Hemingway H, Head J, Brunner EJ (2008). Biological and behavioural explanations of social inequalities in coronary heart disease: the Whitehall II study. Diabetologia 51, 1980–1988.
Monsivais P, Drewnowski A (2007). The rising cost of low-energy-density foods. J Am Diet Assoc 107, 2071–2076.
Monsivais P, Drewnowski A (2009). 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 109, 814–822.
Mullie P, Clarys P, Hulens M, Vansant G (2010). Dietary patterns and socioeconomic position. Eur J Clin Nutr 64, 231–238.
Murakami K, Miyake Y, Sasaki S, Tanaka K, Ohya Y, Hirota Y (2009). Monetary diet cost is associated with not only favorable but also unfavorable aspects of diet in pregnant Japanese women: The Osaka Maternal and Child Health Study. Environ Health Insights 3, 27–35.
Neuhouser ML, Kristal AR, McLerran D, Patterson RE, Atkinson J (1999). Validity of short food frequency questionnaires used in cancer chemoprevention trials: results from the Prostate Cancer Prevention Trial. Cancer Epidemiol Biomarkers Prev 8, 721–725.
Northstone K, Emmett PM (2010). Dietary patterns of men in ALSPAC: associations with socio-demographic and lifestyle characteristics, nutrient intake and comparison with women's dietary patterns. Eur J Clin Nutr 64, 978–986.
Patterson RE, Kristal AR, Tinker LF, Carter RA, Bolton MP, Agurs-Collins T (1999). Measurement characteristics of the Women′s Health Initiative food frequency questionnaire. Ann Epidemiol 9, 178–187.
Ricciuto LE, Tarasuk VS (2007). An examination of income-related disparities in the nutritional quality of food selections among Canadian households from 1986–2001. Soc Sci Med 64, 186–198.
Schroder H, Marrugat J, Covas MI (2006). High monetary costs of dietary patterns associated with lower body mass index: a population-based study. Int J Obes (Lond) 30, 1574–1579.
Shimakawa T, Sorlie P, Carpenter MA, Dennis B, Tell GS, Watson R et al. (1994). Dietary intake patterns and sociodemographic factors in the atherosclerosis risk in communities study. ARIC Study Investigators. Prev Med 23, 769–780.
Sobel ME (1982). Asymptotic confidence intervals for indirect effects in structural equation models. American Sociological Association: Washington, DC.
Torheim LE, Ouattara F, Diarra MM, Thiam FD, Barikmo I, Hatloy A et al. (2004). Nutrient adequacy and dietary diversity in rural Mali: association and determinants. Eur J Clin Nutr 58, 594–604.
Turrell G, Hewitt B, Patterson C, Oldenburg B (2003). Measuring socio-economic position in dietary research: is choice of socio-economic indicator important? Public Health Nutr 6, 191–200.
US Department of Agriculture (2005). Adequate nutrients with calorie needs: Dietary Guidelines for Americans, 2005. Government Printing Office: Washington, DC.
Willett W (1998). Nutritional Epidemiology 2nd edn, Oxford University Press: New York.
Worsley A, Blasche R, Ball K, Crawford D (2003). Income differences in food consumption in the 1995 Australian National Nutrition Survey. Eur J Clin Nutr 57, 1198–1211.
Acknowledgements
This research was supported in part by National Institute of Diabetes and Digestive and Kidney Diseases grants R01DK076608 and R21DK085406. This study was funded by NIH grant NIDDKR01DK076608.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Aggarwal, A., Monsivais, P., Cook, A. et al. Does diet cost mediate the relation between socioeconomic position and diet quality?. Eur J Clin Nutr 65, 1059–1066 (2011). https://doi.org/10.1038/ejcn.2011.72
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ejcn.2011.72
Keywords
This article is cited by
-
New measures to assess the “Other” three pillars of food security–availability, utilization, and stability
International Journal of Behavioral Nutrition and Physical Activity (2023)
-
The relationship between dietary patterns and blood mineral concentration among children in Hunan Province of China
BMC Public Health (2023)
-
The relationship between food and cooking skills, and eating behaviors in people with overweight or obesity
International Journal of Obesity (2023)
-
Daily food insecurity is associated with diet quality, but not energy intake, in winter and during COVID-19, among low-income adults
Nutrition Journal (2022)
-
Associations of childhood and adult socioeconomic circumstances with recommended food habits among young and midlife Finnish employees
BMC Nutrition (2022)