Socioeconomic and ethnic differences in the relation between dietary costs and dietary quality: the HELIUS study

Joreintje D. Mackenbach; S. Coosje Dijkstra; Joline W.J. Beulens; Jacob C. Seidell; Marieke B. Snijder; Karien Stronks; Pablo Monsivais; Mary Nicolaou

doi:10.1186/s12937-019-0445-3

Socioeconomic and ethnic differences in the relation between dietary costs and dietary quality: the HELIUS study

Joreintje D. Mackenbach^*, S. Coosje Dijkstra, Joline W.J. Beulens, Jacob C. Seidell, Marieke B. Snijder, Karien Stronks, Pablo Monsivais, Mary Nicolaou

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

BACKGROUND: Healthier dietary patterns are generally more costly than less healthy patterns, but dietary costs may be more important for dietary quality in lower educated and ethnic minority groups. The aim of this study was to investigate the association between dietary costs and dietary quality and interactions with ethnicity and socioeconomic position (SEP).

METHODS: We used cross-sectional data from 4717 Dutch, Surinamese, Turkish and Moroccan origin participants of the multi-ethnic HELIUS study (the Netherlands), who completed an ethnic-specific food frequency questionnaire (FFQ). The primary outcome measure was dietary quality according to adherence to the Dutch Healthy Diet index 2015 (DHD15-index, range 0-130). Individual dietary costs (the monetary value attached to consumed diets in Euros) were estimated by merging a food price variable with the FFQ nutrient composition database. Regression analyses were used to examine main and interaction effects. Analyses were adjusted for age, sex, smoking, energy intake, physical activity, ethnicity and educational level.

RESULTS: Having higher dietary costs was associated with higher dietary quality. Analyses stratified by educational level showed that associations were stronger in higher educated (Btertile3 = 8.06, 95%CI = 5.63; 10.48) than in lower educated participants (Btertile3 = 5.09, 95%CI = 2.74; 7.44). Stratification by ethnic origin showed strongest associations in Turkish participants (Btertile2 = 9.31, 95%CI = 5.96; 12.65) and weakest associations in Moroccan participants (Btertile3 = 4.29, 95%CI = 0.58; 8.01). Regardless of their level of education, Turkish and Moroccan individuals consumed higher quality diets at the lowest cost than Dutch participants.

CONCLUSIONS: The importance of dietary costs for dietary quality differs between socioeconomic and ethnic subgroups. Increasing individual food budgets or decreasing food prices may be effective for the promotion of healthy diets, but differential effects across socioeconomic and ethnic subgroups may be expected.

Original language	English
Article number	21
Pages (from-to)	1-9
Number of pages	9
Journal	Nutrition journal
Volume	18
DOIs	https://doi.org/10.1186/s12937-019-0445-3
Publication status	Published - 28 Mar 2019

Funding

The HELIUS study is conducted by the Academic Medical Center Amsterdam and the Public Health Service of Amsterdam. Both organizations provided core support for HELIUS. The HELIUS study is also funded by the Dutch Heart Foundation, the Netherlands Organization for Health Research and Development (ZonMw), the European Union (FP7) and the European Fund for the Integration of non-EU immigrants (EIF). JDM’s work was funded by an NWO VENI grant on “Making the healthy choice easier – role of the local food environment” (grant number 451–17-032). The Dutch Food Price database was constructed by JDM, SCD and MN, with support from the Health Behaviors and Chronic Diseases (HBCD) program of the Amsterdam Public Health research institute (JDM, SCD and MN) and the Netherlands Organisation for Scientific Research (JDM). This paper was also supported by the Determinants of Diet and Physical (DEDIPAC) knowledge hub, which is supported by the Joint Programming Initiative ‘Healthy Diet for a Healthy Life’. The funding agencies supporting this work are: France: Institut National de la Recherche Agronomique (INRA); Norway: The Research Council of Norway; The Netherlands: The Netherlands Organisation for Health Research and Development (ZonMw); The UK: The Medical Research Council (MRC). JWJ Beulens received an unrestricted research grant from Unilever R&D on the cardiometabolic effects of fatty acids (2013–2016). The authors declare no other potential conflicts of interest.

Funders	Funder number
Amsterdam Public Health Research Institute
DEDIPAC
Determinants of Diet and Physical
Dutch Heart Foundation
European Fund
JDM
Netherlands Organization for Health Research and Development
Medical Research Council
European Commission
ZonMw
Nederlandse Organisatie voor Wetenschappelijk Onderzoek	451–17-032
Seventh Framework Programme
Norges forskningsråd
Institut National de la Recherche Agronomique

Keywords

DASH
Diet
Dietary costs
Dutch healthy eating index
Ethnicity
Food cost
HELIUS study
Mediterranean diet
Socioeconomic position

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12937-019-0445-3

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440156

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@article{dbc11beab14946eebc66f419a229aa00,

title = "Socioeconomic and ethnic differences in the relation between dietary costs and dietary quality: the HELIUS study",

abstract = "BACKGROUND: Healthier dietary patterns are generally more costly than less healthy patterns, but dietary costs may be more important for dietary quality in lower educated and ethnic minority groups. The aim of this study was to investigate the association between dietary costs and dietary quality and interactions with ethnicity and socioeconomic position (SEP).METHODS: We used cross-sectional data from 4717 Dutch, Surinamese, Turkish and Moroccan origin participants of the multi-ethnic HELIUS study (the Netherlands), who completed an ethnic-specific food frequency questionnaire (FFQ). The primary outcome measure was dietary quality according to adherence to the Dutch Healthy Diet index 2015 (DHD15-index, range 0-130). Individual dietary costs (the monetary value attached to consumed diets in Euros) were estimated by merging a food price variable with the FFQ nutrient composition database. Regression analyses were used to examine main and interaction effects. Analyses were adjusted for age, sex, smoking, energy intake, physical activity, ethnicity and educational level.RESULTS: Having higher dietary costs was associated with higher dietary quality. Analyses stratified by educational level showed that associations were stronger in higher educated (Btertile3 = 8.06, 95%CI = 5.63; 10.48) than in lower educated participants (Btertile3 = 5.09, 95%CI = 2.74; 7.44). Stratification by ethnic origin showed strongest associations in Turkish participants (Btertile2 = 9.31, 95%CI = 5.96; 12.65) and weakest associations in Moroccan participants (Btertile3 = 4.29, 95%CI = 0.58; 8.01). Regardless of their level of education, Turkish and Moroccan individuals consumed higher quality diets at the lowest cost than Dutch participants.CONCLUSIONS: The importance of dietary costs for dietary quality differs between socioeconomic and ethnic subgroups. Increasing individual food budgets or decreasing food prices may be effective for the promotion of healthy diets, but differential effects across socioeconomic and ethnic subgroups may be expected.",

keywords = "DASH, Diet, Dietary costs, Dutch healthy eating index, Ethnicity, Food cost, HELIUS study, Mediterranean diet, Socioeconomic position",

author = "Mackenbach, {Joreintje D.} and Dijkstra, {S. Coosje} and Beulens, {Joline W.J.} and Seidell, {Jacob C.} and Snijder, {Marieke B.} and Karien Stronks and Pablo Monsivais and Mary Nicolaou",

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doi = "10.1186/s12937-019-0445-3",

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T1 - Socioeconomic and ethnic differences in the relation between dietary costs and dietary quality

T2 - the HELIUS study

AU - Mackenbach, Joreintje D.

AU - Dijkstra, S. Coosje

AU - Beulens, Joline W.J.

AU - Seidell, Jacob C.

AU - Snijder, Marieke B.

AU - Stronks, Karien

AU - Monsivais, Pablo

AU - Nicolaou, Mary

PY - 2019/3/28

Y1 - 2019/3/28

N2 - BACKGROUND: Healthier dietary patterns are generally more costly than less healthy patterns, but dietary costs may be more important for dietary quality in lower educated and ethnic minority groups. The aim of this study was to investigate the association between dietary costs and dietary quality and interactions with ethnicity and socioeconomic position (SEP).METHODS: We used cross-sectional data from 4717 Dutch, Surinamese, Turkish and Moroccan origin participants of the multi-ethnic HELIUS study (the Netherlands), who completed an ethnic-specific food frequency questionnaire (FFQ). The primary outcome measure was dietary quality according to adherence to the Dutch Healthy Diet index 2015 (DHD15-index, range 0-130). Individual dietary costs (the monetary value attached to consumed diets in Euros) were estimated by merging a food price variable with the FFQ nutrient composition database. Regression analyses were used to examine main and interaction effects. Analyses were adjusted for age, sex, smoking, energy intake, physical activity, ethnicity and educational level.RESULTS: Having higher dietary costs was associated with higher dietary quality. Analyses stratified by educational level showed that associations were stronger in higher educated (Btertile3 = 8.06, 95%CI = 5.63; 10.48) than in lower educated participants (Btertile3 = 5.09, 95%CI = 2.74; 7.44). Stratification by ethnic origin showed strongest associations in Turkish participants (Btertile2 = 9.31, 95%CI = 5.96; 12.65) and weakest associations in Moroccan participants (Btertile3 = 4.29, 95%CI = 0.58; 8.01). Regardless of their level of education, Turkish and Moroccan individuals consumed higher quality diets at the lowest cost than Dutch participants.CONCLUSIONS: The importance of dietary costs for dietary quality differs between socioeconomic and ethnic subgroups. Increasing individual food budgets or decreasing food prices may be effective for the promotion of healthy diets, but differential effects across socioeconomic and ethnic subgroups may be expected.

AB - BACKGROUND: Healthier dietary patterns are generally more costly than less healthy patterns, but dietary costs may be more important for dietary quality in lower educated and ethnic minority groups. The aim of this study was to investigate the association between dietary costs and dietary quality and interactions with ethnicity and socioeconomic position (SEP).METHODS: We used cross-sectional data from 4717 Dutch, Surinamese, Turkish and Moroccan origin participants of the multi-ethnic HELIUS study (the Netherlands), who completed an ethnic-specific food frequency questionnaire (FFQ). The primary outcome measure was dietary quality according to adherence to the Dutch Healthy Diet index 2015 (DHD15-index, range 0-130). Individual dietary costs (the monetary value attached to consumed diets in Euros) were estimated by merging a food price variable with the FFQ nutrient composition database. Regression analyses were used to examine main and interaction effects. Analyses were adjusted for age, sex, smoking, energy intake, physical activity, ethnicity and educational level.RESULTS: Having higher dietary costs was associated with higher dietary quality. Analyses stratified by educational level showed that associations were stronger in higher educated (Btertile3 = 8.06, 95%CI = 5.63; 10.48) than in lower educated participants (Btertile3 = 5.09, 95%CI = 2.74; 7.44). Stratification by ethnic origin showed strongest associations in Turkish participants (Btertile2 = 9.31, 95%CI = 5.96; 12.65) and weakest associations in Moroccan participants (Btertile3 = 4.29, 95%CI = 0.58; 8.01). Regardless of their level of education, Turkish and Moroccan individuals consumed higher quality diets at the lowest cost than Dutch participants.CONCLUSIONS: The importance of dietary costs for dietary quality differs between socioeconomic and ethnic subgroups. Increasing individual food budgets or decreasing food prices may be effective for the promotion of healthy diets, but differential effects across socioeconomic and ethnic subgroups may be expected.

KW - DASH

KW - Diet

KW - Dietary costs

KW - Dutch healthy eating index

KW - Ethnicity

KW - Food cost

KW - HELIUS study

KW - Mediterranean diet

KW - Socioeconomic position

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DO - 10.1186/s12937-019-0445-3

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JO - Nutrition journal

JF - Nutrition journal

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ER -

Socioeconomic and ethnic differences in the relation between dietary costs and dietary quality: the HELIUS study

Abstract

Funding

Keywords

UN SDGs

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