The role of material and psychosocial resources in explaining socioeconomic inequalities in diet: A structural equation modelling approach.

We examined whether material and psychosocial resources may explain socioeconomic differences in diet quality. Cross-sectional survey data from 1461 Dutch adults (42.5 (SD 13.7) years on average and 64% female) on socio-demographics, diet quality, psychosocial factors and perceptions of and objective healthiness of the food environment were used in a structural equation model to examine mediating pathways. Indicators for socioeconomic position (SEP) were income, educational, and occupational level and the 2015 Dutch Healthy Diet (DHD15) index assessed diet quality. Material resources included food expenditure, perceptions of healthy food accessibility and healthfulness of the food retail environment. Psychosocial resources were cooking skills, resilience to unhealthy food environments, insensitivity to food cues and healthy eating habits. Higher SEP was associated with better diet quality; Beducation 8.5 (95%CI 6.7; 10.3), Bincome 5.8 (95%CI 3.7; 7.8) and Boccupation 7.5 (95%CI 5.5; 9.4). Material resources did not mediate the association between SEP and diet quality and neither did the psychosocial resources insensitivity to food cues and eating habits. Cooking skills mediated between 13.3% and 19.0% and resilience to unhealthy food environments mediated between 5.9% and 8.6% of the relation between SEP and the DHD15-index. Individual-level factors such as cooking skills can only explain a small proportion of the SEP differences in diet quality. On top of other psychosocial and material resources not included in this study, it is likely that structural factors outside the individual, such as financial, work and living circumstances also play an important role

The cost of healthy versus current diets in the Netherlands for households with a low, middle and high education

The cost of food is an important driver of food choice and most evidence suggests that healthier diets are more costly than less healthy diets. However, current attempts to model the cost of healthy and current diets do not take into account the variation in diets or food prices. We calculated the differential cost between healthy and current diets for households with a low, medium and high education in the Netherlands using the DIETCOST program. The DIETCOST program accounts for variations in dietary patterns and allows for the calculation of the distribution of the cost of bi-weekly healthy and current household diets. Data from the Dutch National Food Consumption Survey 2012–2016 was used to construct commonly consumed food lists for the population as a whole and for households with a low, medium and high education and linked to a local food price database. The average cost of current household diets was €211/fortnight (SD 8.9) and the healthy household diet was on average €50 (24%) more expensive. For households with a low, medium and high education, healthy diets were on average 10% (€17), 26% (€50) and 36% (€72) more expensive compared to current diets, respectively. All healthy diets could be classified as affordable (i.e. requiring less than 30% of the average disposable income) as diets required around 20% of the income. To conclude, while healthy diets were found to be affordable, we found that these were more expensive than current diets, especially for those with a higher educational level. This suggests that individuals will need to spend more money on food if they aim to adhere to dietary guidelines under the assumption that they will minimally adjust their diet. Bridging the gap between the cost of healthy and less healthy foods could be an important strategy for improving population diets

Who uses what food retailers? A cluster analysis of food retail usage in the Netherlands.

The aim of this study is to describe how individuals use different food retailers and how food retail usage varies according to socio-demographic and diet-related characteristics. A cross-sectional survey among Dutch adults (N = 1784) was used. Results from the Two-step cluster analysis indicated that there were five clusters of food retail users. Use of discount supermarkets, organic supermarkets, fast-food outlets, and restaurants contributed to clustering, but use of regular supermarkets, local food shops and whether food retailers were close to home or further from home did not. The clusters included mixed food outlet users, discount supermarket and restaurant users, fast-food and restaurant users, predominant discount supermarket users and supermarkets, fast-food and restaurant users. Participants in each cluster had their own characteristics especially in terms of socio-economic position and diet quality. Future studies need to consider further how food retail selection links physical exposure to the food environment and diet.The ‘Eet & Leef’ study, and the work of JDM, is funded by an NWO VENI grant on “Making the healthy choice easier – role of the local food environment” (grant number 451-17-032). During the start of the manuscript, JCH and JDM were further funded by the Netherlands Heart Foundation (Hartstichting) and the Netherlands Organisation for Health Research and Development (ZonMw) through the Supreme Nudge (CVON2016–04) project. JCH and JA are currently supported by the Medical Research Council [Unit Programme number MC_UU_00006/7]. The funders played no role in the design of the study, the collection, analysis, and interpretation of data, or the writing of the manuscript. For the purpose of Open Access, the authors have applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising

Changes in UK price disparities between healthy and less healthy foods over 10 years: An updated analysis with insights in the context of inflationary increases in the cost-of-living from 2021.

Food prices and affordability play an important role in influencing dietary choices, which in turn have implications for public health. With inflationary increases in the cost-of-living in the UK since 2021, understanding the dynamics of food prices becomes increasingly important. In this longitudinal study, we aimed to examine changes in food prices from 2013 to 2023 by food group and by food healthiness. We established a dataset spanning the years 2013-2023 by combining price data from the UK Consumer Price Index for food and beverage items with nutrient and food data from the UK nutrient databank and UK Department of Health & Social Care's National Diet and Nutrition Survey data. We calculated the price (£/100 kcal) for each food item by year as well as before and during the period of inflationary pressure, and classified items into food groups according to the UK Eatwell Guide and as either "more healthy" or "less healthy" using the UK nutrient profiling score model. In 2023, bread, rice, potatoes and pasta was cheapest (£0.12/100 kcal) and fruit and vegetables most expensive (£1.01/100 kcal). Less healthy food was cheaper than more healthy food (£0.33/100 kcal versus £0.81/100 kcal). Before the inflationary pressure period (from 2013 to late 2021), the price of foods decreased by 3%. After this period, the price of food increased by 22%: relative increases were highest in the food group milk and dairy food (31%) and less healthy category (26%). While healthier foods saw smaller relative price increases since 2021, they remain more expensive, potentially exacerbating dietary inequalities. Policy responses should ensure food affordability and mitigate price disparities via, for example, healthy food subsidies

Who uses what food retailers? A cluster analysis of food retail usage in the Netherlands

The aim of this study is to describe how individuals use different food retailers and how food retail usage varies according to socio-demographic and diet-related characteristics. A cross-sectional survey among Dutch adults (N = 1784) was used. Results from the Two-step cluster analysis indicated that there were five clusters of food retail users. Use of discount supermarkets, organic supermarkets, fast-food outlets, and restaurants contributed to clustering, but use of regular supermarkets, local food shops and whether food retailers were close to home or further from home did not. The clusters included mixed food outlet users, discount supermarket and restaurant users, fast-food and restaurant users, predominant discount supermarket users and supermarkets, fast-food and restaurant users. Participants in each cluster had their own characteristics especially in terms of socio-economic position and diet quality. Future studies need to consider further how food retail selection links physical exposure to the food environment and diet

Shifting toward a healthier dietary pattern through nudging and pricing strategies: A secondary analysis of a randomized virtual supermarket experiment.

BACKGROUND: Nudging and salient pricing are promising strategies to promote healthy food purchases, but it is possible their effects differ across food groups. OBJECTIVE: To investigate in which food groups nudging and/or pricing strategies most effectively changed product purchases and resulted in within-food groups substitutions or spillover effects. METHODS: In total, 318 participants successfully completed a web-based virtual supermarket experiment in the Netherlands. We conducted a secondary analysis of a mixed randomized experiment consisting of 5 conditions (within subject) and 3 arms (between subject) to investigate the single and combined effects of nudging (e.g., making healthy products salient), taxes (25% price increase), and/or subsidies (25% price decrease) across food groups (fruit and vegetables, grains, dairy, protein products, fats, beverages, snacks, and other foods). Generalized linear mixed models were used to estimate the incidence rate ratios and 95% CIs for changes in the number of products purchased. RESULTS: Compared with the control condition, the combination of subsidies on healthy products and taxes on unhealthy products in the nudging and price salience condition was overall the most effective, as the number of healthy purchases from fruit and vegetables increased by 9% [incidence rate ratio (IRR) = 1.09; 95% CI: 1.02, 1.18], grains by 16% (IRR = 1.16; 95% CI: 1.05, 1.28), and dairy by 58% (IRR = 1.58; 95% CI: 1.31, 1.89), whereas the protein and beverage purchases did not significantly change. Regarding unhealthy purchases, grains decreased by 39% (IRR = 0.72; 95% CI: 0.63, 0.82) and dairy by 30% (IRR = 0.77; 95% CI: 0.68, 0.87), whereas beverage and snack purchases did not significantly change. The groups of grains and dairy showed within-food group substitution patterns toward healthier products. Beneficial spillover effects to minimally targeted food groups were seen for unhealthy proteins (IRR = 0.81; 95% CI: 0.73, 0.91). CONCLUSIONS: Nudging and salient pricing strategies have a differential effect on purchases of a variety of food groups. The largest effects were found for dairy and grains, which may therefore be the most promising food groups to target in order to achieve healthier purchases. The randomized trial on which the current secondary analyses were based is registered in the Dutch trial registry (NTR7293; www.trialregister.nl)

The cost of healthy versus current diets in the Netherlands for households with a low, middle and high education

The cost of food is an important driver of food choice and most evidence suggests that healthier diets are more costly than less healthy diets. However, current attempts to model the cost of healthy and current diets do not take into account the variation in diets or food prices. We calculated the differential cost between healthy and current diets for households with a low, medium and high education in the Netherlands using the DIETCOST program. The DIETCOST program accounts for variations in dietary patterns and allows for the calculation of the distribution of the cost of bi-weekly healthy and current household diets. Data from the Dutch National Food Consumption Survey 2012–2016 was used to construct commonly consumed food lists for the population as a whole and for households with a low, medium and high education and linked to a local food price database. The average cost of current household diets was €211/fortnight (SD 8.9) and the healthy household diet was on average €50 (24%) more expensive. For households with a low, medium and high education, healthy diets were on average 10% (€17), 26% (€50) and 36% (€72) more expensive compared to current diets, respectively. All healthy diets could be classified as affordable (i.e. requiring less than 30% of the average disposable income) as diets required around 20% of the income. To conclude, while healthy diets were found to be affordable, we found that these were more expensive than current diets, especially for those with a higher educational level. This suggests that individuals will need to spend more money on food if they aim to adhere to dietary guidelines under the assumption that they will minimally adjust their diet. Bridging the gap between the cost of healthy and less healthy foods could be an important strategy for improving population diets

Shifting toward a healthier dietary pattern through nudging and pricing strategies: A secondary analysis of a randomized virtual supermarket experiment

BACKGROUND: Nudging and salient pricing are promising strategies to promote healthy food purchases, but it is possible their effects differ across food groups. OBJECTIVE: To investigate in which food groups nudging and/or pricing strategies most effectively changed product purchases and resulted in within-food groups substitutions or spillover effects. METHODS: In total, 318 participants successfully completed a web-based virtual supermarket experiment in the Netherlands. We conducted a secondary analysis of a mixed randomized experiment consisting of 5 conditions (within subject) and 3 arms (between subject) to investigate the single and combined effects of nudging (e.g., making healthy products salient), taxes (25% price increase), and/or subsidies (25% price decrease) across food groups (fruit and vegetables, grains, dairy, protein products, fats, beverages, snacks, and other foods). Generalized linear mixed models were used to estimate the incidence rate ratios and 95% CIs for changes in the number of products purchased. RESULTS: Compared with the control condition, the combination of subsidies on healthy products and taxes on unhealthy products in the nudging and price salience condition was overall the most effective, as the number of healthy purchases from fruit and vegetables increased by 9% [incidence rate ratio (IRR) = 1.09; 95% CI: 1.02, 1.18], grains by 16% (IRR = 1.16; 95% CI: 1.05, 1.28), and dairy by 58% (IRR = 1.58; 95% CI: 1.31, 1.89), whereas the protein and beverage purchases did not significantly change. Regarding unhealthy purchases, grains decreased by 39% (IRR = 0.72; 95% CI: 0.63, 0.82) and dairy by 30% (IRR = 0.77; 95% CI: 0.68, 0.87), whereas beverage and snack purchases did not significantly change. The groups of grains and dairy showed within-food group substitution patterns toward healthier products. Beneficial spillover effects to minimally targeted food groups were seen for unhealthy proteins (IRR = 0.81; 95% CI: 0.73, 0.91). CONCLUSIONS: Nudging and salient pricing strategies have a differential effect on purchases of a variety of food groups. The largest effects were found for dairy and grains, which may therefore be the most promising food groups to target in order to achieve healthier purchases. The randomized trial on which the current secondary analyses were based is registered in the Dutch trial registry (NTR7293; www.trialregister.nl)

Socioeconomic distribution of food outlet availability through online food delivery services in seven European countries: A cross-sectional study.

This area-level cross-sectional study examined online food outlet availability through the most popular online food delivery service platforms (OFDS) across seven European countries, and explored how this online food outlet availability was socioeconomically distributed. Data collection of online food outlet availability was automated in England, Italy, Luxembourg, the Netherlands, Portugal, Spain and Switzerland. We used a geographic information system to join online food outlet availability to socio-demographic information. Median number of food outlets delivering through OFDS was highest in England and lowest in Italy, Portugal and Spain. We also found that high-income areas have the greatest online food outlet availability in most countries. In England, areas with a middle income had the least online food outlets available and no income data was available for Switzerland. Further work is needed to understand drivers of disparities in online food outlet availability, as well as possible implications for public health