Diet cost and quality using the Healthy Eating Index-2015 in adults from urban and rural areas of Mexico

Objective: To assess the association between diet cost and quality by place of residence. Design: We analysed cross-sectional data of the National Health and Nutrition Survey-2012. Diet cost was estimated by linking dietary data, obtained from a 7-d SFFQ, with municipality food prices, which were derived from a national expenditure survey. Diet quality was assessed using the Healthy Eating Index-2015 (HEI-2015). Association between quintiles of diet cost and HEI-2015 was assessed using linear regression analysis. Settings: Mexico. Participants: 2438 adults (18-59 years). Results: Diet cost was positively associated with diet quality (HEI-2015) in urban but not in rural areas. Compared with quintile (Q1) of cost, the increment in diet quality score was 1 center dot 17 (95 % CI -0 center dot 06, 4 center dot 33) for Q2, 2 center dot 14 (95 % CI -0 center dot 06, 4 center dot 33) for Q3, 4 center dot 70 (95 % CI 2 center dot 62, 6 center dot 79) for Q4 and 6 center dot 34 (95 % CI 4 center dot 20, 8 center dot 49) for Q5 (P-trend < 0 center dot 001). Individuals in rural v. urban areas on average have higher quality diets at lower cost with higher intakes of whole grains and beans and lower intakes of Na, added sugars and saturated fats. Living in the South, being indigenous and having low socio-economic status were also associated with higher quality diets. Conclusions: Diet cost was positively associated with diet quality, but only in urban areas. Further studies are needed to understand the relation between diet cost and quality in rural areas. To improve overall diet quality in Mexico, strategies that aim to reduce the cost of high-quality diets should consider the heterogeneity by place of residence

Sustainability of Diets in Mexico: Diet Quality, Environmental Footprint, Diet Cost, and Sociodemographic Factors

BackgroundLittle is known about the current intake of sustainable diets globally and specifically in middle-income countries, considering nutritional, environmental and economic factors. ObjectiveTo assess and characterize the sustainability of Mexican diets and their association with sociodemographic factors. DesignDietary data of 2,438 adults within the National Health and Nutrition Survey 2012 by integrating diet quality measured by the Healthy Eating Index (HEI-2015), diet cost, and four environmental indicators were analyzed: land use (LU), biodiversity loss (BDL), carbon footprint (CFP), and blue water footprint (BWFP). We defined healthier more sustainable diets (MSD) as those with HEI-2015 above the overall median, and diet cost and environmental indicators below the median. Logistic regression was used to evaluate the association of sociodemographic factors with MSD. ResultsMSD were consumed by 10.2% of adults (4% of urban and 22% of rural), who had lower intake of animal-source foods, unhealthy foods (refined grains, added sugar and fats, mixed processed dishes and sweetened beverages), fruits, and vegetables, and higher intake of whole grains than non-MSD subjects. Characteristics of MSD vs. non-MSD (urban; rural) were: HEI-2015 (62.6 vs. 51.9; 66.8 vs. 57.6), diet-cost (1.9 vs. 2.8; 1.9 vs. 2.5 USD), LU (3.3 vs. 6.6; 3.2 vs. 5.9 m(2)), BDL (105 vs. 780; 87 vs. 586 species x 10(-10)), BWFP (244 vs. 403; 244 vs. 391 L), and CFP (1.6 vs. 4.4; 1.6 vs. 3.7 kg CO(2)eq). Adults from rural vs. urban (OR 2.7; 95% CI: 1.7, 4.1), or from the South (OR 2.1; 95% CI: 1.1, 3.9), Center (OR 2.3; 95% CI: 1.3, 4.4) vs. the North were more likely to consume MSD, while adults with high vs. low socioeconomic status were less likely (OR 0.17; 95% CI: 0.09, 0.3). ConclusionsThe MSD is a realistic diet pattern mainly found in disadvantaged populations, but diet quality is still sub-optimal. Increased consumption of legumes, fruits, and vegetables, and a reduction in unhealthy foods, is required to improve nutritional quality of diets while ensuring their environmental sustainability

Does Mexico have the agricultural land resources to feed its population with a healthy and sustainable diet?

Reaching healthy and sustainable diets for all people with the world's limited resources is one of the biggest challenges of humanity. The Healthy Reference Diet (HRD) is a recent proposal by the Eat-Lancet Commission for addressing this problem. Mexico has a high burden of obesity and persistent malnutrition. Recent national policies have focused on different strategies to transform the food system which include designing new dietary guidelines using the HRD adapted for the Mexican context and supporting small farmers to reduce food imports. The aim of the paper is to explore whether Mexico has enough land resources to produce food for a healthy and sustainable diet for its population, with no international trade, and what changes are needed to reach this in terms of diets, the food system, and in land use. Four scenarios are explored for changing the food system to reduce agricultural land use. The results show that Mexico has enough agricultural land to produce food for all its population to ensure healthy and sustainable diets with the current food supply chain. A healthy and sustainable diet demands 20 % to 50 % less agricultural land, depending on the type of dietary recommendation, than the present average diet of the Mexican population. But changes are needed in the food system in terms of land use such as exchanging pasture for cropland and changing the type of crop production like reducing cropland for sugar cane and feed for livestock, and increasing cropland for legumes and nuts. Furthermore, reducing losses in the supply chain and increasing crop yields reduces considerably the demand of agricultural land. Further research is needed to explore the socioeconomic issues and policies for reaching these changes. The insights of this paper should be considered when designing policy strategies and recommendations to reach a sustainable food system