Background
Although cost is a frequently cited barrier to healthful eating, limited prospective data exist.
Objective
This study examined the association of diet cost with diet quality change.
Design
An 18-month randomized clinical trial evaluated a dietary intervention.
Participants/setting
Youth with type 1 diabetes duration ≥1 year, age 8.0 to 16.9 years (N=136), receiving care at an outpatient tertiary diabetes center in Boston, Massachusetts participated along with a parent from 2010 to 2013. Eighty-two percent of participants were from middle to upper income households.
Intervention
The family-based behavioral intervention targeted intake of whole plant foods.
Main outcome measures
Diet quality as indicated by the Healthy Eating Index-2005 (HEI-2005, measures conformance to 2005 Dietary Guidelines for Americans) and whole plant food density (WPFD, cup/oz equivalents per 1000 kcal of target food groups) were calculated from three-day food records of youth and parent dietary intake at six and four time points, respectively. Food prices were obtained from two online supermarkets common to the study location; daily diet cost was calculated by summing prices of reported foods.
Statistical analyses performed
Random effects models estimated treatment group differences in time-varying diet cost. Separate models for youth and parent adjusted for covariates examined associations of time-varying change in diet quality with change in diet cost.
Results
There was no treatment effect on time-varying diet cost for either youth [β (95%CI) = −0.49 (−1.07, 0.08), p=.10] or parents [β=0.24 (−1.61, 2.08) p=.80]. Additionally, time-varying change in diet quality indicators was not associated with time-varying change in diet cost for youth. Among parents, a 1 cup/oz-equivalent increase in whole plant food density was associated with a $.63/day lower diet cost [β=−0.63 (−1.20, −0.05), p=0.03].
Conclusions
Improved diet quality was not accompanied by greater cost for youth with type 1 diabetes and their parents participating in a randomized clinical trial. Findings challenge the prevailing assumption that improving diet quality necessitates greater cost.