title: Relation of food cost to healthfulness of diet among US women.
abstract: BACKGROUND
  Few studies have evaluated the cost of a diet that may prevent cardiovascular disease. High scores on the Alternative Healthy Eating Index (AHEI) have been associated with lower rates of cardiovascular disease.
  
  
  OBJECTIVE
  We sought to evaluate the cost of a dietary pattern that may prevent cardiovascular disease among women residing in the United States.
  
  
  METHODS
  By using food-cost data from the US Department of Agriculture, we explored relations between spending on food and AHEI scores among 78,191 participants in the Nurses' Health Study. By using linear regression, we estimated the change in AHEI score (range: 2.5-87.5) for a $1 increase in spending on various food groups.
  
  
  RESULTS
  Study participants in the highest energy-adjusted spending quintile spent 124% as much money each day as those in the lowest quintile. The difference in AHEI scores (10th-90th percentile) between all study participants was 30 index points (Spearman's correlation coefficient between total spending and AHEI = 0.44). The difference in AHEI scores (10th-90th percentile) within each quintile of spending ranged from 25 to 29 index points. Greater spending on nuts, soy and beans, and whole grains was associated with a higher AHEI score. Greater spending on red and processed meats and high-fat dairy was associated with a lower AHEI score.
  
  
  CONCLUSIONS
  Although spending more money was associated with a healthier diet, large improvements in diet may be achieved without increased spending. The purchase of plant-based foods may offer the best investment for dietary health.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA. abernste@hsph.harvard.edu
authors.forename: Adam M
authors.initials: AM
authors.lastname: Bernstein
authors.forename: David E
authors.initials: DE
authors.lastname: Bloom
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Rosner
authors.forename: Mary
authors.initials: M
authors.lastname: Franz
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D003365:Costs and Cost Analysis; D004032:Diet / Q000191:economics* / Q000592:standards; D002149:Energy Intake; D005260:Female; D015438:Health Behavior; D006801:Humans; D016014:Linear Models; D017059:Models, Econometric; D014481:United States
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