title: Monetary Value of Diet Is Associated with Dietary Quality and Nutrient Adequacy among Urban Adults, Differentially by Sex, Race and Poverty Status.
abstract: OBJECTIVE
  The association between monetary value of the diet (MVD, $/day) with dietary quality was examined using a large sample of urban US adults, differentially by socio-demographic factors.
  
  
  METHODS
  This was a cross-sectional study of 2,111 participants, aged 30-64y, using data from the Healthy Aging in Neighborhoods of Diversity across the Life Span Study. Dietary quality indices included Healthy Eating Index-2010 (HEI-2010) and Mean Adequacy Ratio (MAR), (two 24-hr recalls). A national food price database was used to estimate MVD. Multiple linear/logistic regression analyses were conducted stratifying separately by sex, race and poverty status.
  
  
  RESULTS
  Women had significantly higher HEI-2010 scores than men (43.35 vs 41.57 out of 100, respectively), whereas MAR scores were higher for men (76.8 vs 69.9, out of 100), reflecting energy intake gender differentials. Importantly, a $3/day higher MVD (IQR: $3.70/d (Q1) to $6.62/d (Q4)) was associated with a 4.98±0.35 higher total HEI-2010 and a 3.88±0.37 higher MAR score, after energy-adjustment and control for key confounders. For HEI-2010 and MAR, stronger associations were observed among participants above poverty and among women, whilethe MVD vs. HEI-2010 association was additionally stronger among Whites. Sex and poverty status differentials were observed for many MAR and some HEI-2010 components.
  
  
  CONCLUSIONS
  Despite positive associations between measures of dietary quality and MVD, particularly above poverty and among women, approaching compliance with the Dietary Guidelines (80 or more for HEI-2010) requires a substantially higher MVD. Thus, nutrition education may further improve people's decision-making regarding food venues and dietary choices.
authors.affiliation: Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, Maryland, United States of America.
authors.forename: May A
authors.initials: MA
authors.lastname: Beydoun
authors.affiliation: Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, United States of America.
authors.forename: Marie T
authors.initials: MT
authors.lastname: Fanelli-Kuczmarski
authors.affiliation: University of Maryland, Baltimore County, Baltimore, Maryland, United States of America.
authors.forename: Allyssa
authors.initials: A
authors.lastname: Allen
authors.affiliation: Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, Virginia, United States of America.
authors.forename: Hind A
authors.initials: HA
authors.lastname: Beydoun
authors.affiliation: Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Barry M
authors.initials: BM
authors.lastname: Popkin
authors.affiliation: Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, Maryland, United States of America.
authors.forename: Michele K
authors.initials: MK
authors.lastname: Evans
authors.affiliation: Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, Maryland, United States of America.
authors.forename: Alan B
authors.initials: AB
authors.lastname: Zonderman
mesh_terms: D000328:Adult; D003132:Commerce; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005518:Food Preferences; D063427:Food Quality; D006801:Humans; D008297:Male; D009753:Nutritive Value; D011203:Poverty / Q000191:economics*; D044469:Racial Groups; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D014505:Urban Population