Accessibility and Affordability of Supermarkets: Associations With the DASH Diet.
BACKGROUND
It is unknown whether there is an interplay of affordability (economic accessibility) and proximity (geographic accessibility) of supermarkets in relation to having a Dietary Approaches to Stop Hypertension (DASH)-accordant diet.


METHODS
Data (collected: 2005-2015, analyzed: 2016) were from the cross-sectional, population-based Fenland Study cohort: 9,274 adults aged 29-64 years, living in Cambridgeshire, United Kingdom. Dietary quality was evaluated using an index of DASH dietary accordance, based on recorded consumption of foods and beverages in a validated 130-item, semi-quantitative food frequency questionnaire. DASH accordance was defined as a DASH score in the top quintile. Dietary costs (£/day) were estimated by attributing a food price variable to the foods consumed according to the questionnaire. Individuals were classified as having low-, medium-, or high-cost diets. Supermarket affordability was determined based on the cost of a 101-item market basket. Distances between home address to the nearest supermarket (geographic accessibility) and nearest economically-appropriate supermarket (economic accessibility) were divided into tertiles.


RESULTS
Higher-cost diets were more likely to be DASH-accordant. After adjustment for key demographics and exposure to other food outlets, individuals with lowest economic accessibility to supermarkets had lower odds of being DASH-accordant (OR=0.59, 95% CI=0.52, 0.68) than individuals with greatest economic accessibility. This association was stronger than with geographic accessibility alone (OR=0.85, 95% CI=0.74, 0.98).


CONCLUSIONS
Results suggest that geographic and economic access to food should be taken into account when considering approaches to promote adherence to healthy diets for the prevention of cardiovascular diseases and other chronic disease.
Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU Medical Center Amsterdam, Amsterdam, the Netherlands.
Joreintje D
JD
Mackenbach
UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom.
Thomas
T
Burgoine
Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU Medical Center Amsterdam, Amsterdam, the Netherlands.
Jeroen
J
Lakerveld
UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom.
Nita G
NG
Forouhi
UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom; Primary Care Unit, Department of Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
Simon J
SJ
Griffin
UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom.
Nicholas J
NJ
Wareham
UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom. Electronic address: pm491@medschl.cam.ac.uk.
Pablo
P
Monsivais
D000328:Adult; D001107:Architectural Accessibility; D015331:Cohort Studies; D003132:Commerce / Q000191:economics*; D003611:Dairy Products / Q000191:economics; D000073601:Dietary Approaches To Stop Hypertension / Q000191:economics*; D005260:Female; D005638:Fruit / Q000191:economics; D006801:Humans; D006973:Hypertension / Q000178:diet therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D006113:United Kingdom; D014675:Vegetables / Q000191:economics; D000067348:Whole Grains / Q000191:economics