title: Dietary changes needed to reach nutritional adequacy without increasing diet cost according to income: An analysis among French adults.
abstract: OBJECTIVE
  To explore the dietary changes needed to achieve nutritional adequacy across income levels at constant energy and diet cost.
  
  
  METHODS
  Individual diet modelling was used to design iso-caloric, nutritionally adequate optimised diets for each observed diet in a sample of adult normo-reporters aged ≥20 years (n = 1,719) from the Individual and National Dietary Survey (INCA2), 2006-2007. Diet cost was estimated from mean national food prices (2006-2007). A first set of free-cost models explored the impact of optimisation on the variation of diet cost. A second set of iso-cost models explored the dietary changes induced by the optimisation with cost set equal to the observed one. Analyses of dietary changes were conducted by income quintiles, adjusting for energy intake, sociodemographic and socioeconomic variables, and smoking status.
  
  
  RESULTS
  The cost of observed diets increased with increasing income quintiles. In free-cost models, the optimisation increased diet cost on average (+0.22 ± 1.03 euros/d) and within each income quintile, with no significant difference between quintiles, but with systematic increases for observed costs lower than 3.85 euros/d. In iso-cost models, it was possible to design nutritionally adequate diets whatever the initial observed cost. On average, the optimisation at iso-cost increased fruits and vegetables (+171 g/day), starchy foods (+121 g/d), water and beverages (+91 g/d), and dairy products (+20 g/d), and decreased the other food groups (e.g. mixed dishes and salted snacks), leading to increased total diet weight (+300 g/d). Those changes were mostly similar across income quintiles, but lower-income individuals needed to introduce significantly more fruit and vegetables than higher-income ones.
  
  
  CONCLUSIONS
  In France, the dietary changes needed to reach nutritional adequacy without increasing cost are similar regardless of income, but may be more difficult to implement when the budget for food is lower than 3.85 euros/d.
authors.affiliation: MS-Nutrition, Faculté de Médecine La Timone, Marseille, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Maillot
authors.affiliation: MS-Nutrition, Faculté de Médecine La Timone, Marseille, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Vieux
authors.affiliation: Danone Nutricia Research, Centre Daniel Carasso, Palaiseau, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Delaere
authors.affiliation: Danone Nutricia Research, Centre Daniel Carasso, Palaiseau, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Lluch
authors.affiliation: NORT, Aix-Marseille Université, INRA, INSERM, Marseille, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Darmon
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis / Q000191:economics; D004032:Diet / Q000191:economics / Q000592:standards*; D015930:Diet Records; D002149:Energy Intake / Q000502:physiology*; D005247:Feeding Behavior / Q000502:physiology; D005602:France; D005638:Fruit; D006801:Humans; D007182:Income; D008875:Middle Aged; D018673:Nutrition Policy; D009752:Nutritional Status / Q000502:physiology; D009753:Nutritive Value / Q000502:physiology*; D014675:Vegetables