Nutrition economics: The cost of eating well

Transcription

1 Nutrition economics: The cost of eating well Adam Drewnowski, PhD Director, UW Center for Obesity Research Director, Center for Public Health Nutrition Director, Nutritional Sciences Program Professor of Epidemiology; Adjunct Professor of Medicine University of Washington, Seattle, WA Food Technology Summit, Mexico City October 1, 2014 Master Lecture on Food Innovation. Frida Kahlo room 7 pm

2 Outline Diet quality varies by socioeconomic status. Rich people have better diets. Is price the reason? What do different foods cost? Cheap calories can be nutrient poor. Some nutrient-rich foods cost more. Food prices data from US, France, and Mexico. What do different diets cost? Some healthier diets cost more. Nutrient density of foods and diets in Mexico. Eat better for less. Nutrition resilience and positive deviance in Mexico. What can the food industry do.

3 How food choices are made Nutrient density Energy density Health Money Weight Taste Food choices Eating behavior Cost Time Access Nutrition knowledge Cooking skills

4 What do different foods cost? Cost per 100 g and per 100 kcal

5 How we measure food costs Nutrient composition data FNDDS 3.0 USDA ANSES ENSANUT Energy Density Kcal/100g Nutrient density What foods give you most calories per $? Prices data CNPP national prices database Linked to NHANES Kantar panel (France) Mexico economic data Energy Cost $/1000 kcal Nutrient cost Food price and quality What foods give you most nutrients per $?

6 The key concepts are: Energy density, Nutrient density, and Energy-adjusted food or diet cost

7 How to measure food cost: USDA 2012 When was this said? Cabbage at 2.5 cents per pound seems cheap..but 10 cents worth of cabbage furnishes 500 calories of energy while 10 cents worth of wheat flour at 3 cents per pound furnishes 5,490 calories of energy and is truly cheap. Milner RD. The cost of food as related to its nutritive value. Agriculture Yearbook 1902, pp National Agricultural Library Digital Repository. Accessed at:

8 Water content drives energy density Tap w ater Vegetables Veg mixed dishes Fruit juices SSB ED (kcal/100g) Milk Fruit Dairy products Shellfish Fish Refined grains Whole grains Eggs Poultry Meat Fatty fish Meat mixed dishes Cheese Sugar Pastries Deli meat Salty snacks Animal fat Oil

9 Mean cost per 100g by food group Prices data for 1387 foods by USDA food group ($/100 g) Sugars, sweets Fats and oils Fruit Vegetables Grains Vegetables, fruit, and eggs are cheapest per 100g Beans, legumes, nuts, seeds Eggs Meat, poultry fish Milk and products Meat, poultry, fish are most expensive per 100g

10 Vegetables and fruit cost less per 100g Prices data for 1387 foods by USDA food group ($/100 kcal) Meat, poultry, fish Mean cost per 100 g ($/100 g) Vegetables Fruit Milk and milk products Eggs Dry beans, legumes, nuts, seeds Fats and oils Grains Sugars, sweets, beverages Mean energy density (kcal/100g)

11 But vegetables and fruit are mostly water Prices data for 1387 foods by USDA 9 major food groups 100 Mean water content (g/100g) Vegetables Fruit Milk and milk products Eggs Meat, poultry, fish Dry beans, legumes, nuts, seeds Sugars, sweets, beverages Fats and oils Grains Mean energy density (kcal/100g)

12 Dry foods cost less per 100 kcal Prices data for 1387 foods by USDA food group 100 Mean water content (g/100g) Milk and milk products Meat, poultry, fish Eggs Dry beans, legumes, nuts, seeds Sugars, sweets, beverages Fats and oils Grains Lower cost Fruit Higher cost Vegetables Mean cost per 100 kcal ($)

13 Energy-dense foods cost less per 100 kcal Prices data for 1387 foods by USDA food group 400 Fats and oils Energy density kcal per 100 g) Grains Dry beans, legumes, nuts, seeds Sugars, sweets, beverages Meat, poultry, fish Milk and milk products Eggs Fruit Vegetables 0 Lower energy density higher cost Mean cost per 100 kcal ($/100 kcal)

14 For each food group there are foods at all levels of cost Cost per 100 kcal National food prices from the USDA

15 Grains, sugars, and fats are cheaper Data from USDA FNDDS 1.0 and CNPP prices database oils Grains Fats Sugars Higher cost 700 Energy density (kcal/100g) sugar cereals desserts Log scale pasta Lower cost beverages Energy cost ($/1000 kcal)

16 Meat and fish cost more per kcal Data from USDA FNDDS 1.0 and CNPP prices database Dairy Meat Eggs Beans Higher cost 700 Energy density (kcal/100g) eggs beans nuts meat fish Log scale Lower cost yogurt shellfish Energy cost ($/1000 kcal)

17 Vegetables and fruit cost most per kcal Data from USDA FNDDS 1.0 and CNPP prices database 900 Fruits Vegetables 800 Higher cost 700 Energy density (kcal/100g) fried potatoes Log scale Lower cost canned fruit potatoes dried fruit fresh fruit Salad greens Energy cost ($/1000 kcal)

18 There are many price options within each food group Dairy Meat Eggs Beans Grains Fruits Vegetables Fats Sugars oil Higher cost 700 Energy density (kcal/100g) sugar cereals nuts cheese meat Log scale 200 beans pasta Lower cost milk yogurt Salad greens Energy cost ($/1000 kcal) fruit

19 What is value? Calories Convenience Low cost Satisfaction fullness Time saving No cooking Food choices Eating behavior

20 Grains and sweets have most calories per $ 900 Dairy Meat Eggs Beans Grains Fruits Vegetables Fats Sweets Densité énergétique (kcal/100g) Higher cost fish and produce Lower cost fats and sweets Kcal/$

21 Obesity-promoting foods are also the least expensive Coincidence or not?

22 Relation between change in food and beverage consumption and weight change over 4 years Data from 3 cohorts of 120,877 U.S. women and men who were free of chronic diseases and not obese at baseline, with follow-up periods from 1986 to 2006 or 1991 to Mozaffarian et al. N Engl J Med 2011

23 Can only the rich be thin? P. laitiers Viande Œufs Leg. Secs Céréales Fruits Légumes Graisses Sucres Bas coût Densité énergétique (kcal/100g) Prevent obesity Promote obesity 100 Coût élevé Kcal/$

24 What are food prices in France? Prices data from Kantar panel

25 Energy density, purchase price, and energy cost for selected food items in France Energy density kcal/100g Purchase price /100g Energy cost /100kcal Sunflower oil Pasta, cooked White bread, sliced Biscuits Sweets Potato chips Wholegrain bread Pâté Coca-Cola Ground beef, 15% fat Orange juice* Yogurt Apples, fresh Almonds Carrots, fresh Ground beef, 5% fat Tomatoes, fresh Cod, frozen Lettuce, fresh Strawberries, fresh

26 Energy density, purchase price, and energy cost for selected food items in France Energy density kcal/100g Purchase price /100g Energy cost /100kcal Sunflower oil Pasta, cooked White bread, sliced Biscuits Sweets Potato chips Wholegrain bread Pâté Coca-Cola Ground beef, 15% fat Orange juice* Yogurt Apples, fresh Almonds Carrots, fresh Ground beef, 5% fat Tomatoes, fresh Cod, frozen Lettuce, fresh Strawberries, fresh

27 Densité énergétique (kcal/100g) et coût de l énergie ($/1000kcal) 1000 Données : USDA FNDDS 1.0 et indice des prix CNPP P. laitiers Viandes Œufs Leg. Secs Céréales Fruits Légumes Graisses Sucres Densité énergétique (kcal/100g) 100 Echelle log! Coût de l énergie ($/1000kcal)

28 Energy density (kcal/100g) and cost ($/1000kcal) Data from US and from France P. laitiers Viandes Œufs Leg. Secs Céréales Fruits Légumes Graisses Sucres 1000 Densité énergétique (kcal/100g) Coût de l énergie ($/1000kcal)

29 What are food prices in Mexico? National food prices from the National Institute for Geography and Statistics (INEGI) in Mexico. Calculations by Prof Alfonso Mendoza University of Puebla, Mexico

30 Energy density, purchase price, and energy cost for selected food items in Mexico Energy density kcal/100g Purchase price $/100g Energy cost $/100kcal Lard, vegetable Corn tortillas Lard, animal Potatoes, fried Sweet cookies Fried beans Chocolate Sweetened cereal Whole milk Soda Yogurt, whole milk Orange, fresh Hamburger Avocado Leafy green vegetables Strawberries, fresh Tomatoes, fresh Apple, fresh Lettuce, fresh Seafood, fresh

31 Foods energy density and cost in Mexico Food prices for 124 foods in ENSANUT from INEG 900 milk meat beans grains vegetables fruit fats sweets Energy density kcal/100g lard 800 butter cereals sweets 500 RTE cereal peanuts 400 cereal desserts chorizo 300 Tortillas tamales 200 beans yogurt meat poultry rice 100 fish milk mariscos 0 sodas Nutrient rich? Energy cost $MXP per 100 kcal

32 How to measure nutrient density? Nutrient profiling methods rate foods based on their nutrient content relative to calories

33 Naturally nutrient rich score NNR7 (Preliminary version for Mexico) 7 nutrients to encourage Protein Fiber Vitamin D 3 nutrients to limit Saturated Fat Iron Calcium Vitamin C Added Sugars Potassium Sodium

34 Energy and nutrient density in Mexico Food prices for 124 foods in ENSANUT from INEG Energy density kcal/100g milk meat beans grains vegetables fruit fats sweets butter peanuts sweets fats grains cheese dried fruit fried potatoes beans fish fruit skim milk vegetables sodas yogurt Nutrient density NNR7 score

35 Nutrient density and cost in Mexico Food prices for 124 foods in ENSANUT from INEG 500 milk meat beans grains vegetables fruit fats sweets Nutrient density NNR7 score oranges 400 peppers broccoli fish 100 beans lard meat Energy cost $ MXN per 100 kcal

36 Nutrient density (NR9.3 per 100 kcal) Some nutrient-dense foods cost more Data from USDA FNDDS 1.0 and CNPP prices database legumes Lower cost Dairy Meat Eggs Grains Fruit Vegetables beans potatoes dried fruit citrus broccoli bananas canned fruit carrots yellow peppers salad greens blueberries Nutrient rich Higher cost Energy cost ($/1000 kcal)

37 Existing ways of looking at nutrient density per 100 kcal The Nutrient Rich Foods (NRF) Index Is a nutrient profiling system 9 nutrients to encourage Protein Fiber Vitamin A Iron Calcium Vitamin C 3 nutrients to limit Saturated Fat Added Sugars Food category Across the board Encourage Limit Iron Calcium Vitamin A Vitamin C Fiber Protein Total fat Saturated fat Trans FA 100 g/100 ml 100 kcal/kj Serving size Algorithm: Threshold Algorithm: X Score Testing & validation Potassium Magnesium Vitamin E Sodium Sugars Sodium Drewnowski, Fulgoni. Nutr Rev 2008 Energy density and nutrient density are inversely linked

38 The real issue is whether healthier diets cost more Energy-dense foods cost less per calorie. Some nutrient-rich foods cost more per calorie Some healthier diets i.e. diets of higher nutrient content - do cost more. This is based on observed eating habits in the US, France and Mexico.

39 French INCA II data: At each energy level, higher energy density = lower cost 100 Data from ENSANUT Mexico: $MXN/d and ED Diet cost (Euros/week) EI 5 EI 4 EI 3 EI 2 EI Energy density (KJ/g)

40 Are nutrient-dense diets more expensive? We use multiple diet quality metrics Nutrient composition data FNDDS 3.0 USDA CIQUAL ENSANUT Dietary Intake data NHANES INCA II ENSANUT Prices data CNPP price database Kantar panel (France) Mexican INEG HEI 2005 HEI 2010 MAR

41 Healthy Eating Index Component Points Std. for max. score Std. for min. score Total Fruit (includes 100% juice) cup equiv. per 1,000 kcal No Fruit Whole Fruit (not juice) cup equiv. per 1,000 kcal No Whole Fruit Total Vegetables cup equiv. per 1,000 kcal No vegetables Dark Green and Orange Vegetables and Legumes cup equiv. per 1,000 kcal No Dark Green or Orange Vegetables and Legumes Total Grains oz equiv. per 1,000 kcal No Grains Whole Grains oz equiv. per 1,000 kcal No Whole Grains Milk cup equiv. per 1,000 kcal No Milk Meat and Beans oz equiv. per 1,000 kcal No Meat or Beans Oils grams per 1,000 kcal No Oil Saturated Fat 10 7% of energy 15% of energy Sodium gram per 1,000 kcal 2.0 g per 1,000 kcal Calories from Solid Fat, Alcohol, and Added Sugar (SoFAAS) 20 20% of energy 50% of energy 41

42 Higher diet costs = higher HEI scores Rehm Monsivais Drewnowski AJCN2011:94: men HEI 2005 component Solid fat, alcohol, added sugar (20) Sodium (10) Saturated fat (10) Oils (10) Meat and beans (10) Milk (10) Whole grains (5) Total grains (5) Dark green and orange vegetables (5) Total vegetables (5) Non-juice fruit (5) Total fruit (5) 0 q1 q2 q5 Energy adjusted quintiles of diet cost

43 Higher diet costs = higher HEI scores Rehm Monsivais Drewnowski AJCN2011:94: women HEI 2005 component Solid fat, alcohol, added sugar (20) Sodium (10) Saturated fat (10) Oils (10) Meat and beans (10) Milk (10) Whole grains (5) Total grains (5) Dark green and orange vegetables (5) Total vegetables (5) Non-juice fruit (5) Total fruit (5) 0 q1 q2 q5 Energy adjusted quintiles of diet cost

44 Higher HEI components = higher costs (but not always) 180 Cost as % change from Q Only some food groups cost more Dark green, orange veg Whole fruit Total fruit Total vegetables Whole grains Milk Meat & beans 0 Q1 Q2 Q3 Q4 Q5-30 Quintiles of energy adjusted nutrient intakes

45 Higher HEI components = higher costs (but not always) 180 Cost as % change from Q Some food groups cost less Dark green, orange veg Total vegetables Oils Total grains 0 Q1 Q2 Q3 Q4 Q5-30 Quintiles of energy adjusted nutrient intakes

46 The 2010 Dietary Guidelines Advisory Committee recommendations Shift to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds. Increase the intake of seafood and fat-free and low-fat milk and milk products. Consume only moderate amounts of lean meats, poultry, and eggs. Significantly reduce intake of foods containing added sugars and solid fats (SoFAS). Reduce sodium intake and lower intake of refined grains, especially those that are coupled with added sugar, solid fat, and sodium. These were used to develop HEI 2010

47 Healthy Eating Index Component Points Std. for max. score Std. for min. score Total Fruit (includes 100% juice) cup equiv. per 1,000 kcal No Fruit Whole Fruit (not juice) cup equiv. per 1,000 kcal No Whole Fruit Total Vegetables cup equiv. per 1,000 kcal No Vegetables Greens and beans cup equiv. per 1,000 kcal No Dark Green Vegetables or beans and peas Whole Grains oz equiv. per 1,000 kcal No Whole Grains Dairy cup equiv. per 1,000 kcal No Dairy Total Protein Foods oz equiv. per 1,000 kcal No Protein Foods Seafood and plant proteins oz equiv. per 1,000 kcal No seafood/plant proteins Fatty acids 10 (PUFA+MUFA)/SFA>2.5 Ratio <1.2 Refined grains 10 <1.8 oz equiv per 1000 kcal 4.3 oz equiv Sodium gram per 1,000 kcal 2.0 g per 1,000 kcal Calories from Solid Fat, Alcohol, and Added Sugar (SoFAAS) 20 19% of energy 50% of energy 47

48 HEI 2010 scores by diet cost quintiles Rehm etl al (submitted for publication)

49 Measuring nutrients and cost Dietary intake data from FFQ 384 foods Nutrient composition data Minnesota database 384 foods Price data Seattle supermarkets foods Energy Density Kcal/100g Nutrient density Energy Cost $/1000 kcal Nutrient cost 49

50 Following dietary guidelines can cost more Aggarwal et al. PLoS One Nutrient rich diets cost more 140 Cost as % of Q Fat, sugar rich diets cost less Q1 Q2 Q3 Q4 Q5 Quintiles of energy adjusted nutrient intakes Vitamin D (mcg) Calcium (mg) Potassium (mg) Fiber (g) Added sugars Trans fats Total Saturated Fat (g/d)

51 Innovation: Can fortification make certain nutrients less expensive and more available to all?

52 The concept of positive deviance Despite poverty, people can have healthy diets. Are there people who have high HEI scores and low diet costs? Who are these positive deviants? What do they eat?

53 What is positive deviance? Seattle Obesity Study SOS I R01 DK Less costly diet Good diet Needs improvement Healthy Eating Index More costly diet Cost ($/2,000 kcal)

54 What is positive deviance? Seattle Obesity Study SOS I R01 DK Healthy Eating Index Healthy Eating Index Cost ($/2,000 kcal) PD Exp-low Exp-high Cost ($/2,000 kcal)

55 What is positive deviance? Seattle Obesity Study SOS I R01 DK HEI 2010 component Eat better for less Solid fat, alcohol, added sugar (20) Sodium (10) Saturated fat (10) Oils (10) Meat and beans (10) Milk including soy beverages (10) Whole grains (5) Total grains (5) Dark green and orange vegetables (5) Total vegetables (5) Non-juice fruit (5) Total fruit (5) 0 High q1 cost Low q2 cost Low q3 cost

56 Nutrition resilience in Mexico ENSANUT Preliminary data on nutrient adequacy and SES In general, diet quality is better at higher SES but there is varaibility

57 Nutrition resilience in Mexico ENSANUT Preliminary data on nutrient adequacy and diet cost Eat better for less The circled group get nutrient adequate diet at low cost Who are they and what are they doing?

58 What should food industry do? To provide nutrient-rich foods at lower cost. Industry needs new metrics Nutrient density index Affordability index Sustainability index Industry needs more consumer research What nutrient-rich foods are most appealing? Tasty? Culturally appropriate? Industry needs innovation. Nutrient density can also be improved through fortification. Product portfolios should be screened for nutrient density.

59 Thank you