Influence of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages : outcomes of the Supermarket Healthy Eating for Life randomized controlled trial

The Dietary Approaches to Stop Hypertension (DASH) diet rich in fruits, vegetables, whole grains and low fat dairy products has shown to lower blood pressure and improve blood lipids. Both economic (affordability of a healthier diet) and environmental factors (accessibility of healthy products) have been proposed as barriers to the adoption and long-term adherence to DASH. The objective was to assess the importance of geographic and economic accessibility of supermarkets for adherence to the DASH diet. We used a cross-sectional, population-based cohort study of 11,857 adults aged 29-64 years, living in Cambridgeshire, UK. 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 (FFQ). DASH accordance was defined as a DASH score in the top quintile. Dietary costs (GBP/day) were estimated by attributing a food price variable to the foods consumed according to the FFQ. Individuals were classified as having low, medium or high cost diets. Supermarket cost tiers were determined on the basis of a 101-item market basket. Distances between home address nearest supermarket (geographic accessibility), and nearest economically appropriate supermarket (economic accessibility) were divided into tertiles. Higher-cost diets were more likely to be DASH-accordant. After adjustment for key demographics and exposure to other food outlets, individuals with greatest economic accessibility to supermarkets had higher odds of being DASH-accordant (odds ratio=0.59, 95% confidence interval=0.52; 0.68) than individuals with least economic accessibility to supermarkets. This association was stronger than with geographic accessibility alone (odds ratio=0.85, 95% confidence interval=0.74; 0.98). Results suggest that geographic and economic access to food should be taken into account when considering approaches to promote adherence to healthy diets and the prevention of cardiovascular diseases and other chronic disease.

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