4. Discussion
stroke, diabetes mellitus, abdominal obesity, alcoholic beverages, hypertriglyceridemia, diet-related chronic diseases
OBESE, STROKE, DIABETES MELLITUS, CONGESTIVE HEART FAILURE, HYPERTRIGLYCERIDEMIA, CORONARY ARTERY DISEASE
Current findings showed that higher diet quality, measured either by adherence to MedDiet, by adherence to a healthy provegetarian dietary pattern, or by a low inflammatory index, was associated with a higher diet cost per 1,000 kcal/day. These results showed in previous studies on the adult population are consistent with those of the current study with older adults, which shows the strength of these findings (In addition to other factors that may influence diet quality, such as nutrition knowledge, food accessibility and availability, current results confirm that economic resources, and food prices can be an important component of interventions and policies aimed at improving population diets and preventing diet-related chronic diseases (The scientific literature reflected estimates of savings in medical care that would mean greater adherence to the MedDiet. Thus, in an economic model published in 2019, those results showed that increasing the percentage of the population adhering to MedDiet by 20% produced annual savings in cardiovascular disease-related costs in the United States and Canada. Moreover, when adherence increased to 80%, savings continued to increase proportionately (A positive association between the cost of the adjusted diet per 1,000 kcal and the prevalence of abdominal obesity was also observed. However, the current analysis adjusted for sex and educational level showed that this association was only relevant for men. When the analysis delved into the reasons for this positive association between the prevalence of abdominal obesity and the cost of diet in men, it was found that current participants who were abdominally obese at the beginning of the study consumed higher amounts of processed meats and alcoholic beverages, both fermented and distilled, than those who did not show abdominal obesity (data not shown). Our results show that participants with higher monetary expenditure on foods also had the lowest energy density in their diet. The group with the higher expenditure consumed more alcoholic beverages; however, they also had more fruits, vegetables, and meat, which are products more expensive than others. Furthermore, the “cheaper” diets were more energy dense and included more foods with a high energy density and low nutritional value such as sugary sweetened beverages, sweets, pastries, and convenience foods. When the association between diet cost and some food groups was evaluated, processed meats and alcoholic beverages were associated with higher monetary expenditures. Moreover, it cannot rule out the existence of reverse causation because of the cross-sectional design. A previous study associated protein intake with a higher cost of the diet, regardless of overall diet quality. Nevertheless, the source of the protein consumed seemed to have an impact on diet quality. Animal protein sources with lower salt, saturated fat, and added sugars were associated with higher diet quality (The literature showed that the usual consumption of light to moderate alcoholic beverages, mainly red wine, is associated with a lower risk of total mortality, coronary artery disease, diabetes mellitus, congestive heart failure, and stroke. However, higher levels of alcohol consumption were associated with increased cardiovascular risk (In a study conducted with Spanish adults in 2016 (In this study, the cost of the diet was inversely proportional to the prevalence of hypertriglyceridemia and low HDL-cholesterol per 1,000 kcal. The adjusted analysis showed that hypertriglyceridemia was related to the economic cost of diet in men and low levels of education, while HDL-cholesterol was related to the economic cost of diet in both sexes and low educational levels. These results agree with those previously published that showed that lower cardiovascular risk was associated with greater adherence to healthy eating patterns (This study showed that women living alone and subjects with higher education had higher costs of their diet adjusted for 1,000 kcal. The adjusted analysis also revealed that sex and educational level were confounding factors for most of the outcomes. Other previous studies conducted on adults showed the same positive association between diet cost and educational level (Previous studies conducted in children or youth populations associated a healthier diet with a greater cost. The low sociocultural and socioeconomic level of the parents was related to a lower amount of money spent on food, and therefore, to unhealthier diets (Finally, the current higher cost of the diet was related to higher consumption of some food characteristics of MedDiet, such as fruits and vegetables, whole grains, and fish and seafood. These results are in line with those shown in previous studies (