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Cost-effective options for increasing consumption of
under-consumed food groups and nutrients in the USA
Mary Brauchla1and Victor L Fulgoni III2
,
*
1PepsiCo R&D Nutrition, Chicago, IL, USA: 2Nutrition Impact LLC, 9275 D Drive North, Battle Creek, MI 49014, USA
Submitted 18 September 2020: Final revision received 18 December 2020: Accepted 27 January 2021
Abstract
Objective: To identify the most cost-effective options/contributors of under-
consumed food groups and nutrients in the USA.
Design: Twenty-four-hour dietary recall data were used for the dietary sources of
under-consumed food groups and nutrients. Costs were estimated using USDA
National Food Price Database 2001–2004 after adjustments for inflation using
Consumer Price Index.
Setting: National Health and Nutrition Examination Survey, 2013–2016.
Participants: A total of 10 112 adults aged 19þyears.
Results: Top five cost-effective options for food groups were apple and citrus juice,
bananas, apples, and melons for fruit; baked/boiled white potatoes, mixtures
of mashed potatoes, lettuce, carrots and string beans for vegetables; oatmeal, pop-
corn, rice, yeast breads and pasta/noodles/cooked grains for whole grain;
and reduced-fat, low-fat milk, flavoured milk and cheese for dairy. Top five
cost-effective sources of under-consumed nutrients were rice, tortillas, pasta/
noodles/cooked grains, rolls and buns, and peanut butter–jelly sandwiches for
Mg; grits/cooked cereals, low- and high-sugar ready-to-eat (RTE) cereal, rolls
and buns, and rice for Fe; low- and high-sugar RTE cereals, rice, protein and nutri-
tional powders, and rolls and buns for Zn; carrots, margarine, other red and orange
vegetables, liver and organ meats, butter and animal fats for vitamin A; and citrus
juice, other fruit juice, vegetable juice, mustard and other condiments, and apple
juice for vitamin C.
Conclusions: Apple/citrus juice, white potatoes/carrots, oatmeal, RTE cereals and
milk were the most cost-effective food sources of multiple under-consumed food
groups and nutrients and can help promote healthy eating habits at minimal cost.
Keywords
National Health and Nutrition
Examination Survey
Cost
Vegetables
Fruits
Dairy
Whole grain
Vitamin C
A healthy eating pattern primarily composed of fruits,
vegetables, whole grains and low-fat dairy has been con-
sistently recommended by the Dietary Guidelines for
Americans (DGA) and other organisations(1–3).Specific
food group intake recommendations are provided in
ChooseMyPlate(4), and the USDA has also developed sev-
eral food patterns that meet energy and food group recom-
mendations for individuals with specific dietary needs or
preferences (e.g. vegetarians)(5). However, there is still a
wide gap between food group recommendations and con-
sumption: more than three-quarters of the US population
currently do not meet daily intake recommendation for
fruits (nearly 80 %), vegetables (nearly 90 %), whole grains
(nearly 100 %) and dairy (nearly 80 %)(1).
These gaps between recommended and actual food
group consumption are significant because they translate
to inadequate intakes of several essential nutrients. The
2015–2020 DGA(1) identified several nutrients as ‘under-
consumed’including vitamin A, vitamin D, vitamin E, vita-
min C, Ca, Fe (for certain age/gender groups), Mg, choline,
K, and fibre; four of these nutrients (Ca, vitamin D, K and
fibre) are classified as ‘nutrients of public health concern’
because intake at low levels is associated with adverse
health outcomes. Many of these under-consumed nutrients
are primarily found in fruits, vegetables, whole grains, and
dairy, and previous public health messaging has promoted
higher intakes of these food groups to close nutrient gaps.
Despite targeted public health messaging around these
food groups intake remains well below the recommended
levels(1). The reasons underlying low food group intakes
are multifactorial, but one contributor is the economic
impact of choosing ‘healthier’foods(6–8). Food purchase
Public Health Nutrition: page 1 of 7 doi:10.1017/S1368980021000537
*Corresponding author: Email vic3rd@aol.com
© PepsiCo and Nutrition Impact, LLC, 2021. Published by Cambridge University Press on behalf of The Nutrition Society. This is an Open Access
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decisions are often driven by food cost, which makes cost a
major determinant of dietary intakes(8–10). Rao et al.(11) con-
ducted a meta-analysis and systematic review of twenty-
seven studies and reported that healthier dietary patterns
cost about $1·50 more per day (˜$550 more per year) com-
pared to less healthy dietary patterns. In a recent analysis,
we estimated that the USDA’s Healthy Food Patterns
are generally more expensive than current US diet(12).
Additional studies have also come to the same conclusions:
higher diet quality diets cost more and are associated with
higher spending(13–16). Therefore, there is a clear need
for more solution-oriented research to identify low-cost
healthier dietary options for low socio-economic status
individuals and budget-conscious shoppers.
In a recently published analysis, we compared the cost
of obtaining ‘shortfall nutrients’including nutrients of pub-
lic health concern (dietary fibre, vitamin D, Ca and K) from
different food groups to identify cost-effective options for
healthy and sustainable eating patterns for Americans(17).
The present analysis builds on our previous work by iden-
tifying the most cost-effective contributors to under-
consumed food groups and additional nutrients in the USA.
Methods
Database and subjects
Data from What We Eat in America (WWEIA), the dietary
component of the National Health and Nutrition Examina-
tion Survey (NHANES), were used(18). NHANES is a con-
tinuous, nationally representative, cross-sectional survey
of non-institutionalised, civilian US population conducted
by the National Center for Health Statistics (NCHS) using
a complex, multistage, probability sampling design, and
the data are released in 2-year cycles. The present analysis
combined two NHANES data cycles (NHANES 2013–2014
and NHANES 2015–2016). Day one 24-h dietary recall data
from adults aged 19þyears (n10 112) excluding pregnant
and/or lactating females (n218) and those with incomplete
or unreliable dietary records as evaluated by the USDA
Food Surveys Research Group staff (n1461) were included
in the analysis.
Estimation of dietary intake
Dietary intake data were obtained via in-person 24-h
dietary recall interviews administered using an Automated
Multiple-Pass Method(19). To determine food sources of
food groups (fruits, vegetables, whole grains and dairy)
and under-consumed nutrients (Mg, Fe, Zn, vitamin A
and vitamin C), USDA’s WWEIA food groups were used
at food main group (n15), food subgroup (n48) and food
category (n155) level(20). Food category ‘Baby foods’were
excluded from the analysis, since the current analysis was
focused on the adult population. Intake and composition
of food groups were calculated using the NHANES cycle-
specific Food Patterns Equivalents Databases (FPED)(21).
Nutrient intake and composition were determined using
the respective Food & Nutrient Database for Dietary
Studies (FNDDS) for each NHANES cycle(22).
Estimation of food cost
The USDA National Food Price Database (NFPD) was used
to estimate cost of foods and nutrients from foods and bev-
erages. The NFPD is derived from the Nielsen Homescan
Consumer Panel and provides costs of all foods and bever-
ages in NHANES 2001–2004(23,24). Food cost for 2013–2016
was computed after adjusting the base food cost for infla-
tion from 2001–2004 to 2013–2016 using Consumer Price
Index (CPI) data from Bureau of Labor Statistics (BLS)(25)
as described previously(12,17). The prices for foods and bev-
erages were calculated per cup equivalent for dairy, fruits
and vegetables, per ounce equivalent for whole grains, and
per g, mg or μg for nutrients. NHANES food codes for 2013–
2016 cycles were matched to NHANES 2001–2004 and then
linked with NFPD to estimate base food cost. New food
codes in NHANES 2013–2016 that were not present in
NHANES 2001–2004 were hand-matched to the most closely
matching food code. Cost-effectiveness was evaluated as
amounts food groups and nutrients available per dollar.
Statistics
All statistical analyses were performed with SAS software
(version 9.4; SAS Institute Inc.). Data were adjusted for
the complex sample design of NHANES using appropriate
survey weights, strata, primary sampling units and day one
dietary sample weights.
Results
The top five cost-effective options for fruit were apple juice,
citrus juice, bananas, apples and melons providing 2·73–
4·20 cup equivalents per dollar. Except for apple juice,
these were also the top contributors of daily intake of fruit.
Together, the top five cost-effective options contributed
54·8 % (2·67 % þ13·6 % þ12·6 % þ17·8 % þ8·11 % contri-
bution from apple juice, citrus juice, bananas, apples and
melons, respectively) of daily intake of fruit (Table 1).
Baked or boiled white potatoes, mixtures of mashed
potatoes and white potato, lettuce, carrots, and string beans
were top five cost-effective options for vegetables provid-
ing 2·45–3·71 cup equivalents per dollar. Together these
contributed about 22·2 % of daily intake of vegetables
(Table 1).
For whole grain, the top five cost-effective options were
oatmeal, popcorn, rice, yeast breads and pasta/noodles/
cooked grains providing 3·06–5·13 ounce equivalents per
dollar. Yeast bread was the top contributor of whole grain
and provided 32·9 % of daily intake. The top five cost-
effective options of whole grain combined contributed to
53·6 % of total daily intake (Table 1).
2 M Brauchla and VL Fulgoni III
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Reduced-fat milk, low-fat milk, low-fat flavoured milk,
reduced-fat flavoured milk and cheese were top five
cost-effective options for dairy providing 2·35–4·50 cup
equivalents per dollar. Cheese and reduced-fat milk were
also the top two contributors of dairy and provided 21·2 %
and 11·0 % of daily intake, respectively. The remaining
three of the top five cost-effective options for dairy com-
bined contributed to less than 5 % of total daily intake
(Table 1).
Rice and rolls/buns were among the top five cost-
effective sources for Mg, Fe and Zn, while high- and
low-sugar ready-to-eat (RTE) cereals were also among
the top five cost-effective sources of Fe and Zn and among
the top ten for vitamin A. Oatmeal, the top cost-effective
option for whole grains, was also among the top ten
cost-effective contributors of Mg, Fe, Zn, and vitamin A.
Other top five cost-effective sources of these minerals were
tortillas, pasta/noodles/cooked grains and peanut butter–
jelly sandwiches for Mg; grits for Fe; and protein/nutritional
powders for Zn. The top five cost-effective sources of these
minerals were relatively minor sources (except RTE cereals
for Fe and Zn) and contributed to 3·79 % of daily Mg, 19·3 %
Table 1 Top ten cost-effective contributors of under-consumed food groups and their contribution to current intake*
Category no Category n
Rank by
cost†
Cost-effectiveness
(units of food group/
dollar)‡
% Contribution
to daily intake
of food group Rank by %
daily intake
of food groupMean
SE
Mean
SE
Food group: total fruits (cup eq)
7004 Apple juice 241 1 4·20 0·01 2·67 0·41 11
7002 Citrus juice 1069 2 4·19 0·07 13·6 0·6 2
6004 Bananas 1432 3 3·45 0·002 12·6 0·6 3
6002 Apples 1100 4 2·95 0·01 17·8 0·8 1
6014 Melons 489 5 2·73 0·07 8·11 0·87 4
7006 Other fruit juice 498 6 2·59 0·04 5·85 0·58 7
6016 Dried fruits 321 7 1·95 0·16 1·75 0·18 13
6008 Peaches and nectarines 284 8 1·86 0·08 2·44 0·36 12
6006 Grapes 480 9 1·85 0·001 3·55 0·29 10
7220 Smoothies and grain drinks 379 10 1·44 0·06 5·98 0·66 6
Food group: total vegetables excluding legumes (cup eq)
6802 White potatoes, baked or boiled 476 1 3·71 0·08 4·06 0·36 8
6806 Mashed potatoes and white potato mixtures 793 2 3·16 0·07 5·81 0·46 4
6410 Lettuce and lettuce salads 2137 3 2·91 0·04 7·47 0·36 2
6404 Carrots 681 4 2·72 0·01 2·39 0·29 16
6412 String beans 450 5 2·45 0·04 2·52 0·25 15
6414 Onions 929 6 2·36 0·10 1·10 0·06 26
5002 Potato chips 1262 7 1·78 0·02 4·82 0·22 6
6804 French fries and other fried white potatoes 1586 8 1·78 0·04 6·73 0·25 3
6422 Vegetable mixed dishes 525 9 1·73 0·13 3·48 0·27 12
7008 Vegetable juice 119 10 1·72 0·20 0·90 0·13 29
Food group: whole grain (oz eq)
4802 Oatmeal 575 1 5·13 0·10 8·50 0·52 4
5006 Popcorn 492 2 4·45 0·14 5·67 0·34 6
4002 Rice 1558 3 3·52 0·25 4·31 0·53 7
4202 Yeast breads 3636 4 3·27 0·12 32·9 1·0 1
4004 Pasta, noodles, cooked grains 296 5 3·06 0·63 2·18 0·45 10
4604 Ready-to-eat cereal, lower sugar (≤21·2 g/100 g) 806 6 2·40 0·13 9·67 0·55 2
3722 Peanut butter and jelly sandwiches (single code) 110 7 2·04 0·24 1·00 0·18 17
4602 Ready-to-eat cereal, higher sugar (>21·2 g/100 g) 962 8 2·03 0·06 8·93 0·52 3
5004 Tortilla, maize, other chips 1268 9 1·36 0·11 6·69 0·59 5
3720 Cheese sandwiches (single code) 72 10 1·30 0·37 0·55 0·10 20
Food group: total dairy (cup eq)
1004 Milk, reduced fat 1467 1 4·50 0·02 11·0 0·7 2
1006 Milk, low fat 421 2 4·48 0·02 3·12 0·24 7
1206 Flavoured milk, low fat 32 3 2·81 0·12 0·48 0·14 34
1204 Flavoured milk, reduced fat 92 4 2·60 0·09 0·78 0·12 23
1602 Cheese 3150 5 2·35 0·03 21·2 0·7 1
1008 Milk, non-fat 436 6 2·34 0·01 4·17 0·40 6
1002 Milk, whole 1010 7 2·24 0·02 6·90 0·65 4
1202 Flavoured milk, whole 85 8 2·08 0·08 0·63 0·21 28
3720 Cheese sandwiches (single code) 72 9 1·99 0·03 0·49 0·07 33
1402 Milk shakes and other dairy drinks 127 10 1·71 0·09 1·21 0·20 20
n, number of consumers; NHANES, National Health and Nutrition Examination Survey.
*Data from NHANES 2013–2016 for adults aged 19þyears.
†Ranking of foods from most cost-effective to least cost-effective source.
‡Cost-effectiveness was evaluated as amount of food group available per dollar; % contribution to daily intake of food group was calculated as intake of a food group from an
individual food source/total daily intake of that food group from all dietary sources ×100.
Cost-effective food group and nutrient options 3
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of daily Fe, and 10·5 % of daily Zn. High- and low-sugar RTE
cereals provided 14·8 % of daily Fe and 7·36 % of daily Zn
(Table 2).
Carrots, margarine, other red and orange vegetables,
liver and organ meats, butter and animal fats were the
top five cost-effective sources of vitamin A; and citrus juice,
other fruit juice, vegetable juice, mustard and other condi-
ments, and apple juice were the top five cost-effective
sources for vitamin C. Carrots and citrus juice were also
the top dietary contributors of vitamin A and vitamin C, pro-
viding 6·21 % and 13·4 % of daily intakes, respectively. The
other top five cost-effective sources (rank 2–5) of vitamin A
and vitamin C were minor contributors and together pro-
vided 7·07 % and 9·11 % of their respective daily intakes
(Table 2).
Oatmeal, the top cost-effective option for whole grains
was also among the top ten cost-effective contributors of
Mg, Fe, Zn and vitamin A. Similarly, RTE cereals were also
among the top ten cost-effective contributors of Fe, Zn and
vitamin A, in addition to being among top five cost-effective
options for whole grain. Milk, in addition to being the top
cost-effective option for dairy, was among the top ten cost-
effective contributors of Zn and vitamin A while carrots, the
fourth most cost-effective option for vegetables, was the
top cost-effective contributor of vitamin A. Citrus juice was
the second most cost-effective option for fruit and the most
cost-effective source of vitamin C (Tables 1 and 2).
Discussion
In the present analysis of NHANES 2013–2016 using a
recent nationally representative sample of US adults, the
most cost-effective sources of fruits, vegetables, whole
grains and dairy were apple juice, white potatoes, oatmeal
and reduced-fat milk, respectively. To the best of our
knowledge, this is the first analysis of nationally represen-
tative, non-institutionalised population of US adults identi-
fying the cost-effective contributors to key food groups.
Additionally, in the present analysis, rice, grits and cooked
cereals, RTE cereals, carrots, and citrus juice were the most
cost-effective sources of Mg, Fe, Zn, vitamin A and vitamin
C, respectively.
Numerous studies comparing the cost of foods and diets
have indicated that healthier options cost more than less
healthy options(11–16). Cost of food is a major factor in
food choice and has therefore been a significant barrier
to healthy eating, especially among low socio-economic
groups(26–28). However, few studies have compared the
cost of different foods or identified lower cost options for
under-consumed food groups or nutrients.
Previous research identified potatoes and beans as the
lowest-cost sources of K and fibre among frequently con-
sumed vegetables(29). In addition, our results suggest that
potatoes are the most cost-effective source of vegetables
and more than twofold less expensive than the most
consumed vegetable option ‘other vegetables and combi-
nations’(3·71 v. 1·68 cups equivalents per dollar). For
whole grains and dairy, the most cost-effective contributors
were oatmeal and reduced-fat milk which were 36 % and
48 % less expensive, respectively, than the most common
dietary sources of whole grains and dairy, namely bread
and cheese. In the present analysis, the most cost-effective
food sources of under-consumed minerals Mg, Fe and
Zn were also less expensive than their respective most
common dietary sources. In a dietary modelling study
aimed to eliminate shortfall of fruit intake among children
of 4–18 years old, a combination of 100 % fruit juice þ
whole fruit was found to be 4·3 % less expensive option
than whole fruit alone(30). In the present study, we found
that apple juice was the most cost-effective source of fruit
intake and was about 30 % less expensive (42 % more fruit
cup eq per dollar) than apples, the top dietary source
of fruit.
Foods such as oatmeal, RTE cereals, milk, carrots and
citrus juice were among the most cost-effective food
sources of multiple under-consumed food groups and
nutrients. The present analysis shows that per dollar, oat-
meal provides 5 oz eq (>100 % of daily recommended
amount) of whole grain, 221 mg (>50 % RDA) of Mg,
14 mg (>75 % RDA) of Fe, 5·6 mg (>50 % RDA) of Zn
and 556 μg retinol activity equivalents (RAE) (>60 %
RDA) of Zn along with other nutrients. Similarly, for each
dollar spent, RTE cereals provide >2 oz eq whole grain
(>50 % of daily recommended amount), 33 mg (>100 %
RDA) of Fe, >10 mg (>90 % RDA) of Zn and 800 μg RAE
(>85 % RDA) of vitamin A; and milk provided 4·5 cups
eq (>100 % of daily recommended amount) of dairy,
>5mg (>40 % RDA) of Zn and >600 μg RAE (>60 %
RDA) of vitamin A. Additionally, these foods are meaning-
ful sources of other key nutrients not analysed in this report.
These foods could easily be included (if not already in) in
the USDA’s Thrifty Food Plan (TFP) which is the national
standard for minimal cost diet to help meet dietary recom-
mendations and serves as the basis for the allotment of
Supplemental Nutrition Assistance Program (SNAP) bene-
fits(30). The average American family spends about 25 %
more on foods than in the TFP and even low-income fam-
ilies spend more than the TFP, highlighting the importance
of communicating low-cost food and beverage options to
both low SES and budget-conscious shoppers.
This study has several strengths and limitations. Using a
large, nationally representative database to estimate nutrient
cost is a major strength of the present study. However, using
self-reported 24-h dietary recall data may be a limitation, as it
is subject to over- or under-reporting and may not provide a
true picture of usual eating habits. The USDA NFPD
assumes that all foods were purchased at retail and pre-
pared at home, restaurant prices were not included,
and may not reflect seasonal, geographic/location-related
differences in food price/diet cost. Some food codes in
NHANES 2013–2016 had to be hand-matched to the closest
4 M Brauchla and VL Fulgoni III
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Table 2 Top ten cost-effective contributors of under-consumed nutrients and their contribution to current daily intake*
Categoryno Category n
Rank by
cost†
Cost-effective-
ness (units of
nutrient/dollar)‡
% Contribution
to daily intake
of nutrients Rank by %
daily intake
of nutrientMean
SE
Mean
SE
Nutrient: Mg (mg)
4002 Rice 1558 1 301·0 4·0 1·09 0·09 28
4208 Tortillas 864 2 279·0 39·0 1·02 0·13 33
4004 Pasta, noodles, cooked grains 296 3 236·0 25·0 0·50 0·06 61
4204 Rolls and buns 1327 4 235·0 18·0 0·84 0·05 44
3722 Peanut butter and jelly sandwiches (single code) 110 5 234·0 4·0 0·34 0·04 79
4802 Oatmeal 575 6 221·0 6·0 1·08 0·07 29
2802 Beans, peas, legumes 1166 7 220·0 9·0 1·93 0·14 11
9802 Protein and nutritional powders 183 8 217·0 16·0 1·39 0·21 18
2804 Nuts and seeds 1744 9 181·0 4·0 6·31 0·38 1
5006 Popcorn 492 10 179·0 6·0 0·67 0·05 50
Nutrient: Fe (mg)
4804 Grits and other cooked cereals 230 1 35·8 5·5 0·62 0·10 43
4604 Ready-to-eat cereal, lower sugar (≤21·2 g/100 g) 806 2 33·0 1·9 8·39 0·41 1
4204 Rolls and buns 1327 3 31·5 2·2 2·41 0·12 10
4602 Ready-to-eat cereal, higher sugar (>21·2 g/100 g) 962 4 23·0 0·8 6·39 0·26 2
4002 Rice 1558 5 19·6 0·6 1·51 0·13 18
4802 Oatmeal 575 6 13·7 0·4 1·43 0·10 19
4208 Tortillas 864 7 11·0 1·5 0·86 0·10 31
5204 Saltine crackers 339 8 10·1 0·4 0·23 0·02 83
4004 Pasta, noodles, cooked grains 296 9 9·85 0·52 0·44 0·04 55
2802 Beans, peas, legumes 1166 10 9·84 0·43 1·85 0·13 14
Nutrient: Zn (mg)
4602 Ready-to-eat cereal, higher sugar (>21·2 g/100 g) 962 1 11·4 0·4 4·02 0·20 3
4604 Ready-to-eat cereal, lower sugar (≤21·2 g/100 g) 806 2 10·3 0·8 3·34 0·20 7
4002 Rice 1558 3 9·62 0·19 0·95 0·08 26
9802 Protein and nutritional powders 183 4 7·86 0·59 1·38 0·21 20
4204 Rolls and buns 1327 5 7·39 0·52 0·72 0·04 34
3702 Burgers (single code) 654 6 6·57 0·10 3·20 0·22 9
4802 Oatmeal 575 7 5·60 0·20 0·74 0·05 33
4004 Pasta, noodles, cooked grains 296 8 5·48 0·41 0·31 0·04 71
4208 Tortillas 864 9 5·47 0·73 0·55 0·07 53
1004 Milk, reduced fat 1467 10 5·24 0·03 1·79 0·12 16
Nutrient: vitamin A, RAE (mcg)
6404 Carrots 681 1 2910·0 22 6·21 0·76 1
8004 Margarine 787 2 2309·0 53·0 1·33 0·12 26
6406 Other red and orange vegetables 314 3 1942·0 108·0 3·58 0·36 7
2010 Liver and organ meats 49 4 1682·0 679·0 0·79 0·31 37
8002 Butter and animal fats 986 5 807·0 10·0 1·37 0·09 23
4602 Ready-to-eat cereal, higher sugar (>21·2 g/100 g) 962 6 801·0 24·0 5·02 0·26 4
7008 Vegetable juice 119 7 734·0 89·0 0·93 0·20 35
1006 Milk, low fat 421 8 634·0 4·0 1·09 0·09 30
1004 Milk, reduced fat 1467 9 602·0 3·0 3·65 0·25 6
4802 Oatmeal 575 10 576·0 28·0 1·36 0·12 24
Nutrient: vitamin C (mg)
7002 Citrus juice 1069 1 359·0 5·0 13·4 0·6 1
7006 Other fruit juice 498 2 186·0 5·0 4·86 0·45 6
7008 Vegetable juice 119 3 182·0 33·0 1·85 0·28 13
8406 Mustard and other condiments 1470 4 148·0 17·0 1·50 0·20 19
7004 Apple juice 241 5 123·0 6·0 0·90 0·15 31
7204 Fruit drinks 1267 6 116·0 7·0 6·68 0·38 3
6406 Other red and orange vegetables 314 7 102·0 15·0 1·51 0·31 18
6408 Dark green vegetables, excluding lettuce 970 8 78·0 2·7 5·62 0·48 4
7804 Enhanced or fortified water 65 9 72·8 3·5 0·82 0·14 32
9999 Not included in a food category 244 10 69·9 31·4 0·21 0·11 60
n, number of consumers; NHANES, National Health and Nutrition Examination Survey; RAE, retinol activity equivalents.
*Data from NHANES 2013–2016 for adults aged 19þyears.
†Ranking of foods from most cost-effective to least cost-effective source.
‡Cost-effectiveness was evaluated as amount of a nutrient available per dollar; % contribution to daily intake of nutrient was calculated as intake of a nutrient from an individual
food source/total daily intake of that nutrient from all dietary sources ×100.
Cost-effective food group and nutrient options 5
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available food codes in NHANES 2001–2004 database, and
this process may have introduced inaccuracies in cost esti-
mations. Additionally, there may be inaccuracies in the
adjustment for inflation, based on CPI/BLS food categories
as price differentials within a category would not have been
captured.
In conclusion, apple/citrus juice, white potatoes/
carrots, oatmeal, RTE cereals and milk were the most
cost-effective food sources of multiple under-consumed
food groups and nutrients. This information should be
included in dietary recommendations to ensure healthy
eating habits at minimal cost to the consumer.
Acknowledgements
Acknowledgements: The views expressed in this manu-
script are those of the authors and do not necessarily reflect
the position or policy of PepsiCo Inc. Financial support:
The present research was funded and supported by
PepsiCo Inc. Conflict of interest: Mary Brauchla is an
employee of PepsiCo, Inc., which manufactures oatmeal
products under the brand name Quaker Oats®and juice
under the names Tropicana®,Naked
®and Dole®.
Victor L. Fulgoni, III, as Senior Vice-President of Nutrition
Impact, provides food and nutrition consulting services
for food and beverage companies. Authorship: V.L.F., III
conceptualised the study, conducted the final NHANES
database analyses, interpreted the data, drafted the initial
manuscript, and reviewed and revised the manuscript.
M.B. conceptualised the study, interpreted the data, and
reviewed and revised the manuscript. All authors approved
the final manuscript version of the present research and
agree to be accountable for all aspects of the work.
Ethics of human subject participation: This study was con-
ducted according to the guidelines laid down in the
Declaration of Helsinki, and all procedures involving
research study participants were approved by the
Research Ethics Review Board at the National Center for
Health Statistics. Written informed consent was obtained
from all subjects/patients.
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