Objective: To investigate the direct and indirect cost differences associated with eating a 'healthy' or 'unhealthy' diet.
Design: Analysis of data from a baseline postal questionnaire for the UK Women's Cohort Study, including a detailed food frequency questionnaire (FFQ), supplemented by a telephone interview on a sub-sample.
Subjects: The first 15,191 women who responded to the questionnaire, aged 35-69 years with similar numbers of meat eaters, fish eaters and vegetarians.
Results: A healthy diet indicator (hdi), with values from 0 (lowest) to 8 (highest) was developed based on the WHO dietary recommendations. Direct monetary cost of the diet was calculated using prices from the 1995 National Food Survey and the Tesco home shopping catalogue. Women in the healthy diet group were almost four times as likely to be vegetarian and have a higher educational level. For direct costs, the difference between the most extreme hdi groups was 1.48 day-1 (equivalent to 540 year-1), with fruit and vegetable expenditure being the main items making a healthy diet more expensive. Forty-nine per cent of the food budget was spent on fruit and vegetables in hdi group 8 compared to 29% in hdi group 0. Interestingly, 52% of those questioned in both extreme hdi groups did not think that it was difficult to eat healthily.
Conclusions: To achieve a particularly healthy diet independent predictive factors were spending more money, being a vegetarian, having a higher energy intake, having a lower body mass index (BMI) and being older.