Nutrition quality of food purchases varies by household income: The SHoPPER study

Background: Lower household income has been consistently associated with poorer diet quality. Household food purchases may be an important intervention target to improve diet quality among low income populations. Associations between household income and the diet quality of household food purchases were examined. Methods: Food purchase receipt data were collected for 14 days from 202 urban households participating in a study about food shopping. Purchase data were analyzed using NDS-R software and scored using the Healthy Eating Index 2010 (HEI 2010). HEI total and subscores, and proportion of grocery dollars spent on food categories (e.g. fruits, vegetables, sugar sweetened beverages) were examined by household income-to-poverty ratio. Results: Compared to lower income households, after adjusting for education, marital status and race, higher income households had significantly higher HEI total scores (mean [sd] = 68.2 [13.3] versus 51.6 [13.9], respectively, adjusted p = 0.05), higher total vegetable scores (mean [sd] = 3.6 [1.4] versus 2.3 [1.6], respectively, adjusted p <.01), higher dairy scores (mean [sd] = 5.6 [3.0] versus 5.0 [3.3], p =.05) and lower proportion of grocery dollars spent on frozen desserts (1% [.02] versus 3% [.07], respectively, p =.02). Conclusions: Lower income households purchase less healthful foods compared with higher income households. Food purchasing patterns may mediate income differences in dietary intake quality.