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Availability of healthy foods and dietary patterns: the Multi-Ethnic Study of Atherosclerosis

¹ From the Department of Epidemiology (MF, ML, FB, and TG) and the Center for Human Nutrition (BC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD); the Department of Epidemiology, National Centre for Cardiovascular Research, Madrid, Spain (MF); the Division of General Internal Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of Medicine, Baltimore, MD (FB); the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI (AVD-R and LVM); and the Division of Epidemiology and Disease Control, School of Public Health, University of Texas Health Sciences Center, Houston, TX (JAN).

² The MESA is supported by contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95169 from the National Heart, Lung, and Blood Institute. AVD-R was supported by grant R01-HL071759 from the National Heart, Lung, and Blood Institute. FB was supported by the Mid-Career Mentorship Award in Patient-Oriented Research (K24 DK62222) and Diabetes Research and Training Center Grant P60 DK079637. MF was supported by the Center for a Livable Future at the Johns Hopkins Bloomberg School of Public Health and the Fulbright Program.

³ Reprints not available. Address correspondence to M Franco, Department of Epidemiology, National Centre for Cardiovascular Research, Madrid, Spain, Melchor Fernandez Almagro 3, E-28029 Madrid, Spain. E-mail: mfranco{at}cnic.es.

Background: Inadequate availability of healthy foods may be a barrier to achieving recommended diets.

Objective: The objective was to study the association between the directly measured availability of healthy foods and diet quality.

Design: We conducted a cross-sectional study of 759 participants from the Baltimore site of the Multi-Ethnic Study of Atherosclerosis. Diet was characterized by using a food-frequency questionnaire and summarized by using 2 empirically derived dietary patterns reflecting low- and high-quality diets. For each participant, the availability of healthy foods was directly assessed by using 3 measures: in all food stores within their census tract, in their closest food store, and in all food stores within 1 mile (1.6 km) of their residence.

Results: Twenty-four percent of the black participants lived in neighborhoods with a low availability of healthy food compared with 5% of white participants (P < 0.01). After adjustment for age, sex, income, and education, a lower availability of healthy foods in the tract of residence or in the closest store was associated with higher scores on the low-quality dietary pattern (P < 0.05). Less consistent associations were observed for the high-quality dietary pattern.

Conclusions: Healthy foods were less available for black participants. Low availability of healthy foods was associated with a lower-quality diet. The extent to which improvements in the availability of healthy foods results in higher-quality diets deserves further investigation.

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