Price and Diet Quality Comparison of Ultra-Processed and Minimally Processed Menus

Objectives: A recently published menu that contained >80% of energy from ultra-processed foods (UPF) yet met recommendations in the Dietary Guidelines for Americans (DGA) suggested it may be feasible to achieve a high diet quality with UPFs; however, further analysis of price and diet quality is warranted. The price and diet quality amongst two menus aligned with the Dietary Guidelines of Americans (DGA) but differing in level of ultra-processed foods (UPF) were investigated. Methods: Items from a previously published 7-day menu containing ≥80% kcal from UPF (NOVA category 4) but meeting DGA recommendations were priced using national supermarket websites. To create a minimally processed version of the same menu, UPF food items were substituted with as minimally processed as possible (e.g. NOVA 1=minimally processed, but NOVA 2 and 3 alternatives were used when NOVA 1 was not available) equivalents within NOVA categories 1-3 (validated by Registered Dietitians) and priced using supermarket websites. Food equivalents were found on the Food Patterns Equivalents Database to calculate diet quality using the Healthy Eating Index-2015 (HEI). Results: In the MPF menu, 81% of food items were classified as NOVA 1-3. HEI scores were similar between menus (MPF 89/100, UPF 86/100). Both menus had optimal scores for HEI categories apart from whole grains (MPF 7/10, UPF 6/10), sodium (MPF 7/10, UPF 0/10), ratio of unsaturated to saturated fatty acid (MPF 6/10, UPF 10/10), and refined grains (MPF 9/10, UPF 10/10). Across the 7 days, the MPF menu total purchase cost was $309.76 and the UPF menu cost $299.63. The price of food servings eaten was $94.26 and $87.72 for the MPF and UPF menu, respectively. In contrast, the average "liberal" weekly food serving spending for a 1-person US household is $80.05 according to the US Department of Agriculture. Conclusions: Compared to a UPF menu, an item-matched MPF menu received scores closer to optimal for whole grains and sodium, and lower scores for unsaturated to saturated fatty acid ratio and refined grains. With a cost difference between menus within 4% and both 10-17% more expensive than the US average, the UPF menu did not improve feasibility from a cost perspective versus a matched MPF menu.