Planning dietary improvements without additional costs for low-income individuals in Brazil: linear programming optimization as a tool for public policy in nutrition and health

BACKGROUND: Meeting nutrient intake recommendations may demand substantial modifications in dietary patterns, and may increase diet cost. Incentives for modifying one’s dietary intake that disregard prices are unlikely to be effective in the general population, especially among low-income strata, due to the high percentage of income committed to food purchases. The aim of this study is to evaluate how much the nutrient content can be increased through a modeled diet, without any cost increase, for low-income Brazilian households. METHODS: Low-income households were selected from the Household Budget Survey (24,688 households) and National Dietary Survey (6,032 households, 16,962 individuals), from where we obtained food prices and consumption data. Food quantities were modeled using linear programming to find diets that meet nutritional recommendations in two sets of models: cost-constrained (the cost should not be higher than the observed diet cost) and cost-free. Minimum and maximum amounts of each food in the modelled diets were allowed at three levels of food acceptability: rigorous (least deviance from the current observed diets), moderate, and flexible (higher deviance from the current observed diets). RESULTS: We found no feasible solution that would accommodate all the nutritional targets. The most frequent limiting nutrients were calcium; vitamins D, E, and A; zinc; fiber; sodium; and saturated and trans-fats. However, increases in nutrient contents were observed, especially for fiber, calcium, copper, magnesium, vitamin A, vitamin C, and vitamin E. In general, the best achievement was obtained with cost-free models. Fruits and beans increased in all models; large increase in whole cereals was observed only in the flexible models; large increase in vegetables was observed only in the cost-free models; and fish increased only in the cost-free models. Reductions were observed for rice, red and processed meats, sugar-sweetened beverages, and sweets. The mean observed cost was US$2.16 per person/day. The mean cost in the cost-free models was US$2.90 (moderate), US$2.70 (rigorous), and US$2.60 (flexible). CONCLUSION: The complete nutritional adequacy is unattainable, although feasible changes would substantially improve diet quality by improving nutrient content without additional costs.