Starck CSBlumfield MKeighley TMarshall SPetocz PInan-Eroglu EAbbott KCassettari TAli AWham CKruger RKira GFayet-Moore F2023-08-172023-09-042021-07-272023-08-172023-09-042021-07-27Starck CS, Blumfield M, Keighley T, Marshall S, Petocz P, Inan-Eroglu E, Abbott K, Cassettari T, Ali A, Wham C, Kruger R, Kira G, Fayet-Moore F. (2021). Nutrient Dense, Low-Cost Foods Can Improve the Affordability and Quality of the New Zealand Diet-A Substitution Modeling Study.. Int J Environ Res Public Health. 18. 15. (pp. 7950-).1661-7827http://hdl.handle.net/10179/19963Copyright: © 2021 by the authors.The high prevalence of non-communicable disease in New Zealand (NZ) is driven in part by unhealthy diet selections, with food costs contributing to an increased risk for vulnerable population groups. This study aimed to: (i) identify the nutrient density-to-cost ratio of NZ foods; (ii) model the impact of substituting foods with a lower nutrient density-to-cost ratio with those with a higher nutrient density-to-cost ratio on diet quality and affordability in representative NZ population samples for low and medium socioeconomic status (SES) households by ethnicity; and (iii) evaluate food processing level. Foods were categorized, coded for processing level and discretionary status, analyzed for nutrient density and cost, and ranked by nutrient density-to-cost ratio. The top quartile of nutrient dense, low-cost foods were 56% unprocessed (vegetables, fruit, porridge, pasta, rice, nuts/seeds), 31% ultra-processed (vegetable dishes, fortified bread, breakfast cereals unfortified <15 g sugars/100 g and fortified 15–30 g sugars/100 g), 6% processed (fruit juice), and 6% culinary processed (oils). Using substitution modeling, diet quality improved by 59% and 71% for adults and children, respectively, and affordability increased by 20–24%, depending on ethnicity and SES. The NZ diet can be made healthier and more affordable when nutritious, low-cost foods are selected. Processing levels in the healthier, modeled diet suggest that some non-discretionary ultra-processed foods may provide a valuable source of low-cost nutrition for food insecure populations.7950-CC BY 4.0https://creativecommons.org/licenses/by/4.0/cost and cost analysisdieteconomic modelsethnic groupsfood qualityfood securitynutrientssocioeconomic factorsAdultChildCosts and Cost AnalysisDietEnergy IntakeFast FoodsHumansNew ZealandNutrientsJournal article10.3390/ijerph181579501660-46012023-08-17Massey_Darkjournal-article