BACKGROUND: Using a food-based analysis, healthy dietary patterns in adults are more expensive than less healthy ones; studies are needed in youth. Therefore, the objective of the present study was to determine relationships between monetary daily diet cost, diet quality, and parental socioeconomic status. DESIGN AND METHODS: Data were obtained from a representative national sample of 3534 children and young people in Spain, aged 2 to 24 years. Dietary assessment was performed with a 24-hour recall. Mediterranean diet adherence was measured by the KIDMED questionnaire. Average food cost was calculated from official Spanish government data. Monetary daily diet cost was expressed as euros per day (€/d) and euros per day standardized to a 1000kcal diet (€/1000kcal/d). RESULTS: Mean monetary daily diet cost was 3.16±1.57€/d (1.56±0.72€/1000kcal/d). Socioeconomic status was positively associated with monetary daily diet cost and diet quality measured by the KIDMED index (€/d and €/1000kcal/d, p<0.019). High Mediterranean diet adherence (KIDMED score 8-12) was 0.71 €/d (0.28€/1000kcal/d) more expensive than low compliance (KIDMED score 0-3). Analysis for nonlinear association between the KIDMED index and monetary daily diet cost per1000kcal showed no further cost increases beyond a KIDMED score of 8 (linear p<0.001; nonlinear p = 0.010). CONCLUSION: Higher monetary daily diet cost is associated with healthy eating in Spanish youth. Higher socioeconomic status is a determinant for higher monetary daily diet cost and quality.

This work was supported by grants from the SpanishMinistry of Health [RED: Alimentación saludable en la prevención primaria de enfermedades crónicas: la Red Predimed, one of the Redes Temáticas de Investigación Cooperativa Sanitaria (RETICs)] FundaciónDieta Mediterránea, Spain; and Kellogg’s España SA and Kellogg’s Company, Battle Creek, USA via the Fundación Universitaria de Las Palmas de Gran Canaria and the Fundación para la Investigacio´nNutricional and by King Abdullah scholarship program [2014,ID2631], Instituto de Salud Carlos III FEDER (CB06/02/0029), AGAUR (2014 SGR 240). The CIBERESP and the CIBEROBN and the RETIC Predimed are initiatives of the Instituto de Salud Carlos III, Madrid, Spain.