The development of the gluten free healthy food basket in Cyprus. Is it affordable among low-income adults diagnosed with celiac disease?

Abstract

Background Gluten free (GF) diets are not only restrictive but also costly. The main aim of this study was to evaluate the acceptability, cost and affordability of a Gluten Free Healthy Food Basket (GFHFB) and further examine whether low-income Cypriots diagnosed with celiac disease (CD) experience food stress. Methods GFΗFBs were constructed for adult women and adult men (±40 years) diagnosed with CD. Feasibility and acceptability was tested through three focus groups. Affordability was defined as the cost of the GFΗFB as a percentage of the Guaranteed Minimum Income (GMI). Results The GFΗFB was 33.6 and 47 euros/month more expensive compared to the HB (Healthy Basket) for women and men, respectively. The total budget for GF-manufactured products were 27.81 and 28.5% of the total food budget, for women and men, respectively. For low-income people receiving the GMI, the proportion of income that would need to be spent on the GFHFB ranges from around 42 to 60%. Conclusions The GFΗFB is costly and not affordable among low-income Cypriots diagnosed with CD; thus, they are likely to suffer from food stress. As such, the risk of reducing their adherence to a GF diet is high and thus compromises their long-term health.

Analysis of Healthy Living Behavior, Age, and Income on Gluten-Free Food Consumption

“…A study in Cyprus examined that affordability was defined as the Gluten-free Healthy Food Basket (GFΗFB) cost as a percentage of the Guaranteed Minimum Income (GMI). As a result, GFΗFB was 33.6 and 47 euros/month more expensive than the other healthy basket food (Chrysostomou, Andreou, & Andreou, 2019). This makes it difficult for low-income people to spend their income on this food.…”

The purchase of the Diabetic Healthy Food Basket in Cyprus results in cost savings: is it affordable among the low-income population?

“…In addition, affordability rates for low-income people range accordingly. Better affordability is shown for DHFB, following HFB, and then higher affordability is shown for GDHFB (41•92, 59•54 % for woman and man, respectively) (18,19) .…”

“…Particularly, a recent study in Cyprus has shown that for low-income people diagnosed with celiac disease and receiving GMI, the proportion of income that must be spent on GFHFB ranges from around 42 to 60 %. Particularly, GFHFB was 33•6 and 47 Euros/month more expensive compared with HFB for women and men, respectively (19) . Thus, comparing the three food baskets (DHFB, GFHFB, HFB) developed for the Cypriot population, it seems that DHFB is the most cost-efficient nutrition therapy for both household types (142•61/202•93 euros, 201•2/285•8 euros, 168•29/240•51 euros for women and men, respectively).…”

“…The risk of experiencing food insecurity among people suffering from noncommunicable diseases (NCD), such as diabetes, has not yet been examined, although the prevalence of food insecurity and low affordability has been extensively and deeply examined among healthy populations of different nations (13)(14)(15)(16)(17)(18) . Recently, a study by Chrysostomou et al has shown that the Cypriot Gluten-Free Healthy Food Basket (GFHFB) is costly and not affordable among lowincome Cypriots diagnosed with celiac disease, and thus, patients are likely to experience food insecurity, compromising their long-term health (19) .…”

Cost and accessibility of empiric food elimination diets for treatment of eosinophilic oesophagitis

“…These results are similar to studies internationally and in Australia that have investigated affordability of a gluten-free diet for low-income earners. 12,29 Given our results highlight the risk of unaffordability of empiric elimination diets for some family types, the impact of cost of empiric elimination on adherence and financial reimbursement of allergen foods in this group for long-term compliance should be further explored. Despite these barriers, dietary approaches have been demonstrated to be more costeffective long-term compared to medical management.…”