Longitudinal Associations between Monetary Value of the Diet, DASH Diet Score and the Allostatic Load among Middle-Aged Urban Adults

Lower cost can lead to poorer-quality diets, potentially worsening metabolic profiles. We explored these pathways among urban adults. Longitudinal data were extracted from 1224–1479 participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. DASH((mean)) (Dietary Approaches to Stop Hypertension) score was computed using four 24 h recalls (v1/v2: 2004–2013) linked with a national food price database to estimate monetary value of the diet [MVD((mean))]. Allostatic load (AL) was measured at visits 2 (v2) and 3 (v3) in 2009–2018. Mixed-effects regression and structural equation modeling (SEM) were conducted, linking MVD((mean))/DASH((mean)) to AL [v2 and annual change(v3–v2)] and exploring mediating pathways between MVD((mean)) and AL((v3)) through DASH((mean)), stratifying by sex, race and poverty status. MVD((mean)) tertiles were linearly associated with contemporaneous DASH((mean)), after energy adjustment. In mixed-effects regression models, DASH((mean)) was consistently linked to lower AL((v2)). DASH((mean)) and MVD((mean)) were positively associated with higher serum albumin((v2)). In SEM, MVD((mean)) was linked to AL((v3)) through DASH((mean)), mainly among Whites and specifically for the cholesterol and Waist-Hip-Ratio AL components. In summary, energy and other covariate-adjusted increase in MVD may have a sizeable impact on DASH which can reduce follow-up AL among urban White middle-aged adults. More studies are needed to replicate findings in comparable samples of urban adults.