Availability of healthy foods and dietary patterns: the Multi-Ethnic Study of Atherosclerosis

Background: Inadequate availability of healthy foods may be a barrier to achieving recommended diets. Objective: The objective was to study the association between the directly measured availability of healthy foods and diet quality. Design: We conducted a cross-sectional study of 759 participants from the Baltimore site of the Multi-Ethnic Study of Atherosclerosis. Diet was characterized by using a food-frequency questionnaire and summarized by using 2 empirically derived dietary patterns reflecting low- and high-quality diets. For each participant, the availability of healthy foods was directly assessed by using 3 measures: in all food stores within their census tract, in their closest food store, and in all food stores within 1 mile (1.6 km) of their residence. Results: Twenty-four percent of the black participants lived in neighborhoods with a low availability of healthy food compared with 5% of white participants (P < 0.01). After adjustment for age, sex, income, and education, a lower availability of healthy foods in the tract of residence or in the closest store was associated with higher scores on the low- quality dietary pattern (P < 0.05). Less consistent associations were observed for the high-quality dietary pattern. Conclusions: Healthy foods were less available for black participants. Low availability of healthy foods was associated with a lower-quality diet. The extent to which improvements in the availability of healthy foods results in higher-quality diets deserves further investigation. Am J Clin Nutr 2009; 89:897-904.